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Mistaken identity leads to big hospital bill mix-up : Shots

In 2013, Grace E. Elliott spent a night in a hospital in Florida for a kidney infection that was treated with antibiotics. Eight years later, she got a large bill from the health system that bought the hospital. This bill was for an unrelated surgical procedure she didn’t need and never received. It was a case of mistaken identity, she knew, but proving that wasn’t easy.

Shelby Knowles for KHN

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Shelby Knowles for KHN

In 2013, Grace E. Elliott spent a night in a hospital in Florida for a kidney infection that was treated with antibiotics. Eight years later, she got a large bill from the health system that bought the hospital. This bill was for an unrelated surgical procedure she didn’t need and never received. It was a case of mistaken identity, she knew, but proving that wasn’t easy.

Shelby Knowles for KHN

Earlier this year, Grace Elizabeth Elliott got a mysterious hospital bill for medical care she had never received.

She soon discovered how far a clerical error can reach — even across a continent — and how frustrating it can be to fix.

During a college break in 2013, Elliott, then 22, began to feel faint and feverish while visiting her parents in Venice, Fla., which is about an hour south of Tampa. Her mother, a nurse, drove her to a facility that locals knew simply as Venice Hospital.

In the emergency department, Elliott was diagnosed with a kidney infection and held overnight before being discharged with a prescription for antibiotics, a common treatment for the illness.

“My hospital bill was about $100, which I remember because that was a lot of money for me as an undergrad,” said Elliott, now 31.

She recovered and eventually moved to California to teach preschool. Venice Regional Medical Center was bought by Community Health Systems, based in Franklin, Tenn., in 2014 and eventually renamed ShorePoint Health Venice.

The kidney infection and overnight stay in the E.R. would have been little more than a memory for Elliott.

Then another bill came.

The Patients: Grace E. Elliott, 31, a preschool teacher living with her husband in San Francisco, and Grace A. Elliott, 81, a retiree in Venice, Fla.

Medical Services: For Grace E., an emergency department visit and overnight stay, plus antibiotics to treat a kidney infection in 2013. For Grace A., a shoulder replacement and rehabilitation services in 2021.

Service Provider: Venice Regional Medical Center, later renamed ShorePoint Health Venice.

Total Bill: $1,170, the patient’s responsibility for shoulder replacement services, after adjustments and payments of $13,210.21 by a health plan with no connection to Grace E. Elliott. The initial charges were $123,854.14.

What Gives: This is a case of mistaken identity, a billing mystery that started at a hospital registration desk and didn’t end until months after the file had been handed over to a collections agency.

Early this year, Grace E. Elliott’s mother opened a bill from ShorePoint Health Venice that was addressed to her daughter and sought more than $1,000 for recent hospital services, Elliott said. She “immediately knew something was wrong.”

Months of sleuthing eventually revealed that the bill was meant for Grace Ann Elliott, a much older woman who underwent a shoulder replacement procedure and rehabilitation services at the Venice hospital last year.

Experts said that accessing the wrong patient’s file because of a name mix-up is a common error — but one for which safeguards, like checking a patient’s photo identification, usually exist.

The hospital had treated at least two Grace Elliotts. When Grace A. Elliott showed up for her shoulder replacement, a hospital employee had pulled up Grace E. Elliott’s account by mistake.

“This is the kind of thing that can definitely happen,” said Shannon Hartsfield, a Florida attorney who specializes in health care privacy violations. (Hartsfield does not represent anyone involved in this case.) “All kinds of human errors happen. A worker can pull up the names, click the wrong button, and then not check [the current patient’s] date of birth to confirm.”

It was a seemingly obvious error: The younger Elliott was billed for a procedure she didn’t have by a hospital she had not visited in years. But it took her nearly a year of hours-long phone calls to undo the damage.

At first, worried that she had been the victim of identity theft, Grace E. Elliott contacted ShorePoint Health Venice and was bounced from one department to another. At one point, a billing employee disclosed to Elliott the birthdate the hospital had on file for the patient who had the shoulder replacement — it was not hers. Elliott then sent the hospital a copy of her ID.

It took weeks for an administrator at ShorePoint’s corporate office in Florida to admit the hospital’s error and promise to correct it.

In August, though, Grace E. Elliott received a notice that the corporate office had sold the debt to a collections agency called Medical Data Systems. Even though the hospital had acknowledged its error, the agency was coming after Grace E. Elliott for the balance due for Grace A. Elliott’s shoulder surgery.

“I thought, ‘Well, I’ll just work with them directly,’” Grace E. Elliott said.

Her appeal was denied. Medical Data Systems said in its denial letter that it had contacted the hospital and confirmed the name and address on file. The agency also included a copy of Grace A. Elliott’s expired driver license to Grace E. — along with several pages of the older woman’s medical information — in support of its conclusion.

“A collection agency, as a business associate of a hospital, has an obligation to ensure that the wrong patient’s information is not shared,” Hartsfield said.

In an email to KHN, Cheryl Spanier, a vice president of the collections agency wrote that “MDS follows all state and federal rules and regulations.” Spanier declined to comment on Elliott’s case, saying she needed the written consent of both the health system and the patient to do so.

Elliott’s second appeal was also denied. She was told to contact the hospital to clear up the issue. But because the health system had long since sold the debt, Elliott said, she got no traction in trying to get ShorePoint Health Venice to help her. The hospital closed in September.

Resolution: In mid-November, shortly after a reporter contacted ShorePoint Health, which operates other hospitals and facilities in Florida, Grace E. Elliott received a call from Stanley Padfield, the Venice hospital’s outgoing privacy officer and director of health information management. “He said, ‘It’s taken care of,’ ” Elliott said, adding that she was relieved but skeptical. “I’ve heard that over and over.”

Elliott said Padfield told her that she had become listed as Grace A. Elliott’s guarantor, meaning she was legally responsible for the debt of a woman she had never met.

Elliott soon received a letter from Padfield stating that ShorePoint Health had removed her information from Grace A. Elliott’s account and confirmed that she had not been reported to any credit agencies. The letter said her information had been removed from the collection agency’s database and acknowledged that the hospital’s fix initially “was not appropriately communicated” to collections.

Padfield said the error started with a “registration clerk,” who he said had “received additional privacy education as a result of this incident.”

Devyn Brazelton, marketing coordinator for ShorePoint Health, told KHN the hospital believes the error was “an isolated incident.”

Using the date of birth provided by a hospital worker, Elliott was able to contact Grace A. Elliott and explain the mix-up.

“I’m a little upset right now,” Grace A. Elliott told KHN on the day she learned about the billing error and disclosure of her medical information.

The Takeaway: Grace E. Elliott said that when she asked Padfield, the Venice hospital’s outgoing privacy officer, whether she could have done something to fight such an obvious case of mistaken identity, he replied, “Probably not.”

This, experts said, is the dark secret of identity issues: Once a mistake has been entered into a database, it can be remarkably difficult to fix. And such incorrect information can live for generations.

