Category: From California Healthline.org

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

Former health care executive Wendell Potter spent part of 2020 publishing high-profile apologies for the work he used to do — the lies he said he told the American people for his old employers. These days, he said, he’s also trying to debunk myths he once sold.

“What I used to do for a living was mislead people into thinking that we had the best health care system in the world,” Potter said.

In this episode, Potter talks about his transformation from health care executive to  health care whistleblower. His is also a story about the long, messy process of change — whether that’s changing your own life or trying to change a bigger system.

Here’s a transcript of the episode.

“An Arm and a Leg” is a co-production of Kaiser Health News and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

To hear all Kaiser Health News podcasts, click here.

And subscribe to “An Arm and a Leg” on iTunes, Pocket Casts, Google Play or Spotify.

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).

As the rollout of covid-19 vaccines picks up across the U.S., moving from hospital distribution to pharmacies, pop-up sites and drive-thru clinics, health experts say it’s vital that these expanded venues be prepared to handle rare but potentially life-threatening allergic reactions.

“You want to be able to treat anaphylaxis,” said Dr. Mitchell Grayson, an allergist-immunologist with Nationwide Children’s Hospital in Columbus, Ohio. “I hope they’re in a place where an ambulance can arrive within five to 10 minutes.”

Of the more than 6 million people in the U.S. who have received shots of the two new covid vaccines, at least 29 have suffered anaphylaxis, a severe and dangerous reaction that can constrict airways and send the body into shock, according to the Centers for Disease Control and Prevention.

Such incidents have been rare — about 5.5 cases for every million doses of vaccine administered in the U.S. between mid-December and early January — and the patients recovered. For most people, the risk of getting the coronavirus is far higher than the risk of a vaccine reaction and is not a reason to avoid the shots, Grayson said.

Still, the rate of anaphylaxis so far is about five times higher for the covid vaccines than for flu shots, and some of those stricken had no history of allergic reactions. In this early phase of the vaccine rollout, all the patients were treated in hospitals and health centers that could offer immediate access to full-service emergency care.

As states look to scale up distribution, the shots will be administered by a varied assortment of professionals at venues including drugstores, dental offices and temporary sites attended by National Guard troops, among others. Health officials say every site involved in the wider community rollout must be able to recognize problems and have the training and equipment to respond swiftly if something goes wrong.

“We are really pushing to make sure that anybody administering vaccines needs not just to have the EpiPen available but, frankly, to know how to use it,” said Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, in a call with reporters. She was referring to a common epinephrine injector that many people with severe allergies carry with them. Those health care workers must also know the warning signs of the need for advanced care, she added.

Anaphylaxis typically occurs within minutes and can cause hives, nausea, vomiting, dizziness or fainting, and life-threatening problems such as low blood pressure and constricted airways. Initial treatment is an injection of epinephrine, or adrenalin, to reduce the body’s allergic response. However, severely affected patients can require intensive treatments including oxygen, IV antihistamines and steroids such as cortisone to save their lives. Community sites are unlikely to have these treatments on hand and would need quick access to emergency responders.

Anybody administering vaccines needs not just to have the EpiPen available, but, frankly, to know how to use it.

Dr. Nancy Messonnier, CDC

Scientists are still investigating what’s triggering the severe reactions to the Pfizer-BioNTech and Moderna mRNA vaccines. They suspect the culprit may be polyethylene glycol, or PEG, a component present in both vaccines that has been associated with allergic reactions.

Even as they call for education and support for providers, experts are urging the more than 50 million Americans with allergies — whether to foods, insect venom, medications or other vaccines — to be proactive about finding a venue that’s properly prepared. Before scheduling a vaccine, contact the site and ask pointed questions about its emergency precautions, said Dr. Kimberly Blumenthal, quality and safety officer for allergy at Massachusetts General Hospital.

“Ask the question: Do they have an anaphylaxis kit? Can they take vital signs?” she said. People who routinely carry EpiPens should remember to bring them when they are vaccinated, she added.

A CDC website details a list of equipment and medications that sites should have on hand and urges that all patients be observed for 15 minutes after vaccination or 30 minutes if they’re at higher risk for reactions. The list recommends — but does not require — that sites stock the more intensive treatments, such as IV fluids. People who experience severe reactions shouldn’t get the recommended second dose of the vaccine, the agency said.

“Appropriate medical treatment for severe allergic reactions must be immediately available in the event that an acute anaphylactic reaction occurs following administration of an mRNA COVID-19 vaccine,” the site says.

Still, that’s a tall order, given the scope of the vaccination effort. The federal government is sending vaccines to more than 40,000 pharmacy locations involving 19 chains, including CVS, Walgreens, Costco and Rite Aid. At the same time, dozens of pop-up inoculation sites are ramping up in New York City, and drive-thru clinics have been set up in Ohio, Florida and other states.

Drive-thru sites, in particular, worry allergists like Blumenthal, who said it’s crucial to recognize symptoms of anaphylaxis quickly. “If you’re in a car, are you going to have your windows open? Where are the medicines? Are you in a parking lot?” she said. “It just sounds logistically more challenging.”

Ask the question: Do they have an anaphylaxis kit? Can they take vital signs?

Dr. Kimberly Blumenthal, Massachusetts General Hospital

In Columbus, more than 2,400 people had been vaccinated by Jan. 6 at a drive-thru clinic set up at the Ohio Expo Center. No allergic reactions have been reported, according to Kelli Newman, a spokesperson for Columbus Public Health. But if they occur, she said, health officials are prepared.

“We have a partnership with our EMS and they are observing those being vaccinated for 15 minutes to make sure there are no adverse reactions,” Newman said in an email. “They have two EMS trucks available with emergency equipment and epinephrine, if needed.”

Similarly, representatives for CVS Health and Walgreens said they have the staff and supplies to handle “rare but severe” reactions.

“We have emergency management protocols in place that are required for all vaccine providers, which, following a clinical assessment, may include administering epinephrine, calling 911 and administering CPR, if needed,” Rebekah Pajak, a spokesperson for Walgreens, said in an email.

If the vaccine sites have appropriately trained staffers, plus adequate supplies and equipment, the vast majority of people should opt for the shot, especially as the pandemic continues to surge, said Dr. David Lang, immediate past president of the American Academy of Allergy, Asthma & Immunology and chairman of the department of immunology at the Cleveland Clinic.

“The overwhelming likelihood is that you won’t have anaphylaxis and the overwhelming benefit far exceeds the risk for harm,” Lang 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).

