Category: From California Healthline.org

DENVER — D.j. Mattern had her Type 1 diabetes under control until COVID’s economic upheaval cost her husband his hotel maintenance job and their health coverage. The 42-year-old Denver woman suddenly faced insulin’s exorbitant list price — anywhere from $125 to $450 per vial — just as their household income shrank.

She scrounged extra insulin from friends, and her doctor gave her a couple of samples. But as she rationed her supplies, her blood sugar rose so high her glucose monitor couldn’t even register a number. In June, she was hospitalized.

“My blood was too acidic. My system was shutting down. My digestive tract was paralyzed,” Mattern said, after three weeks in the hospital. “I was almost near death.”

So she turned to a growing underground network of people with diabetes who share extra insulin when they have it, free of charge. It wasn’t supposed to be this way, many thought, after Colorado last year was the first of 12 states to implement a cap on the copayments that some insurers can charge consumers for insulin. But as the COVID pandemic has caused people to lose jobs and health insurance, demand for insulin sharing has skyrocketed. Many patients who once had good insurance are now realizing the $100 cap is only a partial solution, applying just to state-regulated health plans.

Colorado’s cap does nothing for the majority of people with employer-sponsored plans or those without insurance coverage. According to the state chapter of Type 1 International, an insulin access advocacy group, only 3% of patients with Type 1 diabetes under 65 could benefit from the cap.

Such laws, often backed by pharmaceutical companies, give the impression that things are improving, said Colorado chapter leader Martha Bierut. “But the reality is, we have a much longer road ahead of us.”

The struggle to afford insulin has forced many people into that underground network. Through social media and word-of-mouth, those in need of insulin connect with counterparts who have a supply to spare. Insurers typically allow patients a set amount of insulin per month, but patients use varying amounts to control their blood sugar levels depending on factors such as their diet and activity that day.

Though it’s illegal to share a prescription medication, those involved say they simply don’t care: They’re out to save lives. They bristle at the suggestion that the exchanges resemble back-alley drug deals. The supplies are given freely, and no money changes hands.

For those who can’t afford their insulin, they have little choice. It’s a your-money-or-your-life scenario for which the American free-market health care system seems to have no answer.

“I can choose not to buy the iPhone or a new car or to have avocado toast for breakfast,” said Jill Weinstein, who lives in Denver and has Type 1 diabetes. “I can’t choose not to buy the insulin, because I will die.”

Exacerbated by the Pandemic

Surveys conducted before the pandemic showed that 1 in 4 people with either Type 1 or Type 2 diabetes had rationed insulin because of the cost. For many Blacks, Hispanics and Native Americans, the pinch was especially bad. These populations are more likely to have diabetes and also more likely to face economic disparities that make insulin unaffordable.

Then COVID-19 arrived, with economic stress and the virus itself hitting people in those groups the hardest.

This year, the American Diabetes Association reported a surge in calls to its crisis hotline regarding insulin access problems. In June, the group found, 18% of people with diabetes were unemployed, compared with 12% of the general public. Many are wrestling with the tough choices of whether to pay for food, rent, utilities or insulin.

Rep. Dylan Roberts, a Democrat who sponsored Colorado’s copay cap bill, said legislators knew the measure was only the first step in addressing high insulin costs. The law also tasked the state’s attorney general to produce a report, due Nov. 1, on insulin affordability and solutions.

“We went as far as we could,” Roberts said. “While I feel Colorado has been a leader on this, we need to do a whole lot more both at the state and national level.”

According to the American Diabetes Association, 36 other states have introduced insulin copay cap legislation, but the pandemic stalled progress on most of those bills.

Insulin prices are high in the U.S. because few limits exist for what pharmaceutical manufacturers can charge. Three large drugmakers dominate the insulin market and have raised prices in near lockstep. A vial that 20 years ago cost $25 to $30 now can run 10 to 15 times that much. And people with diabetes can need as many as four or five vials per month.

“It all boils down to cost,” said Gail deVore, who lives in Denver and has Type 1 diabetes. “We’re the only developed nation that charges what we charge.”

Before the COVID crisis triggered border closures, patients often crossed into Mexico or Canada to buy insulin at a fraction of the U.S. price. President Donald Trump has taken steps to lower drug prices, including allowing for the importation of insulin in some cases from Canada, but that plan will take months to implement.

The Kindness of Strangers

DeVore posts on social media three or four times a year asking if anybody needs supplies. While she’s always encountered demand, her last tweet in August garnered 12 responses within 24 hours.

“I can feel the anxiety,” deVore said. “It’s unbelievable.”

She recalled helping one young man who had moved to Colorado for a new job but whose health insurance didn’t kick in for 90 days. She used a map to choose a random intersection halfway between them. When deVore arrived on the dusty rural road after dark, his car was already there. She handed him a vial of insulin and testing supplies. He thanked her profusely, almost in tears, she said, and they parted ways.

“The desperation was obvious on his face,” she said.

It’s unclear just how widespread such sharing of insulin has become. In 2019, Michelle Litchman, a researcher at the University of Utah’s College of Nursing, surveyed 159 patients with diabetes, finding that 56% had donated insulin.

“People with diabetes are sometimes labeled as noncompliant, but many people don’t have access to what they need,” she said. “Here are people who are genuinely trying to find a way to take care of themselves.”

If insulin affordability doesn’t improve, Litchman suggested in a journal article, health care providers may have to train patients on how to safely engage in underground exchanges.

The hashtag #Insulin4all has become a common way of amplifying calls for help. People sometimes post pictures of the supplies they have to share, while others insert numbers or asterisks within words to avoid social media companies removing their posts.

Although drug manufacturers offer limited assistance programs, they often have lengthy application processes. So they typically don’t help the person who accidentally drops her last glass vial on a tile floor and finds herself out of insulin for the rest of the month. Emergency rooms will treat patients in crisis and have been known to give them an extra vial or two to take home. But each crisis takes a toll on their long-term health.

That’s why members of the diabetes community continue to look out for one another. Laura Marston, a lawyer with Type 1 diabetes who helped to expose insulin pricing practices by Big Pharma, said two of the people she first helped secure insulin, both women in their 40s, are in failing health, the result of a lifetime of challenges controlling their disease.

“The last I heard, one is in end-stage renal failure and the other has already had a partial limb amputation,” Marston said. “The effects of this, what we see, you can’t turn your back on it.”

The underground sharing is how Mattern secured her insulin before recently qualifying for Medicaid. When someone on a neighborhood Facebook group asked if anybody needed anything in the midst of the pandemic, she replied with one word: insulin. Soon, an Uber driver arrived with a couple of insulin pens and replacement sensors for her glucose monitor.

“I knew it wasn’t altogether legal,” Mattern said. “But I knew that if I didn’t get it, I wouldn’t be alive.”

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.

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As the coronavirus pandemic broke out across the country, health care providers and scientists relied on the standard method for detecting respiratory viruses: sticking a long swab deep into the nose to get a sample. The obstacles to implementing such testing on a mass scale quickly became clear.

Among them: Many people were wary of the unpleasant procedure, called a nasopharyngeal swab. It can be performed only by trained health workers, putting them at risk of infection and adding costs. And the swabs and chemicals needed to test for the virus almost immediately were in short supply.

Some places, like Los Angeles County, moved early to self-collected oral swabs of saliva and sputum, with the process supervised at drive-thru testing sites by trained personnel swathed in protective gear. Meanwhile, researchers began investigating other cheaper, simpler alternatives to the tried-and-true approach — including dribbling saliva into a test tube.

But the transition has not been immediate. Regulators and scientists are generally cautious about new, unproven technologies and have an understandable bias toward well-established protocols.

“Saliva is not a traditional diagnostic fluid,” said Yale microbiologist Anne Wyllie, part of a team whose saliva-based test, called SalivaDirect, received emergency use authorization from the Food and Drug Administration in August. “When we were hit by a virus that came out of nowhere, we had to respond with the tools that were available.”