For patients, that means it’s crucial to periodically review the information on your patient portal — the online medical profile many providers use to manage things like scheduling appointments, organizing medical records, and answering patient questions.

One downside of electronic medical records is that errors spread easily and repeat frequently. It is important to challenge and correct errors in medical records early and forcefully, with every bit of documentation available. That is true whether the problem is an incorrect name, a medication no longer (or never) taken, or an inaccurate diagnosis.

The process of amending a record can be “very involved,” Hartsfield said. “But with patients able now to see more and more of their medical records, they are going to want those amendments, and health systems and their related entities need to get prepared for that.”

Grace A. Elliott told KHN that she had received a call from ShorePoint Health in the previous few months indicating that she owed money for her shoulder replacement.

She asked for a copy of the bill, she told KHN. Months after she asked, it still hadn’t arrived.

KHN (Kaiser Health News) is a national, editorially independent program of KFF (Kaiser Family Foundation).

December 22, 2022
Tips to keep you and your family safe with COVID, RSV and the flu surging : Shots

A vaccine clinic in Lynwood, Calif., offering free flu and COVID-19 vaccines. Experts are using the word “tripledemic” for rises in COVID-19, influenza and respiratory syncytial virus (RSV).

Mark J. Terrill/AP

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Mark J. Terrill/AP

A vaccine clinic in Lynwood, Calif., offering free flu and COVID-19 vaccines. Experts are using the word “tripledemic” for rises in COVID-19, influenza and respiratory syncytial virus (RSV).

Mark J. Terrill/AP

This year’s holiday season is arriving right in the midst of an unwelcome “tripledemic” of COVID-19, influenza and respiratory syncytial virus (RSV) that have helped strain hospitals nationwide.

Though COVID cases are much lower than they were last winter, case counts are ticking up nationwide, and nearly 3,000 Americans are dying each week. Meanwhile, other respiratory viruses like the flu and RSV have surged this fall.

More than 77{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of hospital beds nationwide are occupied, down slightly from nearly 80{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} earlier this month, according to data from the Department of Health and Human Services — the highest levels seen since last winter’s omicron surge.

NPR asked a handful of public health experts how Americans should approach the holiday season. They suggest that Americans take stock of the risk and take appropriate safety measures to protect themselves and those who are most likely to face severe disease — including older people and the immunocompromised.

“Everyone is obviously ready to do as much as they can that they have done in normal holiday periods, especially as many of us have given it up for a couple years,” said Dr. Henry Wu, an epidemiologist and travel doctor at Emory University. “We’re entering a new normal where we have to navigate how best to do what we want to do.”

Think about your holiday plans and dial in your safety measures accordingly

Now’s the time to look ahead and think about what plans you have for the holidays, Wu said. Which events are the highest priorities for you? Who do you want to see?

Then, do a risk assessment. Think about how much you’re willing to risk getting sick — and same for the people you plan to see. Are you a healthy young adult doing a small get-together with other healthy young adults? Or will you be attending a large, multigenerational family reunion with children and older people together in the same house?

Thinking through those questions can help you decide which safety measures to take. “Every family and every individual is going to be a little different,” Wu said.

Some people may feel totally comfortable getting together at a bar. Others, not so much. “If you would like to do as much as you can to avoid getting sick when you’re getting together, if you want to protect the vulnerable person, whether they’re elderly or an infant, then definitely incorporate some of the lessons from the last few years,” he said, including limiting your exposure before travel and testing for COVID before you go.

Get the flu shot and a COVID booster if you haven’t already

All the public health experts who spoke with NPR agreed on this easy way to reduce the risk to you and those around you: Get your shots!

The bivalent COVID-19 booster shots made by Pfizer and Moderna are available to almost all Americans, including most children. And for those who need or prefer a non-mRNA shot, the Novavax vaccine is available as a booster to adults who completed an initial vaccine course at least six months ago.

Flu shots, too, are important. The CDC estimates that at least 13 million Americans have already been infected with the flu this season, and over 100,000 hospitalized — a caseload much larger than last winter, when many Americans were still following COVID-related precautions.

But flu shot uptake this year has been low. Only about a quarter of American adults have been vaccinated, according to the CDC. Those who haven’t gotten their shot yet should seek one soon, said Dr. Preeti Malani, an infectious disease specialist at the University of Michigan.

“The sense is that this year’s vaccine is actually a pretty good match to the strain circulating. And much like COVID vaccines, flu shots don’t prevent all infections, but they can help prevent hospitalizations, deaths, as well as transmission,” Malani said in an interview last week with NPR.

If you’re not feeling well, stay home

This was the other easy source of agreement. “If you have symptoms, if you are feeling unwell, we are going to ask you to stay home. We are saying we don’t really want people to gather if they’re feeling unwell,” said CDC head Rochelle Walensky in an interview with NPR last week.

One scientific review of 130 COVID studies conducted by mid-2021, published earlier this year in the journal PLOS Medicine, suggests that the risk of getting infected from someone who’s asymptomatic is much lower than from someone with symptoms.

That makes staying home when sick “one of the most profoundly important things we can do this holiday season to keep other people safe,” said Dr. Monica Gandhi, an infectious disease specialist at the University of California San Francisco. “That means not going to that holiday party when you’re coughing and sneezing.”

If you do feel sick, get tested — COVID tests are widely available this year at pharmacies and grocery stores. And health care providers can arrange a flu test.

“If you are diagnosed early, we have antivirals that can be used to shorten your disease course and your disease severity,” Walensky said.

Shift some activities outdoors and maximize ventilation indoors where possible

“I consider ventilation one of the strongest things we can do to protect ourselves during respiratory pathogen season,” said Gandhi.

Respiratory diseases such as COVID have a difficult time spreading outdoors, where natural airflow is remarkably effective at dispersing droplets and pathogens.

Not everything can realistically be moved outdoors. Many social gatherings and religious services will be indoors. For family members traveling long distances to see each other, spending a lot of time indoors together is inescapable.

For more flexible plans, like catching up with an old friend from high school, you could consider outdoor activities if the weather allows — like a walk in the park, ice skating or strolling an outdoor holiday market, rather than getting together at a bar or restaurant.

For the indoor gatherings, Gandhi suggests doing what you can to improve ventilation. Open windows if the weather allows. If not, HEPA filters, cracked windows and ceiling fans can help too.

“I think that has really come out as the strongest non-pharmaceutical intervention that’s been revealed during this pandemic, because it just eliminates all respiratory pathogens,” she said.

Consider wearing a high-quality mask in crowded settings, especially if you’re a vulnerable person

Some indoor time in public might be unavoidable during a holiday season, like during travel and religious services. Health officials at the CDC, along with some municipalities, are encouraging people to wear “high-quality, well-fitting” masks in public when possible — especially those who are more vulnerable, like older people and immunocompromised people.

“Especially in crowded indoor spaces, whether it’s on the subway or in an airplane, a lot of people are sick around us right now. So put that mask on,” Malani said.

