Con la escuela virtual… ¿qué pasa con las vacunas obligatorias?

El doctor Chris Kjolhede está enfocado en los niños del centro de Nueva York.

Como codirector de los centros de salud escolares de Bassett Healthcare Network, el pediatra supervisa alrededor de 21 clínicas de salud escolares en toda la región, una zona rural pobre conocida por sus fábricas y paralizada por la epidemia de opioides.

Desde un esguince de tobillo en el recreo hasta preguntas sobre el control de la natalidad, las clínicas sirven como proveedoras de atención primaria para muchos estudiantes, dentro y fuera del aula.

La meta principal es asegurarse que los niños estén al día con las vacunas obligatorias, dijo Kjolhede.

Pero, en marzo, COVID revocó el acuerdo cuando obligó a cerrar las escuelas.

Lo primero que me pregunté, dijo Kjolhede, fue: “¿qué va a pasar ahora?”.

Las escuelas juegan un papel fundamental en los esfuerzos de vacunación en los Estados Unidos. Las leyes requieren que los niños tengan ciertas vacunas para inscribirse y asistir a clases.

Pero para evitar que COVID-19 no siguiera propagándose, muchos distritos escolares han optado por comenzar el año académico en internet.

La decisión neutraliza en muchos casos el impulso de los padres por vacunar a sus hijos para el regreso a la escuela, dijo el doctor Nathaniel Beers, miembro del Consejo de Salud Escolar de la Academia Americana de Pediatría.

Beers, quien también ocupó varios roles en el sistema de Escuelas Públicas del Distrito de Columbia, agregó que si la educación no es en persona, “es más difícil de hacer cumplir los requisitos”.

Los funcionarios de salud pública han confiado en las escuelas como un medio para controlar las enfermedades prevenibles por vacunas durante más de un siglo. Las leyes de vacunación surgieron por primera vez en la década de 1850 en Massachusetts como un medio para controlar la viruela, según cuentan los Centros para el Control y Prevención de Enfermedades (CDC).

Todos los estados requieren que los niños reciban ciertas vacunas contra enfermedades como la poliomielitis, las paperas y el sarampión antes de empezar el año escolar o al jardín de infantes, al menos que el niño tenga una exención médica.

Algunos estados permiten a las personas optar por no vacunar a los niños por razones religiosas o filosóficas, aunque estas exenciones se han asociado con brotes de enfermedades que de otro modo estarían bien controladas, como por ejemplo el sarampión.

“Cuando entran al sistema, en preescolar, es donde se detecta si están atrasados con sus vacunas”, dijo Claire Hannan, directora ejecutiva de la Asociación de Administradores de Inmunización.

A nivel local, la responsabilidad de rastrear si los estudiantes cumplen con los requisitos de vacunación generalmente recae en la enfermera de la escuela. Si no, un oficinista o administrador hace el trabajo, dijo Linda Mendonca, presidenta electa de la Asociación Nacional de Enfermeras Escolares.

Si no los cumplen, algunas escuelas trabajan con los padres para programar citas con un proveedor de salud. Otras aíslan a los niños en el aula, y otras son tan estrictas que “ni siquiera puedes cruzar la puerta a menos que estés debidamente inmunizado”, dijo Beers.

La pandemia de COVID-19 ha provocado una baja dramática en la vacunación. En mayo, un informe de los CDC mostró una fuerte caída en la cantidad de pedidos al programa Vaccines For Children, una iniciativa federal que compra vacunas para la mitad de los niños del país.

Un segundo comunicado reveló tendencias similares: la cobertura de vacunación en Michigan disminuyó entre todas las edades, con la excepción de las vacunas que se administran al nacer, que generalmente se dan en el hospital.

En Pennsylvania, por ejemplo, el Departamento de Salud estatal suspendió en julio los requisitos de vacunas durante dos meses después del inicio del año escolar.

“El departamento no puede enfatizar más que hay que vacunarse lo antes posible”, dijo Nate Wardle, secretario de prensa del departamento de salud de ese estado, en una declaración escrita. Sin embargo, la orden de permanecer en casa por COVID hizo que durante meses los consultorios pediátricos no hicieran citas con niños sanos.

Beers reconoció que el cierre de las escuelas, entre otras acciones como restringir los viajes y cerrar grandes espacios de reunión, hace que los niños sean menos propensos a contraer o propagar enfermedades que generalmente se incuban en las aulas. Por ejemplo, según los datos de los CDC, el sarampión prácticamente ha desaparecido: se habían reportado 12 casos hasta el 19 de agosto de este año, en comparación con 1,282 en 2019.

“Lo que sería una gran vergüenza es que las escuelas vuelvan a abrir en persona y los niños vuelvan a estar juntos y empecemos a tener brotes de otras enfermedades que se pueden prevenir con vacunas”, agregó.

Los centros de salud de las escuelas de Nueva York se están comunicando activamente con los padres sobre las vacunas. En Cooperstown, Kjolhede se acercó a todos los superintendentes poco después del cierre en marzo para preguntar si la clínica podía permanecer abierta. Todos menos uno dijeron que no.

Luego, el personal concertó citas de telesalud y llamó a los estudiantes que necesitaban atención en persona para concertar visitas, incluidos aquellos que necesitaban una vacuna antes del comienzo de este año escolar, dijo. Afortunadamente, el centro de salud que permaneció abierto tenía una puerta que permitía a los pacientes ingresar a la clínica sin caminar por la escuela.

A varias horas de distancia, la doctora Lisa Handwerker está lidiando con la forma de abordar el problema de que cientos de estudiantes en sus seis clínicas de salud en las escuelas de la ciudad de Nueva York no han recibido vacunas mandatorias.

El departamento de salud de la ciudad le dio una lista de estudiantes bajo su cuidado que necesitaban vacunas adicionales, dijo. A más de 400 niños les faltaba la segunda dosis para prevenir la meningitis meningocócica, que generalmente se administra a adolescentes y adultos jóvenes de 16 a 23 años. Debido a que el departamento usó datos del último año académico para compilar la lista, Handwerker no tiene información sobre nuevos estudiantes. Algunas familias abandonaron la ciudad por la falta de ingresos y recursos provocada por la pandemia.

“Tuvimos dificultades con al menos la mitad de los niños en nuestra lista de vacunas”, dijo Handwerker. “Luego, cuando hablamos a las familias, se mostraron reacias a salir de sus casas”.

Ese no fue el caso de Tracey Wolf, una madre de dos hijos que visitó al médico recientemente para vacunar a su hijo Jordan contra el sarampión, las paperas, la rubéola y el VPH antes de comenzar el séptimo grado. Asistirá a la escuela secundaria en Dunedin, Florida, en persona, dijo Wolf, de 38 años.

Parecía una tontería mantener a Jordan, de 13 años, alejado de sus compañeros de clase cuando ya juega béisbol y sale con sus amigos, dijo. Sus calificaciones también bajaron la primavera pasada cuando la amenaza COVID transformó su salón de clases en una computadora.

También llevó a su hijo de 6 meses a recibir sus vacunas. Cuando se le preguntó si tenía miedo de ir al consultorio de su médico, respondió: “No más que ir al supermercado”.

Independientemente de si un niño comienza la escuela en casa o en el aula, los expertos en inmunización enfatizaron la importancia de vacunar siguiendo el calendario de inmunizaciones. Esas fechas tienen en cuenta la etapa de desarrollo del niño para maximizar la eficacia de la vacuna. Dicho esto, es preferible que los niños reciban las vacunas de su médico habitual para evitar la pérdida de los registros de vacunación y las vacunas adicionales, completó Beers.

Sin embargo, el 19 de agosto, el Departamento de Salud y Servicios Humanos (HHS) emitió una declaración que permite a los farmacéuticos administrar vacunas infantiles a niños y adolescents de 3 a 18 años.

Esta historia fue producida por Kaiser Health News, un programa editorial independiente de la 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).