Eight months into the pandemic, the move toward saliva screening is gaining traction, with tens of thousands of people across the country undergoing such testing daily. However, saliva tests still represented only a small percentage of the more than 900,000 tests conducted daily on average at the end of September.

Yale is providing its protocol on an open-source basis and recently designated laboratories in Minnesota, Florida and New York as capable of performing the test. Besides the Yale test, the FDA has authorized emergency use of several others, including versions developed at Rutgers University, the University of Illinois at Urbana-Champaign, the University of South Carolina and SUNY Upstate Medical University. A further advance, an at-home saliva test, could be headed for FDA authorization, too.

Since the start of the pandemic, the Trump administration’s approach to testing has been hampered by missteps and controversy. As a key health agency during an unprecedented emergency, the FDA’s effectiveness relies on public trust in how it balances the need for speed in authorizing innovative products, like saliva tests and vaccines, with ensuring safety and effectiveness, said Ann Keller, an associate professor of health policy at the University of California-Berkeley.

“You obviously want to get new tests into the mix quickly in order to address the emergency, but you still need to uphold your standards,” Keller said. The White House’s public pressure on the FDA has complicated the agency’s efforts by undermining its credibility and independence, she said.

Respiratory viruses colonize areas inside the nasal cavity and at the back of the throat. Besides the nasopharyngeal approach, nasal samples obtained with shorter and less invasive swabs have proven effective for the coronavirus and have become widely adopted, although they also generally require a health care worker’s involvement. The millions of rapid tests that will be distributed across the country, per a recent White House announcement, rely on nasal swabs.

In the early months of the pandemic, some studies reported significant levels of the virus in oral secretions. In a Hong Kong study published in February, for example, the virus was found in the saliva of 11 of 12 patients with confirmed coronavirus infection.

In Los Angeles, which began using the oral swab test in late March, more than 10,000 samples are collected per day, said Fred Turner, chief executive of Curative, the company that developed it.

Turner sees an advantage to the swabbing strategy. The self-swab procedure takes only 20 to 30 seconds, while producing enough saliva for testing can take people two to three minutes, and sometimes longer, he said. “That might not sound like much difference,” Turner said, “but it is when you’re trying to push 5,000 people through a test site.”

Curative’s three labs process tens of thousands of tests from jurisdictions across the country in addition to L.A., Turner said. A test developed at SUNY Upstate Medical University, which is expected to become available at state labs around New York, also uses an oral swab.

For the Curative test, a health care worker is supposed to oversee the sample collection —reminding people to cough to bring up fluids, for example. When investigators at the University of Illinois launched what they called a “Manhattan Project” to develop a saliva test by mid-June, they hoped to make it possible for people to visit a collection site, drool into a test tube, seal it and drop it off without the aid of a health care worker.

The university is now testing more than 10,000 people a day at its three campuses and is seeking to expand access to communities across the state and country, said chemistry professor Paul Hergenrother, who led the research team. Like the similar Yale test, it is being made freely available to other laboratories. The University of Notre Dame, in Indiana, recently adopted it.

Like tests using nasopharyngeal and other kinds of nasal swabs, these saliva tests are based on PCR technology, which amplifies small amounts of viral genetic material to facilitate detection. Both the Yale and University of Illinois tests have managed to simplify the process by eliminating a standard intermediate step: the extraction of viral RNA. Their protocols also don’t require viral transport media, or VTM — the chemicals generally used to stabilize the samples after collection.

“You don’t need swabs, you don’t need health care workers, you don’t need VTM, and you don’t need RNA isolation kits,” Hergenrother said.

In correspondence published in the New England Journal of Medicine, the Yale team reported detecting more viral RNA in saliva specimens than in nasopharyngeal ones, with a higher proportion of the saliva tests showing positive results for up to 10 days after initial diagnosis.

The National Basketball Association provided $500,000 in support for the Yale project, said David Weiss, the NBA’s senior vice president for player matters. He said the Yale team’s decision to eliminate the process of RNA extraction, which separates the genetic material from other substances that could complicate detection, involved trade-offs but did not compromise the value of the test.

“Any molecular test that has an RNA extraction step is almost by definition going to be more sensitive, but it will also be more expensive and take longer and use supplies that are in shorter supply,” he said. “If we’re trying to look at surveillance testing to open up schools and nursing homes, a test that’s still very sensitive and a lot cheaper is an important innovation.”

Prices for coronavirus tests vary widely, running upward of $100. Tests based on the Yale or University of Illinois protocols, which require only inexpensive materials, could be available for as little as $10. The Curative testing service, which includes collection and transportation of samples as well as the laboratory component, averages around $150 per test depending on volume, said Clayton Kazan, chief medical director of the L.A. County Fire Department, which uses the tests.

Despite the advances in sample collection, tests using PCR — polymerase chain reaction — technology still require laboratory processing. Researchers have been investigating other approaches, including saliva-based antigen tests, that could be self-administered at home and would provide immediate results. (While PCR can detect coronavirus genetic material, antigen tests look for viral proteins that can signify a current infection.)

At least one company has announced it is seeking emergency use authorization for a saliva antigen test, although two others have dropped plans to develop their own versions as infeasible, according to The New York Times. Meanwhile, scientists at Columbia University, the University of Wisconsin and elsewhere are investigating the use of saliva with other kinds of rapid-test technologies.

“There’s tons of interest” in an at-home saliva test, noted Yvonne Maldonado, chief of pediatric infectious diseases at Stanford University School of Medicine.

“People really do want to get that pregnancy-type kit out there,” she said. “You could basically send people a little packet with little strips, and you pull off a strip every day and put in under your tongue.”

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.

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President Donald Trump’s COVID-19 diagnosis is raising fresh questions about the White House’s strategy for testing and containing the virus for a president whose cavalier attitude about the coronavirus has persisted since it landed on American shores.

The president has said others are tested before getting close to him, appearing to hold it as an iron shield of safety. He has largely eschewed mask-wearing and social distancing in meetings, travel and public events, while holding rallies for thousands of often maskless supporters. 

The Trump administration has increasingly pinned its coronavirus testing strategy for the nation on antigen tests, which do not need a traditional lab for processing and quickly return results to patients. But the results are less accurate than those of the slower PCR tests. 

Testing “isn’t a ‘get out of jail free’ card,” said Dr. Alan Wells, medical director of clinical labs at the University of Pittsburgh Medical Center and creator of its test for the novel coronavirus. In general, antigen tests can miss up to half the cases that are detected by polymerase chain reaction tests, depending on the population of patients tested, he said.

The White House said the president’s diagnosis was confirmed with a PCR test but declined to say which test delivered his initial result. The White House has been using a new antigen test from Abbott Laboratories to screen its staff for COVID-19, according to two administration officials. 

The test, known as BinaxNOW, received an emergency use authorization from the Food and Drug Administration in August. It produces results in 15 minutes. Yet little is independently known about how effective it is. According to the company, the test is 97% accurate in detecting positives and 98.5% accurate in identifying those without disease. Abbott’s stated performance of its antigen test was based on examining people within seven days of COVID symptoms appearing.

The president and first lady have both had symptoms, according to White House Chief of Staff Mark Meadows and the first lady’s Twitter account. The president was admitted to Walter Reed National Military Medical Center on Friday evening “out of an abundance of caution,” White House Press Secretary Kayleigh McEnany said in a statement.

Vice President Mike Pence is also tested daily for the virus and tested negative, spokesperson Devin O’Malley said Friday, but he did not respond to a follow-up question about which test was used.

Trump heavily promoted another Abbott rapid testing device, the ID NOW, earlier this year. But that test relies on different technology than the newer Abbott antigen test.  

“I have not seen any independent evaluation of the Binax assay in the literature or in the blogs,” Wells said. “It is an unknown.” 

The Department of Health and Human Services announced in August that it had signed a $760 million contract with Abbott for 150 million BinaxNOW antigen tests that are now being distributed to nursing homes and historically black colleges and universities, as well as to governors to help inform decisions about opening and closing schools. The Big Ten football conference has also pinned playing hopes on the deployment of antigen tests following Trump’s political pressure. 