Keely Connolly thought she would be safe once the ambulance arrived at Hutchinson Regional Medical Center in Kansas.

She was having difficulty breathing because she’d had to miss a kidney dialysis treatment a few days earlier for lack of child care. Her potassium was dangerously high, putting her at risk of a heart attack. But she trusted she would be fine once she was admitted and dialysis was begun.

She panicked when a nurse told her that no beds were available and that she would have to be transferred — possibly more than 450 miles away to Denver. She had heard a rumor about a dialysis patient who died waiting for a bed at a hospital in Wichita, about an hour down the road.

“‘I don’t want to die in the ER,’” Connolly, 32, recalled thinking. “I just wanted them to fix me, but then the woman came in and said, ‘There are no beds.’ I got really scared and I didn’t know if they had time to get me anywhere else.”

When a bed was finally located 65 miles away in Salina, Connolly, who has kidney failure, was relieved but worried: How long would she be gone? Who would care for her young daughter? How would she get home? What would it all cost?

Connolly was caught in a situation experts have warned about since the beginning of the coronavirus pandemic: Covid-19 patients are overwhelming hospitals, squeezing space and staff needed to treat emergencies like Connolly’s.

While it has happened in pockets throughout the country since the spring, the pressure on hospitals is widespread now — reaching into both urban and rural communities at an alarming pace, even as local officials and citizens continue to slam public health departments and pandemic guidelines. Traveling nurses are hard to come by as their services are in high demand nationwide and their pay has escalated beyond the reach of some smaller hospitals.

“This is the first time since I have been here that we’ve had a scenario where multiple hospitals, for longer periods of time, are experiencing some kind of shortages,” said Cindy Samuelson, a senior vice president of the Kansas Hospital Association.

And it got worse after Connolly’s emergency in mid-November. The 14-day rolling average positive test rate in Reno County, where Hutchinson is the county seat, reached 46% on Dec. 22, though it has since come down to 24% as of Jan. 4, said D.J. Gering, data analyst for the Reno County Health Department. The results did not include inmates from the Hutchinson Correctional Center, the local state prison.

By Oct. 1, four covid deaths had been recorded in the county of about 62,000. By Jan. 4, the death toll since the pandemic began had jumped to 105. For comparison, Gering said, Reno County had 19 deaths attributed to pneumonia and influenza combined in all of 2019.

Hospitalizations at the 190-licensed-bed Hutchinson Regional Medical Center increased 800% from mid-October to mid-December then started to temper at the end of the month, said Chuck Welch, vice president of Hutchinson Regional Medical System.

“I hate to be overly optimistic until we are well past the possible holiday surge from Christmas and New Year’s,” he said in an email.

Operating between 90% and 95% capacity, the hospital is providing care to patients with a multitude of needs and still has room to expand. The problem, Welch said, has been staffing.

Competing for traveling nurses and specialists against larger hospitals to backfill positions open from sick or quarantining staffers has been challenging. When the hospital has been faced with increasing numbers of covid patients seeking emergency care, handling “normal” emergencies like Connolly’s has been much more difficult, Welch said.

While staffers work to transfer patients as close to home as possible, with so many hospitals in Kansas beyond capacity, it has become more common than before to transfer as far away as Colorado and Nebraska. Such transfers require medical flights, which are typically not covered by insurance and can cost patients upward of $50,000, Welch said.

“It is collateral damage,” he said. “It is something that has sort of been lost out of the narrative of these folks where everybody is relieved when we find them a bed. Everybody forgets about the downstream impact of the cost of those transports.”

Connolly recovered after three days in the Salina hospital. But the question still looms about the costs for her emergency care. Connolly had left her job as a corrections officer at the prison in September because coronavirus cases began to spike inside. Without her employer-sponsored health insurance, Connolly now relies on Medicaid and Medicare Part A, which means she is responsible for more out-of-pocket costs for things like pharmaceuticals and ambulance services.

Connolly worries so much about her finances that she’s been too scared to look at her recent ambulance bills. Being a single parent, living with kidney failure and undergoing dialysis during a pandemic are her primary concerns.

As with many underlying conditions, covid-19 appears to pose an extra risk for people with kidney failure and patients undergoing dialysis, said Dr. Alan Kliger, a nephrologist at Yale University and co-chair of the American Society of Nephrology’s COVID-19 Response Team.

Data from New York and Europe early in the pandemic showed that about 1 in 5 dialysis patients who acquired covid died, he said. However, the complication and mortality rates have fallen in recent months, according to unpublished survey data from members of the nephrology society, Kliger said.

“It’s still a high risk,” he said.

For Connolly, the pandemic has also complicated her three-times-a-week 3½-hour dialysis schedule. For example, when her daughter’s kindergarten class was told to quarantine for 14 days after an in-class exposure to the virus, she had to scramble to find babysitters so she could attend dialysis.

“I don’t want too many people to watch her because of covid,” Connolly said of her daughter, adding that she is lucky the girl’s father is supportive. But he can’t always step in, which means if Connolly can’t find a sitter, she may have to skip or reschedule dialysis.

Connolly wants to get another job. But living in a county where so many refuse to wear masks and some elected leaders accuse the health department of providing false information about covid testing rates and statistics makes her afraid to be in public more than necessary.

“I want to work,” she said. “I had a good job. I served my community. The reality of knowing how bad it is at the hospital — I have seen it firsthand. And now I am out and seeing people without masks and I am thinking, ‘If I get this and I have to go back, I may not leave the hospital next time.’”

The reality, said Kliger, Welch and others, is that while the virus runs rampant, hospitals will struggle to keep up, which potentially endangers medical staffers and anyone needing hospital care — and the virus will continue to spread as long as people refuse to wear masks and disregard scientifically sound guidelines.

Connolly said she would love to see more empathy for people who have underlying health concerns like her from those resisting safety measures such as masks.

“Even if they think that it doesn’t work, what if it does? What if it could? I don’t really understand how wearing a mask is going to take so much out of your day, compared to someone who is immunocompromised and gets sick,” said Connolly. “Or you lose your grandma, or your parent. That’s going to affect your life a lot longer than wearing a mask for a little while.”

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).

Use Our Content

It can be republished for free.

Democrats have argued for more generous pandemic relief, more pressure on drugmakers to lower prices and more attention to systemic racism in health care. On Jan. 20, with control of the Senate and the House of Representatives, they’ll have the power to choose which health care proposals get a vote in Congress.