Ejercicio y dieta son más importantes que nunca en tiempos de coronavirus

Si en estos tiempos tu vida es como la mía, aquella rutina pre-pandémica que incluía ejercicio regular y una alimentación disciplinada probablemente ha dado paso a noches sedentarias en en el sofá, a atracones de televisión mientras te comes un helado de chocolate o macarrones con queso.

Pero no nos castiguemos por ello. Varios médicos con los que hablé recientemente me dijeron que la mayoría de sus pacientes, y muchos de sus colegas, están luchando por mantener hábitos saludables en medio de la ansiedad de la pandemia. “La cuarentena de 15” (el número de libras ganadas) es un fenómeno real.

El doble desafío de proteger nuestra salud, incluyendo nuestro sistema inmunológico, mientras se confrontan las tentaciones poco saludables “es una lucha con la que todos estamos lidiando”, dijo el doctor David Kilgore, director del programa de medicina integral de la Universidad de California-Irvine.

Mucho antes de COVID-19, más del 40% de los adultos en los Estados Unidos eran obesos, lo que los pone en riesgo de sufrir las peores consecuencias de la infección. Pero incluso las personas acostumbradas a mantener una buena forma física y una buena nutrición tienen problemas para romper los malos hábitos que han desarrollado en los últimos cinco meses.

Karen Clark, residente de Knoxville, Tennessee, descubrió el remo competitivo no hace mucho y sus múltiples entrenamientos semanales quemaban cualquier exceso de calorías que consumiera. Pero la pandemia lo cambió todo: ya no podía reunirse con sus compañeros de equipo para remar y dejó de hacer ejercicio en el YMCA.

De repente, se quedó encerrada en casa. Y, como para mucha gente, eso significó un estilo de vida más sedentario, encadenada al escritorio, sin reuniones fuera de la casa ni paseos para ir a  almorzar con los colegas.

“Me dediqué a comer comida fácil y reconfortante, a hacer rutinas cómodas y a ver una gran cantidad de Netflix y Amazon Prime, como todo el mundo”, contó Clark. “A los 25 años, cuando subía 10 libras dejaba de tomar cerveza y helado por una semana. Pero cuando ganas 12 libras a los 62, perderlas es un largo camino”.

Empezó ese camino en julio, cuando dejó de comprar papitas fritas, helados y otras golosinas. Y en agosto, redescubrió la máquina de remar en su sótano.

Pero no te preocupes si te falta la disciplina de Clark, o no tienes una máquina de remar. Todavía puedes recuperar algo de control sobre tu vida.

Una buena manera de empezar es establecer algunas rutinas diarias básicas, ya que en muchos casos eso es exactamente lo que la pandemia se ha llevado, señaló el doctor W. Scott Butsch, director de medicina para la obesidad en el Instituto Bariátrico y Metabólico de la Clínica Cleveland. Butsch recomienda “estructurar” el día con actividad física, que puede ser tan simple como una corta caminata en la mañana y una más larga después del trabajo.

Y, especialmente si tienes niños en casa que estudian a distancia este otoño, prepara tus comidas al principio del día, o incluso al principio de la semana, dijo Butsch.

Si no has hecho ejercicio durante un tiempo, “comienza despacio y gradualmente sube hasta donde puedas tolerar un ritmo cardíaco elevado”, recomendó la doctora Leticia Polanco, del South Bay Primary Medical Group, al sur de San Diego. Si tu gimnasio está cerrado o no puedes reunirte con tus compañeros de ejercicio habituales, hay muchas maneras de hacer que tu cuerpo se mueva en casa y en el vecindario, dijo.

Sal a caminar, a correr o a andar en bicicleta, si alguna de esas actividades te atrae. Aunque muchas jurisdicciones a lo largo de los Estados Unidos requieren que los residentes usen máscaras cuando están en público, puede no ser necesario —e incluso puede ser dañino para algunas personas con condiciones respiratorias— mientras se hace ejercicio.

“Está claro que es difícil hacer ejercicio con una máscara puesta”, expresó la doctora Yvonne Maldonado, pediatra especializada en enfermedades infecciosas de la Facultad de Medicina de la Universidad de Stanford. “Vamos de excursión a las colinas y llevamos nuestras máscaras con nosotros y no las usamos a menos que alguien se acerque. Entonces nos ponemos la máscara, y luego nos la quitamos y seguimos adelante”.

Si prefieres evitar el tema de la máscara, piensa en tu casa como un gimnasio ingeniosamente disfrazado. Pon música y baila, o haz hula-hoop, sugirió Polanco. También puedes levantar pesas, o encontrar una estación de televisión por cable con yoga u otros programas de entrenamiento.

Si buscas en Internet “videos de ejercicios”, encontrarás innumerables entrenamientos tanto para principiantes como para aficionados al fitness con experiencia. Prueba una de esas aplicaciones de entrenamientos de siete minutos tan populares en estos días. Puedes descargarlas de Google Play o del Apple Store.

Si extrañas la camaradería de hacer ejercicio con otros, los grupos virtuales de fitness pueden parecer un mal sustituto, pero pueden proporcionar motivación y responsabilidad, así como entrenamientos de vídeo en vivo con personas que piensan de la misma manera. Una forma de encontrar tales grupos es buscar “comunidad virtual de fitness”.

Muchos gimnasios también ofrecen clases digitales de fitness y sesiones de entrenamiento físico en vivo, a menudo anunciadas en sus sitios web.

Si lo tuyo son los deportes de grupo, puedes tener opciones o no, dependiendo de donde vivas.

En Los Ángeles, los deportes grupales en el interior y exterior en los parques municipales se han clausurado hasta nuevo aviso. Los únicos deportes permitidos son el tenis y el golf.

En el condado de Montgomery, Maryland, la Ron Schell Draft League, una liga de softball para hombres de 50 años o más, se reanudará a principios de este mes después de la temporada de primavera debido a COVID-19, dijo Dave Hyder, el comisionado de la liga.

Pero señaló que ha sido difícil conseguir suficientes jugadores debido a la preocupación por COVID.

“En el grupo de mayores, hay mucha gente que está en una categoría de alto riesgo o puede tener un cónyuge en una categoría de alto riesgo, y no quieren arriesgarse a jugar”, explicó Hyder, de 67 años, que sí piensa jugar.

Los jugadores tendrán que situarse, al menos, a 6 pies de distancia y usar máscaras mientras estén fuera del campo. En la cancha, el catcher es el único jugador que debe usar una máscara. Esto se debe a que las máscaras pueden empañar las gafas o resbalar, causando un deterioro de la visión que podría ser peligroso para los corredores de base o los jardineros, explicó Hyder.

Sea cual sea la forma de ejercicio que elijas, recuerda que no te mantendrá sano a menos que también reduzcas el consumo de alimentos grasos y azucarados que pueden aumentar el riesgo de enfermedades crónicas como la obesidad, la diabetes y la hipertensión, todos ellos factores de riesgo de COVID-19.

Kim Guess, dietista de la Universidad de California en Berkeley, recomienda que las personas consuman un suministro saludable de frijoles y lentejas, granos enteros, nueces y semillas, así como vegetales congelados, tofu, tempeh y pescado enlatado, como el atún y el salmón.

“Empieza con algo realmente simple”, recomendó. “Incluso podría ser un acompañamiento de verduras que vaya con lo que están acostumbrados a preparar”.

Sean cuales sean los primeros pasos que decidas dar, ahora es un buen momento para empezar a comer mejor y a mover más tu cuerpo.

Mantenerse sano es “muy importante hoy en día, más que en otros tiempos, porque estamos luchando contra este virus que no tiene tratamiento”, apuntó Butsch de la Clínica Cleveland. “El tratamiento es nuestro sistema inmunológico”.

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).

How next-gen computer generated maps detect partisan gerrymandering

In October 2019, a state court determined that North Carolina’s congressional districts had been severely gerrymandered and struck down the state’s map. The court’s ruling was informed, in part, by tens of thousands of alternative maps demonstrating that the district boundaries had very likely been manipulated for political gain, the very definition of gerrymandering.

Researchers had generated a slew of alternative, computer-generated maps designed to help identify potential patterns of bias. The approach is increasingly used, alongside other tests, to ferret out alleged gerrymandering. District manipulations can be so subtle that they’re undetectable just by looking at them. “The eyeball test is no good,” says Jonathan Katz, a political scientist and statistician at Caltech.

