Author: bkellaway

What Happened Inside Ed Buck’s Apartment?

Addiction Recovery Bulletin

Real Life Hollywood Horror –

September 16, 2020 – One death is a tragedy; two deaths are a pattern. As the strange events on North Laurel Avenue captured the attention of the national media, a shocking new detail came to light. It appeared that Buck was not a nobody. He was a Democratic Party “megadonor and political activist” (ABC News); a “prominent political activist” (NBC). He was “high-profile” (The New York Post); he was “high-powered” (Fox). Frustrated by the lack of response from law enforcement, the family of Gemmel Moore filed a wrongful-death lawsuit against Buck, the county and the district attorney. Their lawyers tallied several hundred thousand dollars in political contributions that Buck had made to Democratic candidates at all levels of office, from city to federal. They said that Buck was being shielded thanks to his political donations and status. They said that the county does not investigate crimes against Black gay men.

In the past decade, deaths in Los Angeles County related to meth overdose had increased 707 percent, from 50 in 2007 to 320 the year Moore died. Meth gave you a dopamine rush that was quick and enveloping. The supply was always plentiful. The Sinaloa cartel and its competitors moved the product from Mexico into Southern California, where distributors split up parcels and sent them into the city. The street price in Los Angeles stayed low, under $20 a dose, so meth was accessible to the very poor and homeless. The comedown made you twitchy and miserable; you could get addicted after your first time using. To the average medical examiner or L.A. County sheriff’s deputy in July 2017, the death of Gemmel Moore at the home of an older white john would have seemed like a sad, unremarkable story with familiar components: a sex worker, methamphetamine, bad luck.

The person with the power to bring a criminal case against Buck was Jackie Lacey, the first Black district attorney of Los Angeles County, and a Democrat. The day before the first anniversary of Moore’s death, Lacey announced that her team had completed an investigation and would not file charges. Demonstrators gathered outside 1234 North Laurel. Nothing changed, and they returned a year later. The signs said: “JACKIE LACEY: PROSECUTE ED BUCK.” “This is a national emergency for people who look like us,” said an activist named Jerome Kitchen, who is Black. Weeks passed, and no arrest was made.

On Sept. 11, 2019, at 5:20 in the morning, a man walked into the cashier’s booth at the Shell station on Santa Monica and North Laurel, three blocks from Buck’s apartment. The man was Black and wore jeans and a button-up shirt. His hand kept rising to touch his chest. “I think I’m having a heart attack,” he said. 

more@NYTimes

The post What Happened Inside Ed Buck’s Apartment? appeared first on Addiction/Recovery eBulletin.

KHN’s ‘What the Health?’: It’s Scandal Week

Can’t see the audio player? Click here to listen on SoundCloud.

President Donald Trump finally released his promised executive order aimed at bringing down drug costs. It factors in international prices to determine what Medicare pays for prescriptions. But the order has no force of law unless the Department of Health and Human Services issues regulations, which could take months or even years if drug companies challenge the effort in court, as they have promised.

Meanwhile, several agencies within HHS are engulfed in scandal. The White House-installed HHS spokesperson took medical leave after a spate of stories about how he tried to interfere with the work of career scientists regarding the COVID-19 pandemic. The head of the Medicare and Medicaid programs spent millions of taxpayer dollars to burnish her personal image, according to Democratic congressional investigators. And HHS Secretary Alex Azar apparently overruled the Food and Drug Administration over efforts to regulate a class of COVID diagnostic tests.

This week’s panelists are Julie Rovner of KHN, Alice Miranda Ollstein of Politico, Tami Luhby of CNN and Sarah Karlin-Smith of the Pink Sheet.

Among the other takeaways from this week’s podcast:

  • Trump’s comments Wednesday contradicting testimony by Dr. Robert Redfield, head of the Centers for Disease Control and Prevention, about the importance of masks and the timing of a coronavirus vaccine are not the first time he has disputed statements by his scientific and medical advisers. But confusion created by the differing statements could erode trust in a vaccine development process that has already been highly politicized.
  • Drugmakers oppose any efforts to limit the prices of Medicare drugs and vow to fight the effort in court and politically. They may have some allies in the Senate, where Republicans are not keen on the idea of endorsing price controls.
  • Although the president frequently speaks about his efforts to curb high prescription drug costs, he has not made much headway in helping consumers. Still, the issue has great political appeal, and he has been able to keep the heat on the pharmaceutical industry.
  • It’s been a traumatic week at the Department of Health and Human Services. The head of the communications team, Michael Caputo, has taken medical leave after acknowledging that he and his aides tried to influence studies published in the CDC’s journal and then hosting an online event in which he alleged without any proof that government scientists were working to undermine the administration. Also, the head of the Centers for Medicare & Medicaid Services, Seema Verma, was criticized in a congressional report for spending millions to hire consultants to help raise her public profile.
  • Data reported by the Census Bureau this week shows that the number of uninsured in the U.S. grew by nearly a million people in 2019. That came even as the number of workers rose by more than 2 million and median household income increased. The numbers are based on 2019, before the coronavirus pandemic.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: KHN’s “Lack of Antigen Test Reporting Leaves Country ‘Blind to the Pandemic,” by Rachana Pradhan, Lauren Weber and Hannah Recht

Alice Miranda Ollstein: Politico’s “Harvest of Shame: Farmworkers Face Coronavirus Disaster,” by Helena Bottemiller Evich, Ximena Bustillo and Liz Crampton

Tami Luhby: The Washington Post’s “Medicaid Rolls Swell Amid the Pandemic’s Historic Job Losses, Straining State Budgets,” by Amy Goldstein

Sarah Karlin-Smith: KHN’s “Hospitals, Nursing Homes Fail to Separate COVID Patients, Putting Others at Risk,” by Christina Jewett

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunes, Stitcher, Google Play, Spotify, or Pocket Casts.


This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Underwater earthquakes’ sound waves reveal changes in ocean warming

Sound waves traveling thousands of kilometers through the ocean may help scientists monitor climate change.