The victories of the Rev. Raphael Warnock and Jon Ossoff in Georgia last week gave Democrats two more Senate seats and the upper hand in the Senate’s now 50-50 split. After Vice President-elect Kamala Harris takes the oath of office, she will serve as the tiebreaker as needed — in effect, Democrats’ 51st vote.

But that vote count is too small to eliminate the filibuster, meaning Democrats will not have enough votes to pass many of their plans without Republicans. That will likely doom many Democratic health care proposals, like offering Americans a government-sponsored public insurance option, and complicate efforts to pass further pandemic relief.

It remains to be seen how willing lawmakers are to compromise with one another in the aftermath of a pro-Trump mob’s breach of the Capitol on Wednesday. Thursday, Democrats demanded the president’s removal for inciting rioters who disrupted the certification of President-elect Joe Biden’s victory, assaulted Capitol Police officers and damaged federal property. One demonstrator and a police officer were killed, and three demonstrators died of medical emergencies.

Democrats’ slim margins in the Senate and the House — where they can afford to lose only four votes and still pass legislation — will also give individual lawmakers more leverage, handing those who disagree with party leaders an incentive to push their own priorities in exchange for their votes. There will be little room for intraparty disagreements, and Democrats made it clear during the presidential primaries that they disagree about how to achieve their health care goals.

In less than two weeks, Democrats will lead the committees charged with marking up health care legislation and vetting Biden’s health nominees.

The change will hand control of the Senate Health, Education, Labor and Pensions Committee to Sen. Patty Murray (D-Wash.), who brokered the 2013 agreement with then-House Speaker Paul Ryan that ended a long government shutdown, among other bipartisan deals.

In 2019, Murray and the committee’s Republican chairman, Sen. Lamar Alexander of Tennessee, introduced a wide-ranging package to lower health costs for consumers. Among its proposals was an initiative to lower prescription drug prices by eliminating loopholes that allow brand-name drugmakers to block competition.

In an interview before Democrats secured the Senate, Murray said her committee work will be focused on the problems that prevent all Americans from receiving equitable, affordable treatment in health care. Racial disparities, evidenced by disproportionate mortality rates among Black mothers and among communities of color suffering the worst impacts of the pandemic, will be a priority, she said.

“Not everybody goes into the doctor and gets the same advice, feels the same comfort level and is believed,” Murray said.

Murray said she will press for senators to consider how any piece of legislation will affect communities of color. “It will be the question I ask about every step we take,” she said.

On Wednesday, she called out Republicans for standing in the way of fighting the pandemic “with policies that would directly help those struggling the most and would help us build back from this crisis stronger and fairer.”

“With a Biden-Harris Administration and a Senate Democratic majority, the challenges we face won’t get any less tough — but we’ve finally got the opportunity to face them head on and start taking action,” Murray said in a statement. “I can’t wait to start getting things done.”

The Senate Finance Committee, which oversees Medicare, Medicaid and health-related tax policies, will be run by Sen. Ron Wyden (D-Ore.). While the HELP committee will also hold a confirmation hearing for Biden’s nominee for secretary of the Department of Health and Human Services, Xavier Becerra, it is the Finance Committee that will vote to advance his confirmation.

Senate Republicans signaled they would delay considering Becerra’s nomination before Biden officially announced his name last month. Calling him unqualified due to his lack of a health care background, they questioned his support for a single-payer health care system and opposed his efforts to preserve abortion rights. As California’s attorney general, Becerra led efforts to fight lawsuits brought by Republican state officials against the Affordable Care Act.

But Democrats’ slim edge in the Senate is expected to be enough to drown out Republicans’ objections to the nomination. Last month, praising Becerra’s commitment to responding to the pandemic, protecting health care coverage and addressing racial disparities, Wyden said he looked forward to Becerra’s hearing “so he can get on the job and start helping people during this unprecedented crisis.”

Also, after months of decrying the Trump administration’s failures managing the pandemic, Democrats will control which relief bills get a vote.

Last month’s package did not include their demands for more funding for state and local governments, and House Republicans blocked a Democratic effort to increase stimulus checks to $2,000, from $600.

Democrats have been united in their calls for more assistance, though they have disagreed at times about how to push for it.

In the fall, with the election approaching and no deal in sight, moderate Democrats in tough races pushed for House Speaker Nancy Pelosi to abandon negotiations for a $2.2 trillion relief package that Republicans called a nonstarter in favor of passing more modest but desperately needed relief.

“Every member of the leadership team, Democrats and Republicans, have messed up. Everyone is accountable,” Rep. Max Rose (D-N.Y.) told Politico. “Get something done. Get something done!” He lost his bid for reelection.

More progressive voices like Rep. Alexandria Ocasio-Cortez (D-N.Y.) and Sen. Bernie Sanders (I-Vt.) have been a force for more generous aid, particularly larger stimulus checks.

Beyond the pandemic, top Democrats have mentioned drug pricing as another area ripe for action. But one of their most popular proposals, which would authorize the federal government to negotiate drug prices for those on Medicare, is unlikely to attract the Republican votes it would need. When House Democrats passed one such proposal in 2019, Senate Republicans vowed it would never pass.

Members of Democrats’ more progressive wing, for their part, argued the proposal may not go far enough.

After years of Republican efforts to undermine the Affordable Care Act, though, it looks likely that efforts to stabilize the law could gain more traction under a Democratic-controlled Congress. The House passed legislation last summer aimed at increasing coverage and affordability, including by capping insurance costs at no more than 8.5% of income and expanding subsidies.

Lawmakers like Murray and Wyden have been quick to point out that the pandemic’s devastating consequences — lost jobs and lost insurance coverage, to name just a couple — have only underscored the need to strengthen the health care system.

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).

Ante la pandemia, los demócratas han abogado por ayudas más generosas, más presión sobre las farmacéuticas para que bajen los precios y más atención al racismo sistémico en la atención de salud.

El 20 de enero, con el control del Senado y la Cámara de Representantes, tendrán el poder de elegir qué propuestas de salud se votarán en el Congreso.

Las victorias del reverendo Raphael Warnock y Jon Ossoff en Georgia dieron a los demócratas dos escaños más en el Senado y la ventaja en un Senado dividido 50-50. Cuando la vicepresidenta electa, Kamala Harris, jure el cargo, su voto servirá como desempate, convirtiéndose así en el voto 51 de los demócratas.