U.S. states redraw their district lines every 10 years to adjust for changing demographics picked up by the national census. The last round a decade ago raised eyebrows, most notably for districts drawn in Michigan, North Carolina and Pennsylvania.

“The post-2010 round of redistricting is widely viewed as a time of extreme, even egregious, partisan gerrymandering,” retired political scientist Richard Engstrom wrote in the January 2020 Social Science Quarterly.

A 2017 report by the nonpartisan Brennan Center for Justice at New York University School of Law noted that existing congressional maps were largely biased in favor of the Republican Party. In 26 states, which account for 85 percent of U.S. congressional districts, as many as 17 Republicans in the House of Representatives owe their seats to gerrymandering. In states where Democrats controlled the redistricting process, partisan bias is also a problem, but the effect is smaller because those states are often made up of fewer districts.

Since 2011, legal scholars, political scientists and mathematicians conducting gerrymandering research have served as expert witnesses in more than 250 state and federal court cases regarding redistricting.

With the 2020 U.S. census now under way, legislators will soon be revising electoral districts again. This time around, researchers hope that instead of serving as expert witnesses in court, they can help identify problematic districting before the new maps even go into effect.

“In 2010, the politicians were thinking very hard on how to draw maps,” while the public and academics weren’t paying a lot of attention, says Jon Eguia, an applied game theorist at Michigan State University in East Lansing. “So in 2011, [those politicians] drew a lot of very bad maps in very many states. Now we’re all paying attention.”

Measuring bias

According to the U.S. Constitution and the Voting Rights Act of 1965, a state’s voting districts must each contain about the same number of people and be drawn in a way that doesn’t disenfranchise racial or ethnic minorities. States can have additional rules, such as contiguity of districts or that cities or counties be kept intact.

That leaves two main tactics for gerrymandering: “packing” the opposing political party’s supporters into a few districts in hopes your party dominates the rest, or “cracking” these supporters by spreading them across many districts to dilute their collective voting power. Those skilled in gerrymandering draw district boundaries that ensure decade-long protection for the ruling party.  

Early methods to test a state map for gerrymandering, which are still in use today, rely on a concept known as partisan symmetry. If a map provides symmetric, or equal, opportunity for all parties in a contest to convert votes into seats, that map is deemed fair. States with packed and cracked districts won’t pass tests based on symmetry.

Symmetry-based tests gained prominence after LULAC v. Perry, a 2006 Supreme Court case that reviewed a mid-decade redistricting plan in Texas. In that case, scientists entered into evidence a partisan bias test — a simulation of what would have happened in an election if the parties’ vote shares were reversed. For instance, if Party A wins 10 out of 15 seats with 70 percent of the vote in an actual election, then Party B, in a hypothetical election, should win 10 seats if it had 70 percent of the vote. Deviation from that “symmetry” equals the level of partisan bias.

In LULAC, the justices largely upheld Texas’ map. But the court indicated willingness to use a symmetry-based method in a future case, though perhaps not solely the partisan bias test. Justice Anthony Kennedy expressed concerns about that particular test, saying it was unclear how much bias was too much. Kennedy also questioned the method’s reliance on statistical simulations rather than real-world results. “We are wary of adopting a constitutional standard that invalidates a map based on unfair results that would occur in a hypothetical state of affairs,” he wrote in the plurality opinion for LULAC.

Real-world symmetry

Kennedy’s feedback on LULAC prompted researchers to develop other symmetry-based tests that used actual election results.

One such approach is the median-mean difference test. That test arises from the basic statistical principle that the difference between the median and the mean indicates the level of skew in the data, with values closer to zero less skewed and vice versa. In 2015 in the Election Law Journal, political scientists Michael McDonald and Robin Best of Binghamton University in New York explained how a median-mean analysis could help identify partisan skew in a state.

A party’s mean vote share comes from averaging vote shares across all districts in a state. A party’s median vote share comes from the district in the middle of a distribution, with the party’s worst-performing district in terms of vote share at one end and the best-performing district at the other. If the difference between a party’s median and mean vote shares is high, that indicates a possibly biased skew, though McDonald and Best noted that some natural skew is inevitable and must be factored into any analysis.

Another approach is called the efficiency gap, which measures the difference in packing and cracking between parties by tallying “wasted” votes. So, if Party A draws an electoral map that spreads Party B’s voters across districts, votes cast for Candidate B in districts won by A are wasted. Conversely, if Party A packs Party B’s voters into a few districts, votes cast for Candidate B beyond the majority needed to win are also wasted. Each party should have about the same number of wasted votes in an election. So the efficiency gap, first described in 2015 in the University of Chicago Law Review, is calculated by taking the difference in wasted votes between parties and dividing that by the total number of votes cast.

PlanScore, a nonpartisan group of legal, political and mapping experts, has shown how the various symmetry tests can be used in tandem to flag possible gerrymandering. In its analysis of the congressional map used in North Carolina’s 2018 congressional elections, where Republicans won 10 seats and Democrats three, PlanScore found bias using all three tests: The partisan bias test showed that in a hypothetical, tied election, Republicans would win 26.9 percent extra seats. In the median-mean test, the median Republican vote share was 5.8 percent higher than its mean vote share. And the efficiency gap was 27.7 percent in favor of Republicans.

Natural advantage

Critics of symmetry-based tests, though, say that the presence of packing and cracking does not prove that the governing party has intentionally gerrymandered the state’s districts. Instead, asymmetries can also arise from natural variations in where voters live. Crucially, Republicans tend to be more dispersed across states while Democrats are concentrated in cities.

“The party that’s more spread out has a geographic advantage,” says applied mathematician Jonathan Mattingly of Duke University. “That’s our system.”

Tests that have emerged over the last few years, known broadly as ensemble methods, accept that natural advantage. These tests rely on computers to generate thousands, or even millions, of possible maps. The programs draw myriad boundary lines around a given district and estimate which party would win that district under each scenario.

Consider a state in which one party wins four to seven seats in almost all maps generated, while the state is using a map that regularly gives that party nine seats, Eguia says. That discrepancy suggests partisan gerrymandering.

Lawyers working on gerrymandering cases tend to use ensemble and symmetry methods in tandem, says Ruth Greenwood, an attorney in Cambridge, Mass., with PlanScore and the nonpartisan nonprofit Campaign Legal Center. That’s because each alternative map can also be evaluated for symmetry using the various tests. Averaging symmetry scores in the ensemble maps and comparing those values with the symmetry scores of the real-life map can illuminate when the difference is stark and therefore can’t be chalked up to any “natural advantage.”

Using all methods together also means that when a map’s fairness is questioned, the lawyers can show that “on any metric, the result is terrible,” Greenwood says.

States at the helm

The issue of gerrymandering was weaving through the federal courts until June 2019, when the Supreme Court ruled 5–4 in Rucho v. Common Cause that partisan gerrymandering fell outside federal jurisdiction. The decision was in response to an appeal challenging a federal court’s January 2018 ruling that North Carolina’s congressional district map had been gerrymandered along partisan lines, giving Republicans 10 out of 13 seats in 2016 and 2018, despite the fact that in both elections Republicans won only about half the popular vote.

By removing the federal court system from gerrymandering cases, the Supreme Court left the issue to the states, a charge a North Carolina state court quickly took up in Harper v. Lewis. The state court relied on much of the same evidence presented in Rucho. That evidence included testimony by Mattingly showing that in a universe with 24,518 alternative congressional district maps, the map North Carolina was using was an egregious outlier. In the maps Mattingly generated, Republicans carried 10 or more seats less than 1 percent of the time.

In October 2019, the three-judge panel in the Harper case ruled that state lawmakers needed to redraw the congressional district map for 2020. Plaintiffs, however, then challenged the state’s remedial map, which would likely result in Republicans winning eight out of 13 seats. Mattingly again provided expert testimony, this time adding 57,202 more maps made using less stringent constraints than the first batch. His research showed a much more purple state, with a 7–6 or 6–7 party split arising in the majority of those alternative maps.