As greenhouse gas emissions warm the planet, the ocean is absorbing vast amounts of that heat. To monitor the change, a global fleet of about 4,000 devices called Argo floats is collecting temperature data from the ocean’s upper 2,000 meters. But that data collection is scanty in some regions, including deeper reaches of the ocean and areas under sea ice.

So Wenbo Wu, a seismologist at Caltech, and colleagues are resurfacing a decades-old idea: using the speed of sound in seawater to estimate ocean temperatures. In a new study, Wu’s team developed and tested a way to use earthquake-generated sound waves traveling across the East Indian Ocean to estimate temperature changes in those waters from 2005 to 2016.

Comparing that data with similar information from Argo floats and computer models showed that the new results matched well. That finding suggests that the technique, dubbed seismic ocean thermometry, holds promise for tracking the impact of climate change on less well-studied ocean regions, the researchers report in the Sept. 18 Science.

Sound waves are carried through water by the vibration of water molecules, and at higher temperatures, those molecules vibrate more easily. As a result, the waves travel a bit faster when the water is warmer. But those changes are so small that, to be measurable, researchers need to track the waves over very long distances.

Fortunately, sound waves can travel great distances through the ocean, thanks to a curious phenomenon known as the SOFAR Channel, short for Sound Fixing and Ranging. Formed by different salinity and temperature layers within the water, the SOFAR channel is a horizontal layer that acts as a wave guide, guiding sound waves in much the same way that optical fibers guide light waves, Wu says. The waves bounce back and forth against the upper and lower boundaries of the channel, but can continue on their way, virtually unaltered, for tens of thousands of kilometers (SN: 7/16/60).

In 1979, physical oceanographers Walter Munk, then at the Scripps Institution of Oceanography in La Jolla, Calif., and Carl Wunsch, now an emeritus professor at both MIT and Harvard University, came up with a plan to use these ocean properties to measure water temperatures from surface to seafloor, a technique they called “ocean acoustic tomography.” They would transmit sound signals through the SOFAR Channel and measure the time that it took for the waves to arrive at receivers located 10,000 kilometers away. In this way, the researchers hoped to compile a global database of ocean temperatures (SN: 1/26/1991).

But environmental groups lobbied against and ultimately halted the experiment, stating that the human-made signals might have adverse effects on marine mammals, as Wunsch notes in a commentary in the same issue of Science.

Forty years later, scientists have determined that the ocean is in fact a very noisy place, and that the proposed human-made signals would have been faint compared with the rumbles of quakes, the belches of undersea volcanoes and the groans of colliding icebergs, says seismologist Emile Okal of Northwestern University in Evanston, Ill., who was not involved in the new study.

Still, Wu and colleagues have devised a work-around that sidesteps any environmental concerns: Rather than use human-made signals, they employ earthquakes. When an undersea earthquake rumbles, it releases energy as seismic waves known as P waves and S waves that vibrate through the seafloor. Some of that energy enters the water, and when it does, the seismic waves slow down, becoming T waves.

Those T waves can also travel along the SOFAR Channel. So, to track changes in ocean temperature, Wu and colleagues identified “repeaters” — earthquakes that the team determined to originate from the same location, but occurring at different times. The East Indian Ocean, Wu says, was chosen for this proof-of-concept study largely because it’s very seismically active, offering an abundance of such earthquakes. After identifying over 2,000 repeaters from 2005 to 2016, the team then measured differences in the sound waves’ travel time across the East Indian Ocean, a span of some 3,000 kilometers. 

The data revealed a slight warming trend in the waters, of about 0.044 degrees Celsius per decade. That trend is similar to, though a bit faster than, the one indicated by real-time temperatures collected by Argo floats. Wu says the team next plans to test the technique with receivers that are farther away, including off of Australia’s west coast.

That extra distance will be important to prove that the new method works, Okal says. “It’s a fascinating study,” he says, but the distances involved are very short as far as T waves go and the temperature changes being estimated are very small. That means that any uncertainty in matching the precise origins of two repeater quakes could translate to uncertainty in the travel times, and thus the temperature changes. But future studies over greater distances could help mitigate this concern, he says.

“It’s really breaking new ground,” says Frederik Simons, a geophysicist at Princeton University, who was not involved in the new research. “They’ve really worked out a good way to tease out very subtle, slow temporal changes. It’s technically really savvy.”

And, Simons adds, in many locations seismic records are decades older than the temperature records collected by Argo floats. That means that scientists may be able to use seismic ocean thermometry to come up with new estimates of past ocean temperatures. “The hunt will be on for high-quality archival records.”

Preparing Future Clinicians to Intervene in Opioid Crisis

Original post: Newswise - Drug and Drug Abuse Preparing Future Clinicians to Intervene in Opioid Crisis

Newswise imageOpioid use disorder and overdose have reached unprecedented levels around the world. In the United States, remediation of pain is one of the most common reasons American adults seek healthcare. Therefore, it is vital that clinicians practicing in diverse roles and settings have a clinical understanding of pain and substance use disorders as well as knowledge about public health and opioid policy interventions.

Urban Hospitals of Last Resort Cling to Life in Time of COVID

Victor Coronado felt lightheaded one morning last month when he stood up to grab an iced tea. The right side of his body suddenly felt heavy. He heard himself slur his words. “That’s when I knew I was going to have a stroke,” he said.

Coronado was rushed to Mercy Hospital & Medical Center, the hospital nearest his home on Chicago’s South Side. Doctors there pumped medicine into his veins to break up the clot that had traveled to his brain.

Coronado may outlive the hospital that saved him. Founded 168 years ago as the city’s first hospital, Mercy survived the Great Chicago Fire of 1871 but is succumbing to modern economics, which have underfinanced the hospitals serving the poor. In July, the 412-bed hospital informed state regulators it planned to shutter all inpatient services as soon as February.

“If something else happens, who is to say if the responders can get my husband to the nearest hospital?” said Coronado’s wife, Sallie.

While rural hospitals have been closing at a quickening pace over the past two decades, a number of inner-city hospitals now face a similar fate. And experts fear that the economic damage inflicted by the COVID-19 pandemic on safety-net hospitals and the ailing finances of the cities and states that subsidize them are helping push some urban hospitals over the edge.