However, even senior federal officials concede that a test alone isn’t likely to stop the spread of a virus that has sickened more than 7 million Americans.

“Testing does not substitute for avoiding crowded indoor spaces, washing hands, or wearing a mask when you can’t physically distance; further, a negative test today does not mean that you won’t be positive tomorrow,” Adm. Brett Giroir, the senior HHS official helming the administration’s testing effort, said in a statement at the time.

Trump could be part of a “super-spreading event,” said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

Given the timing of Trump’s positive test — which he announced on Twitter early Friday — his infection “likely happened five or more days ago,” Osterholm said. “If so, then he was widely infectious as early as Tuesday,” the day of the first presidential debate in Cleveland.

Other experts say it’s too soon to say whether Trump was infected in a super-spreader event. “The president and his wife have had many exposures to many people in enclosed venues without protection,” so they could have been infected at any number of places, said Dr. William Schaffner, an infectious disease specialist at the Vanderbilt University School of Medicine. 

Although Democratic presidential candidate and former Vice President Joe Biden tested negative for the virus with a PCR test Friday, experts note that false negative results are common in the first few days after infection. Test results over the next several days will yield more useful information.

It can take more than a week for the virus to reproduce enough to be detected, Wells said: “You are probably not detectable for three, five, seven, even 10 days after you’re exposed.” 

In Minnesota, where Trump held an outdoor campaign rally in Duluth with hundreds of attendees Wednesday, health officials warned that a 14-day quarantine is necessary, regardless of test results.

“Anyone who was a direct contact of President Trump or known COVID-19 cases needs to quarantine and should get tested,” the Minnesota Department of Health said.

Ongoing lapses in test result reporting could hamper efforts to track and isolate sick people. As of Sept. 10, 21 states and the District of Columbia were not reporting all antigen test results, according to a KHN investigation, a lapse in reporting that officials say leaves them blind to disease spread. Since then, public health departments in Arizona, North Carolina and South Dakota all have announced plans to add antigen testing to their case reporting.

Requests for comment to the D.C. Department of Health were referred to Mayor Muriel Bowser’s office, which did not respond. District health officials told KHN in early September that the White House does not report antigen test results to them — a potential violation of federal law under the CARES Act, which says any institution performing tests to diagnose COVID-19 must report all results to local or state public health departments.

Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security, said it’s not surprising that Trump tested positive, given that so many of his close associates — including his national security adviser and Secret Service officers —have also been infected by the virus.

“When you look at the number of social contacts and travel schedules, it’s not surprising,” Adalja 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.

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El diagnóstico de COVID-19 del presidente Donald Trump está generando nuevas preguntas sobre la estrategia de la Casa Blanca para realizar pruebas y contener la propagación del virus, con un presidente que ha tenido una actitud arrogante desde que el coronavirus aterrizó en suelo estadounidense.

El presidente ha dicho que las personas con las que se reúne se hacen la prueba, como para generar un escudo de seguridad. Pero él mismo ha evitado casi siempre usar máscara y distanciarse socialmente en reuniones, viajes y eventos públicos, mientras organiza mitines para miles de simpatizantes, que tampoco usan tapabocas.

La estrategia de pruebas para COVID de la Administración Trump se basa en los tests de antígenos, que no necesitan un laboratorio tradicional para procesar y obtener resultados rápidamente. Pero estos resultados son menos precisos que los de las pruebas de PCR, que llevan más tiempo.

Las pruebas “no son una salvoconducto”, dijo el doctor Alan Wells, director médico de laboratorios clínicos del Centro Médico de la Universidad de Pittsburgh y creador de su propia prueba para el coronavirus. En general, las pruebas de antígenos pueden pasar por alto hasta la mitad de los casos detectados por las pruebas de reacción en cadena de la polimerasa, dependiendo de la población de pacientes examinados, agregó.

La Casa Blanca dijo que el diagnóstico del presidente se confirmó con una prueba de PCR, pero se negó a decir cuál fue la prueba que se usó para el resultado inicial. La administración ha estado utilizando una nueva prueba de antígeno del laboratorio Abbott para detectar COVID-19 en su personal, según dos funcionarios.

La prueba, conocida como BinaxNOW, recibió una autorización de uso de emergencia de la Administración de Alimentos y Medicamentos (FDA) en agosto. Produce resultados en 15 minutos. Sin embargo, se sabe poco de forma independiente sobre su eficacia.

Según la compañía, la prueba tiene una precisión del 97% en la detección de casos positivos y una precisión del 98,5% en la identificación de personas sin enfermedad. El desempeño declarado de Abbott de su prueba de antígeno se basó en examinar a las personas dentro de los siete días posteriores a la aparición de síntomas de COVID.

Tanto el presidente como la primera dama han tenido síntomas, según Mark Meadows, jefe de gabinete de la Casa Blanca, y la cuenta de Twitter de Melania Trump. El presidente fue admitido en el hospital militar Walter Reed el viernes 2 de septiembre por la noche “por precaución”, dijo la secretaria de prensa de la Casa Blanca, Kayleigh McEnany, en un comunicado.

El vicepresidente Mike Pence también se somete a pruebas diarias para detectar el virus y dio negativo, dijo el vocero Devin O’Malley, pero no respondió a una pregunta de seguimiento sobre qué prueba se utilizó.

Trump promovió en gran medida otra prueba rápida de Abbott, ID NOW, a principios de este año. Pero esa prueba se basa en una tecnología diferente a la nueva prueba de antígenos del mismo laboratorio.

“No he visto ninguna evaluación independiente del ensayo Binax en la literatura o en blogs”, dijo Wells. “Es un desconocido”.

El Departamento de Salud y Servicios Humanos (HHS) anunció en agosto que había firmado un contrato de $760 millones con Abbott por 150 millones de pruebas de antígeno BinaxNOW, que ahora se están distribuyendo a hogares de adultos mayores y universidades históricamente afroamericanas, así como a los gobernadores para ayudar a decidir sobre reaperturas, o cierres, de escuelas.

Sin embargo, incluso los altos funcionarios federales admiten que no es probable que una prueba por sí sola detenga la propagación de un virus que ha enfermado a más de 7 millones de estadounidenses.

“Las pruebas no sustituyen evitar espacios interiores abarrotados, lavarse las manos o usar una máscara; además, una prueba negativa hoy no significa que no será positiva mañana”, dijo el almirante Brett Giroir, el alto funcionario del HHS que dirigió el esfuerzo de pruebas de la administración, en un comunicado en ese momento.

Trump podría ser parte de un “evento de superdifusión”, dijo el doctor Michael Osterholm, director del Centro de Investigación y Política de Enfermedades Infecciosas de la Universidad de Minnesota.

Dado el momento de la prueba positiva de Trump, que anunció en Twitter la madrugada del viernes 2, su infección “probablemente ocurrió hace cinco o más días”, dijo Osterholm. “Si es así, entonces ya era muy contagioso el martes”, el día del primer debate presidencial en Cleveland.

Al menos siete personas que asistieron al anuncio de Trump de su nominación de la jueza Amy Coney Barrett para la Corte Suprema, el 26 de septiembre, han dado positivo desde entonces. Entre ellos: la ex asesora de Trump, Kellyanne Conway, los senadores republicanos Mike Lee y Thom Tillis, y el presidente de la Universidad de Notre Dame, el reverendo John Jenkins.

Los expertos dicen que es demasiado pronto para decir cómo se infectó Trump. “El presidente y su esposa han estado expuestos a muchas personas en lugares cerrados sin protección”, dijo el doctor William Schaffner, especialista en enfermedades infecciosas de la Escuela de Medicina de la Universidad de Vanderbilt.

Aunque el candidato presidencial demócrata Joe Biden dio negativo para el virus con una prueba de PCR el viernes 2, expertos señalan que los falsos negativos son comunes en los primeros días después de la infección. Los resultados de pruebas durante los próximos días proporcionarán información más útil.