Studies are mixed on the effectiveness of masks on a large scale.

But in laboratory settings, masks like N95s or KN95s have been shown to block virus particles. Wearing one of these high-quality masks can cut your risk of getting infected when around others who aren’t masked, though they of course aren’t foolproof.

“I don’t think a mask is a difficult thing to do,” said Wu. “I really encourage folks to keep that mask handy and use it” when you find yourself in a crowded and poorly ventilated indoor space.

December 21, 2022
How the cost of cancer treatment is driving Americans into debt : Shots

Jeni Rae Peters and daughter embrace at their home in Rapid City, S.D. In 2020, Peters was diagnosed with stage 2 breast cancer. After treatment, Peters estimates that her medical bills exceeded $30,000.

Dawnee LeBeau for NPR

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Dawnee LeBeau for NPR

Jeni Rae Peters and daughter embrace at their home in Rapid City, S.D. In 2020, Peters was diagnosed with stage 2 breast cancer. After treatment, Peters estimates that her medical bills exceeded $30,000.

Dawnee LeBeau for NPR

RAPID CITY, S.D. ― Jeni Rae Peters would make promises to herself as she lay awake nights after being diagnosed with breast cancer two years ago.

“My kids had lost so much,” said Peters, a single mom and mental health counselor. She had just adopted two girls and was fostering four other children. “I swore I wouldn’t force them to have yet another parent.”

Multiple surgeries, radiation, and chemotherapy controlled the cancer. But, despite having insurance, Peters was left with more than $30,000 of debt, threats from bill collectors, and more anxious nights thinking of her kids.

“Do I pull them out of day care? Do I stop their schooling and tutoring? Do I not help them with college?” Peters asked herself. “My doctor saved my life, but my medical bills are stealing from my children’s lives.”

Cancer kills about 600,000 people in the U.S. every year, making it a leading cause of death. Many more survive it, because of breakthroughs in medicines and therapies.

But the high costs of modern-day care have left millions with a devastating financial burden. That’s forced patients and their families to make gut-wrenching sacrifices even as they confront a grave illness, according to a KHN-NPR investigation of America’s sprawling medical debt problem. The project shows few suffer more than those with cancer.

About two-thirds of adults with health care debt who’ve had cancer themselves or in their family have cut spending on food, clothing, or other household basics, a poll conducted by KFF (Kaiser Family Foundation) for this project found. About 1 in 4 have declared bankruptcy or lost their home to eviction or foreclosure.

Other research shows that patients from minority communities are more likely to experience financial hardships caused by cancer than white patients, reinforcing racial disparities that shadow the U.S. health care system.

“It’s crippling,” said Dr. Veena Shankaran, a University of Washington oncologist who began studying the financial impact of cancer after seeing patients ruined by medical bills. “Even if someone survives the cancer, they often can’t shake the debt.”

Shankaran found that cancer patients were 71{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} more likely than Americans without the disease to have bills in collections, face tax liens and mortgage foreclosure, or experience other financial setbacks. Analyzing bankruptcy records and cancer registries in Washington state, Shankaran and other researchers also discovered that cancer patients were 2½ times more likely to declare bankruptcy than those without the disease.

And cancer patients who went bankrupt were more likely to die than those who did not. Oncologists have a name for this: “financial toxicity,” a term that echoes the intractable vomiting, life-threatening infections and other noxious effects of chemotherapy.

“Sometimes,” Shankaran said, “it’s tough to think about what the system puts patients through.”

Cancer diagnosis upends a family

At the three-bedroom home in Rapid City that Peters shares with her children and a friend, there isn’t time most days to dwell on these worries. There are ice skating lessons and driving tests and countless meals to prepare. Teenagers drift in and out, chattering about homework and tattoos and driving.

Despite having medical insurance, Peters had to pay thousands of dollars out of pocket. “I don’t even know anymore how much I owe,” she said. “Sometimes it feels like people just send me random bills. I don’t even know what they’re for.”

Dawnee LeBeau for NPR

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Dawnee LeBeau for NPR

Despite having medical insurance, Peters had to pay thousands of dollars out of pocket. “I don’t even know anymore how much I owe,” she said. “Sometimes it feels like people just send me random bills. I don’t even know what they’re for.”

Dawnee LeBeau for NPR

The smallest children congregate at a small kitchen table under a wall decorated with seven old telephones. (As Peters tells it, the red one is a hotline to Santa, a green one to the Grinch, and a space shuttle-shaped phone connects to astronauts orbiting the Earth.)

Peters, 44, presides cheerfully over the chaos, directing her children with snide asides and expressions of love. She watches proudly as one teenage daughter helps another with math in the living room. Later she dances with a 5-year-old to Queen under a disco ball in the entry hall.

Peters, who sports tattoos and earlier this year dyed her hair purple, never planned to have a family. In her late 30s, she wanted to do more for her adopted community, so she took in foster children, many of whom come from the nearby Pine Ridge Indian Reservation. One of her daughters had been homeless.

“Foster kids are amazing humans,” she said. “I joke I’m the most reluctant parent of the most amazing children that have ever existed. And I get to help raise these little people to be healthy and safe.”

In spring 2020, the secure world Peters had carefully tended was shattered. As the COVID pandemic spread across the country, she was diagnosed with stage 2 breast cancer.

Within weeks, she had an intravenous port inserted into her chest. Surgeons removed both her breasts, then her ovaries after tests showed she was at risk of ovarian cancer, as well.

Cancer treatment today often entails a costly, debilitating march of procedures, infusions, and radiation sessions that can exhaust patients physically and emotionally. It was scary, Peters said. But she rallied her children. “We talked a lot about how they had all lost siblings or parents or other relatives,” she said. “All I had to do was lose my boobs.”

Much harder, she said, were the endless and perplexing medical bills.

There were bills from the anesthesiologists who attended her surgeries, from the hospital, and from a surgery center. For a while, the hospital stopped sending bills. Then in April, Peters got a call one morning from a bill collector saying she owed $13,000. In total, Peters estimates her medical debts now exceed $30,000.

High costs, despite insurance

Debts of that size Peters carried aren’t unusual. Nationwide, about 1 in 5 indebted adults who have had cancer or have a family member who’s been sick say they owe $10,000 or more, according to the KFF poll. Those dealing with cancer are also more likely than others with health care debt to owe large sums and to say they don’t expect to ever pay them off.

This debt has been fueled in part by the advent of lifesaving therapies that also come with eye-popping price tags. The National Cancer Institute calculated the average cost of medical care and drugs tops $42,000 in the year following a cancer diagnosis. Some treatments can exceed $1 million.

Usually, most costs are covered. But patients are increasingly on the hook for large bills because of annual deductibles and other health plan cost sharing. The average leukemia patient with private health insurance, for example, can expect to pay more than $5,100 in the year after diagnosis, according to an analysis by the consulting firm Milliman.