By the nature of their mission, safety-net hospitals, wherever they are, struggle because they treat a large share of patients who are uninsured — and can’t pay bills — or are covered by Medicaid, whose payments don’t cover costs. But metropolitan hospitals confront additional threats beyond what rural hospitals do. State-of-the-art hospitals in affluent city neighborhoods are luring more of the safety-net hospitals’ best-insured patients.

These combined financial pressures have been exacerbated by the pandemic at a time their role has become more important: Their core patients — the poor and people of color — have been disproportionately stricken by COVID-19 in metropolitan regions like Chicago.

“We’ve had three hospital closures in the last year or so, all of them Black neighborhoods,” said Dr. David Ansell, senior vice president for community health equity at Rush University Medical Center, a teaching hospital on Chicago’s West Side. He said the decision to close Mercy “is really criminal in my mind, because people will die as a result.”

Mercy is following the same lethal path as did two other hospitals with largely lower-income patient bases that shuttered last year: Hahnemann University Hospital in Philadelphia, and Providence Hospital in Washington, D.C., which ended its inpatient services. Washington’s only public hospital, United Medical Center — in the city’s poorest ward — is slated to close in 2023 as well, and some services are already curtailed.

Slow Death of Urban Safety Nets

So far, urban hospital closures have remained infrequent compared with the cascading disappearance of their rural counterparts. But the closing of a few could portend problems at others. Even some of those that remain open may cut back crucial specialties like labor and delivery services or trauma care, forcing patients to travel farther for help when minutes can matter.

Nancy Kane, an adjunct professor at Harvard T.H. Chan School of Public Health who has studied urban safety-net hospital changes since 2010, said that “some close, but most of them have tried to get into a bigger system and hang on for a few more years until management closes them.”

For much of the 20th century, most cities ran their own hospitals to care for the indigent. But after the creation of Medicare and Medicaid, and as the rising cost of health care became a burden for local budgets, many jurisdictions turned away from that model. Today only 498 of 5,230 general hospitals in the country are owned by governments or a public hospital district.

Instead, many hospitals in low-income urban neighborhoods are run by nonprofits — often faith-based — and in some cases, for-profit corporations. In recent years owners have unloaded safety-net hospitals to entities with limited patience for keeping them alive.

In 2018, the for-profit hospital chain Tenet Healthcare Corp. sold Hahnemann to Joel Freedman, a California private equity investor, for $170 million. A year later, Freedman filed for bankruptcy on the hospital, saying its losses were insurmountable, while separating its real estate, including the physical building, into another corporation, which could ease its sale to developers.

In 2018, Tenet sold another safety-net hospital, Westlake Hospital in Melrose Park, Illinois, a suburb west of Chicago, to a private investment company. Two weeks after the sale, the firm announced it would close the hospital, which ultimately led the owners to pay Melrose Park $1.5 million to settle a lawsuit alleging they had misled local officials by claiming before the sale they would keep it open.

Some government-run hospitals are also struggling to stay open. Hoping to stem losses, the District of Columbia outsourced management of United Medical Center to private consulting firms. But far from turning the hospital around, one firm was accused of misusing taxpayer funds, and it oversaw a string of serious patient safety incidents, including violations in its obstetrics ward so egregious that the district was forced to shut the ward down in 2017.

Earlier this year, the district struck a deal with Universal Health Services, a Fortune 500 company with 400 hospitals and $11 billion in revenues, to run a new hospital that would replace United, albeit with a third fewer beds. Universal also operates George Washington University Hospital in the city in partnership with George Washington University. That relationship has been contentious: Last year the university accused the company of diverting $100 million that should have stayed in the medical system. In June, a judge dismissed most of the university’s complaint.

No Saviors for Mercy

Chicago has three publicly owned hospitals, but much of the care for low-income patients falls on private safety-net hospitals like Mercy that are near their homes and have strong reputations. These hospitals have been sources of civic pride as well as major providers of jobs in neighborhoods that have few.

Fifty-five percent of Chicagoans living in poverty and 62% of its African American residents live within Mercy’s service area, according to Mercy’s 2019 community needs assessment, a federally mandated report. The neighborhoods served by Mercy are distinguished by higher rates of death from diabetes, cancer and stroke. Babies are more likely to be born early and at low weight or die in infancy. The nearest hospitals from Mercy can be 15 minutes or more away by car, and many residents don’t have cars.

“You’re going to have this big gap of about 7 miles where there’s no hospital,” Ansell said. “It creates a health care desert on the South Side.”

Dr. Maya Rolfe, who was a resident at Mercy until July, said the loss of the hospital’s labor and delivery department would cause substantial harm, especially since African American women suffer from a higher rate of maternal mortality than do white women. “Mercy serves a lot of high-risk women,” she said.

Mercy, a nonprofit, has been in financial trouble for a while. In 2012, it joined Trinity Health, a giant nonprofit Roman Catholic health system headquartered in Michigan with operations in 22 states. In the next seven years, Trinity invested $124 million in infrastructure improvements and $112 million in financial support.

During that time, the hospital continued to be battered by headwinds facing hospitals everywhere, including the migration of well-reimbursed surgeries and procedures to outpatient settings. Likewise, patients with private insurance, which provides higher reimbursements than government programs do, departed to Chicago’s better-capitalized university hospitals, including Rush, the University of Chicago Medical Center and Northwestern Memorial Hospital. Seventy-five percent of Mercy’s revenues come from government insurance programs Medicare and Medicaid.

Only 42% of its beds were occupied on average, according to the most recent state data, from 2018. Mercy told state regulators it is losing $4 million a month and required at least $100 million in additional building upgrades to operate safely.

Trinity said it spent more than a year shopping for a buyer. After that yielded no success, Mercy joined forces with three other struggling South Side hospitals to consolidate into a single health system planning to build one hospital and a handful of outpatient facilities to replace their antiquated buildings. They sought state financial help.

The plan would have cost $1.1 billion over a decade. At the close of the legislative session, Illinois lawmakers — already strapped for funding because of the economic effects of the pandemic — balked at the hospitals’ request for the state to cover half the cost. Lamont Robinson, a Democratic state representative whose district includes Mercy Hospital, said that was because the group did not declare where the new hospital would be built.