El virus puede tardar más de una semana en reproducirse lo suficiente como para ser detectado, dijo Wells: “Probablemente no seas detectable durante tres, cinco, siete, incluso 10 días después de estar expuesto”.

En Minnesota, donde Trump realizó un mitin de campaña al aire libre en Duluth con cientos de asistentes el miércoles 30 de septiembre, funcionarios de salud advirtieron que es necesaria una cuarentena de 14 días, independientemente de los resultados de las pruebas.

Las fallas continuas en los informes de los resultados de las pruebas podrían obstaculizar los esfuerzos para rastrear y aislar a las personas enfermas. Hasta el 10 de septiembre, 21 estados y el Distrito de Columbia no informaban todos los resultados de las pruebas de antígenos, según una investigación de KHN. Un lapso en los informes que, según los funcionarios, les impide visualizar con claridad la propagación de la enfermedad. Desde entonces, los departamentos de salud pública de Arizona, Carolina del Norte y Dakota del Sur han anunciado planes para agregar pruebas de antígenos a sus informes de casos.

Las solicitudes de comentarios al Departamento de Salud de DC se remitieron a la oficina de la alcaldesa Muriel Bowser, que no respondió. Funcionarios de salud del distrito le dijeron a KHN a principios de septiembre que la Casa Blanca no les informa los resultados de las pruebas de antígenos, una posible violación de un apartado de la Ley CARES, que indica que cualquier institución que realice pruebas para diagnosticar COVID-19 debe informar todos los resultados a las oficinas locales o departamentos estatales de salud pública.

El doctor Amesh Adalja, investigador principal del Centro de Seguridad Sanitaria de la Universidad Johns Hopkins, dijo que no es sorprendente que Trump diera positivo, dado que muchos de sus cercanos, incluidos su asesor de seguridad nacional y oficiales del Servicio Secreto, también se infectaron.

“Cuando miras la cantidad de contactos sociales y los viajes, no es sorprendente”, dijo Adalja.

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.

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“CBS This Morning” tells the story of Matthew Fentress, a young man who developed serious heart disease after a bout of flu when he was just 25. Now 31, he owes more than $10,000 in hospital bills. KHN Editor-in-Chief Elisabeth Rosenthal explains that the same cardiomyopathy Fentress got can also be a complication of COVID-19.

Fentress’ story is the latest in the ongoing crowdsourced Bill of the Month investigation, a collaboration with KHN, NPR and “CBS This Morning.”

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.

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Nils Hase, a retiree who lives in Tarpon Springs, Florida, is wearing a mask and loading his Home Depot haul into his car on a recent weekday afternoon. In the store, because Home Depot insists customers and staff across the country wear masks, most faces were covered. But out here in the parking lot, in a state with a serious infection rate but no mask mandate, plenty of those masks hang down around people’s chins.

“It bothers me. They are being defiant,” Hase said. “And most of the people I see that walk in without a mask are just looking for a fight. They are asking you to ‘Just ask me. Just give me a reason to yell at you.’ I just stay away from them and keep on with my own life.”

Six and a half months after President Donald Trump declared the coronavirus emergency, COVID-19 has killed more than 207,000 Americans and infected 7.3 million, now including Trump himself and the first lady.

Scientists are warning of a larger wave of infection this winter. They agree the simplest, easiest way to fight that surge is to get most people to wear masks most of the time.

Yet the political fight over face coverings rages. It plays out on city streets, in suburban grocery stores, in rural sheriff’s offices and at the highest echelons of government — all the way to the presidential debate stage this week in Cleveland. There, most of Trump’s contingent refused to wear required masks, and one of them tested positive soon afterward. Only time will tell if they spread the infection, but their behavior is mirrored across the nation.

Hefty Price in Iowa

In April, Iowa health officials cut an agreement with Iowa University to do modeling on the impact of coronavirus. Among the data are estimates of future death rates and the projection that more than a thousand Iowans could be saved by adopting a universal mask policy.

Later that month, the researchers warned Republican Gov. Kim Reynolds not to ease restrictions aimed at curtailing the virus, saying a spike would result later in the year. They also recommended a strong policy on facial coverings, producing a report that said face shields would dramatically lower the virus’s toll.

Reynolds took none of that advice. She started easing restrictions in late April. She argued it was more important to reopen the state’s economy while encouraging people to be responsible and wear masks than to throw down a mandate she called unenforceable.

“I think the goal is to strongly encourage and recommend that people wear them,” she said in late August. “I believe that people are.”

Yet at that moment, Iowa was proving the university’s predictions true, suffering the highest infection rate in the nation. In late September, the state was one of only seven that remained in the “red zone,” averaging more than 890 new infections a day.

The governor’s intransigence on masks highlights a troubling problem. At a time when experts believe the nation needs to unite around a strategy to curb a potentially catastrophic winter, the cheapest, best option — masks — have become increasingly politicized. Even Republicans like Reynolds, who agree masks work, refuse to take the advice of their experts. They oppose mandates and favor an educational approach that many people actively resist.

Dissent Within the Trump Administration

The trouble starts at the top. The Trump administration’s leading medical advisers have testified repeatedly that masks were the country’s best tool to blunt a second wave that could be significantly deadlier than the initial spike.

Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, went as far to say face coverings were a more certain bet than a vaccine if everyone would wear them.

“If we did it for six, eight, 10, 12 weeks, we’d bring this pandemic under control,” Redfield said during a Sept. 16 hearing. “They are our best defense.”

Trump contradicted him before the day was done, and just a few days earlier, as the president and his coterie did in Cleveland, Trump modeled exactly the opposite behavior. At a campaign rally of thousands in Nevada, he cheered on the mostly maskless crowd. The next day, he held a massive mask-optional indoor rally at a warehouse in Henderson, Nevada, defying state restrictions. He advised the owner (who was later fined $3,000) that he’d protect the man if the state went after him.

“I’ll be with you all the way. Don’t worry about a thing,” Trump said.

But Trump’s actions and statements are worrisome for scientists and public health experts. They have watched in horror and frustration as the president’s dismissive attitude toward masks and COVID-19 itself has gone hand in hand with growing politicization of the public health response.

Meanwhile, the White House Coronavirus Task Force, led by Vice President Mike Pence, issued a “state report” on Montana on Sept. 20 that included the suggestion that the state “consider fines for violations of face mask mandates in high transmission areas.” At a press conference, Gov. Steve Bullock, a Democrat, said fining people would not be “the Montana way.” The state is, however, one of 34 with a mask mandate in place.

Indeed, the single-strongest predictor of whether or not a state will mandate strong mask policies bears little relationship to a state’s disease problem, according to a recent study by a team at the University of Washington.

After analyzing comprehensive data on mask policies, researchers led by Chris Adolph, a professor of political science and statistics, found that having a Republican governor would predict a 30-day delay in recommending mask policies. In a state that is also ideologically conservative, the delay would be closer to 40 days. A state’s death rate or infection rate had a much weaker influence.

“Because mask mandates are far less costly than business closures or stay-at-home orders, when we started to monitor these policies in April, we hoped their adoption would be universal,” Adolph said. “Instead, we found the same pattern: Republican governors resisted mandating masks even when public health conditions called for them.”

Adolph’s research suggests Trump is at least amplifying disdain for masks and, in fact, the phenomenon has been playing out across the country, most strikingly among some of Trump’s most ardent supporters — law enforcement and extremely conservative politicians.

Anti-Mask Sheriffs

In Washington state, Florida and even Democratic California, sheriffs made headlines by taking actions in opposition to local masking guidelines.

In Washington’s Snohomish County, where the first case of COVID-19 was discovered in the United States, Sheriff Adam Fortney declared in an April Facebook post: “The impacts of COVID 19 no longer warrant the suspension of our constitutional rights.”

Democratic Gov. Jay Inslee ordered people to wear masks in public in late June, just as a summer-long rise of infections began. Lewis County Sheriff Rob Snaza responded by telling a cheering crowd outside a church, “Don’t be a sheep.” Klickitat County Sheriff Bob Songer on the radio called Inslee “an idiot” over the order.