Even Medicare can leave seniors with huge bills. The average blood cancer patient covered by fee-for-service Medicare can expect to pay more than $17,000 out-of-pocket in the year following diagnosis, Milliman found.

Additionally ongoing surgeries, tests, and medications can make patients pay large out-of-pocket costs year after year. Physicians and patient advocates say this cost sharing ― originally billed as a way to encourage patients to shop for care ― is devastating. “The problem is that model doesn’t work very well with cancer,” said Dr. David Eagle, an oncologist at New York Cancer & Blood Specialists.

Peters tries her best to support her children, including her daughter Lisha Jane Featherman. She had never planned to have a family. In her late 30s, she wanted to do more for her adopted community, so she took in foster children. Now, she has two adopted kids and four foster kids.

Dawnee LeBeau for NPR

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Dawnee LeBeau for NPR

Peters tries her best to support her children, including her daughter Lisha Jane Featherman. She had never planned to have a family. In her late 30s, she wanted to do more for her adopted community, so she took in foster children. Now, she has two adopted kids and four foster kids.

Dawnee LeBeau for NPR

More broadly, the KHN-NPR investigation found that about 100 million people in the U.S. are now in debt from medical or dental bills. Poor health is among the most powerful predictors of debt, with this debt concentrated in parts of the country with the highest levels of illness.

According to the KFF poll, 6 in 10 adults with a chronic disease such as cancer, diabetes, or heart disease or with a close family member who is sick have had some kind of health care debt in the past five years. The poll was designed to capture not just bills patients haven’t paid, but also other borrowing used to pay for health care, such as credit cards, payment plans, and loans from friends and family.

For her part, Peters has had seven surgeries since 2020. Through it all, she had health insurance through her employers. Peters said she knew she had to keep working or would lose coverage and face even bigger bills. Like most plans, however, hers have required she pay thousands of dollars out-of-pocket.

Within weeks of her diagnosis, the bills rolled in. Then collectors started calling. One call came as Peters was lying in the recovery room after her double mastectomy. “I was kind of delirious, and I thought it was my kids,” she said. “It was someone asking me to pay a medical bill.”

Peters faced more bills when she switched jobs later that year and her insurance changed. The deductible and cap on her out-of-pocket costs reset.

In 2021, the deductible and out-of-pocket limit reset again, as they do every year for most health plans. So when Peters slipped on the ice and broke her wrist ― a fracture likely made worse by chemotherapy that weakened her bones ― she was charged thousands more.

This year has brought more surgeries and yet more bills, as her deductible and out-of-pocket limit reset again.

“I don’t even know anymore how much I owe,” Peters said. “Sometimes it feels like people just send me random bills. I don’t even know what they’re for.”

Making sacrifices to pay the bills

Before getting sick, Peters was earning about $60,000 a year. It was enough to provide for her children, she said, supplemented with a stipend she receives for foster care.

Peters took on extra work to pay some of the bills and support her family. Five days a week, she works back-to-back shifts at both a mental health crisis center and a clinic counseling teenagers.

Dawnee LeBeau for NPR

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Dawnee LeBeau for NPR

Peters took on extra work to pay some of the bills and support her family. Five days a week, she works back-to-back shifts at both a mental health crisis center and a clinic counseling teenagers.

Dawnee LeBeau for NPR

The family budget was always tight. Peters and her kids don’t take extravagant vacations. Peters doesn’t own her home and has next to no savings. Now, she said, they are living at the edge. “I keep praying there is a shoe fairy,” she said, joking about the demands of so many growing feet in her home.

Peters took on extra work to pay some of the bills. Five days a week, she works back-to-back shifts at both a mental health crisis center and a clinic counseling teenagers, some of whom are suicidal. Last year, three friends on the East Coast paid off some of the debt.

But Peters’ credit score has tumbled below 600. And the bills pile high on the microwave in her kitchen. “I’m middle-class,” she said. “Could I make payments on some of these? Yes, I suppose I could.”

That would require trade-offs. She could drop car insurance for her teenage daughter, who just got her license. Canceling ice skating for another daughter would yield an extra $60 a month. But Peters is reluctant.

“Do you know what it feels like to be a foster kid and get a gold medal in ice skating? Do you know what kind of citizen they could become if they know they’re special?” she said. “There seems to be a myth that you can pay for it all. You can’t.”

Many cancer patients face difficult choices.

About 4 in 10 with debt have taken money out of a retirement, college, or other long-term savings account, the KFF poll found; about 3 in 10 have moved in with family or friends or made another change in their living situation.

Dr. Kashyap Patel, chief executive of Carolina Blood and Cancer Care Associates, said the South Carolina practice has found patients turning to food banks and other charities to get by. One patient was living in his car. Patel estimated that half the patients need some kind of financial aid. Even then, many end up in debt.

The Leukemia & Lymphoma Society, which typically helps blood cancer patients navigate health insurance and find food, housing, and other nonmedical assistance, is hearing from more patients simply seeking cash to pay off debt, said Nikki Yuill, who oversees the group’s call center.

“People tell us they won’t get follow-up care because they can’t take on more debt,” Yuill said, recalling one man who refused to call an ambulance even though he couldn’t get to the hospital. “It breaks your heart.”

Academic research has revealed widespread self-rationing by patients. For example, while nearly 1 in 5 people taking oral chemotherapy abandon treatment, about half stop when out-of-pocket costs exceed $2,000, according to a 2017 analysis.

Robin Yabroff, an epidemiologist at the American Cancer Society, said more research must be done to understand the lasting effects of medical debt on cancer survivors and their families. “What does it mean for a family if they have to liquidate savings or drain college funds or sell their home?” Yabroff said. “We just don’t know yet.”

As Peters put away bags of groceries in her kitchen, she conceded she doesn’t know what will happen to her family. Like many patients, she worries about how she’ll pay for tests and follow-up care if the cancer reappears.

She is still wading through collection notices in the mail and fielding calls from debt collectors. Peters told one that she was prepared to go to court and ask the judge to decide which of her children should be cut off from after-school activities to pay off the debts.

She asked another debt collector whether he had kids. “He told me that it had been my choice to get the surgery,” Peters recalled. “And I said, ‘Yeah, I guess I chose not to be dead.’ “

The audio version of this story was produced by Seth Tupper at South Dakota Public Broadcasting.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. It is an editorially independent operating program of KFF (Kaiser Family Foundation).

July 11, 2022
Supreme Court’s abortion decision puts doctors in legal limbo : Shots

Dr. Kara Beasley protests the overturning of Roe vs. Wade by the U.S. Supreme Court, in Denver, Colorado on June 24, 2022.

JASON CONNOLLY/AFP via Getty Images

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Dr. Kara Beasley protests the overturning of Roe vs. Wade by the U.S. Supreme Court, in Denver, Colorado on June 24, 2022.

JASON CONNOLLY/AFP via Getty Images

Historically, doctors have played a big role in abortion’s legality. Back in the 1860s, physicians with the newly-formed American Medical Association worked to outlaw abortion in the U.S.