Pero este estrecho margen de votos no eliminará el “filibusteo” (discursos obstruccionistas y dilatorios), lo que significa que los demócratas no tendrán suficientes votos para aprobar muchos de sus planes sin los republicanos.

Eso pondrá en peligro muchas propuestas demócratas de salud, como la de ofrecer a los estadounidenses una opción de seguro público patrocinada por el gobierno, y complicará los esfuerzos para aprobar más ayudas para la pandemia.

Queda por ver si los legisladores serán más proclives al compromiso después que una turba pro-Trump invadiera el Capitolio, el 6 de enero, atacando a la policía y dañando propiedad federal. Hubo cinco muertos.

Los estrechos márgenes de los demócratas en el Senado y en la Cámara de Representantes — donde pueden permitirse perder cuatro votos y aun así aprobar una legislación— también darán más influencia a algunos legisladores que, al no estar de acuerdo con los líderes de sus partidos, tendrán un incentivo para impulsar sus propias agendas a cambio de sus votos.

Habrá poco espacio para los desacuerdos intrapartidarios; y los demócratas dejaron claro, durante las primarias presidenciales, que no están todos de acuerdo sobre cómo lograr sus objetivos de salud pública.

En menos de dos semanas, los demócratas dirigirán los comités encargados de establecer la legislación sobre salud y de examinar a los nominados de Biden en esta área.

El control del Comité de Salud, Educación, Trabajo y Pensiones del Senado pasará a la senadora Patty Murray, demócrata de Washington, quien negoció el acuerdo de 2013 con el entonces presidente de la Cámara de Representantes, Paul Ryan, que puso fin a un largo cierre del gobierno, entre otros acuerdos bipartidistas.

En 2019, Murray y el presidente republicano del comité, el senador Lamar Alexander, de Tennessee, introdujeron un amplio paquete legislativo para reducir los costos de salud. Entre sus propuestas se encontraba una iniciativa para bajar los precios de los medicamentos recetados, mediante la eliminación de las lagunas legales que permiten a los fabricantes de medicamentos de marca bloquear a la competencia.

Durante una entrevista, antes de que los demócratas se aseguren el Senado, Murray dijo que el trabajo de su comité se centrará en los problemas que impiden a los estadounidenses recibir un tratamiento médico equitativo y asequible.

La prioridad, dijo, serán las disparidades raciales, evidenciadas por los desproporcionados índices de mortalidad entre las madres de raza negras, y entre las comunidades de color, que sufren los peores impactos de la pandemia de covid-19.

“No todos los que acuden al médico reciben la misma atención, sienten el mismo nivel de comodidad y muchas veces no se les cree”, dijo Murray.

Murray aseguró que presionará a los senadores para que consideren el impacto en las comunidades de color de cada pieza legislativa. “Esa será la cuestión en cada paso que demos”, añadió.

El miércoles 6, pidió a los republicanos que se incorporen a la lucha contra la pandemia “con políticas que ayuden directamente a los que más sufren y que nos ayuden a salir de esta crisis con más fortaleza y justicia”.

“Con una administración Biden-Harris y una mayoría demócrata en el Senado, los desafíos que enfrentamos no serán menores, pero finalmente tenemos la oportunidad de enfrentarlos y comenzar a tomar medidas”, declaró Murray. “Estoy deseando ponerme manos a la obra”.

El Comité de Finanzas del Senado, que supervisa Medicare, Medicaid y las políticas fiscales relacionadas con la salud, estará encabezado por el senador Ron Wyden, demócrata de Oregon.

Si bien el comité HELP también celebrará una audiencia de confirmación para Xavier Becerra, el candidato de Biden a la Secretaría del Departamento de Salud y Servicios Humanos; es el Comité de Finanzas el que votará para avanzar su confirmación.

En diciembre, los republicanos del Senado amenazaron con retrasar la nominación de Becerra antes de que Biden lo anunciara oficialmente. Los republicanos le reprochan a Becerra su falta de experiencia en el campo de la salud, cuestionan su apoyo a un sistema de salud de un solo pagador y se oponen a su defensa del derecho al aborto.

Como fiscal general de California, Becerra se enfrentó a las demandas presentadas por los funcionarios estatales republicanos contra la Ley de Cuidado de Salud A Bajo Precio (ACA).

Pero se espera que la escasa ventaja de los demócratas en el Senado sea suficiente para rechazar las objeciones de los republicanos a la nominación.

El mes pasado, Wyden alabó el compromiso de Becerra para responder a la pandemia, proteger la cobertura de los cuidados de salud y abordar las disparidades raciales; y dijo que esperaba con interés la audiencia de Becerra “para que pueda ponerse a trabajar y empezar a ayudar a la gente durante esta crisis sin precedentes”.

Además, después de meses de denunciar los fracasos de la administración Trump en el manejo de la pandemia, los demócratas controlarán qué proyectos de ley de ayuda se votarán.

El paquete del mes pasado no incluyó sus demandas de más fondos para los gobiernos estatales y locales, y los republicanos de la Cámara de Representantes bloquearon una iniciativa demócrata que pretendía aumentar los cheques de estímulo de $600 a $2,000.

Los demócratas se han unido en sus demandas de más ayuda, aunque a veces han estado en desacuerdo sobre cómo llevarla a cabo.

En el otoño, con las elecciones cerca y sin ningún acuerdo a la vista, los demócratas moderados, que buscaban ganar su propia elección, presionaron a la presidenta de la Cámara de Representantes, Nancy Pelosi, para que abandonara las negociaciones por un paquete de ayuda de $2,2 billones, que los republicanos calificaron como un fracaso, y aprobara una ayuda más modesta pero desesperadamente necesaria.

“Tanto el liderazgo demócrata, como el republicano, ha metido la pata. Todos son responsables”, declaró a Politico el representante Max Rose, demócrata de Nueva York. “Hagan algo ¡Hagan algo!” Rose perdió la reelección.

Voces más progresistas, como la de la representante Alexandria Ocasio-Cortez, demócrata de Nueva York, y el senador Bernie Sanders, independiente de Vermont, han presionado a favor de una ayuda más generosa, con mayores cheques de estímulo.

Más allá de la pandemia, el liderazgo demócrata ha mencionado el precio de los medicamentos como otra área de acción. Pero una de sus propuestas más populares, que autorizaría al gobierno federal a negociar los precios de los medicamentos para quienes están en Medicare, es poco probable que atraiga los votos republicanos que necesitaría.