But with the state’s 2020 primary fast approaching, a state court approved the remedial map in December 2019. That new map will stand for only a short time, though. Along with every other state, North Carolina will go through redistricting again in 2021 after the census tallies are in. New Jersey and Virginia — which hold statewide elections in odd years — may struggle to finish their maps before the 2021 elections, since the census was delayed due to the pandemic.

Meanwhile, census watchers worry that the Trump administration’s recent decision to move the completion deadline for the population count from October 31 to September 30 could lead to undercounts among hard-to-reach groups, thereby affecting the placement of district boundaries.

Greenwood expects a spike in lawsuits, though now at the state rather than federal level, challenging the newly drawn maps. And a small cadre of researchers is now ready to serve as expert witnesses in those cases, Eguia says.

The upcoming mapmaking process doesn’t have to repeat the mistakes of a decade ago, he adds. In 2011, lawmakers drew maps largely behind closed doors without researchers present — resulting in a decade of lawsuits, he says. Why not, instead, bring researchers into the room, with their tests and myriad maps, from the get-go? “That’s what the community of experts would prefer,” he says. “That’s what I would advocate for.”

How Dare You – An Open Letter to AA Trustees

This is an edited version of the “Open Letter” which was sent to the AA Trustees on August 3, 2020.[1]

By Paul W

Introduction

Alcoholics Anonymous has lost sight of its purpose, of its mission. Yes, its members and backers rightly praise the institution and its good work. Yes, AA does help people to place their alcoholism in remission. Unfortunately, the core purpose of Alcoholics Anonymous is gone… or is it?

AA’s Preamble begins, “Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism.”

Does AA really seek to help all who suffer from alcoholism?

Or, does it want to help only those who are, or will become, theists? If AA is for all, why the heavy theistic approach? Why the plethora of references to God, directly or through euphemisms (Him, He, Power, Higher Power)? If AA is spiritual, not religious, why the clear difficulty in defining, explaining, and laying out examples of “spiritual” without a religious tone? And, why the literal blizzard of God references in Alcoholics Anonymous?

This and more leads to, How Dare You…

  • continue to claim that Alcoholics Anonymous is “Spiritual, not Religious” in the face of significant evidence to the contrary.

  • ignore the numerous United States (State and Federal) court rulings that AA is religious – and the Canadian Human Rights Tribunals which have or were ready to rule likewise.

  • abandon the growing population of alcoholics who might have been “saved” because you, Corporate AA, insist on ignoring the thousands of people who have no religious beliefs.[2]

AA’s Religious Nature

Historical

AA owes much to the Christian Oxford Group. AA also has strong ties to religious personages and organizations and “people of (religious) faith.” AA was born of religious experiences, sudden revelations, bright lights, prayers, and finding God.

Bill Wilson and Dr. Bob Smith leap to mind. Bill’s writings clearly indicate his religiosity. Co-founder, Dr. Bob’s practice of making novitiates pray on their knees and his writing that a newcomer “must surrender himself absolutely to God” and that he “must have devotions every morning … prayer and some reading of the Bible.” All this points directly to religiosity.[3]

In Bill Wilson’s book, Alcoholics Anonymous Comes of Age, reverence is given to Dr. Samuel M. Shoemaker, Episcopal minister, Father Ed Dowling, S.J.[4], and Sister Ignatia, Sisters of Charity.

Atheists and agnostics have been ignored, disguised, or presented in a manner so as to be easily mistaken for theists. Hank P. and Jim B. are prime examples. Both were part of the original membership and were responsible for the modifying phrase, “as we understood Him” being added to “God” in Steps 3 and 11. On page 17 of Alcoholics Anonymous Comes of Age, Bill wrote, “A newcomer named Jimmy B., who like Henry [aka Hank] was an ex-salesman and former atheist.” This is misleading, as Jim B remained an atheist for his whole life.[5]

The “Big Book”

The premier publication, Alcoholics Anonymous[6] (“Big Book”), is filled with “God” often enough that any claim of AA being “not religious” is specious.[7] The book, Alcoholics Anonymous gives no clear evidence of how “the program”[8] works for those in the increasing secular population. Basically, it is up to the non-theists to “work things out” for themselves. Corporate AA offers no help or encouragement.

“God” and euphemisms for a god are ubiquitous in the Big Book. So much so that a reader who is without a god can only understand the program through a Churchillian effort. No assistance is offered by Corporate AA. Non-theists are on their own.

Need Examples?

Believe it or not, the following are just a few examples of the unassisted work a non-theist is confronted with. (All page references are to Alcoholics Anonymous.)

Chapter 2, “There Is a Solution”. “… the simple kit of spiritual tools” which later turn out to be the (Godly) Twelve Steps (page 25).[9]

Chapter 4, “We Agnostics”[10]. “And it means, of course that we are going to talk about God” (page 45). This sentence turns out to be a proper indication of the rest of the book and the program.[8]

“When, therefore, we speak to you of God, we mean your own conception of God” (page 47). It is a far stretch of imagination to picture a non-theist going through the program trying to translate “Bill’s words” and all statements of “God” into secular concepts and language. Clearly, AA is not a (non-theistic) “spiritual” program.

“… as we see it, there is an All Powerful, Guiding, Creative Intelligence” (page 49).

“Actually, we were fooling ourselves, for deep down in every man, woman, and child, is the fundamental idea of God” (page 55, emphasis added). This is an unabashed claim that a God exists and everyone knows it, even if buried deep in the subconscious. These are the thoughts of a man convinced that everyone will come to accepting God. Obviously AA is a theistic program, based on a God of the Ten Commandments. Bill Wilson, and AA itself, hold tightly to the hope and belief that all will “Come to Believe.”

“God restored us all to our right minds” (page 57). A reader must conclude that to be in ones “right mind” is to be a theist. This passage holds that atheists, agnostics, Free-Thinkers, Humanists, and the like are not in their right minds. How dare you claim that AA is open to all?

Chapter 5, “How It Works”. outlines the “program” of Alcoholics Anonymous, it introduces the Twelve Steps. Part of this chapter, especially the listing of the Twelve Steps, is read aloud at many meetings open to the public, as “How it Works.” It is reasonable to assume this chapter is the official program of AA, a theistic program.

Writing about the scourge of alcoholism Bill Wilson states, “Without help it is too much for us. But there is One who has all power – that One is God. May you find Him now” (page 59). Clearly, AA expects its members to “find God”, not to remain non-theistic.

“We had to have God’s help” (page 62). In AA’s mind, those without a god cannot gain sobriety. On the same page is, “…we could at last abandon ourselves utterly to Him.” This relates directly to AA’s Step 3, “Made a decision to turn our will and our lives over to the care of God as we understood Him” (italics in the original). AA holds that God is essential for sobriety. AA is theistic, is religious.

On page 63 we find “the Third Step prayer.” Prayer is a religious act, offering oneself to a god is a religious act. Strange for an organization which claims to be “spiritual, not religious.”

“We asked God to mold our ideas and help us to live up to them” (page 69). Another prayer, another religious act.[11]

Chapter 6, “Into Action”. On page 80 we are told of a man who finds that it is better to follow the program “… than to stand before his Creator guilty of …” Judgement after death is a religious belief or truth. It is “religious.”

A miraculous happening is reported on page 84, “… that God is doing for us what we could not do for ourselves.” A miracle performed by a god is religious.

Chapter 7, “Working With Others”. On page 93 those doing Twelfth Step work (proselytizing) are instructed, “Stress the spiritual feature freely. If the man be agnostic or atheist, make it emphatic that he does not have to agree with your conception of God. He can choose any conception he likes, provided it makes sense to him. The main thing is that he be willing to believe in a Power greater than himself and that he live by spiritual principles” (italics in original).

AA holds that one must have a God of some sort (“Power” is capitalized). AA has been unable to give examples or definitions of power which are not insulting. As for “spiritual principles,” AA has been woefully poor at explaining them in a non-religious fashion.

There are many more direct references to God and to prayer (a religious activity) in Alcoholics Anonymous. They are easy to find.