A century later, they were doing the opposite.

In the 1950s and 1960s, when states were liberalizing abortion laws, “the charge for that actually came from doctors who said, ‘This is insane, we can’t practice medicine, we can’t exercise our medical judgment if you’re telling us that this is off the table,’ ” explains Melissa Murray, law professor at New York University.

The Supreme Court ruled in doctors’ favor in Roe v. Wade in 1973. The majority opinion spoke of “the right of a woman in consultation with her physician to choose an abortion,” Murray says.

Yet doctors and patients are all but absent from the latest Supreme Court majority opinion on abortion in Dobbs v. Jackson Women’s Health Organization. In fact, in the opinion, Justice Samuel Alito uses the derogatory term “abortionist” instead of physician or doctor or obstetrician-gynecologist.

Legal experts say that signals a major shift in how the court views abortion, and creates a perilous new legal reality for physicians. In states where abortion is restricted, health care providers may be in the position of counseling patients who want an abortion, including those facing pregnancy complications, in a legal context that treats them as potential criminals.

“Alito’s framing is that abortion is and was a crime – that’s the language he uses,” says Mary Ziegler, a law professor at the University of California, Davis. There’s no dispute, she says, that “the result of a decision overruling Roe in the short term is going to be the criminalization of doctors.”

Roe v. Wade was doctor-centered

Doctors were at the heart of the court’s first landmark ruling on abortion, Roe v. Wade.

“The original Roe decision – it was very, very doctor-centered – extremely so,” says Ziegler, who has written extensively on the legal history of abortion. “At its inception, this was a right that was very much about health care and about the doctor-patient relationship.”

Roe and the abortion decisions that came after it like Planned Parenthood v. Casey, “had the framework that abortion is some sort of individual right, but it’s also health care,” explains Carmel Shachar, executive director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School.

The court essentially told states: “You can put restrictions on abortion services and on provider qualifications as you do for other types of health care, and as long as they are not so onerous that we think they’re implicating Roe and Casey, we’re fine with that,” Shachar says.

State legislatures that wanted to restrict abortion did so using the apparatus of health care regulation, she says.

Those restrictions have included informed consent laws, waiting periods, telemedicine restrictions, clinic regulations, hospital admitting requirements for providers, insurance restrictions and more.

The effort to restrict abortion through medically unnecessary regulations – “was simultaneously, I think, treating abortion as health care and delegitimizing the idea that abortion is health care,” Ziegler says.

These regulations often tried to control the details of how doctors provide abortions more strictly than other areas of medicine, she notes. “The anti-abortion movement’s framing was basically, ‘We’re protecting women from the ‘abortion industry’ by regulating the way abortion providers work.’ “

A new legal framework

A more recent abortion decision – Gonzales v. Carhart in 2007 – previewed the Supreme Court’s move away from deferring to doctors in the context of abortion, Ziegler says. At stake was the legality of so-called “partial birth abortion,” a procedure used to perform late-term abortions, which Congress had banned in 2003.

“The fight in that case was about whether doctors get to define what this procedure is and whether it’s needed for patients or whether Congress does,” she says. “The Supreme Court in the case essentially says, if there’s any kind of disagreement about science – legislators get to break the tie.”

In Dobbs, the latest decision about abortion from the Supreme Court, “it’s an even bigger breach because there’s not even the pretense of caring about doctors,” she says.

Supporters of the Dobbs opinion don’t see the absence of physicians as an omission. Abortion “really doesn’t have any place in the practice of medicine,” Dr. Christina Francis of the Association of Pro-Life Obstetricians and Gynecologists told NPR after the decision was released. Her group submitted an amicus brief in the Dobbs case, which urged the court to overturn Roe v. Wade.

In his opinion for the majority, Alito quotes the Mississippi law banning abortion after 15 weeks, which called abortion “a barbaric practice, dangerous for the maternal patient, and demeaning to the medical profession.”

Ziegler says the idea has been percolating for years in the anti-abortion movement “that abortion was not medicine, was not health care.” She says it was fueled in the 1980s when Bernard Nathanson, a doctor who formerly provided abortions, had a political and religious conversion.

“He wrote this book in the ’80s called Aborting America, which was what he called an exposé of the ‘abortion industry,’ ” she explains. “That term really caught on with the anti-abortion movement – that essentially abortion was a for-profit industry, kind of like the tobacco industry.”

That idea has continued to be powerful and its influence is apparent in Dobbs, she says. Alito’s opinion reflects the idea that “abortion providers are not doctors in the sense we usually understand – that they were historically thought of as criminals and what they’re doing is unprotected.”

A ‘glaring’ omission

Many doctors and legal analysts adamantly disagree with Alito’s view. Two dozen medical groups, including the American College of Obstetricians and Gynecologists and the American Medical Association, told the court that abortion is a key part of reproductive health care, that it is safe, and that doctors need to be able to treat patients without government interference.

“I think the failure to consider the interests of the pregnant person and of the clinicians that treat them [in the majority opinion] was glaring,” says Molly Meegan, chief legal officer and general counsel at ACOG. She adds the use of the term “abortionist” in the opinion was “inflammatory, inaccurate – these are clinicians, these are providers, these are medical professionals.”

Shachar at Harvard takes issue with the “history and traditions” approach Alito used in his analysis to determine that abortion is not a protected right, focusing on statutes from the 19th century.

“Medical care has just changed so dramatically from – bite a bullet and we’ll amputate your leg,” she says. “It’s really shocking to say, ‘We need to go by the historical conception,’ when we have all agreed that we want to live in a modern society that has medical care, that doesn’t treat women like chattel.”

Michele Goodwin, who directs the Center for Biotechnology and Global Health Policy at UC Irvine, says Dobbs and the state abortion laws that can now take effect single out physicians who provide abortions “for disparate treatment amongst various other kinds of care.”

“That would be one thing if, in fact, these were very risky procedures that led to high rates of mortality, but, in fact, it’s just the opposite,” she says. Abortion is very safe, she adds, pointing out that pregnancy leads to death 14 times more often than an abortion. That means that doctors who provide abortions “are absolutely essential, actually, in the provision of reproductive health care,” she says.

The role of doctors ahead

Physicians who provide abortions are in an incredibly difficult spot as they try to navigate the new legal landscape, especially in cases where a pregnant patient is sick or has complications. Intervene, and you risk violating the law and being sued, losing your medical license, even going to jail. Don’t intervene and you could be risking your patient’s life, and potentially being sued by the patient or family.

“We are hearing from our doctors on the ground at all times of day and night,” says Meegan of ACOG. “They are scared, they are in an impossible situation, and they don’t know how to define laws that are happening by the minute.”

Dr. Katie McHugh is an OB-GYN who provides labor and delivery and abortion care at several clinics around Indiana, where abortion is currently still legal. Since the Supreme Court decision, she’s seen a wave of new patients coming from Ohio, Tennessee, and Kentucky for abortion care. She’s trying to keep track of the laws in these neighboring states to know what she can do for these patients.