Cuando los demócratas de la Cámara de Representantes aprobaron una de estas propuestas en 2019, los senadores republicanos aseguraron que ellos nunca la aprobarían.

Los miembros del ala más progresista de los demócratas, por su parte, argumentaron que la propuesta no era suficientemente agresiva.

Sin embargo, después de años de esfuerzos republicanos por socavar ACA, parece probable que la estabilización de la ley pueda cobrar fuerza en un Congreso controlado por los demócratas.

La Cámara de Representantes aprobó, el verano pasado, una legislación destinada a aumentar la cobertura y la asequibilidad, incluyendo la limitación de los costos de los seguros a no más del 8,5% de los ingresos y la ampliación de los subsidios.

Legisladores como Murray y Wyden se han apresurado a señalar que las consecuencias devastadoras de la pandemia, la pérdida de puestos de trabajo y la pérdida de cobertura del seguro, por nombrar sólo dos, han puesto de relieve la necesidad de fortalecer el sistema de salud.

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).

KHN Editor-in-Chief Elisabeth Rosenthal discussed issues with the U.S. rollout of the covid-19 vaccines with NPR’s “Weekend Edition” and MSNBC’s “The Week With Joshua Johnson” on Jan. 3.

• Click here to hear Rosenthal on NPR
• Click here to watch Rosenthal on MSNBC

KHN chief Washington correspondent Julie Rovner discussed covid’s impact on current politics with WAMU’s “1A” on Dec. 31.

• Click here to hear Rovner on WAMU

KHN Midwest correspondent Lauren Weber discussed covid in a 2020 news roundup on WAMU’s “1A” on Dec. 31.

• Click here to hear Weber on WAMU

KHN senior correspondent Phil Galewitz discussed deep cleaning the White House before the Bidens arrive with Newsy on Dec. 23.

• Click here to watch Galewitz on Newsy
• Read Galewitz’s “As Biden Gets Sworn In, White House Will Get Scrubbed Down”

KHN Midwest correspondent Cara Anthony discussed what it’s like to be a reporter during a pandemic with St. Louis Public Radio’s “We Live Here.”

• Click here to hear Anthony on St. Louis Public Radio

With supplies of covid-19 vaccines scarce, a federal advisory panel recommends first putting shots into the arms of health care workers, who keep the nation’s medical system running, and long-term care residents most likely to die from the coronavirus.

Nowhere on the list of prioritized recipients are public officials’ spouses.

Yet the first ladies of Kentucky and West Virginia; Republican Vice President Mike Pence’s wife, Karen Pence; Democratic President-elect Joe Biden’s wife, Jill Biden; and Vice President-elect Kamala Harris’ husband, Doug Emhoff, were among the first Americans to get the potentially lifesaving shots.

Kentucky also vaccinated six former governors and four former first ladies, including current Democratic Gov. Andy Beshear’s parents.

The early vaccinations of political spouses spurred outrage on social media, with several Twitter users saying they should not be able to “jump the line” ahead of doctors, nurses and older people.

In most of the 29 states that responded to KHN inquiries of all 50 governors’ offices, top elected officials said they — and their spouses — will be vaccinated but have chosen to wait their turn behind more vulnerable constituents. Some Congress members from both parties said much the same when they refused early doses offered in the name of keeping the government running. Those weren’t offered to their spouses.

Governors who got the shots along with their spouses, and the vice president’s office, said they wanted to set an example for residents, build trust, bridge ideological divides and show that the vaccine is safe and effective.

But that’s a rationale some critics don’t buy.

“It looks more like cutting in line than it does securing trust. The politicians can get the hospitals to give it to them under this illusion of building trust. But it’s a façade,” said Arthur Caplan, a bioethics professor and founding head of the medical ethics division at New York University Grossman School of Medicine. “People might say: ‘Yup, typical rich people. They can’t be trusted.’ This undermines what they set out to do.”

Besides, Caplan said, the public doesn’t trust politicians all that much anyway, so inoculating celebrities, religious leaders or sports figures would likely do more to boost confidence in the vaccine. Rock ’n’ roll king Elvis Presley famously got the polio vaccine in 1956 to help win over those who were skeptical; the actions of governors’ wives from that period are less remembered.

Dr. José Romero, chairperson of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, said in an email to KHN that while his group provides an outline for distributing limited vaccine doses, “jurisdictions have the flexibility to do what’s appropriate for their population.” Kentucky and Texas officials pointed out that CDC Director Dr. Robert Redfield encouraged governors to publicly get the vaccine.

No one mentioned medical reasons for their spouses to get vaccines; hospitals are generally not vaccinating the spouses of medical professionals who have gotten the shot. (It’s unclear whether vaccinated people can still spread the virus, so it’s possible that a vaccinated person could pass the virus to their spouse or have to quarantine if an unvaccinated spouse were to get covid.)

The office of West Virginia’s governor, Republican Jim Justice, released pictures of him, his wife, Cathy Justice, and other officials receiving shots. He also showed his own vaccination on YouTube.

Beshear’s office in Kentucky also released photos of him getting the vaccine in December on the same day as his wife, Britainy Beshear, and other state officials.

“There is no question that there is vaccine hesitancy out there,” Beshear said at a coronavirus briefing on Monday, the day former Kentucky governors and their spouses were vaccinated. He alluded to a future program involving faith leaders and others. “Validators are incredibly important to building that confidence.”

His father, Democratic former Gov. Steve Beshear, posted photos of his vaccination on his Facebook page, saying that he and his wife, Jane Beshear, along with other former Kentucky governors of both parties and their spouses, stepped up partly to show residents the vaccine is safe and encourage them to get it when it’s available to them.

Kentucky is currently in the first stage of vaccine distribution, which targets health care workers and residents of long-term care and assisted living facilities. Fewer than 15,000 of the 58,500 doses received for long-term care had been given out when the former governors and their spouses were vaccinated.

Tres Watson, a former communications director for the Republican Party of Kentucky who founded a political consulting firm, was skeptical about the intentions behind the event. He said it seemed to be a public relations effort created so the governor could vaccinate his parents.

“I understand the continuity of government, but first ladies have no part in the continuity of government,” he said. “You need to stick with the priorities. Once you start making exceptions, that’s when you run into problems.”

Officials representing the Biden-Harris transition team and three other states where governors got vaccinated — Republican-led West Virginia and Texas, and Democratic-led Kansas — either didn’t respond to KHN or didn’t answer questions about spouses. Alabama’s Republican governor, Kay Ivey, got the vaccine and is divorced.