“We were all supportive of the merger but not with the lack of information,” Robinson said.

Mercy said in an email that the location would have been chosen after the hospital organizations combined and chose new leaders. Trinity said in a statement: “We are committed to continuing to serve the Mercy Chicago community through investment in additional ambulatory and community-based services that are driven by high-priority community needs.”

Blame for Mercy’s closure has been spread widely to include the city and state governments as well as Mercy’s owner. Trinity Health had $8.8 billion in cash and liquid investments at the end of March and until the pandemic hit had been running a slight profit. Earlier this year in Philadelphia, Trinity Health announced it would phase out inpatient services at another of its safety-net hospitals, Mercy Catholic Medical Center-Mercy Philadelphia Campus, a 157-bed hospital that has been around since 1918.

“People put their money where they want to,” said Rolfe, the former medical resident at Mercy in Chicago. Noting that the city has no qualms about spending large sums to beautify its downtown while other neighborhoods are in danger of losing a major institution, she said: “It shows to me that those patients are not that important as patients that exist in other communities.”


This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

Students’ Mass Migration Back to College Gets a Failing Grade

Who thought it would be a good idea to move thousands of teenagers and young adults across the country to college campuses, where, unencumbered by parental supervision, many college kids did what college kids do?

Actually, Nigel Goldenfeld and Sergei Maslov, two University of Illinois at Urbana-Champaign physics researchers, thought they had it figured out. They created a predictive model for the campus, which showed that with a robust, twice-a-week testing program for students, faculty and staff who are regularly on campus, a mask mandate and an app for contact tracing, COVID-19 cases could be kept below 500 people for the whole semester. They even accounted for close interactions among college students.

But that model failed to take into account that kids who test positive for the virus, whether sick or asymptomatic, might continue to party. From Aug. 16, when campus reopened, to Sept. 14, more than 1,900 new cases of COVID-19 were detected, according to the university’s COVID-19 dashboard. One thousand cases occurred in the first two weeks of the fall semester.

“What is not in the models is that students will actually fail to isolate,” said Goldenfeld during a Sept. 2 press briefing, “that they would go to a party even if they knew they were COVID-positive or that they would host a party while they were COVID-positive. … We didn’t include that behavior in the model.”

Many other colleges across the country also thought through how to bring students back to campus. Several schools looked at computer models to see how COVID-19 would affect students and staff. But, as with the plan developed at Illinois, these models were sometimes based on a set of assumptions that ended up being wrong. In other cases, models that showed what could happen without mitigation strategies were ignored by university administrators, who went forward with plans to bring students back.

Either way, the great student migration has resulted in COVID outbreaks on college campuses nationwide. The University of Central Florida: 378 cases since the week ending Aug. 8. Texas Christian University: 600 cases in August and 220 in September so far. The University of Iowa: 1,804 cases from Aug. 18 to Sept. 9. The University of South Carolina: 2,185 cases since Aug. 1. Making matters worse, some afflicted schools are setting off a second student migration by sending their students back home.

The administration of the University of Illinois at Urbana-Champaign asked students to lock down for two weeks on Sept. 2. And Goldenfeld said during a Sept. 2 news conference that it was too early for him to make a new prediction whether COVID cases could be kept under control for the semester.

He said he and Maslov would adjust their model but were waiting to see how students would respond to the lockdown. Cases of COVID-19 on campus declined since the implementation of the lockdown, which was lifted Sept. 16.

The administration of the University of Illinois at Urbana-Champaign has collaborated directly with Goldenfeld and Maslov, and has been transparent about the model on which it is basing its decisions. Other universities haven’t been as upfront.

After hearing that Penn State planned to open again for the fall, a concerned faculty group, Coalition for a Just University, created a model predicting what COVID-19 spread would look like at the University Park campus in State College, Pennsylvania. The coalition’s modeling group, composed of engineering and science faculty, chose to remain anonymous, fearing retribution from the university. Its predictive model showed that more than 1,800 students could become sick and two could die of COVID-19 during the semester if only 1% of students were tested each day, which is Penn State’s plan. Since Aug. 28, 1,100 students at the University Park campus (attended by some 47,000 students total) have tested positive for COVID-19.

The team sent the model to university administrators but received no response. A Penn State spokesperson told the Centre Daily Times, a local newspaper, that the methodology of the model was “flawed” and that the group that released it had “advocated against any reopening of campuses.” The coalition is advocating for Penn State to move classes entirely online, at least temporarily until the testing plan is improved, or for the whole semester if the testing procedure isn’t changed, said a spokesperson for the group.

The Penn State spokesperson later said the university had developed its own predictive model but declined to share its results with the paper. Penn State did not respond to a request for comment.

Penn State isn’t alone in its lack of transparency. Edwin Michael, a professor of epidemiology who recently left the University of Notre Dame to work at the University of South Florida, said he created a simulation in April to show how COVID-19 could spread on Notre Dame’s campus in South Bend, Indiana. He said he shared it with university officials but never heard back.

The model showed that on a campus of 20,000 people, if 25 students returned to campus with COVID-19 and there were no mitigation strategies, up to 7,500 students could soon be infected. Roughly 470 would need hospitalization and 365 would need treatment in the intensive care unit.

It was a dire prediction with a purpose. He said it was created “simply to highlight that an outbreak is inevitable if students were to return infected.”

Dennis Brown, a spokesperson for Notre Dame, said that Michael’s predictive model was forwarded to members of the planning committee in May “and subsequently taken into consideration.”

“However, because it made certain assumptions that did not align with the plans being made at Notre Dame, we did not find it relevant to our situation and decided to use other predictive models,” Brown wrote in an email.

Brown declined to give more information on what predictive models Notre Dame did use. Notre Dame has implemented mitigation strategies, such as requiring mask-wearing on campus at all times and limiting gatherings to 10 people, but on Aug. 18 imposed two weeks of remote classes for all students after a spike in cases on campus the first week back. The university has documented 649 cases among students since Aug. 3. In-person classes started phasing in on Sept. 2.