A Thought Experiment

Ask yourselves:

  1. What are the qualities, characteristics of religion or religiousness that Alcoholics Anonymous lacks?

  2. What are the indicators which demonstrate AA’s spirituality that are devoid of religious connotations?

  3. Why does the plethora of references to God, Him, Higher Power, etc., not indicate a religious nature of Alcoholics Anonymous? (Don’t religions have a god?)

  4. How is the practice of group prayers at AA meetings and functions not a sign of religiousness?

  5. How is the passing of General Service Conference Advisory Actions “freezing” Bill Wilson’s words in Alcoholics Anonymous and Twelve Steps and Twelve Traditions not an act of declaring infallibility?

Conclusion

Trustees, please be honest. At least admit that, while AA is not a specific religion, it is religious, to the extent that it relies on a male God, most likely Christian.

  • There is no doubt that AA supports the writings of its founder, Bill Wilson. Consequently, when he wrote a letter mistakenly stating that the Lord’s Prayer is not just a Christian Prayer[12] AA was accepting the inclusion of this prayer in its meetings.

  • There is no doubt that AA practices religious rituals at its meetings, opening and closing with prayers.

  • That Corporate AA does not even ask that meetings and groups identifying as AA not include religious rituals in its meetings and affairs.

  • That you still allow the delisting of secular meetings or refusals to list in the first place.

  • That you studiously ignore Bill Wilson’s permissive words expressed in Alcoholics Anonymous Comes of Age.[13]

  • And, finally that you are reluctant to make any serious corrections to the “program” and related literature, especially the “Big Book,” for financial reasons.[6] This reluctance extends even to ignoring contradictory comments and erroneous statements, especially those made by Bill Wilson.

Forget about correcting the “Big Book.” It is a valuable, historical volume, much like medical books and papers from the 1930s and earlier. Be courageous and embark on writing a new book, one which retains Bill Wilson’s basic thoughts and modern thoughts which include all who suffer from alcoholism. Or, simply state that AA is for theists and others need not apply. I suspect that there is an alcoholic or two or more available to be the Martin Luther for AA.


Notes:

[1] The trustees have responsibility for three incorporated entities; The General Service Board of Alcoholics Anonymous, Inc., Alcoholics Anonymous World Services, Inc., and Alcoholics Anonymous Grapevine, Inc. Trustees of AA refers to both Class A and Class B Trustees.

[2] Pew Research has predicted that the “not-religious” population of the United States (Atheists, Agnostics, Free-Thinkers, Humanists, etc., and “Nones”) will equal and even surpass the population identifying as “Christian” in a few years.

[3] Dr. Bob and the Good Oldtimers, page 131. This book is “General Service Conference-approved literature.”

[4] Father Dowling, S.J. pointed out the similarity of the Twelve Steps to the Spiritual Exercises of Saint Ignatius, the founder of the Jesuit order. (Alcoholics Anonymous Comes of Age, page 253.)

[5] Jim B (Burwell) was responsible for getting AA started in Baltimore, Philadelphia, Washington D.C. and San Diego. Jim’s story is in Alcoholics Anonymous, (pages 219-231) titled “The Vicious Cycle.” Unfortunately, editing appears to have obscured his life-long atheism. Jim is also featured in Twelve Steps and Twelve Traditions, as Ed in Tradition Three, where the impression that he came to believe in God is made. Why Bill Wilson changed Jim’s name to Ed is unknown.

[6] I call the book, Alcoholics Anonymous, “premier” because of the reverence it is afforded and its monetary value to AA. It is the largest seller of official AA publications. This alone is a massive obstacle to serious thoughts about changes to or corrections of the “Big Book” text. (AA’s net literature sales represent 55% of its income, whereas member and group contributions are 41% of income, with investment income being 4%. AA’s net profit – reported as “Excess of Income” – for that year was just short of $4-million. This is from a recent Annual Report from Owen J. Flanagan and Company, Certified Public Accountants.) “Follow the money” is true, even in AA.

[7] The fact that “God” is so prevalent throughout AA literature and practices, coupled with Corporate AA’s inability to explain “spiritual” without a deity, are clear indication of AA’s religious nature.

[8] The word “program” refers to the Twelve Steps and well as the Twelve Traditions and the Twelve Concepts. The focus here is on the Twelve Steps outlined in “How It Works” in Alcoholics Anonymous and elaborated on in Twelve Steps and Twelve Traditions. Both publications carry the AA imprimatur, “This is A.A. General Service Conference-approved literature” and have been protected from change or revision by General Service Conference Advisory Actions.

[9] Alcoholics Anonymous has been woefully unable to define “spiritual” in a clear and concise manner. After years of denying the need for non-theistic literature on secular spirituality, AA made two attempts. The first was for literature on spiritual experiences which was to include stories from atheists and agnostics. This failed completely. The second attempt resulted in the pamphlet, “Many Paths to Spirituality,” which was a disappointment. Finally, Alcoholics Anonymous World Services, Inc. obtained permission to print the United Kingdom’s pamphlet, “The God Word.” Its success is questionable.

[10] Except for most personal stories, the majority of the “Big Book” was written by Bill Wilson. (He even wrote “To Wives” even though Lois volunteered to do so.) Bill wrote the chapter, “We Agnostics” alone. There is no evidence that this chapter was prepared in collaboration with other agnostics, atheists, or non-theists. Bill actually dares to speak for all non-theists. His lack of understanding is clear in the “Conference-approved” book, Twelve Steps and Twelve Traditions, where, on page 28, Bill Wilson states, “Religion says the existence of God can be proved; the agnostic says it can’t be proved; and the atheist claims proof of the nonexistence of God.” This last statement is absolutely false. The word “atheist” indicates those who live a-theistically; without a god. This one sentence has resulted in many AA theistic members having unwarranted negative opinions of atheists.

[11] Additionally, four of AA’s Twelve Steps involve prayers or religious acts.

Step 5, “Admitted to God to ourselves, and to another human being the exact nature of our wrongs.”

Step 6, “Were entirely ready to have God remove all these defects of character.” (Uncovered and listed in Step Four.)

Step 7, “Humbly asked Him to remove our shortcomings.”

Step 11, “Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for the knowledge of His will for us and the power to carry that out.”

[12] Ignoring the fact that Jesus originated that prayer. See the New Testament; Matthew 6: 9-13 and Luke 11: 2-4.

[13] Alcoholics Anonymous Comes of Age (AACoA) is “General Service Conference-approved literature.” It was published in 18 years after Alcoholics Anonymous. In AACoA, Bill Wilson, quotes the long form of Tradition Three and then states, “This means that these two or three alcoholics could try for sobriety in any way they liked. They could disagree with any or all of A.A.’s principles and still call themselves an A.A. group.” Recall that at the time of AACoA, “principles” referred to the Twelve Steps and the Twelve Traditions. Put simply, Bill Wilson gave cart blanch to groups of alcoholics to write their own, secular Steps (“any way they liked”). In a word, all that God stuff is unnecessary.


Paul has been a member of AA since 1989. He is comfortable as a nontheist and identifies as an atheist. Among the AA many service positions Paul has held are General Service Representative and District Committee Member. He has spoken at AA Area functions about the lack of literature for nonbelievers and has been a supporter of recognizing nontheists as full members of AA. Before retirement, he was a consultant with an international professional services firm where he specialized in education and organizational behavior. Paul and his wife live in New Jersey, she a Christian (of her own definition) and he an atheist. They have six children (50% atheists), six grandchildren, and one great-grandchild.


The post How Dare You – An Open Letter to AA Trustees first appeared on AA Agnostica.

The New Experimental Antiviral Drug Test on Monkeys

The scientists are infecting the laboratory monkeys with a lethal strain of coronavirus for the purpose of testing an experimental antiviral drug. The research team at the United States National Institutes of Health has tested this experimental drug against viral infections on 18 rhesus macaques. 

For the first time, this experimental antiviral drug was developed against Ebola. The team of researchers infected all the laboratory monkeys with MERS-CoV (Middle East respiratory syndrome-related coronavirus). 