Politicians in other states have taken the opposite tack.

In Arkansas, Republican Gov. Asa Hutchinson is focused on ensuring high-priority groups such as health care workers, long-term care staffers and residents are vaccinated, said spokesperson LaConda Watson. “He and his wife will receive the vaccination when it’s their turn,” she said.

In Missouri, Kelli Jones, communications director for Republican Gov. Mike Parson, said in an email that he and the first lady fully intend to get the vaccine. Like governors from Colorado, Nevada and elsewhere, they’ve both recovered from covid-19, Jones said, and will “wait until their age group is eligible” under the state plan. Doctors recommend vaccinations even for people who have already had covid.

Cissy Sanders, 52, an events manager who lives in Austin, Texas, said she understands why lawmakers would need to get the vaccine. Her own governor, Republican Greg Abbott, received it on live television to instill confidence, said his press secretary, Renae Eze, who wouldn’t address whether Abbott’s wife was vaccinated.

But Sanders said politicians’ spouses should not be vaccinated before nursing home residents like her 71-year-old mom. Sanders’ mother received the vaccine in late December — after some public officials’ spouses — but she said far too many nursing home residents across America are still waiting.

“Why is a non-high-risk group — i.e., these spouses — going before the most high-risk group? Who makes these decisions? Who thinks this is a good, responsible, safe decision to make?” she said. “Political spouses have not been at ground zero for the virus. Nursing home residents have been.”

KHN Montana correspondent Katheryn Houghton, California Healthline correspondent Angela Hart and KHN senior correspondents Markian Hawryluk and JoNel Aleccia contributed to this report.

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

The party split in Congress is so slim that, even with Democrats technically in the majority, passing major health care legislation will be extremely difficult. So speculation about President-elect Joe Biden’s health agenda has focused on the things he can accomplish using executive authority. Although there is a long list of things he could do, even longer is the list of things he is being urged to undo — actions taken by President Donald Trump.

While Trump was not able to make good on his highest-profile health-related promises from his 2016 campaign — including repealing the Affordable Care Act and broadly lowering prescription drug prices — his administration did make substantial changes to the nation’s health care system using executive branch authority. And many of those changes are anathema to Democrats, particularly those aimed at hobbling the ACA.

For example, the Trump administration made it easier for those who buy their own insurance to purchase cheaper plans that don’t cover all the ACA benefits and may not cover preexisting conditions. It also eliminated protections from discrimination in health care to people who are transgender.

Trump’s use of tools like regulations, guidance and executive orders to modify health programs “was like an attack by a thousand paper cuts,” said Maura Calsyn, managing director of health policy at the Center for American Progress, a Democratic think tank. Approaching the November election, she said, “the administration was in the process of doing irreparable harm to the nation’s health care system.”

Reversing many of those changes will be a big part of Biden’s health agenda, in many cases coming even before trying to act on his own campaign pledges, such as creating a government-sponsored health plan for the ACA.

Chris Jennings, a health adviser to Presidents Barack Obama and Bill Clinton, said he refers to those Trump health policies as “bird droppings. As in you have to clean up the bird droppings before you have a clean slate.”

Republicans, when they take over from a Democratic administration, think of their predecessor’s policies the same way.

Though changing policies made by the executive branch seems easy, that’s not always the case.

“These are issue-by-issue determinations that must be made, and they require process evaluation, legal evaluation, resource consideration and timeliness,” said Jennings. In other words, some policies will take more time and personnel resources than others. And health policies will have to compete for White House attention with policies the new administration will want to change on anything from the environment to immigration to education.

Even within health care, issues as diverse as the operations of the ACA marketplaces, women’s reproductive health and stem cell research will vie to be high on the list.

A Guide to Executive Actions

Some types of actions are easier to reverse than others.

Executive orders issued by the president, for example, can be summarily overturned by a new executive order. Agency “guidance” can similarly be written over, although the Trump administration has worked to make that more onerous.

Since the 1980s, for example, every time the presidency has changed parties, one of the incoming president’s first actions has been to issue an executive order to either reimpose or eliminate the “Mexico City Policy” that governs funding for international family planning organizations that “perform or promote” abortion. Why do new administrations address abortion so quickly? Because the anniversary of the landmark Supreme Court abortion decision Roe v. Wade is two days after Inauguration Day, so the action is always politically timely.

Harder to change are formal regulations, such as one effectively banning Planned Parenthood from the federal family planning program, Title X. They are governed by a law, the Administrative Procedure Act, that lays out a very specific — and often time-consuming — process. “You have to cross your t’s and dot your legal i’s,” said Nicholas Bagley, who teaches administrative law at the University of Michigan Law School.

And if you don’t? Then regulations can be challenged in court — as those of the Trump administration were dozens of times. That’s something Biden officials will take pains to avoid, said Calsyn. “I would expect to see very deliberate notice and comment rule-making, considering the reshaped judiciary” with so many Trump-appointed judges, she said.

What Comes First?

Undoing a previous administration’s actions is an exercise in trying to push many things through a very narrow tube in a short time. Department regulations have to go not just through the leadership in each department, but also through the Office of Management and Budget “for a technical review, cost-benefit analysis and legal authority,” said Bagley. “That can take time.”

Complicating matters, many health regulations emanate not just from the Department of Health and Human Services, but jointly from HHS and other departments, including Labor and Treasury, which likely means more time to negotiate decisions among multiple departments.

Finally, said Bagley, “for really high-profile things, you’ve got to get the president’s attention, and he’s got limited time, too.” Anything pandemic-related is likely to come first, he said.

Some items get pushed to the front of the line because of calendar considerations, as with the abortion executive orders. Others need more immediate attention because they are part of active court cases.

“You have all these court schedules and briefing schedules that will dictate the timeline where they make all these decisions,” said Katie Keith, a health policy researcher and law professor at Georgetown University.

The Trump administration’s efforts to allow states to set work requirements for many low-income adults who gained Medicaid coverage under the Affordable Care Act’s expansion of the program is the highest-profile Trump action that falls into that latter category. The Supreme Court has agreed to hear a case challenging HHS approval of work requirements for Arkansas and New Hampshire in the next few months. Some Democrats are concerned about how the high court, with its new conservative majority, might rule, and the Biden administration will have to move fast if officials decide they want to head off that case.