“We’re trying to be very, very careful,” she says. “Especially as things are evolving, I’m sure that I have made a mistake. And it is so scary to me to know that I’m not only worrying about my patients’ medical safety, which I always worry about, but now I am worrying about their legal safety, my own legal safety.”

“The criminalization of both patients and providers is incredibly disruptive to just normal patient care,” she adds.

The legal landscape is very much in flux. Bans are going into effect, some have been blocked by judges, and new restrictions are being drafted by state lawmakers. The laws that are in effect are often confusing and unclear, and doctors warn that is likely to affect care beyond abortion, including miscarriage care and treatment for ectopic pregnancy and more.

It could be that doctors’ groups like the American Medical Association and ACOG get involved in the legal fight here and again play a role in pushing to liberalize abortion laws, just like they did decades ago.

“I think that medical societies have a responsibility and an influence that should be used right now,” says Meegan. She notes AMA recently adopted a resolution that defines abortion as a human right, and that many organized medical groups across specialties are united in fighting against the criminalization of medical care.

“Recent political and legal mobilizations around abortion have not been led by doctors,” notes Ziegler. “Historically, doctors have been a really big reason abortion was decriminalized before, and if [they’re] going to be again, I think you have to have the medical profession potentially be more outspoken and united in talking about this than it has been to date.”

July 4, 2022
When divorced parents can’t agree on vaccinating the kids : Shots

Heather wanted to have her two children vaccinated against COVID-19, while her ex-husband did not. In Pennsylvania, decisions about children’s health must be made jointly by parents with shared legal custody.

Emma Lee/WHYY

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Heather wanted to have her two children vaccinated against COVID-19, while her ex-husband did not. In Pennsylvania, decisions about children’s health must be made jointly by parents with shared legal custody.

Emma Lee/WHYY

Heather and Norm have had their share of disagreements. Their separation seven years ago and the ensuing custody battle were contentious. But over the years, the pair has found a way to weather disputes cordially. They’ve made big decisions together and checked in regularly about their two kids, now ages 9 and 11.

But the rhythm of give and take they so carefully cultivated came to an abrupt end last fall, when it came time to decide whether to vaccinate their kids against COVID-19 — Heather was for it; Norm was against. (WHYY News has withheld their last names to protect the privacy of their children.)

In Pennsylvania, decisions about children’s health must be made jointly by parents with shared legal custody, so the dispute went to court. And Heather and Norm weren’t the only ones who couldn’t come to an agreement on their own. In the months since the vaccine was approved for children, family court judges across the commonwealth have seen skyrocketing numbers of similar cases: divorced parents who can’t agree on what to do.

When parents can’t decide

Heather and Norm had a nasty divorce — they both say so. Drawn-out court battles and arguments that bled onto social media lasted years after their initial separation. But once the dust settled, somewhat miraculously they found they agreed on a lot.

“If someone would have told me in the middle of the divorce that sometime in the future, you and your ex-wife are going to be able to just call each other on the phone and have a chat, I would have said no way,” said Norm. “That is totally impossible.”

The two parents even created similar environments for their kids to grow up in, at least superficially.

On a bucolic 3-acre lot in Montgomery County, Penn., Heather runs a small farm where she grows rare botanicals that she supplies to local restaurants, plus a veggie garden for her family. She keeps bees and a meticulously designed, rustic chic home.

Her ex-husband lives about 20 minutes away, just across the Chester County line, where he spends much of his time in a barn behind his house growing rare mushrooms, which he also sells to local restaurants. The area where Norm does paperwork in the barn smells vaguely of nag champa, and a slender copy of the Tao Te Ching is nestled between invoices on his desk.

Both park big pickup trucks in their driveways. Both have massive trampolines for their kids to jump on.

When the pandemic started, Heather and Norm adjusted nimbly to accommodate virtual school for the kids. Soon, though, they agreed that the arrangement was taking a toll on both children, especially their son, who is older. Usually a good student, he was getting frustrated by electronic assignments, and turning in homework late or not at all. He started developing an irrational fear that a tornado was going to hit, said Heather. Both parents agreed it would benefit their children’s mental health to be back among classmates as soon as that was an option.

Heather was nervous about the kids being in school before they were eligible to be vaccinated, but she assured herself that the time was coming soon, and that when it did, it would be a no-brainer.

“It gave a sense of control about all of the things that have been uncontrollable for the past two years,” she said of the vaccines.

But Norm had a different calculus.

The fact that serious cases of COVID-19 were less common among kids made him feel as if his children being unvaccinated was relatively risk-free. On the flip side, Norm reasoned, the vaccines are very new, meaning there isn’t data on possible side effects years or decades out. And while he acknowledged that the number of cases of initial serious side effects was hard to pinpoint, he didn’t want to take any chances.

“If there’s any risk whatsoever, [then] that greatly outweighs the risk of not getting them vaccinated,” he said.

It’s important to note that COVID-19 is not risk-free for children. During the omicron wave, young children who were not yet eligible for vaccination were five times more likely to be hospitalized with COVID than when the delta variant was more prominent. The majority of those children had no underlying conditions.

Still, children hospitalized with COVID represent a small proportion of hospitalizations, and just over 1,000 children under 18 have died of COVID since the pandemic began.

To demonstrate that his position was, in fact, a result of calculated risk and not political ideology, Norm pointed out that he made the choice to get vaccinated himself. As a 45-year-old, he figured, the potential benefits of being vaccinated outweighed the risks.

“It makes sense for me,” he said. “But again, in my mind it does not make sense for a 9- and 11-year-old healthy child.”

Their disagreement about whether to vaccinate their kids was not Heather and Norm’s first pandemic dispute, but it was the most alarming to Heather. Earlier, she had heard from her kids that their dad encouraged them not to wear masks. (Norm said he believes that most cloth and surgical masks aren’t effective at preventing transmission of SARS-CoV-2, so unless kids are going to wear N95s, masks are not worth it.) Heather was concerned by this, but also knew co-parenting is an exercise in choosing battles. She was unsettled, but ultimately figured it was behavior she couldn’t influence.

“My bubble isn’t just my four-person household,” she said, referring to her kids and her partner. “It extends to another household that I don’t have much input into or control over.”

The vaccination issue was different though. It felt more fundamental to the kids’ safety and well-being. Heather tried to reason and plead with Norm. She tried analogies. It was like letting them ride in a car without a seatbelt, she argued.

“Let’s wait and let them play in traffic and see if they get hit by a car, not everyone dies from that,” she offered, provocatively.

The two had been unable to come to an agreement by the beginning of November, when the Food and Drug Administration authorized the Pfizer vaccine for 5- to 11-year-olds.

Heather said she thought dozens of times about just going ahead and getting her kids vaccinated. The omicron wave and the holidays were on the horizon. Once it was done, there would be no undoing it.

But it wasn’t quite so simple.