The outbreak of this deadly strain of coronavirus has affected nearly 80,000 individuals and led to a death toll of almost 2,600. The research team has analyzed the outcomes in laboratory monkeys after they received the experimental antiviral drug – redeliver.

The results indicated that signs of MERS disease (infection caused by MERS-CoV) were present in all the monkeys that didn’t receive redeliver. The experts in this field observed that signs of this infection were present in six control monkeys. These signs involved an increased rate of respiration, ruffled fur, and decreased appetite.

Related:Global Virus Network (GVN) is Working on Coronavirus Infection (COVID-19) Treatment

Besides this, another finding of this study suggests that any sort of symptoms regarding respiratory disease were absent in the six monkeys who received redeliver 24 hours before getting infected with this deadly MERS-CoV

On the contrary, the signs of disease were present in the lab monkeys that were given this experimental antiviral drug almost 12 hours after scientists infected them with this lethal virus. But still, the signs of disease, in this case, were much less than that of the control group. The viral content in the lungs decreases with a decrease in disease severity. 

The scientists expect that this drug would also be effective in tackling SARS-CoV-2, because of its structural resemblance with MERS-CoV. The cases of this deadly virus have extended from China to 30 other countries. This deadly virus (COVID-19) has infected above 20,000 patients, whereas, the death toll has reached 2,600.

In 2020, MERS-CoV was reported in Saudi Arabia for the first time. Its symptoms involve diarrhea, cough, and fever. But the cases weren’t limited to countries like UK, USA, and UAE. According to a statement given by the researchers at the National Institute of health, MERS-CoV has resemblance with 2019-nCoV.

Related: FDA Approved First-ever Portable MRI Machine

In the past, this new experimental antiviral drug – Remdesivir was being used for providing protection to the laboratory animals against different viruses used in lab experiments. In this recent experimental trial, this new drug has been found to be effective in the treatment of Ebola and Nipah viruses. 

Originally, this plant-related drug was freely available for its testing. And at least two trials of the drug,  that was developed for Ebola treatment, are known to be enough. These motivating results of the study have been presented in a prestigious medical journal, that is also known as The New England Journal of Medicine.

In laboratories, the monkeys were being used as lab animals for the treatment of test vaccines and drugs, and are preferred because of their resemblance with the chimpanzee. The study also suggests that Remdesivir performs its antiviral function and block proteins.

The post The New Experimental Antiviral Drug Test on Monkeys appeared first on Spark Health MD.

Will Labor Day Weekend Bring Another Holiday COVID Surge? Jury’s Out.

Hopefully, summer won’t end the way it began. Memorial Day celebrations helped set off a wave of coronavirus infections across much of the South and West. Gatherings around the Fourth of July seemed to keep those hot spots aflame.

And now Labor Day arrives as those regions are cooling off from COVID-19. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, warned Wednesday that Americans should be cautious to avoid another surge in infection rates. But travelers are also weary of staying home — and tourist destinations are starved for cash.

“Just getting away for an hour up the street and staying at a hotel is like a vacation, for real,” says Kimberly Michaels, who works for NASA in Huntsville, Alabama, and traveled to Nashville, Tennessee, with her boyfriend to celebrate his birthday last weekend.

Lifting Restrictions for Summer’s End

In time for the tail end of summer, many local governments are lifting restrictions to resuscitate tourism activity and rescue small businesses.

Nashville, for instance, gave the green light to pedal taverns this week, allowing the human-powered bars-on-wheels to take to the streets again. “They’re not Nashville’s favorite group, frankly. But fairness requires this protocol change to take place,” Mayor John Cooper said, noting the city’s dramatic reduction in new cases. This week, the city also raised the attendance cap on weddings, funerals and other ceremonies.

Elsewhere, Virginia Beach tried to get some leniency for its struggling restaurants over the holiday weekend. But Virginia Gov. Ralph Northam rejected pleas from the mayor, at the encouragement of Fauci. The country’s top health official has encouraged governors to keep restrictions in place to avoid another holiday-related surge.

“Sometimes, as we start to lift restrictions, the impression that people get is ‘Oh, that must mean it’s safe,’” says epidemiologist Melissa McPheeters of Vanderbilt University. “We want to make sure we don’t give that impression, because this disease has not gone anywhere.”

Some communities have gone the other direction and reimposed restrictions, especially for the three-day weekend. Santa Barbara, California, has banned sunbathing to avoid another surge in cases.

Schooling Screws Up COVID Circles

There’s also a new X-factor with summer’s last holiday weekend. In many states, schools have resumed in-person classes. So families and friends meeting up are now more likely to expose each other to the virus, even if they tried to keep a tight circle over the summer.

“If those bubbles now have kids that went back to school and are interacting with others or they’ve gone back to sports and the bubble has since expanded, that ability to be safely together in a gathering is probably less likely,” says epidemiologist Bertha Hidalgo of the University of Alabama-Birmingham.

And yet, getting together safely — preferably outdoors — is still worth a try, Hidalgo says. She says people’s mental health needs a boost to get through the next few months.

“If you can do the safe things now before winter hits and that cold weather hits, then you’ll be more resilient to get through any bad times that may come,” she says.

In drivable destinations like Nashville that have welcomed visitors throughout the pandemic, tourism has not bounced back entirely. But on some weekend nights, the neon-soaked tourist district can draw a crowd.

This week, Vaj Vemulapalli and his girlfriend, of Dallas, turned back to their hotel after feeling uncomfortable with how tightly people were packed together.

“We crave the social interaction, the going out to bars and everything,” he says. “But at the end of the day, our general stance is it’s not worth getting [COVID-19] just to get a drink.”

Those crowds have limits, though, as Kimberly Michaels and birthday boy Marcus Robinson discovered. They arrived in Nashville fashionably late, masked up and ready to responsibly party. But after they checked into their hotel, they discovered that everything has to shut down by 10:30.

“It’s crazy. It was like the twilight zone,” Robinson says. “We went in [to the hotel], the streets were full. Got dressed, come downstairs. Like, where did everybody go? Like, did something happen? But we didn’t know, because we’re not from here.”

Still, as time goes by, some travelers are willing to take more risks to get back to activities that feel normal.

Suzette Ourso lives outside New Orleans and flew to Nashville for her first out-of-town trip since the pandemic hit. She says she’s cautious, wearing her mask whenever near anyone else.

“I keep hand sanitizer in my purse now. That’s something I’ve never really done before,” she says. “But you can die tomorrow riding in your vehicle. So you can’t live your life in fear, either.”

Ourso has a trip to the beach planned for later in the month.

This story is part of a partnership that includes Nashville Public Radio, NPR and Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Behind The Byline: “At Least I Got the Shot”

[khn_slabs slabs=”350130″ view=”pull-right” /]

Although the coronavirus pandemic shut down many organizations and businesses across the nation, KHN has never been busier ― and health coverage has never been more vital. We’ve revamped our Behind the Byline YouTube series and brought it to Instagram TV.

Journalists and producers from across KHN’s newsrooms take you behind the scenes in these bite-size videos to show the ways they are following the story, connecting with sources and sorting through facts — all while staying safe.

Heidi de Marco – “At Least I Got the Shot”

[khn_slabs slabs=”354965″ view=”pull-right” /]

Photojournalist Heidi de Marco’s stunning images transport viewers to two California hospitals near the U.S.-Mexico border where the influx of patients with COVID-19 overwhelmed local intensive care units in late May. To capture these scenes at El Centro Regional Medical Center in Imperial County and Scripps Mercy Hospital Chula Vista in San Diego County, de Marco donned personal protective equipment and followed each facility’s safety guidelines. Still, she acknowledges, the work increased her risk of exposure to the coronavirus. She also risked bringing the virus home to her family. For her it was worth the risk, in order to give readers a window on health care in the midst of a pandemic — and to share her work with the world.

HHS Plan to Improve Rural Health Focuses on Better Broadband, Telehealth Services

Knowing it may be met with some skepticism, the Trump administration Thursday announced a sweeping plan that officials say will transform health care in rural America.