In Florida, anti-mask resistance has been especially fierce. Again, sheriffs offered the most startling opposition. One, Marion County Sheriff Billy Woods, banned masks for his deputies and visitors to the sheriff’s department offices, though he later relented on visitors.

Even in solid-blue Los Angeles County, the sheriff’s office was reprimanded by the county inspector general because deputies refused to wear masks, in violation of public health orders.

Surprisingly, officials there who support masks were disinclined to push tough enforcement.

“One of the things in all of this is we’re not going to enforce or fine our way out of this,” L.A.’s top public health official, Dr. Muntu Davis, told reporters recently.

Researchers disagree with Davis and Reynolds, not because education doesn’t work, but because it takes a long, sustained effort.

“Developing and deploying health education programs takes time, so in emergencies where rapid compliance is essential for reducing the spread of a novel pathogen, mandates are a critical element,” said Adolph.

Tickets in Tennessee

That’s the path officials took in Nashville, Tennessee, though initially officers opted for a more lenient approach than the mayor wanted. They had to be forced to write tickets with a potential fine of $50. The police still mostly have been giving warnings — thousands on any given weekend — but they’ve also written dozens of tickets and made some arrests.

City officials credit the crackdown with curbing COVID-19, even as it ran rampant in rural Tennessee counties where there are no mask mandates. In late September, Nashville’s Davidson County had 13.5 cases per 100,000 people, while more than three dozen less populous counties had “red zone” infection rates, with more than 25 cases per 100,000 people.

Amid the conflicting messages, including where enforcement has worked, not everyone is convinced that covering your nose and mouth is something that should rise to the level of police.

“I think they have better things to do than force anybody to wear a mask,” said Jennifer Johnson, an X-ray tech in downtown Nashville. “I think it should be at your own risk, but that’s just my opinion.”

Lawsuits Plus Weekly Protests in Florida

Plenty of conservative-leaning citizens and lawmakers agree with her, to the point of suing to block mandates.

In Hillsborough County, Florida, home to Tampa, county commissioners must vote each week to renew a state of emergency that requires masks to be worn in indoor public places.

Jason Kimball, a regular speaker at those meetings opposing the order, grew so angry he started a GoFundMe campaign for a lawsuit. He hit his $5,000 goal in 24 hours.

“You can only do so much as a commission legally, without violating the state constitution and the United States Constitution,” Kimball said at a recent meeting.

Rep. Anthony Sabatini, a state lawmaker who has filed 15 similar lawsuits on behalf of others all over the state, took the case. He claims mask ordinances are an overreach by government and a violation of Florida’s privacy clause.

“The government has never done this before,” Sabatini said. “It’s never told people that they have to wear masks everywhere they go all day long, and that’s basically what it’s come to.”

A judge dismissed Sabatini’s case in Hillsborough County and several of his other lawsuits have been denied.

Like Kimball and many other mask opponents, Sabatini insists masks don’t work, saying anyone can Google it to find out.

Scientists beg to differ, and are distressed political ideology has trumped real data and made it impossible for science to dictate the best responses.

“That’s certainly been a source of frustration for those of us who work in public health,” said Joe Cavanaugh, who runs the Department of Biostatistics at the University of Iowa’s College of Public Health and helped build the modeling distributed to Gov. Reynolds.

Watching Other Countries Succeed

Dr. Ali Mokdad, a former outbreak scientist at the CDC who works for the Institute for Health Metrics and Evaluation at the University of Washington’s School of Medicine, finds it especially painful to watch other countries deal with the pandemic better than the United States.

He traveled the globe to stop outbreaks, and now other countries are using the methods he and his former colleagues at the CDC taught them.

“Why aren’t people wearing a mask? For the first time in our history, of humankind, we have a measure that is really very cheap,” he said. “You can make it at home yourself from something old you have. It saves lives. It saves the economy.”

It is doubly frustrating — and alarming — because while mask adoption had been rising over the summer, it’s recently begun to slip. The shift caused IHME to adjust upward its model of how many people would get infected and die by Jan. 1 in the United States.

“This change in the last week is due mainly to the decline in masks and the increase in mobility,” Mokdad said.

The death rate estimate has since moderated — projected this week at 372,000.

One place where mask use has declined is Iowa, where Mokdad said only 28% of people say in surveys they are always likely to wear a mask when they go out.

Scientists at the University of Iowa had been using data similar to what IHME uses for its coronavirus models. The state won’t let the university make its modeling public, but when some of its data was online, the projection was that Iowa would see more than 1,000 deaths by the end of August if no additional safety steps were taken. As of Tuesday, the state’s official toll was 1,328.

By IHME’s most recent similar estimates, more than 3,400 Iowans will die by Jan. 1. With a universal mask requirement, some 1,600 could be saved. Nationally, nearly 115,000 lives could be spared.

Winter Is Coming

Cavanaugh would welcome even a toothless mandate to spare some of those lives. “Just sending that message at the state level is, I think, an important step in emphasizing the importance of it,” said the University of Iowa researcher.

Sixteen states still do not have a mandate, all of them led by Republicans.

The especially frightening element to the anti-mask movement is that it can only worsen what scientists already warn is going to be a bad winter.

When it’s cold, the virus can survive longer on surfaces, and people are stuck indoors where it can become more concentrated in the aerosolized droplets people exhale.

“We’ve seen it in our data. We’ve seen it in other countries,” Mokdad said. “It’s very strong, and it’s going to happen in the U.S., unfortunately.”

Back in Florida, Nils Hase will keep wearing his mask.

“I’ve always believed in the science behind it,” Hase said. “It’s a virus and we need to be aware of what’s going on. People who don’t, they’re just idiots.”

This story is from a reporting partnership that includes Health News Florida, KPCC, Nashville Public Radio, KHN and NPR. 

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.

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In a wide-ranging executive order, President Donald Trump this month outlined some of the efforts he has made to affect health care since taking office.

One involved uninsured people and the current pandemic. The administration, Trump said, set up a program to provide them “access to necessary COVID-19-related testing and treatment.”

Did it?

We asked the White House for more specifics about the program Trump mentioned but did not get a reply.

Nonetheless, experts said he is likely referring to reimbursement assistance to help pay the COVID testing and treatment costs of uninsured patients available through the Provider Relief Fund.

This fund was established by Congress in the Coronavirus Aid, Relief and Economic Security Act to bolster eligible health care providers for lost revenue or expenses related to the pandemic.

The Trump administration said this spring it would tap into the fund to reimburse providers who test and treat uninsured COVID patients; hence, the executive order’s reference to “coverage access.” Here’s how it works: The assistance doesn’t go directly to patients. Instead, health care providers can apply for reimbursement of costs associated with testing or treating uninsured people for COVID-19. Patients must be uninsured and their primary diagnosis must be COVID-19. The program does not check immigration status in determining eligibility.

Our experts acknowledged that the fund overall has helped providers by making money available, especially important since many physicians, hospitals and other health care facilities are struggling with reduced income as elective surgeries and visits have nose-dived during the pandemic. The relief fund pays providers at standard Medicare rates for testing or treating uninsured COVID patients.

Still, many patients, and some providers, don’t know about the funding to reimburse for uninsured costs. And even providers who are aware of it don’t necessarily know how to use it. Hospitals and other providers are not required to publicize it. Additionally, eligibility restrictions can make it hard for some patients to qualify to have their bills paid.

“It’s absolutely not broad protection or a guarantee of coverage,” said Karen Pollitz, a senior fellow with KFF. “People are uninsured. They remain uninsured. If they don’t know how to ask for this or the provider can’t figure out how to use it, [their bills] are uncollectable.” (KHN is an editorially independent program of KFF.)

What Exactly Is ‘Coverage Access’?

Even before the pandemic, uninsured patients had a hard time finding medical care, often delaying needed medical services until a crisis sent them to the hospital. Federal law ensures that no one needing emergency care is turned away and must be treated until stabilized.