Like most divorced parents, Heather and Norm share legal custody of their children. That means they must make decisions together in three main areas: school, health and religion. If parents can’t come to an agreement on their own, often a mediator is brought in. If a mediator can’t resolve the issue, it could go to a hearing.

If one parent were to act alone by vaccinating their kids, or enrolling them in a new school against the other parent’s wishes, it would be considered a violation of the custody agreement. That parent would technically be in contempt of court.

There is a range of consequences for such a violation, but it’s akin to points on a driver’s license, or a mark on your permanent record. Too many strikes could lead a judge to make a broad decision about whether that parent deserves custody of the children at all. Not wanting to risk a demerit, Heather decided to take the matter through formal legal channels, in family court.

A mediator would not resolve the matter, and passed it along to a judge. Heather anxiously awaited a hearing date.

In the meantime, the kids’ unvaccinated status severely hampered their lives, she said. They were sent home from school to quarantine a number of times because of COVID exposures, while their vaccinated classmates were allowed to remain in class if they tested negative. The family was uninvited to a trip with friends because that family preferred everyone to be vaccinated.

The holidays came and went. A hearing date was scheduled for February.

Vaccine custody cases are on the rise

Heather and Norm are among hundreds of divorced Pennsylvania parents bringing similar cases to court. Hillary Moonay, a family law attorney at Obermeyer Law in Bucks County, Penn., who represents families in custody cases, said her firm has seen a surge in custody cases dealing with all sorts of COVID disputes.

Early in the pandemic, it was about whether parents were taking appropriate masking precautions or with whom a child should stay if a parent was exposed, she said. But once the vaccines were approved for minors, things really took off.

“I’ve been doing this for 25 years, and in that time frame, I’ve probably seen two to three cases related to disputes over children getting vaccines,” said Moonay.

Now, she estimates that her family law firm, which has roughly 20 attorneys and offices in Pennsylvania, New Jersey, New York and Delaware, sees at least one case like this per week.

Norm, who said he got vaccinated himself, feels that choice “does not make sense for a 9- and 11-year-old healthy child.”

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Norm, who said he got vaccinated himself, feels that choice “does not make sense for a 9- and 11-year-old healthy child.”

Nina Feldman/WHYY

The scope of judges’ decisions in these cases can vary widely, said Moonay. A narrow ruling would grant one parent decision-making power solely on the issue of COVID vaccines. But if a judge felt one parent’s position skewed so far outside the best interest of the child, the judge could determine that parent should not have any decision-making power going forward. Moonay said she has seen both outcomes, but that one thing is certain: These disputes feel more high-stakes and more intense than other cases.

“Parents have much stronger feelings about it than they do over a lot of other custody issues,” she said.

In her experience, Moonay said, judges tend to lean heavily on the medical advice of pediatricians and look at the children’s vaccination history in making their decisions. If none of that contradicts the notion that the child should take the vaccine, the judge is likely to recommend it. And, she said, judges are on the lookout for signs that one parent’s position may be politically motivated.

“In some cases, we have the evidence to show that because parents have posted things on social media or have spoken out at school board meetings to show that maybe their position is more than what it looks like in court,” she said.

In Heather’s case, the children’s pediatrician did not provide a letter recommending that the kids get vaccinated. The Kimberton Clinic, which describes itself as practicing holistic medicine, offered a note that neither child had any health reasons not to receive the COVID vaccine, but that it would not recommend it outright. Instead, the clinic simply stated that it hewed to Centers for Disease Control and Prevention guidance, which recommends that healthy children be vaccinated.

That made Heather’s case a bit harder. Her lawyer argued that the kids had had their other vaccinations and were missing out on school and other social activities because they weren’t vaccinated against COVID-19.

Norm represented himself in court. He said he couldn’t afford a lawyer. He attempted to admit a range of evidence backing his case, but the judge refused some of it.

“That was something that definitely didn’t go the way that I thought it was going to go,” Norm said.

He had brought along pieces penned by vaccine-skeptical doctors, such as Marty Makary, arguing that COVID vaccines for kids had more risks than benefits. In the end, the judge admitted data Norm brought from the VAERS database maintained by the CDC, to which anyone can anonymously submit adverse vaccine side effects. He was also able to submit several Johns Hopkins studies looking into the effect of the vaccines on the menstrual cycles of women and girls.

Norm also noted that being pro-vaccine was a new position for Heather. In the past, she had been the one worried about vaccines, and had placed the kids on a delayed vaccine schedule when they were little because she was worried about potential long-term consequences. After their separation, Norm had them vaccinated right away.

Now, they’ve switched positions. Norm said he’s changed his mind because the COVID-19 vaccine doesn’t have a proven track record like the other vaccines recommended for school-age children do. Heather said her calculus shifted due to the urgency of the pandemic — plus, she has a decade of motherhood under her belt.

In her closing remarks, the judge said it was clear both parents cared very much about their children’s well-being, they just had different ideas of how to achieve it. She said she didn’t take these cases lightly.

The parents waited days for the judge to issue a decision. Heather said she was a nervous wreck, genuinely unsure about which way the chips would fall.

It’s not clear how much of Heather and Norm’s complex history or the evidence they submitted was taken into account. In the end, the judge issued a simple order outlining the decision, with no explanation:

Heather would be granted decision-making authority on the matter of COVID-19 vaccination, but nothing else. She made appointments as soon as she got the order.

“It’s relieving news,” said Heather. “I didn’t think it was going to take over three months and close to $10,000. But here we are.”

The battle for their hearts and minds

It wasn’t an unambiguous win for Heather, though. The whole process took a toll on the kids. The push and pull between their mom and dad had made them skeptical of vaccines, and resentful of her. She had kept them in the loop the whole time: updated them that she and their father couldn’t agree, and that the decision was being made by a judge. She broke the news to them separately.

“My son is really sweet,” Heather recalled. “He curled up next to me on the couch and just sort of looked like, ‘Well, OK.’ He was very accepting, and it was very much his personality.”

Her daughter, on the other hand, did not take the news as well.

“She just looked at me and then looked out the window and said, ‘No, I’m not doing that.’”

According to Heather, that’s a function of her daughter’s personality, too. But it’s also the result, Heather thought, of her daughter being told she didn’t have to do anything to her body that she didn’t want to.

“I had to stress in that moment, like, actually, sweetheart, you’re 9. Yes, you are,” Heather said.

It hurt to feel like her daughter had turned against her, but at the same time, that’s part of parenting, Heather said.

“You make difficult decisions to protect your kids all the time,” she said. “You disappoint them.”

Norm was also disappointed by the decision.

“It didn’t make sense to me when we started the conversation; at this point, it makes even less sense to me,” he said, noting that omicron infections had ebbed substantially, and that it was possible a new vaccine could be needed to target a future variant. Recent research also indicates that with omicron the Pfizer vaccine was much less effective in 5- to 11-year-olds than originally anticipated.

Still, Norm said, he had been careful to navigate the conflict without alienating his kids from their mother. He remains committed to that after the decision, as well.