Even before the coronavirus pandemic reached into the nation’s less-populated regions, rural Americans were sicker, poorer and older than the rest of the country. Hospitals are shuttering at record rates, and health care experts have long called for changes.

The new plan, released by Health and Human Services Secretary Alex Azar, acknowledges the gaps in health care and other problems facing rural America. It lists a litany of projects and directives, with many already underway or announced within federal agencies.

“We cannot just tinker around the edges of a rural healthcare system that has struggled for too long,” Azar said in a prepared statement.

Yet, that is exactly what experts say the administration continues to do.

“They tinker around the edges,” said Tommy Barnhart, former president of the National Rural Health Association. And, he added, “there’s a lot of political hype” that has happened under President Donald Trump, as well as previous presidents.

In the past few months, rural health care has increasingly become a focus for Trump, whose polling numbers are souring as COVID-19 kills hundreds of Americans every day, drives down restaurant demand for some farm products and spreads through meatpacking plants. Rural states including Iowa and the Dakotas are reporting the latest surges in cases.

This announcement comes in response to Trump’s executive order last month calling for improved rural health and telehealth access. Earlier this week, three federal agencies also announced they would team up to address gaps in rural broadband service — a key need as large portions of the plan seek to expand telehealth.

The plan is more than 70 pages long and the word “telehealth” appears more than 90 times, with a focus on projects across HHS, including the Health Resources and Services Administration and the Centers for Medicare & Medicaid Services.

Barnhart said CMS has passed some public health emergency waivers since the beginning of the pandemic that helped rural facilities get more funding, including one that specifically was designed to provide additional money for telehealth services. However, those waivers are set to expire when the coronavirus emergency ends. Officials have not yet set a date for when the federal emergency will end.

Andrew Jay Schwartzman, senior counselor to the Benton Institute for Broadband & Society, a private foundation that works to ensure greater internet access, said there are multiple challenges with implementing telehealth across the nation. Many initiatives for robust telehealth programs need fast bandwidth, yet getting the money and setting up the necessary infrastructure is very difficult, he said.

“It will be a long time before this kind of technology will be readily available to much of the country,” he said.

Ge Bai, associate professor of accounting and health policy at Johns Hopkins University in Baltimore, noted that telehealth was short on funding in the HHS initiative. However, she said, the focus on telehealth, as well as a proposed shift in payment for small rural hospitals and changing workforce licensing requirements, had good potential.

“We are so close to the election that this is probably more of a messaging issue to cater to rural residents,” Bai said. “But it doesn’t matter who will be president. This report will give the next administration useful guidance.”

The American Hospital Association, representing 5,000 hospitals nationwide, sent a letter to Trump last week recommending a host of steps the administration could take. As of late Thursday, AHA was still reviewing the HHS plan but said it was “encouraged by the increased attention on rural health care.”

Buried within the HHS announcement are technical initiatives, such as a contract to help clinics and hospitals integrate care, and detailed efforts to address gaps in care, including a proposal to increase funding for school-based mental health programs in the president’s 2021 budget.

A senior HHS official said that while some actions have been taken in recent months to improve rural health — such as the $11 billion provided to rural hospitals through coronavirus relief funding — more is needed.

“We’re putting our stake in the ground that the time for talk is over,” he said. “We’re going to move forward.”


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 Legislative Shuffle, California Prioritizes Safety Gear and Sick Leave During Crisis

SACRAMENTO — California lawmakers convened this year with big plans to tackle soaring health care costs, expand health insurance coverage and improve treatment for mental health and addiction.

But the pandemic abruptly reoriented their priorities, forcing them to grasp for legislative solutions to the virus ripping through the state.

Legislative deliberations this year were defined by quarantined lawmakers, emergency recesses and chaotic video voting — plus a late-night partisan dust-up that led to the death of dozens of bills by the time lawmakers gaveled out early Tuesday morning. Nonetheless, legislators managed to send Gov. Gavin Newsom nearly 430 bills, roughly 40% of the number they’d send in a typical year, according to Sacramento lobbyist Chris Micheli.

Among them were about two dozen COVID-related bills that addressed a range of challenges, including dire shortages of protective gear, sick leave for workers and the administration of a hoped-for COVID-19 vaccine. The measures broadly fit into three categories: dealing with the current crisis, protecting workers and consumers, and preparing for future pandemics.

Newsom has until Sept. 30 to sign the bills into law or veto them.

“In a year that couldn’t be business as usual, this session we were still able to get important business done for the people of California who are facing so many challenges,” said Senate President Pro Tem Toni Atkins. “This year’s session may be over, but this pandemic is not, and neither is our work.”

Just as important as the measures that made it to Newsom’s desk were the ones that didn’t. For instance, bills that would have limited the use of sensitive personal information in contact tracing investigations died, as did a proposal to help rebuild and fund public health infrastructure across California.

“It leaves us with the status quo,” said Michelle Gibbons, executive director of the County Health Executives Association of California, which lobbies on behalf of the state’s county health directors. “If we had sufficient staffing of public health all along, and stronger resources, it would have helped.”

Immediate Action

Narrowly focused bills that targeted real-time COVID-related problems — and avoided big price tags — were among those easily winning approval.

AB-685, by Assembly member Eloise Gómez Reyes (D-San Bernardino), would require employers to notify their workers of COVID-19 infections at work — and would mandate the reporting of infection data to state and local public health authorities.

A different measure, AB-2164, would require Medi-Cal, California’s Medicaid program, to cover more telehealth visits in underserved areas by eliminating an existing requirement for patients and providers to establish an in-person relationship first.

But this wouldn’t be a permanent change: If signed, the law would sunset 180 days after the official COVID-19 state of emergency is over. Rivas said he had to scale back the cost of the measure by applying it only to the pandemic to get it passed.

“Had we not done that, it was very likely this bill would have been held in the Senate Appropriations Committee,” said Assembly member Robert Rivas (D-Hollister), who introduced the bill.

Another bill written with near missile-guided precision is AB-1710, which would allow pharmacists to administer a COVID vaccine once one is approved by the Food and Drug Administration.

“We want to make sure we can gear up as quickly as possible,” said Assembly member Jim Wood (D-Santa Rosa), who authored the bill.

Wood also authored AB-2644, which would require nursing homes to have a full-time “infection preventionist,” and to report deaths from communicable diseases to the state during an emergency. Wood said the bill was written after he “watched with horror” as COVID-19 killed thousands of nursing home residents in the spring.

Consumer and Worker Protections

Lawmakers took on powerful business interests to boost protections for essential workers.

A bill introduced by Sen. Jerry Hill (D-San Mateo) would make it easier for some employees infected with COVID-19 to file a workers’ compensation insurance claim until January 2023.

Should Newsom sign SB-1159, for instance, state law would presume that certain front-line workers — from health care workers in hospitals to firefighters who go into people’s homes — were infected on the job unless their employers prove otherwise.

The California Chamber of Commerce, which opposed the measure, questioned whether an employee’s illness could be traced to their job when the virus is so widespread. By varying degrees, at least 14 states have extended workers’ compensation to include COVID-related scenarios, according to the National Conference of State Legislatures.

Frustrated with outbreaks at meatpacking plants, lawmakers also advanced legislation calling on food-processing companies with at least 500 workers to provide two weeks of paid sick leave to those exposed to COVID-19 or advised to quarantine.

The measure, AB-1867, spearheaded by Assembly member Phil Ting (D-San Francisco), also would close a loophole in the federal emergency paid sick leave benefit that Congress authorized this spring, which excluded health care workers and emergency responders. If Newsom signs the bill, they too would qualify for two weeks of paid sick time.

And in what would be the biggest expansion to the state’s family leave program since it began in 2004, lawmakers voted to extend job protections to more workers who wish to take time off to care for a new baby or a sick relative.

California’s family leave program currently exempts small-business workers from the job protections, leaving millions of workers without the benefit. For example, an employee who works for a company with 20 or fewer employees does not qualify for job protection to bond with an infant. Employers with 50 or fewer workers aren’t required to guarantee someone’s job if they leave to care for a sick parent or other family member.