Professors elsewhere have, like Michael, developed models not necessarily to make accurate predictions, but to make a point that without some kind of mitigation strategy there would inevitably be a COVID-19 outbreak on campus — and that part has held true.

On Aug. 15, five days before the University of Georgia started classes for the fall semester, John Drake, director of the Center for the Ecology of Infectious Disease there, predicted that from 210 to 1,618 students could bring COVID-19 back with them to campus. He also predicted that without any type of risk mitigation, reopening campus could result in more than 30,000 infections among the campus population — about 60% of all students and staff.

“Campuses should anticipate explosive localized outbreaks,” Drake wrote when making his model public. (Like most of the university COVID models mentioned here, his was not peer-reviewed or published in a journal.)

There’s no way to know whether Drake’s prediction was right, since the University of Georgia didn’t conduct entry testing for students who returned. Instead, the university is conducting voluntary randomized testing of asymptomatic individuals on campus and asking anyone who has symptoms to get tested.

On Sept. 9, the university reported more than 1,400 cases of COVID-19 among students in a week. University officials did not respond to questions about whether they had used Drake’s model or others when opting to reopen.

About 70 miles away, Joshua Weitz, a professor who studies viral dynamics at the Georgia Institute of Technology in Atlanta, created his own predictive model, this one with a more dire message: Without any mitigation strategies, 50% of people on Georgia Tech’s campus of about 31,500 would be infected with COVID-19 and 75 would die. The majority of those deaths would be among older faculty and staffers.

He hoped the extreme scenario would show why the school needed to test everyone once a week. Although Georgia Tech has enough tests available and encourages students to be tested once a week, it is not mandatory. Georgia Tech confirmed that Weitz’s model had been taken into consideration when it planned its COVID-19 response. Georgia Tech reported 571 cases of COVID-19 for the month of August.

While some professors created models without mitigation strategies as a cautionary tale to show university administrators what would happen without interventions, others were developed to help campuses adopt a framework to reduce infections once students arrived. Though the limitations of these models run the gamut, their message seems to be the need for constant agility in enforcement policies and awareness about COVID-19’s local spread.

After all, models can’t change one underlying risk that continues regardless of testing plans and other public health strategies: In the end, some college students are still going to be college students, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. (The University of Minnesota delayed the moving of students into university housing by two weeks and started classes online on Sept. 8. The university has had 87 students test positive for COVID-19 through Sept. 10, though students are just this week beginning to move back into residence halls.)

“You don’t need a model to understand that bringing together all the young adult population in college campuses around the country is putting a lit match in a gas can. You don’t need a model to know what’s going to happen next,” Osterholm said.


This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

In Face of COVID Threat, More Dialysis Patients Bring Treatment Home

NIPOMO, Calif. — After Maria Duenas was diagnosed with Type 2 diabetes about a decade ago, she managed the disease with diet and medication.

But Duenas’ kidneys started to fail just as the novel coronavirus established its lethal foothold in the U.S.

On March 19, three days after Duenas, 60, was rushed to the emergency room with dangerously high blood pressure and blood sugar, Gov. Gavin Newsom implemented the nation’s first statewide stay-at-home order.

Less than one week later, Duenas was hooked up to a dialysis machine in the Century City neighborhood of Los Angeles, 160 miles from her Central Coast home, where tubes, pumps and tiny filters cleansed her blood of waste for 3½ hours, doing the work her kidneys could no longer do.

In the beginning, Duenas said she didn’t understand the severity of COVID-19, or her increased vulnerability to it. “It’s not going to happen to me,” she thought. “We’re in a small little town.”

But she was unable to find a spot in a dialysis clinic in, or near, Nipomo. So, with her husband, Jose, at her side, Duenas made long road trips to Century City for more than two months.

In May, Duenas’ doctor told her she was a good candidate for home dialysis, which would save her drive time and stress — and reduce her exposure to the virus.

Now, Duenas assiduously sterilizes herself and her surroundings five nights a week so she can administer dialysis to herself at home while she sleeps.

“There’s always a chance going in that somebody’s going to have COVID and still need dialysis” in a clinic, Duenas said. “I’m very grateful to have this option.”

The increase in home dialysis has accelerated recently, spurred by social-distancing requirements, increased use of telehealth and remote monitoring technologies — and fear of the virus.

While recent, comprehensive data is hard to come by, experts confirm the trend based on what they’re seeing in their own practices. Fresenius Medical Care North America, one of the country’s two dominant dialysis providers, said it conducted 25% more home dialysis training sessions in the first quarter of 2020 than in the same period last year, according to Renal & Urology News.

“People recognized it would be better if they did it at home,” said Dr. Susan Quaggin, president-elect of the American Society of Nephrology. “And certainly from a health provider’s perspective, we feel it’s a great option.”

Nearly half a million people in the United States are on dialysis, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Roughly 85% of them travel to a clinic for their treatments.

Dialysis patients are at higher risk of contracting COVID-19 and getting seriously ill with it, said Dr. Anjay Rastogi, director of the UCLA CORE Kidney Program, where Duenas is a patient.

In an analysis of more than 10,000 deaths in 15 states and New York City, the Centers for Disease Control and Prevention found about 40% of people killed by COVID-19 had diabetes. That percentage rose to half among people under 65.

But people on dialysis are also vulnerable to COVID-19 because they usually visit dialysis clinics two to three times a week for an average of four hours at a time, exposing themselves to other patients and, potentially, the virus, Rastogi said.

“Now even more so, we are strongly urging our patients to consider home dialysis,” he said.

There are two kinds of dialysis: hemodialysis and peritoneal dialysis. In hemodialysis, which is administered in a hospital or clinic, or sometimes at home, a dialysis machine pumps blood out of the body and through a special filter called a dialyzer, which clears waste and extra fluid from the blood before it is returned to the body.

Dialysis treatment centers that offer hemodialysis have intensified their infection-control procedures in response to COVID-19, said Dr. Kevin Stiles, a nephrologist at Kaiser Permanente in Bakersfield. Visitors are no longer allowed to accompany patients, and patients get temperature checks and must wear masks during treatment, he said. (KHN, which produces California Healthline, is not affiliated with Kaiser Permanente.)