But court actions also might help the Biden administration short-circuit the onerous regulatory process. If a regulation the new administration wants to rewrite or repeal has already been blocked by a court, Biden officials can simply choose not to appeal that ruling. That’s what Trump did in ending insurance company subsidies for enrollees with low incomes in 2017.

Allowing a lower-court ruling to stand, however, is not a foolproof strategy. “That raises the possibility of having someone [else] intervene,” said Keith. For example, Democratic attorneys general stepped in to defend the ACA in a case now pending at the Supreme Court when the Trump administration chose not to. “So, you have to be pretty strategic about not appealing,” she said.

Adding On?

One other big decision for the incoming administration is whether it wants to use the opportunity to tweak or add to Trump policies rather than eliminate them. “Is it undoing and full stop?” asked Keith. “Or undoing and adding on?”

She said there is “a full slate of ideologically neutral” policies Trump put out, including ones on price transparency and prescription drugs. If Biden officials don’t want to keep those as they are, they can rewrite them and advance other policies at the same time, saving a round of regulatory effort.

But none of it is easy — or fast.

One big problem is just having enough bodies available to do the work. “There was so much that undermined and hollowed out the federal workforce; there’s a lot of rebuilding that needs to done,” said Calsyn of the Center for American Progress. And Trump officials ran so roughshod over the regulatory process in many cases, she said, “even putting those processes back in place is going to be hard.”

Incoming officials will also have other time-sensitive work to do. Writing regulations for the newly passed ban on “surprise” medical bills will almost certainly be a giant political fight between insurers and health care providers, who will try to re-litigate the legislation as it is implemented. Rules for insurers who sell policies under the ACA will need to be written almost immediately after Biden takes office.

Anyone waiting for a particular Trump policy to be wiped from the books will likely have to pack their patience. But law professor Bagley said he’s optimistic it will all get done.

“One of the things we’ve grown unaccustomed to is a competent administration,” he said. “When people are competent, they can do a lot of things pretty quickly.”

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).

Mia McDermott is no stranger to isolation. Abandoned as an infant in China, she lived in an orphanage until a family in California adopted her as a toddler. She spent her adolescence in boarding schools and early adult years in and out of psychiatric hospitals, where she underwent treatment for bipolar disorder, anxiety and anorexia.

The pandemic left McDermott feeling especially lonely. She restricted social interactions because her fatty liver disease put her at greater risk of complications should she contract covid-19. The 26-year-old Santa Cruz resident stopped regularly eating and taking her psychiatric medications, and contemplated suicide.

When McDermott’s thoughts grew increasingly dark in June, she checked into Second Story, a mental health program based in a home not far from her own, where she finds nonclinical support in a peaceful environment from people who have faced similar challenges.

Second Story is what is known as a “peer respite,” a welcoming place where people can stay when they’re experiencing or nearing a mental health crisis. Betting that a low-key wellness approach, coupled with empathy from people who have “been there,” can help people in distress recover, this unorthodox strategy has gained popularity in recent years as the nation grapples with a severe shortage of psychiatric beds that has been exacerbated by the pandemic.

Peer respites allow guests to avoid psychiatric hospitalization and emergency department visits. They now operate in at least 14 states. California has five, in the San Francisco Bay Area and Los Angeles County.

“When things are really tough and you need extra support but you don’t need hospitalization, where’s that middle ground?” asked Keris Myrick, founder of Hacienda of Hope, a peer respite in Long Beach, California.

People with serious mental illness are more likely to experience emotional distress in the pandemic than the general population, said Dr. Benjamin Druss, a psychiatrist and professor at Emory University’s public health school, elaborating that they tend to have smaller social networks and more medical problems.

That was the case with McDermott. “I don’t have a full-on relationship with my family. My friends are my family,” she said. She yearned to “give them a hug, see their smile or stand close and take a selfie.”

The next best thing was Second Story, located in a pewter-gray split-level, five-bedroom house in Aptos, a quaint beach community near McDermott’s Santa Cruz home.

Peer respites offer people in distress short-term (usually up to two weeks), round-the-clock emotional support from peers — people who have experienced mental health conditions and are trained and often certified by states to support others with similar issues — and activities like arts, meditation and support groups.

“You can’t tell who’s the guest and who’s the staff. We don’t wear uniforms or badges,” said Angelica Garcia-Guerrero, associate director of Hacienda of Hope’s parent organization.

Peer respites are free for guests but rarely covered by insurance. States and counties typically pick up the tab. Hacienda of Hope’s $900,000 annual operating costs are covered by Los Angeles County through the Mental Health Services Act, a policy that directs proceeds from a statewide tax on people who earn more than $1 million annually to behavioral health programs.

In September, California Gov. Gavin Newsom signed a bill that would establish a statewide certification process for mental health peer providers by July 2022.

For now, however, peer respite staff in California are not licensed or certified. Peer respites typically don’t offer clinical care or dispense psychiatric drugs, though guests can bring theirs. Peers share personal stories with guests but avoid labeling them with diagnoses. Guests must come — and can leave — voluntarily. Some respites have few restrictions on who can stay; others don’t allow guests who express suicidal thoughts or are homeless.

Peer respite is one of several types of programs that divert people facing behavioral health crises from the hospital, but the only one without clinical involvement, said Travis Atkinson, a consultant at TBD Solutions, a behavioral health care company. The first peer respites arose around 2000, said Laysha Ostrow, CEO of Live & Learn, which conducts behavioral health research.

The approach seems to be expanding. Live & Learn counts 33 peer respites today in the U.S., up from 19 six years ago. All are overseen and staffed by people with histories of psychiatric disorders. About a dozen other programs employ a mix of peers and laypeople who don’t have psychiatric diagnoses, or aren’t peer-led, Atkinson said.

Though she had stayed at Second Story several times over the past five years, McDermott hesitated to return during the pandemic. However, she felt reassured after learning that guests were required to wear a mask in common areas and get a covid test before their stay. To ensure physical distancing, the respite reduced capacity from six to five guests at a time.

During her two-week stay, McDermott played with the respite’s two cats and piano — activities she found therapeutic. But most helpful was talking to peers in a way she couldn’t with her mental health providers, she said. In the past, McDermott said, she had been involuntarily admitted to a psychiatric hospital after she expressed suicidal thoughts. When she shared similar sentiments with Second Story peers, they offered to talk, or call the hospital if she wanted.

“They were willing to listen,” she said. “But they’re not forceful about helping.”