The relief fund program came amid calls from health insurers, Democrats and others for the Trump administration to reopen enrollment in the Affordable Care Act through the federal marketplace, which operates in 38 states.

Usually, the insurance sign-up period occurs each November. When the virus began causing concern in the U.S. in the spring, some of the 12 states (and the District of Columbia) that run their own marketplaces moved to reopen because of the pandemic, so uninsured residents could sign up.

But the Trump administration decided not to reopen the federal marketplace. Uninsured people who want to enroll either have to wait to sign up starting in November for coverage next year or see if they qualify for special enrollment because they have experienced one of several “qualifying life events.” One such event is job loss that ends health coverage.

That potentially left hospitals and other medical providers holding the bag for the uninsured who fall sick with COVID.

Enter the relief fund.

The Health Resources and Services Administration said the fund so far has handed out a little more than $1 billion for uninsured patient reimbursement, a substantial amount but well short of publicized estimates of what it will ultimately cost hospitals and medical providers to test and treat uninsured COVID patients.

“We are appreciative” that Congress and the administration “did provide some coverage for the uninsured,” said Molly Smith, vice president for coverage and state issues at the American Hospital Association. “But we don’t think it’s the best approach for covering the uninsured.” Hospitals would have preferred something that “would have expanded comprehensive coverage.”

Parts of the program work well, she said, but “there are some pretty substantial flaws.”

Why ‘Access’ Becomes a Slippery Term

When it comes to program eligibility, two main criteria present hurdles for patients: fitting the definition of “uninsured” and receiving a primary diagnosis of COVID-19.

Failing either test could make a patient ineligible. In that case, the hospital or medical provider can either seek payment from the patient — or eat the cost.

To qualify for coverage, the patient cannot have any kind of health insurance coverage, according to guidelines published online by HRSA.

Even having very limited coverage — such as a program in Medicaid that covers only family planning services such as birth control — would disqualify a patient, said Smith. Another disqualification would be the purchase of one of the limited coverage plans touted by the administration that don’t cover all the same services an ACA plan would include.

The second hurdle: COVID-19 must be the primary diagnosis.

“If someone with a heart attack comes in and it turns out COVID is also involved — or could have even been the trigger,” the provider might not be eligible for reimbursement, said Jack Hoadley, a research professor emeritus at Georgetown University.

Another common example, Smith said, is a patient with COVID-19 who develops sepsis, a life-threatening blood infection. Under long-standing coding and billing rules, sepsis would be the primary diagnosis, making any coronavirus-related patient care ineligible under the provider relief program.

Our Ruling

The Trump administration did implement a program to reimburse medical providers for testing and treatment of some uninsured patients, tapping into funding allocated by Congress.

Whether — and to what extent — the measure improved “coverage access” to care is hard to determine. The fund has paid out more than $1 billion so far.

The administration chose this route, which experts said was an incomplete fix, over following some states’ lead in allowing a special enrollment period on the federal marketplace, which would have enabled people without health insurance to buy more comprehensive coverage. Meanwhile, the program has not been publicized and has confusing eligibility rules — both of which have led to speculation that it is not being used as widely as possible.

The administration’s program appears to provide narrow financial assistance for COVID-related health care costs. But patients who fall through the cracks may find themselves facing substantial bills.

We rate this statement as Mostly True.

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.

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In August, Robert Pettigrew was working a series of odd jobs. While washing the windows of a cellphone store he saw a sign, one that he believes the “good Lord” placed there for him.

“Facing eviction?” the sign read. “You could be eligible for up to $3,000 in rent assistance. Apply today.”

It seemed a hopeful omen after a series of financial and health blows. In March, Pettigrew, 52, learned he has an invasive mass on his lung that restricts his breathing. His doctor told him his condition puts him at high risk of developing deadly complications from COVID-19 and advised him to stop working as a night auditor at a Motel 6, where he manned the front desk. Reluctantly, he had to leave that job and start piecing together other work.

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With pay coming in less steadily, Pettigrew and his wife, Stephanie, fell behind on the rent. Eventually, they were many months late, and the couple’s landlord filed to evict them.

Then Pettigrew saw the rental assistance sign.

“There were nights I would lay in bed and my wife would be asleep, and all I could do was say, ‘God, you need to help me. We need you,’” Pettigrew said. “And here he came. He showed himself to us.”

As many as 40 million Americans faced a looming eviction risk in August, according to a report authored by 10 national housing and eviction experts. The Centers for Disease Control and Prevention cited that estimate in early September when it ordered an unprecedented, nationwide eviction moratorium through the end of 2020.

That move — a moratorium from the country’s top public health agency — spotlights a message experts have preached for years without prompting much policy action: Housing stability and health are intertwined.

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The CDC is now citing stable housing as a vital tool to control the coronavirus, which has killed more than 200,000 Americans. Home is where people isolate themselves to avoid transmitting the virus or becoming infected. When local governments issue stay-at-home orders in the name of public health, they presume that residents have a home. For people who have the virus, home is often where they recover from COVID-19’s fever, chills and dry cough — in lieu of, or after, a hospital stay.

But the moratorium is not automatic. Renters have to submit a declaration form to their landlord, agreeing to a series of statements under threat of perjury, including “my housing provider may require payment in full for all payments not made prior to and during the temporary halt, and failure to pay may make me subject to eviction pursuant to state and local laws.”

Confusion surrounding the CDC’s order means some tenants are still being ordered to leave their homes.

A sign inside a Boost Mobile store in Milwaukee prompted Robert Pettigrew to call Community Advocates to ask for help paying rent on the apartment he shares with his wife, daughter and grandson. The Centers for Disease Control and Prevention said stable housing is vital to controlling the coronavirus pandemic. (Coburn Dukehart/Wisconsin Watch)

Princeton University is tracking eviction filings in 17 U.S. cities during the pandemic. As of Sept. 19, landlords in those cities have filed for more than 50,000 evictions since March 15. The tally includes about 11,900 in Houston, 10,900 in Phoenix and 4,100 in Milwaukee.

It’s an incomplete snapshot that excludes some major American cities such as Indianapolis, where local housing advocates said court cases are difficult to track, but landlords have sought to evict thousands of renters.

Children raised in unstable housing are more prone to hospitalization than those with stable housing. Homelessness is associated with delayed childhood development, and mothers in families that lose homes to eviction show higher rates of depression and other health challenges.

Mounting research illustrates that even the threat of eviction can exact a physical and mental toll from tenants.

Nicole MacMillan, 38, lost her job managing vacation rentals in Fort Myers, Florida, in March when the pandemic shut down businesses. Later, she also lost the apartment where she had been living with her two children.

“I actually contacted a doctor, because I thought, mentally, I can’t handle this anymore,” MacMillan said. “I don’t know what I’m going to do or where I’m going to go. And maybe some medication can help me for a little bit.”

But the doctor she reached out to wasn’t accepting new patients.

With few options, MacMillan moved north to live with her grandparents in Grayslake, Illinois. Her children are staying with their fathers while she gets back on her feet. She recently started driving for Uber Eats in the Chicagoland area.

“I need a home for my kids again,” MacMillan said, fighting back tears. The pandemic “has ripped my whole life apart.”

Searching for Assistance to Stay at Home

That store window sign? It directed Pettigrew to Community Advocates, a Milwaukee nonprofit that received $7 million in federal pandemic stimulus funds to help administer a local rental aid program. More than 3,800 applications for assistance have flooded the agency, said Deborah Heffner, its housing strategy director, while tens of thousands more applications have flowed to a separate agency administering the state’s rental relief program in Milwaukee.

Persistence helped the Pettigrews break through the backlog.

“I blew their phone up,” said Stephanie Pettigrew, with a smile.

She qualifies for federal Social Security Disability Insurance, which sends her $400 to $900 in monthly assistance. That income has become increasingly vital since March when Robert left his motel job.

He has since pursued a host of odd jobs to keep food on the table — such as the window-washing he was doing when he saw the rental assistance sign — work where he can limit his exposure to the virus. He brings home $40 on a good day, he said, $10 on a bad one. Before they qualified for rent assistance, February had been the last time the Pettigrews could fully pay their $600 monthly rent bill.