In peritoneal dialysis, which is the more popular home option because it is less cumbersome and restrictive, the inside lining of the stomach acts as a natural filter. Dialysis solution cleanses waste from the body as it is washed into and out of the stomach through a catheter in the abdomen.

Not everyone is eligible for home dialysis, which comes with its own challenges.

Home dialysis requires patients or their caregivers to lift bags of dialysis solution that weigh 5 to 10 pounds, Stiles said. Good eyesight and hand dexterity are also critical because patients must be able to maintain sterile environments.

Home patients need dialysis equipment and regular deliveries of supplies such as dialysis fluid, drain bags, tubing, disinfectant and personal protective equipment. In response to COVID-19, some clinics have arranged courier services and contracted with labs to deliver supplies to patients.

The Trump administration has encouraged greater use of home dialysis and in July proposed increasing Medicare reimbursement rates for home dialysis machines, citing “the importance that this population stay at home during the public health emergency to reduce risk of exposure to the virus.”

Medicare covers almost all patients who receive dialysis treatment, including home dialysis, and patients typically pay 20% as coinsurance.

Medicare, which spends an average of $90,000 per hemodialysis patient annually, spent more than $35 billion on patients with end-stage renal disease in 2016.

Duenas is awaiting a kidney transplant. Until she finds a match, she’ll be administering her own peritoneal dialysis at home.

“To be honest, I didn’t want to do it,” she said of home dialysis. “It was scary having to think about taking care of my own treatment.”

Now, three months later, guided by training and the prompts on the dialysis machine, Duenas feels comfortable, capable and safe.

Looking back, she said, “it was a blessing in disguise.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

USE OUR CONTENT

This story can be republished for free (details).

A Magnificent Game Changer

Chapter 2
Do Tell! Stories by Atheists and Agnostics in AA

By Doris A.

Like many, childhood was a fertile ground for becoming an alcoholic.

My mother had very serious problems with alcohol, binge drinking though her pregnancies and a good part of my childhood. While there were interesting and wonderful things about both of my parents, and childhood memories that still make me smile, there were serious problems in our home. Whether drunk or sober my mother, in the blink of an eye, became erratic and volatile, even violent at times. My dad was not as mercurial, but he was emotionally stunted; shame was his primary tool for parenting.

My mom got sober when I was 10; it was a gift to all of us, yet it did not bring peace and happiness to the family. Sobriety did not resolve my mother’s mental illness nor did it help her troubled marriage. Her enthusiasm for AA and her gift for “program talk” were often coupled with nutty behavior. It was confusing to say the least. By the time I left home I felt like I had gotten off the Titanic with a life raft full of holes.

The first time I drank I was twelve years old; I drank myself into a blackout. Surprisingly my drinking during high school was not all that dramatic. But once I left home to attend college I was off to races. I drank hard and I drank often. I felt liberated by alcohol; it was a psychic lubricant that provided a social ease I do not come by naturally.

But deep in a recess of my brain I knew I had a problem. My drinking had an edge and sloppiness to it, and my blackouts were frequent. I remember one morning in my third year of college waking up with a very severe hang-over. I had to be at school within an hour, so without missing a beat I poured a couple shots of vodka into my soda which I took on the bus to class. This was my “Houston we have a problem” moment; a thought I quickly tucked away in a mental file labeled “to be dealt with later”.

After graduation I had no idea what to do next. That year my parents had divorced. My father decided to move to another part of the country, with my younger sister in tow. My mom then literally packed everything she owned in her car, drove around the country aimlessly and then decided to live in a town not far from my father. I was accepted into graduate school but instead followed my family. It was a bit surreal.

Within a short time my mother was diagnosed with late stage cancer. I set aside thoughts of grad school or a professional job and instead worked in a tavern, drank with the bar flies and watched my mother die a horribly painful death. My drinking was rough that year, I was lost and confused, and then I felt orphaned.

Six months after my mother died I hit the reboot switch and moved to the coast. I settled in one of the nicest cities in the country and immediately it felt like home. I knew I could do better than working in a bar, and I wanted to slow down my drinking. Not ready to give it up, but I figured I could change the trajectory.

A doctoral dissertation called “Experiences of Atheists and Agnostics in AA” was recently submitted and it is based entirely on the book Do Tell. For more info click on the above image.

During the next several years I embedded myself in a social scene that was not about alcohol, hoping that through osmosis I would become a non-problem drinker. I found bright, interesting friends who preferred hiking or talking about books and politics over getting loaded. I met the man I would marry and spend 21 years with, and whom I loved dearly. I entered graduate school and started a career.

During this period I used smoke and mirrors to hide my problem. I was the one who went back to the kitchen for “more ice” and then poured a few more ounces of alcohol in my drink. I had half a bottle of wine before going out with people who rarely had more than a drink or two with dinner. I stopped in a bar for a drink on my way home from work or school. Garden variety alcoholic behavior.

My husband had no experience with alcoholics and was naive about all the tell-tale signs. But after we were married a year and bought our own home things changed. Within a matter of months I started drinking heavily, daily, and secretly. This went on for a year until one day I woke up, went to the phone book and called a drug and alcohol hotline. I was referred to a counselor who told me I needed to go into outpatient treatment and I needed to tell my husband. What followed were many years of trying to stay sober, not trying to stay sober, and everything in between. I never once denied being an alcoholic, but for reasons I don’t fully understand I could not totally surrender.

Shortly after the first call for help I started attending AA. A part of me, the part of me that is resilient and intuitive, knew from the beginning that I had no chance of success without the fellowship. But AA was full of land mines. The biggest problem at first was having to sit in a room hearing all the clichés and AA talk that I heard as a kid from my nutty mother. There was almost a PTSD quality to seeing all those “easy does it signs” on the wall and hearing people recite the Serenity Prayer.

Layered on this was the god talk in AA. By the time I entered the program I was an agnostic that wasn’t ready to be an atheist. The concept of spirituality seemed benign enough. But the idea of a god that would take an interest in relieving me of alcoholism while ignoring the unimaginable suffering of others seemed childish, and just plain wrong. I so badly needed other language to help me develop some type of road map, but it was hard to find. Being a non-believer in AA is not easy. However, I actually have more resentment toward treatment professionals who told me that if I didn’t get god and do the 12 steps as prescribed I would die. I am sure there are many reasons sobriety was so elusive, but being an atheist was not one of them.