By the end of the visit, McDermott said that she felt understood and her loneliness and suicidal feelings had waned. She started eating and taking her medications more consistently, she said.

The small number of studies on respites have found that guests had fewer hospitalizations and accounted for lower Medicaid spending for nearly a year after a respite stay than people with similar conditions who did not stay in a respite. Respite visitors spent less time in the hospital and emergency room the longer they stayed in the respite.

Financial struggles and opposition from neighbors have hindered the growth of respites, however. Live & Learn said that although five peer respites have been created since 2018, at least two others closed due to budget cuts.

Neighbors have challenged nearby respite placements in a few instances. Santa Cruz-area media outlets reported in 2019 that Second Story neighbors had voiced safety concerns with the respite. Neighbor Tony Crane told California Healthline that guests have used drugs and consumed alcohol in the neighborhood, and he worried that peers are not licensed or certified to support people in crisis. He felt it was too risky to let his children ride their bikes near the respite when they were younger.

In a written response, Monica Martinez, whose organization runs Second Story, said neighbors often target community mental health programs due to concerns that “come from misconceptions and stigma surrounding those seeking mental health support.”

Many respites are struggling with increased demand and decreased availability during the pandemic. Sherry Jenkins Tucker, executive director of Georgia Mental Health Consumer Network, said its four respites have had to reduce capacity to enable physical distancing, despite increased demand for services. Other respites have temporarily suspended stays due to the pandemic.

McDermott said her mental health had improved since staying at Second Story in June, but she still struggles with isolation amid the pandemic. “Holidays are hard for me,” said McDermott, who returned to Second Story in November. “I really wanted to be able to have Thanksgiving with people.”

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).

The contact tracers of Washtenaw County in Michigan have been deluged with work and, to cope, the overburdened health department has a new tactic: It is asking residents who test positive for covid-19 to do their own contact tracing.

This story also ran on NPR. It can be republished for free.

Washtenaw is a county of nearly 350,000 residents who live in and around the city of Ann Arbor, about 45 minutes from Detroit. Until mid-October, a county team of 15 contact tracers was managing the workload. But by Thanksgiving, more than 1,000 residents were testing positive for the coronavirus every week, and the tracers could not keep pace.

In Washtenaw County, the process starts with people called case investigators, who receive lab reports of positive coronavirus tests. Their job is to call anyone who has tested positive, tell them they need to isolate and ask them for the names of people with whom they have had close contact. After creating a list of potentially exposed “contacts,” investigators pass it to a new team to start the actual contact tracing. As the number of positive cases builds, the number of calls tracers must make swells.

But in recent weeks, it’s not just the number of positive cases that has increased, overwhelming the capacity of case investigators — so has the number of contacts that each infected person has, said contact tracer Madeline Bacolor.

“There’s just so many more people that are gathering and that are exposed,” she said. “It used to be, we had a case, and maybe that person had seen two people, and now it’s a whole classroom full of day care students or a whole workplace.”

The work to keep people who have been exposed to the virus away from people who have not is crucial, said public health professor Angela Beck, because it breaks viral transmission chains and prevents the virus from spreading unchecked through a community.

Beck teaches at the University of Michigan and runs the campus program for tracing coronavirus exposures among students.

When you’re trying to contain an infectious disease, she said, running out of contact tracers is “not a situation that you want to be in.”

But it’s happening now in health departments in Michigan and around the U.S. where contact tracing workforces have grown, but not fast enough to keep pace with the pandemic’s spread.

As a result, health departments are asking some residents with covid to reach out to their contacts on their own.

Trying ‘a Compromised Strategy’

Once billed as one of the fundamental tools for stemming the spread of the virus, contact tracing has fallen apart in many regions of the country. It’s a systematic breakdown that Lawrence Gostin, a professor of global health law at Georgetown University, said hasn’t happened since the spread and stigma of HIV and AIDS in the 1980s and ’90s.

In Michigan’s rural Upper Peninsula, a public health district spanning five counties warned residents that its tracers were overwhelmed and that they might not receive a call at all, despite testing positive. Health workers would need to focus their efforts on residents 65 and older, teens and children attending school in person, and people living in group settings.

In Michigan’s southwestern corner, contact tracers in Van Buren and Cass counties can no longer keep up with their calls. It’s the same situation in Berrien County: “If you test positive, take action immediately by isolating and notifying close contacts,” the county health officer urged residents in a press release.

Health officials have taken similar actions in all regions of the country, including Oregon, North Dakota, Ohio and Virginia.

Within many health departments, the shortage of contact tracers has been exacerbated by the communications challenge of relaying a recent change in quarantine guidance from the Centers for Disease Control and Prevention — it reduced the quarantine period from 14 days to 10 for some individuals exposed to the virus.

The idea behind the change was that the risk of transmission after 10 days of quarantine was low, and shorter quarantine periods might increase people’s willingness to comply with the orders. But the shift also meant that contact tracers had to spend time learning and explaining the new procedures just when caseloads were exploding.

“It makes things more confusing,” said Bacolor, the contact tracer in Washtenaw County. “People might be hearing something different from their job or school than they are from the health department.”

Asking infected people, some of whom might be sick, to call their own friends and families — in effect, conduct their own contact-tracing operation — is far from ideal, public health experts said.

“It is a last-resort tool,” said Beck, the University of Michigan professor. “It is the best that we can do in the situation that we’re in, but it’s a compromised strategy.”

Contact tracing is more than just alerting people to a potential exposure so they can quarantine. Part of the process is to conduct carefully structured interviews with those exposed, to determine if they’ve developed symptoms of covid-19. If so, contacts of those people also need to be traced and told to quarantine, to prevent the virus from proliferating through successive chains of people in the community.

Trained contact tracers also often ask valuable questions to learn more about how the virus was transmitted from person to person so that local health officials can piece together an understanding about which settings and activities seem particularly likely to promote spread — in-person choir rehearsals and crowded bars, for example — and which are unlikely to generate outbreaks.

Contact tracing is a key part of a tried-and-true strategy known as “test, trace and isolate.” Public health professor Beck said the strategy has been used all over the world and it works — when there are enough people and enough time to do it properly.

And she said effective contact tracing can help mitigate the economic pain of a pandemic because it means that only people with known exposures to the virus must stay away from workplaces and school and refrain from other activities.

But success requires significant investment in public health infrastructure, something that Beck and other researchers said has been lacking for decades in the U.S.

This story is part of a partnership that includes NPR and KHN.

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