In both cases, that would change to employers with five or more workers if the governor signs SB-1383, introduced by Sen. Hannah-Beth Jackson (D-Santa Barbara).

“In the time of COVID, we are relying on families, grandparents, children to take care of each other when they get sick,” Jackson said. “We should be able to protect ourselves, to take responsibility for ourselves, to be able to protect ourselves without fear of losing our jobs.”

Lessons Learned

Inadequate personal protective gear emerged early on as one of the biggest impediments to California’s coronavirus response — and measures advanced by the legislature could prepare the state for future threats.

“We can be more prepared to protect our state in the next health crisis,” said Assembly Speaker Anthony Rendon.

California lawmakers approved a pair of high-profile bills to address protective equipment shortages. The more ambitious proposal, authored by Assembly member Freddie Rodriguez (D-Pomona), would require hospitals to stockpile a three-month supply by April 2021.

“We’ve already lost far too many members to COVID-19,” said Stephanie Roberson, lead lobbyist for the California Nurses Association, which sponsored AB-2537.

“It’s something that could have been prevented,” Roberson said, adding that “it’s the responsibility of employers to protect their workers.”

Newsom also must decide whether the state government should maintain a supply of protective gear for essential workers. SB-275, from Sen. Richard Pan (D-Sacramento) and sponsored by the Service Employees International Union California, would mandate the California Department of Public Health within one year to establish a PPE stockpile for health and other essential workers to last 90 days during a pandemic.

It also would require major employers of health care workers — such as dialysis clinics, nursing homes and hospitals — to establish by 2023 or later an additional 45-day stockpile of PPE.

An August report from the University of California-Berkeley found that at least 20,860 California cases of COVID-19 among essential workers could have been avoided, as well as dozens of deaths, if the state had had a sufficient supply of protective gear.

The powerful California Hospital Association fought both measures, saying the goals are laudable yet unworkable. “We agree that bolstering the supply and reliability of PPE for health care and other essential workers is a top priority,” said spokesperson Jan Emerson-Shea.

“It is critically important to remember, however, that we are still in the midst of a pandemic and there are still significant challenges with the global supply chain of PPE.”

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).

¿Puede este fin de semana de vacaciones disparar otra ola de casos de COVID?

Con suerte, el verano no terminará como comenzó. Las celebraciones de Memorial Day ayudaron a desencadenar una ola de infecciones por coronavirus en gran parte del sur y el oeste de los Estados Unidos. Y las reuniones del 4 de julio dispararon más casos de COVID.

Y ahora llega el Día del Trabajo, cuando esas regiones recién comienzan a registrar una disminución de casos. El doctor Anthony Fauci, director del Instituto Nacional de Alergias y Enfermedades Infecciosas, advirtió el miércoles 2 de septiembre que los estadounidenses deben tener cuidado para evitar otro aumento en las tasas de infección.

Pero la gente está cansada ​​de quedarse en casa, y los destinos turísticos están hambrientos de dinero en efectivo.

“Aunque sea escaparte un par de horas a un hotel cercano son como unas vacaciones de verdad”, dijo Kimberly Michaels, quien trabaja para la NASA en Huntsville, Alabama, y ​​viajó hace pocos días a Nashville, Tennessee, con su novio para celebrar el cumpleaños de él.

Kimberly Michaels y su novio Marcus Robinson manejaron desde Huntsville, Alabama, hasta Nashville, Tennessee, para celebrar el cumpleaños de Robinson. Había mucha gente cuando llegaron pero después el centro quedó vacío. Ellos no sabían que todo cerraba a las 10:30 pm.(BLAKE FARMER/WLPN)

Para el final del verano, muchos gobiernos locales están levantando restricciones para resucitar la actividad turística y rescatar a las pequeñas empresas.

Nashville, por ejemplo, dio luz verde a las tabernas ambulantes, permitiendo que los bares sobre ruedas, impulsados a pedal ​​por humanos, salgan a las calles nuevamente.

“No son el grupo favorito de Nashville, francamente. Pero la justicia requiere que se lleve a cabo este cambio de protocolo”, dijo el alcalde John Cooper, y señaló la dramática reducción de nuevos casos en la ciudad. Lo que llevó a que la primera semana de septiembre se elevara el límite de personas permitido en bodas, funerales y otras ceremonias.

En Virginia, Virginia Beach trató de ser indulgente con sus restaurantes en crisis durante el fin de semana festivo. Pero el gobernador Ralph Northam rechazó las súplicas del alcalde, basándose en las recomendaciones de Fauci. El principal experto en enfermedades infecciosas del país ha alentado a los gobernadores a mantener las restricciones para evitar otro aumento de casos relacionado con las vacaciones.

“A veces, cuando comenzamos a eliminar las restricciones, la gente tiene la impresión de ‘Oh, eso debe significar que es seguro’”, dijo la epidemióloga Melissa McPheeters de la Universidad de Vanderbilt. “Queremos asegurarnos de no dar esa impresión, porque esta enfermedad sigue aquí”.

De hecho, algunas comunidades han vuelto a imponer restricciones, especialmente para el fin de semana largo. Santa Barbara, en California, ha prohibido tomar sol en la playa para evitar otro aumento de casos.

Círculo vicioso: escuelas y COVID

También hay un nuevo factor X en el último fin de semana festivo del verano. En muchos estados, las escuelas han reanudado las clases en persona. Por lo tanto, las familias y los amigos que se encuentran ahora tienen más probabilidades de exponerse mutuamente al virus, incluso si intentaron mantenerse en un círculo cerrado durante el verano.

“Si esas burbujas ahora tienen niños que regresaron a la escuela y están interactuando con otros o han regresado a los deportes y la burbuja se ha expandido, es menos probable que estén en una reunión que sea segura”, explicó la epidemióloga Bertha Hidalgo de la Universidad de Alabama-Birmingham.

Y, sin embargo, vale la pena intentar estar juntos de manera segura, preferiblemente al aire libre, dijo Hidalgo. La experta aseguró que la salud mental de las personas necesita un impulso para pasar los próximos meses.

“Si puedes hacer las cosas de manera segura ahora, antes que llegue el invierno y el clima frío, entonces serás más resistente para superar los malos momentos que puedan venir”, opinó.

En destinos como Nashville que han dado la bienvenida a los visitantes durante la pandemia, el turismo no se ha recuperado por completo. Pero algunas noches de fin de semana, el distrito turístico colmado de luces de neón puede atraer multitudes.

La primera semana de septiembre, Vaj Vemulapalli y su novia, de Dallas, regresaron a su hotel después de sentirse incómodos con lo apretada que estaba la gente.

“Extrañamos la interacción social, ir a bares”, dijo. “Pero al final del día, nuestra postura general es que no vale la pena adquirir COVID-19 sólo por beber”.

Sin embargo, esas multitudes tienen límites, como descubrieron Kimberly Michaels y el cumpleañero Marcus Robinson. Ellos llegaron a Nashville con máscaras y listos para tener una fiesta responsable. Pero después de registrarse en su hotel, descubrieron que todo tenía que cerrar a las 10:30pm.

“Es una locura. Era como una zona en penumbras”, contó Robinson. “Entramos [al hotel], las calles estaban llenas. Nos cambiamos, salimos y nos preguntamos ‘¿a dónde fueron todos? ¿Pasó algo?’ No sabíamos nada porque no somos de aquí”.

Aún así, a medida que pasa el tiempo, algunos viajeros están dispuestos a correr más riesgos para volver a actividades que sienten normales.

Suzette Ourso vive en las afueras de Nueva Orleans y voló a Nashville para su primer viaje fuera de la ciudad desde la pandemia. Dijo que es cautelosa y usa su máscara cuando está cerca de alguien.

“Ahora tengo desinfectante de manos en mi bolso. Nunca lo había tenido antes”, dijo. “Pero puedes morir mañana viajando en tu vehículo. Así que tampoco puedes vivir tu vida con miedo”.

Ourso tiene planeado un viaje a la playa para finales de septiembre.

Esta historia es parte de una alianza entre Nashville Public Radio, NPR y Kaiser Health News.