Over the years I collected sober time, a few years here a few years there. Often it was a string of months. Some of the drinking periods were well hidden until there was some dramatic incident and the game was over for a while. I also added prescription drugs to the mix – painkillers and sedatives.

Although my sense of self became pretty fractured and compartmentalized, I still had the side of me that approximated normal. I was well-regarded professionally, I had many interests, and I had a stable seeming marriage as well as many personal relationships that mattered dearly to me. But my addiction had me by the throat and I acted in ways that still make me cringe to think about. I did crazy things in order to drink, was impaired at work, lied with the skill of a sociopath, acted out in a million other ways, and deeply hurt others.

By the time I hit my late 40s alcohol was taking a toll on all aspects of my life. Approximating normal was no longer easy. I was losing any margin of error. I was severely depressed and anxious and had no vision of being able to stop for good.

Around age 50 I was diagnosed with early stage cancer. Since watching my mother die from cancer in her fifties I had been scared of this for decades, but I was lucky that it was found in the nick of time. I elected to have chemotherapy and was provided with the best medical care imaginable. One would think that this would be the most obvious time to finally get sober. But it wasn’t. I drank a few times during the year of treatment. If chemotherapy hadn’t kicked my ass so hard I am sure I would have drank more.

About a month after being given a clean bill of health, I had one of those “fuck it” moments. Instead of going to work one morning I took a sedative and bought a bottle. I don’t remember much that day but later learned I had driven my car into the edge of a golf course, ran over a sprinkler system and then drove home.

For my husband this was the final straw. He asked me to leave the house or go to a 90 day treatment program. I didn’t know if I could survive another stay in treatment and reached out to family. My brother kindly offered to have me live with him and his wife to get myself sorted out. I packed a few bags and moved back across the country.

The year that followed was profoundly painful. I was demoralized beyond words, I was still a mess from chemotherapy and my heart was deeply broken. I did immerse myself in AA, got a sponsor, found a therapist and tried to cobble together a few friends. I drank a few times too. About a year after moving I went back to visit my husband to sort out our marriage. When I came back I shut myself in my room with large amounts of alcohol and drank for many days.

This was my bottom, but a divine intervention is not what saved me. What did were two people from the fellowship who showed up to help me get the professional care I needed. I had a circle of friends from AA who didn’t flinch. I had a compassionate and skilled therapist who was there with open arms to help. And I had some wee voice in my head that wanted to live.

It took a while for my life not to hurt so much. My husband asked for a divorce and then later remarried. It has taken a very long time to grieve all the losses that have resulted from my drinking. So much time was lost.

But today I can easily say that the gift of having real sobriety is broad and deep, and very tangible. I have gained emotional maturity and am sturdier inside. Life makes sense to me now and most days I feel engaged and content. When I am feeling or acting like a head case I know the things to do to get me back on track. I have better skills at managing my emotions and having honest relationship with others. I am still me, warts and all, but the dark passenger that lives inside of me has gotten very small. Self-destructive urges no longer have the keys to the car.

My alcoholism runs deep, and it is lethal. I am certain that I will always need to be an active member of AA. Having finally tapped into a small but real segment of AA that believes sobriety is possible without god has been a magnificent game changer. I am now more than ever inspired to do service work in the program, so that others like me can find a comfortable seat in the rooms of AA.

I have heard people say that they are grateful for being an alcoholic. I am not one of them. Next time around I would like to be more normal and also to be better at math. But alcohol and drug addiction were in the cards dealt to me. So like every other human being on the planet, all I can do is strive to make the most of my life, to be a half decent person and to love others. I am grateful for having a fellowship – my tribe – that offers me a solution, as we say, one day at a time.

Do Tell! [Front Cover]This is a chapter from the book: Do Tell! Stories by Atheists and Agnostics in AA.

The paperback version of Do Tell! is available at Amazon. It is also available via Amazon in Canada and the United Kingdom.

It can be purchased online in all eBook formats, including Kindle, Kobo and Nook and as an iBook for Macs and iPads.

The post A Magnificent Game Changer first appeared on AA Agnostica.

$11.4 million NIH grant advances drug to treat nicotine addiction

Scientists at Sanford Burnham Prebys Medical Discovery Institute, Camino Pharma, LLC and University of California San Diego School of Medicine have been awarded an $11.4 million grant from the National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH) to advance a novel drug candidate for nicotine addiction into first-in-human Phase 1 studies. The drug targets a neuronal signaling pathway underlying addictive behaviors, and would be a first-in-class medication to help people quit smoking.

Lack of Antigen Test Reporting Leaves Country ‘Blind to the Pandemic’

More than 20 states either don’t release or have incomplete data on the rapid antigen tests now considered key to containing the coronavirus, which has sickened more than 6 million Americans. The lapses leave officials and the public in the dark about the true scope of the pandemic as untold numbers of cases go uncounted.

The gap will only widen as tens of millions of antigen tests sweep the country. Federal officials are prioritizing the tests to quickly detect COVID-19’s spread over slower, but more accurate, PCR tests.

Relying on patchy data on COVID testing carries enormous consequences as officials decide whether to reopen schools and businesses: Go back to normal too quickly and risk even greater outbreaks of disease. Keep people at home too long and risk an even greater economic crisis.

“The absence of information is a very dangerous thing,” said Janet Hamilton, executive director of the Council for State and Territorial Epidemiologists, which represents public health officials. “We will be blind to the pandemic. It will be happening around us and we will have no data.”

The states that don’t report antigen test results or don’t count antigen positives as COVID cases are California, Colorado, Georgia, Illinois, Maryland, Minnesota, Missouri, Montana, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Pennsylvania, South Dakota, Tennessee, Texas, Vermont, Virginia, Washington, Wisconsin and Wyoming, as well as the District of Columbia.