“You read any book about divorce or co-parenting, and it’s always in bold caps-lock letters, ‘Do not disparage the other parent in front of the kids,’” said Norm. “So I’ve been very, very cognizant of that from the beginning.”

Heather said she’s set the same ground rule about Norm. But she does worry how this experience will affect her kids in the long term.

“How does that frame their critical thinking going forward? Do they then live in a limbo where they really never know what’s right?” she said she wonders. As a mother, she considers it her job to give her kids a moral compass.

“That’s hard when their hearts and minds get a little weaponized against what I believe to be a medically sound decision for them,” Heather said.

Norm is more confident that the experience will be a net positive for the kids. He said he thinks it will teach them to navigate conflict and accept differing opinions.

Heather took both children to get their first doses in early March. She hadn’t told them where they were going, and when they arrived at the pharmacy, she said, they felt ambushed and angry with her. She shrugged it off. Sometimes, she figured, this is just a mom’s job.

After the shots, which were painless and quick, her kids stuffed their pockets full of Dum Dums, and Heather took them to Chipotle. It may not have been exactly the celebratory moment she’d imagined, but as she watched them eagerly dig into their quesadillas, she felt that, for the first time in two years, she could finally exhale.

This story comes from NPR’s health reporting partnership with WHYY and KHN (Kaiser Health News).

May 1, 2022
COVID Shots Still Work but Researchers Hunt New Improvements | Health News

By LAURAN NEERGAARD, AP Health-related Writer

COVID-19 vaccinations are at a significant juncture as corporations exam no matter if new methods like mixture photographs or nasal drops can hold up with a mutating coronavirus — even however it is not obvious if variations are required.

Now there is community confusion about who need to get a next booster now and who can wait around. You can find also debate about whether really considerably anyone may possibly will need an further dose in the fall.

“I’m very concerned about booster fatigue” leading to a reduction of self-confidence in vaccines that still present really strong protection versus COVID-19’s worst outcomes, reported Dr. Beth Bell of the University of Washington, an adviser to the U.S. Centers for Condition Control and Avoidance.

In spite of success in stopping major health issues and loss of life, there is escalating stress to acquire vaccines superior at fending off milder infections, far too — as perfectly as alternatives to counter terrifying variants.

Political Cartoons

“We go as a result of a hearth drill it seems like every quarter, each individual a few months or so” when another mutant leads to frantic exams to identify if the pictures are keeping, Pfizer vaccine chief Kathrin Jansen advised a current meeting of the New York Academy of Sciences.

Nonetheless looking for improvements for the following round of vaccinations could appear to be like a luxurious for U.S. families nervous to guard their littlest young children — youngsters under 5 who are not yet eligible for a shot. Moderna’s Dr. Jacqueline Miller informed The Affiliated Press that its application to give two reduced-dose shots to the youngest kids would be submitted to the Food stuff and Drug Administration “fairly shortly.” Pfizer hasn’t but documented details on a 3rd dose of its extra-compact shot for tots, right after two didn’t confirm strong more than enough.

Mix Pictures May possibly BE Next

The first COVID-19 vaccines continue being strongly protective from major health issues, hospitalization and demise, particularly immediately after a booster dose, even towards the most contagious variants.

Updating the vaccine recipe to match the hottest variants is dangerous, simply because the upcoming mutant could be entirely unrelated. So businesses are getting a cue from the flu vaccine, which presents protection towards a few or four distinctive strains in a single shot each and every 12 months.

Moderna and Pfizer are tests 2-in-1 COVID-19 security that they hope to provide this drop. Every “bivalent” shot would combine the first, confirmed vaccine with an omicron-targeted edition.

Moderna has a hint the technique could work. It examined a combo shot that targeted the unique variation of the virus and an before variant named beta — and found vaccine recipients made modest concentrations of antibodies able of fighting not just beta but also more recent mutants like omicron. Moderna now is screening its omicron-qualified bivalent applicant.

But you will find a looming deadline. FDA’s Dr. Doran Fink mentioned if any up-to-date pictures are to be specified in the fall, the company would have to make a decision on a recipe adjust by early summertime.

Really don’t Hope BOOSTERS Just about every Several MONTHS

For the average individual, two doses of the Pfizer or Moderna vaccine as well as one particular booster — a whole of 3 pictures — “gets you set up” and all set for what may possibly grow to be an once-a-year booster, explained Dr. David Kimberlin, a CDC adviser from the University of Alabama at Birmingham.

Immediately after that to start with booster, CDC information indicates an additional dose offers most persons an incremental, temporary reward.

Why the emphasis on three photographs? Vaccination triggers enhancement of antibodies that can fend off coronavirus infection but naturally wane in excess of time. The up coming line of protection: Memory cells that jump into action to make new virus-fighters if an an infection sneaks in. Rockefeller University scientists discovered people memory cells turn into more powerful and in a position to target a lot more varied variations of the virus soon after the 3rd shot.

Even if a person who’s vaccinated gets a gentle an infection, thanks to individuals memory cells “there’s nonetheless loads of time to shield you against critical illness,” said Dr. Paul Offit of the Children’s Healthcare facility of Philadelphia.

But some persons — individuals with seriously weakened immune units — require extra doses up-entrance for a better possibility at security.

And People in america 50 and more mature are staying available a 2nd booster, pursuing equivalent choices by Israel and other countries that give the more shot to give more mature people a very little much more security.

The CDC is developing tips to support these eligible make a decision regardless of whether to get an further shot now or hold out. Amid these who could want a second booster faster are the aged, people with well being troubles that make them particularly susceptible, or who are at significant hazard of publicity from operate or journey.

COULD NASAL VACCINES BLOCK An infection?

It is hard for a shot in the arm to kind heaps of virus-preventing antibodies inside of the nose exactly where the coronavirus latches on. But a nasal vaccine may possibly supply a new approach to avert infections that disrupt people’s day to day lives even if they are moderate.

“When I consider about what would make me get a second booster, I in fact would want to reduce an infection,” said Dr. Grace Lee of Stanford University, who chairs CDC’s immunization advisory committee. “I imagine we require to do superior.”

Nasal vaccines are difficult to acquire and it truly is not crystal clear how immediately any could turn out to be available. But a number of are in medical trials globally. One in late-phase testing, manufactured by India’s Bharat Biotech, makes use of a chimpanzee cold virus to provide a harmless copy of the coronavirus spike protein to the lining of the nose.

“I definitely do not want to abandon the achievement we have had” with COVID-19 photographs, explained Dr. Michael Diamond of Washington University in St. Louis, who served build the prospect that’s now certified to Bharat.

But “we’re going to have a complicated time stopping transmission with the latest systemic vaccines,” Diamond added. “We have all figured out that.”

The Involved Press Health and fitness and Science Department gets support from the Howard Hughes Medical Institute’s Division of Science Schooling. The AP is exclusively responsible for all articles.

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April 24, 2022