Robert and Stephanie Pettigrew embrace outside their two-bedroom rental apartment in Milwaukee on Sept. 4. In August, local group Community Advocates covered more than $4,700 in the Pettigrews’ rental payments, late charges, utility bills and court fees, and is now helping them look for a more affordable place to live. (Coburn Dukehart/Wisconsin Watch)

Just as their finances tightened and their housing situation became less stable, the couple welcomed more family members. Heavenly, Robert’s adult daughter, arrived in May from St. Louis after the child care center where she worked shut down because of concerns over the coronavirus. She brought along her 3-year-old son.

Through its order, the CDC hopes to curtail evictions, which can add family members and friends to already stressed households. The federal order notes that “household contacts are estimated to be 6 times more likely to become infected by [a person with] COVID-19 than other close contacts.”

“That’s where that couch surfing issue comes up — people going from place to place every few nights, not trying to burden anybody in particular, but possibly at risk of spreading around the risk of coronavirus,” said Andrew Bradley of Prosperity Indiana, a nonprofit focusing on community development.

The Pettigrews’ Milwaukee apartment — a kitchen, a front room, two bedrooms and one bathroom — is tight for the three generations now sharing it.

“But it’s our home,” Robert said. “We’ve got a roof over our head. I can’t complain.”

Housing Loss Hits Black and Latino Communities

A U.S. Census Bureau survey conducted before the federal eviction moratorium was announced found that 5.5 million of American adults feared they were either somewhat or very likely to face eviction or foreclosure in the next two months.

State and local governments nationwide are offering a patchwork of help for those people.

In Massachusetts, the governor extended the state’s pause on evictions and foreclosures until Oct. 17. Landlords are challenging that move both in state and federal court, but both courts have let the ban stand while the lawsuits proceed.

“Access to stable housing is a crucial component of containing COVID-19 for every citizen of Massachusetts,” Judge Paul Wilson wrote in a state court ruling. “The balance of harms and the public interest favor upholding the law to protect the public health and economic well-being of tenants and the public in general during this health and economic emergency.”

The cases from Massachusetts may offer a glimpse of how federal challenges to the CDC order could play out.

By contrast, in Wisconsin, Gov. Tony Evers was one of the first governors to lift a state moratorium on evictions during the pandemic — thereby enabling about 8,000 eviction filings from late May to early September, according to a search of an online database of Wisconsin circuit courts.

Milwaukee, Wisconsin’s most populous city, has seen nearly half of those filings, which have largely hit the city’s Black-majority neighborhoods, according to an Eviction Lab analysis.

In other states, housing advocates note similar disparities.

“Poor neighborhoods, neighborhoods of color, have higher rates of asthma and blood pressure — which, of course, are all health issues that the COVID pandemic is then being impacted by,” said Amy Nelson, executive director of the Fair Housing Center of Central Indiana.

“This deadly virus is killing people disproportionately in Black and brown communities at alarming rates,” said Dee Ross, founder of the Indianapolis Tenants Rights Union. “And disproportionately, Black and brown people are the ones being evicted at the highest rate in Indiana.”

Across the country, officials at various levels of government have set aside millions in federal pandemic aid for housing assistance for struggling renters and homeowners. That includes $240 million earmarked in Florida, between state and county governments, $100 million in Los Angeles County and $18 million in Mississippi.

In Wisconsin, residents report that a range of barriers — from application backlogs to onerous paperwork requirements — have limited their access to aid.

In Indiana, more than 36,000 people applied for that state’s $40 million rental assistance program before the application deadline. Marion County, home to Indianapolis, had a separate $25 million program, but it cut off applications after just three days because of overwhelming demand. About 25,000 people sat on the county’s waiting list in late August.

Of that massive need, Bradley, who works in economic development in Indiana, said: “We’re not confident that the people who need the help most even know about the program — that there’s been enough proactive outreach to get to the households that are most impacted.”

After Milwaukeean Robert Pettigrew saw that sign in the store window and reached out to the nonprofit Community Advocates, the group covered more than $4,700 of the Pettigrews’ rental payments, late charges, utility bills and court fees. The nonprofit also referred the couple to a pro-bono lawyer, who helped seal their eviction case — that means it can’t hurt the Pettigrews’ ability to rent in the future, and ensures the family will have housing at least through September. The CDC moratorium has added to that security.

Heavenly Pettigrew and her 3-year-old son moved in with her parents in May after the St. Louis child care center where she’d been working closed because of the pandemic. The two-bedroom, one-bath apartment is tight for three generations, said Heavenly’s father, Robert, “but it’s our home.” (Coburn Dukehart/Wisconsin Watch)

The federal eviction moratorium, if it withstands legal challenges from housing industry groups, “buys critical time” for renters to find assistance through the year’s end, said Emily Benfer, founding director of the Wake Forest Law Health Justice Clinic.

“It’s protecting 30 to 40 million adults and children from eviction and the downward spiral that it causes in long-term, poor health outcomes,” she said.

Doctor: Evictions Akin to ‘Toxic Exposure’

Megan Sandel, a pediatrician at Boston Medical Center, said at least a third of the 14,000 families with children that seek treatment at her medical center have fallen behind on their rent, a figure mirrored in national reports.

Hospital officials worry that evictions during the pandemic will trigger a surge of homeless patients — and patients who lack homes are more challenging and expensive to treat. One study from 2016 found that stable housing reduced Medicaid spending by 12% — and not because members stopped going to the doctor. Primary care use increased 20%, while more expensive emergency room visits dropped by 18%.

A year ago, Boston Medical Center and two area hospitals collaborated to invest $3 million in emergency housing assistance as community organizing focused on affordable housing policies and development. Now the hospitals are looking for additional emergency funds, trying to boost legal resources to prevent evictions and work more closely with public housing authorities and state rental assistance programs.

“We are a safety-net hospital. We don’t have unlimited resources,” Sandel said. “But being able to avert an eviction is like avoiding a toxic exposure.”

Sandel said the real remedy for avoiding an eviction crisis is to offer Americans substantially more emergency rental assistance, along the lines of the $100 billion included in a package proposed by House Democrats in May and dubbed the Heroes Act. Boston Medical Center is among the 26 health care associations and systems that signed a letter urging congressional leaders to agree on rental and homeless assistance as well as a national moratorium on evictions for the entire pandemic.

“Without action from Congress, we are going to see a tsunami of evictions,” the letter stated, “and its fallout will directly impact the health care system and harm the health of families and individuals for years to come.”

Groups representing landlords urge passage of rental assistance, too, although some oppose the CDC order. They point out that property owners must pay bills as well and may lose apartments where renters can’t or won’t pay.

In Milwaukee, Community Advocates is helping the Pettigrews look for a more affordable apartment. Robert Pettigrew continues attending doctors’ appointments for his lungs, searching for safe work. He looks to the future with a sense of resolve — and a request that no one pity his family.

“Life just kicks you in the butt sometimes,” he said. “But I’m the type of person — I’m gonna kick life’s ass back.”

For this story, NPR and KHN partnered with the investigative journalism site Wisconsin Watch, Side Effects Public Media, Wisconsin Public Radio and WBUR.

For a dad whose infant son was afflicted with a rare seizure disorder, a drug invented in 1952 was indispensable for his boy. It was also indispensable to executives at the pharmaceutical firm that acquired the drug in 2014 — not because it was a cure, but because it was a “cash cow,” according to documents released at a House hearing Thursday.

The firm, Mallinckrodt Pharmaceuticals, got ahold of the venerable drug called H.P. Acthar gel by buying the company that owned it before, Questcor, for $5.8 billion in 2014.

According to the documents obtained and released by the House Oversight Committee in a broad probe of drug pricing practices, Mallinckrodt targeted Questcor primarily because of Acthar, a so-called orphan drug that helps 2,500 kids a year in the U.S. afflicted by infantile spasms.