[khn_slabs slabs=”241884″ view=”inline” /]

So far, most of the COVID tests given in the U.S. have been PCR tests, which are processed in medical labs and can take days to return results. By contrast, antigen tests offer results in minutes outside of labs, appealing to everyone from medical clinics to sports teams and universities.

Each relies on swabs to test patients. But unlike using tests run through labs, many providers who would use antigen tests don’t have an easy way to send data electronically to public health authorities.

Since July, though, the federal government has pushed roughly 5 million antigen tests into nearly 14,000 nursing homes to contain outbreaks among staff members and residents. The Department of Health and Human Services also awarded a $760 million contract to buy 150 million rapid antigen tests from Abbott, the Illinois-based diagnostics behemoth. It plans to send 750,000 of those to nursing homes starting this week, Brett Giroir, the HHS official heading the Trump administration’s testing efforts, told industry executives on Sept. 8. Federal officials have not elaborated on how many tests will be sent elsewhere but have suggested many will go to governors to distribute as schools reopen.

The rush of antigen tests, however, won’t be particularly useful to officials if the results are not publicly and uniformly reported.

KHN surveyed 50 states and the District of Columbia on their collection of antigen test results and what is reported publicly. Forty-eight responded between Sept. 3 and 10, revealing significant variation over whether people who test positive for COVID-19 with an antigen test are counted as cases and whether states even publicly report antigen data in their testing numbers:

  • 21 states and D.C. do not report all antigen test results.
  • 15 states and D.C. do not count positive results from antigen tests as COVID cases.
  • Two states do not require antigen test providers to report results, and five others require only positive results to be reported.
  • Nearly half of states believe their antigen test results are underreported.

Consequently, many state counts of infected people could be artificially low. For instance, the lack of reporting could imply infection rates are declining because the virus isn’t spreading as widely — when really more antigen tests are being used and not counted, public health officials and experts say.

“It’s going to look like your cases are coming down when they’re not,” said Jeffrey Morris, a biostatistics professor at the University of Pennsylvania.

[datawrapper id=”KVajt” height=”638″ /]

HHS recognizes that antigen tests are underreported but maintained that officials are not missing the full scale of the pandemic, an agency spokesperson said.

“There is sufficient testing to achieve all objectives outlined in the testing strategy, including identifying newly emergent outbreaks, supporting public health isolation and contact tracing, protecting the vulnerable, supporting safe reopening of schools and businesses, and enabling state testing plans,” spokesperson Mia Heck said.

Part of the problem on antigen test reporting stems from what counts as a COVID case. Guidance from the Centers for Disease Control and Prevention defines a “confirmed” COVID case as one that is determined from a PCR test. Positive results from antigen tests are considered “probable” cases because the tests can be less accurate.

Months after the first COVID antigen test received emergency authorization from the Food and Drug Administration, the CDC revised its COVID case definition in early August to allow a positive antigen test to count as a probable case without assessing whether a person had clinical symptoms or was in close contact with a confirmed infected person.

That prompted many states — including Arkansas, starting Sept. 2 — to adjust how they report cases.

“It’s easy for people to think since we use the word ‘probable’ that maybe it’s a case, maybe it isn’t. But that’s not how we think of it,” said Dr. Jennifer Dillaha, medical director for the Arkansas Department of Health. “It is a real case in the same way that a PCR is a real case.”

Dr. Karen Landers, an assistant state health officer for the Alabama Department of Public Health, said her biggest concern was the potential undercounting of antigen test results as they continue to grow in popularity. While the state has been trying to work with each urgent care or other medical provider, some struggle to submit the results.

“We can’t afford to miss a case,” she said.

The CARES Act, which Congress passed in March, requires a broad range of health care providers to report any COVID test result to state or local health departments. Nonetheless, two states — Montana and New Jersey — said they weren’t requiring antigen test providers to report results, positive or negative. Colorado, Maine, Mississippi, New Hampshire and Wyoming require only positive results to be reported, which can distort the positivity rate.

Sara Mendez, the support services manager for the Brazos County Health Department in Texas, said the department saw an increase of antigen tests being administered as Texas A&M University students returned. Even though the state health department was not including positive COVID cases from antigen tests in its public reports, the local health department felt obligated to do so.

“A lot of the college students will just go and get those done as opposed to the PCR tests,” Mendez said, “so we felt like we were missing out.”

Indiana University undertook a massive antigen testing operation for students living on campus in August, administering 14,870 antigen tests across four campuses through drive-thrus, according to Graham McKeen, an assistant university director for public health. The test results were delivered while students waited in cars for about 30 minutes, with 159 coming back positive. Each night, a university staff member would manually download the spreadsheet off each of the test machines and securely email it to the state health department.

But Indiana began reporting antigen testing only on Aug. 24, adding over 16,000 antigen tests into its public dashboard that day and saying in a news release that it plans to retroactively add in earlier antigen testing figures.

McKeen said that, even though the state is now reporting some antigen data, tests are still missed under the cumbersome reporting system. The state said some of the data is being sent by fax.

“It doesn’t give the community a good handle on the infection in the community,” McKeen said.

Heck, the HHS spokesperson, said that federal agencies are working to improve the reporting of results and that problems were likely to be eased in the future, citing that Abbott’s antigen test includes an electronic reader for automated reporting. By October, 48 million of those tests will be in circulation each month, she said.

Still, to date, “what this is exposing is the antiquated systems that public health agencies have had for years,” said Scott Becker, executive director of the Association of Public Health Laboratories. “So much of the data we’ve gotten is incomplete.”

That data barrier is playing out in nursing homes as well.

Victoria Crenshaw is holding off on using antigen tests to screen residents and staff members at Westminster Canterbury on Chesapeake Bay nursing home in Virginia Beach, Virginia. As senior director, she sees one major holdup: No technology platform is in place to easily send results to health officials. Instead, she and colleagues would need to resort to taping pieces of paper together to deliver details of who was tested, and hope local officials would accept it.

The Trump administration is pushing for nursing homes to use the tests for required screenings at least once a month and as often as twice a week. Under new federal regulations, nursing homes that don’t comply with regular testing and reporting requirements are subject to citations or fines.

“We have no technology today to submit this information,” Crenshaw said, “which leaves us in a vulnerable position.”