Acthar was a “premium-priced product” with a “robust cash flow profile” that would help the company “achieve aspirational goals with a single transaction,” according to the company’s internal discussions.

The premium price when Mallinckrodt acquired the drug was $31,626 for a single vial, after Questcor had hiked it from around $100 in 2000, according to the committee investigation. Mallinckrodt continued the trend, hiking the price five times to ultimately reach $39,864.

That’s what it cost when the father had a doctor prescribe six vials for a six-week course for his son. The premium price was a shock, and his insurance company would cover only four doses.

He appealed to Mallinckrodt.

“We are in a serious bind here,” he said in a message that was among 140,000 documents obtained from the company by House investigators. “Your medication is extremely expensive and we are unable to afford the 80,000 dollars needed for the remaining 2 vials.”

The father is not identified in the committee documents.

A spokesperson for the company said it helped patients who reached out “get access to Acthar,” but did not specify what that entailed.

Mallinckrodt CEO Mark Trudeau told the Oversight Committee on Thursday that his firm “is steadfastly committed to knocking down barriers to patient access — that’s particularly true with Acthar gel.”

“We’ve also improved the ability of patients with a prescription to obtain Acthar through our robust free drug and commercial copay assistance programs, which lead to many patients paying nothing out-of-pocket,” he said, later testifying that the company is committed to lowering the “net price” of the drug to 2015 levels.

Yet, according to the documents, knocking down barriers or lowering prices has had little to do with the interest in owning Acthar. It was more about expanding the market for the drug, and profits for the company, as was the case with five other companies hauled before the committee over two days.

Indeed, Acthar was so important to the goal that executives preparing a presentation on the company’s 2018 prospects bluntly wrote: “Acthar Modernization Strategy defines the Future of the Brand as either a Growth Asset or Cash Cow.”

Trudeau told the committee that presentation was never made. According to the documents, even executives preparing the material seemed aware the words were too bald — but just barely. One junior executive asked in an email, “Do we really want to say ‘cash cow’ to the board?” The company’s chief commercial officer, Hugh O’Neill, responded, “Instead of ‘cash cow,’ I will replace it with profit maximizer.”

Committee Chairwoman Rep. Carolyn Maloney (D-N.Y.) quizzed Trudeau on the description, asking if it’s true “this is how you really see this drug, not as an innovative therapy?”

“That’s in fact not true,” Trudeau said. “That term is typically applied to products for which no investment is likely to be going forward, and, in fact, that’s exactly the opposite.”

He argued that Mallinckrodt had invested $660 million in improving manufacturing of the drug and in seeking evidence that Acthar works for many other uses that the FDA permits.

Rep. Jimmy Gomez (D-Calif.) said Trudeau’s answer misled the committee and he owed Maloney an apology.

“Replacing one term with another term, ‘cash cow’ with ‘profit maximizer,’ doesn’t change the intent of your company, which is to make as much money as possible,” Gomez said.

The “cash cow” document was about getting more patients, saying the strategy was to convince skeptics of Acthar’s other uses that it was not an “overpriced steroid,” and to overcome “lack of acceptance of academic opinion leaders” whose criticism “limits product penetration.”

Democrats on the committee argued that not only was Mallinckrodt’s intent to squeeze as much out of Acthar as it could, but also to get it from taxpayers through Medicare, where prices cannot be negotiated by law.

Rep. Harley Rouda (D-Calif.) pointed out that about 25% of Acthar sales went through Medicare when Mallinckrodt bought Questcor, and that share is over 60% now. Revenue from Medicare rose from under $50 million in 2011 to $725 million in 2018. Overall, the drug accounted for about a third of all the company’s net sales in recent years, Trudeau said.

The hearing was the second this week stemming from an investigation into sky-rocketing drug prices that the committee launched in 2019. Besides Mallinckrodt, the committee hauled in executives at Amgen, Novartis, Celgene, Bristol Myers Squibb and Teva.

“What we learned was shocking. Drug companies are hiking their prices higher and higher — and placing an ever-greater burden on the very patients who rely on these drugs to survive,” Maloney said.

“We also learned that claims by drug companies that their price increases are necessary for research and development are completely bogus,” she added. “The internal company documents we obtained show that drug companies hike prices almost entirely for selfish reasons — they do it to meet internal revenue targets, or to increase their own bonuses in some cases.”

Republicans on the committee were far less critical of the pharmaceutical companies, though many of them also complained that drug prices are too high and that Americans should be able to pay the lower prices available to people in other nations. Some argued that clamping down on pricing in the United States might inhibit new medicines from coming to market.

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.

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Thousands of minks at Utah fur farms have died because of the coronavirus in the past 10 days, forcing nine sites in three counties to quarantine, but the state veterinarian said people don’t appear to be at risk from the outbreak.

The COVID-19 infections likely were spread from workers at the mink ranches to the animals, with no sign so far that the animals are spreading it to humans, said Dr. Dean Taylor, the state veterinarian, who is investigating the outbreak.

“We genuinely don’t feel like there is much of a risk going from the mink to the people,” he said Thursday.

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Between 7,000 and 8,000 minks have died since the disease swept through the ranches that produce the animals, valued for their luxurious pelts. So far, no animals in Utah have been euthanized because of the disease, and it doesn’t appear to be necessary, Taylor said.

Fur from the dead infected animals will be processed to remove any traces of the virus and then used for coats and other garments, according to Fur Commission USA, a mink farming trade group. The U.S. produces more than 3 million mink pelts each year.

Taylor declined to name the farms or the counties where the affected minks were found.

With minks, as with humans, COVID-19 is less deadly for the young.

“It’s going through the breeding colonies and wiping out the older mink and leaving the younger mink unscathed,” Taylor said. Most of the deaths have been in minks between the ages of 1 and 4 years.

In addition to the minks, more than 50 animals in the U.S. had tested positive for the coronavirus as of Sept. 2, according to the U.S. Department of Agriculture. The infections have been detected in pet cats and dogs, as well as lions and tigers at a New York zoo.

Minks seem particularly susceptible to COVID-19, likely because of a protein in their lungs, the ACE2 receptor, which binds to the virus and appears to predict vulnerability to the infection, according to Wageningen University & Research in the Netherlands. Humans also have this protein in their lungs.

The COVID outbreak in Utah has surged since mid-August, when the first cases of the disease in the animals were confirmed by the USDA.

Minks were discovered to be susceptible to the SARS-CoV-2 virus, which causes COVID-19, in April, after outbreaks at several farms in the Netherlands, followed by outbreaks in Denmark and Spain. More than 1 million animals were culled in those countries, according to the Associated Press.

Several workers at the Utah mink farms have tested positive for COVID-19, including some who had no symptoms.

“Some of our mink ranchers have more than one facility, and that’s probably how it spread,” Taylor said.

A study in the Netherlands found that the virus appeared to jump back and forth between people and minks, but the data so far remains limited.

After the initial U.S. cases were confirmed, mink farms across Utah and the rest of the country implemented strict measures to prevent the disease from spreading, such as restricting access, conducting health checks on workers and disinfecting surfaces. The USDA and the Centers for Disease Control and Prevention have issued guidelines for farmed minks and other mustelids, a family of animals that also includes weasels and badgers.

“Obviously, it’s very concerning to have a species that is this susceptible with this high of a death rate,” Taylor said.

The outbreak has led to the quarantine of a quarter of Utah’s three dozen mink ranches and raised concerns across the state, said Clayton Beckstead, regional manager for the Utah Farm Bureau and a fourth-generation mink farmer.

“We’re certainly worried, but I think everybody’s taking pretty extreme biosecurity measures,” said Beckstead, whose own farm has not been affected.

Utah is one of the nation’s top mink producers. Overall, there are 245 fur farms in 22 states, part of an industry valued at $82.6 million a year, according to Fur Commission USA.

Investigating an outbreak of a novel virus in a new species is “daunting,” Taylor said.

“We’re learning as quick as we can,” he said. “We’re scrambling to help these animals and protect this industry.”