Category: From California Healthline.org

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Barbara Faubion’s boss, an insurance broker, used to tell clients: “Listen, you don’t need to be on the phone for four hours with Blue Cross Blue Shield. Let us do that. I have a person.”

Faubion was that person. And she got up every day psyched to go to work, which she said puzzled her friends.

“They’d go, ‘You love your job?!? You spend your whole day talking to an insurance company. Are you kidding me?’”

She was not kidding. Faubion loved to win — and she was really, really good at untangling other people’s health insurance problems.

Now she’s going to teach us some of what she knows.

So why doesn’t every health insurance broker have someone like Faubion on staff? ProPublica reporter Marshall Allen has that answer; there are big clues in his 2019 story about industry commissions and bonuses.

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

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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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Dr. Chris Kjolhede is focused on the children of central New York.

As co-director of school-based health centers at Bassett Healthcare Network, the pediatrician oversees about 21 school-based health clinics across the region — a poor, rural area known for manufacturing and crippled by the opioid epidemic.

From ankles sprained during recess to birth control questions, the clinics serve as the primary care provider for many children both in and out of the classroom. High on the to-do list is making sure kids are up to date on required vaccinations, said Kjolhede.

But, in March, COVID upended the arrangement when it forced schools to close.

“It was like, holy smokes,” he said, “what’s going to happen now?”

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Schools play a pivotal role in U.S. vaccination efforts. Laws require children to have certain immunizations to enroll and attend classes.

But this academic year, to prevent COVID-19 from spreading, many school districts have opted to start classes online. The decision takes away much of the back-to-school leverage pushing parents to stay current on their children’s shots, said Dr. Nathaniel Beers, member of the Council on School Health for the American Academy of Pediatrics. If schooling is not happening in person, said Beers, who also led multiple roles in the District of Columbia Public Schools system, “it is harder to enforce.”

Public health officials have relied on schools as a means to control vaccine-preventable diseases for over a century. Vaccination laws that require immunizations to enter school first emerged in the 1850s in Massachusetts as a means to control smallpox, as the Centers for Disease Control and Prevention has noted.

Every state requires children to receive certain vaccinations against illnesses like polio, mumps and measles before entering the classroom or a child care center, unless the child has a medical exemption. Some states allow people to opt children out of vaccinations for religious or philosophical reasons, although these exemptions have been associated with outbreaks of otherwise well-controlled diseases like measles.

“If they get behind or they don’t get specific vaccines they need, kindergarten is a real catch point to get them up to speed and make sure they’re up to date,” said Claire Hannan, executive director of the Association of Immunization Managers.

At the local level, the responsibility of tracking whether students are compliant generally falls on the school nurse. If one is not present, a clerical worker or administrator does the job, said Linda Mendonca, president-elect of the National Association of School Nurses. Usually, school systems face a deadline for checking every child’s record and reporting compliance to government health officials, she said.

How districts choose to hold noncompliant children accountable varies, Beers said. Some schools work with parents to set up appointments with a provider. Some isolate children in a classroom, he said, and some are so strict that “you can’t even walk through the door unless you are appropriately immunized.”

The COVID-19 pandemic has resulted in steep declines in vaccinations. In May, a report from the CDC showed a sharp drop in the number of orders submitted to the Vaccines For Children program, a federal initiative that purchases vaccines for half the children in the U.S. A second release revealed similar trends — vaccination coverage in Michigan declined among all milestone ages, with the exception of immunizations given at birth, which are generally done in a hospital.

Making Backup Plans

In Pennsylvania, for instance, the state health department in July suspended vaccine requirements for two months after the start of the school year. In addition to causing delays in doctors’ offices, the state said, the pandemic may also prevent school and public health nurses from holding in-school “catch-up” vaccination clinics.

“The department cannot stress enough that as soon as children can be vaccinated, they should be,” said Nate Wardle, press secretary for the state’s health department, in a written statement. However, the lockdown order prompted by COVID meant “that there was a several month period in some parts of the state where well-child visits were not occurring.”

Members of the American Academy of Pediatrics, the National Association of School Nurses and the Association of Immunization Managers said the grace periods are a prudent step to account for the pandemic’s effect on pediatric care. The majority of children already have some protection from diseases from previous vaccines, they said.

Additionally, Beers acknowledged that closing schools — among other actions like restricting travel and shuttering large gathering spaces — make children less likely to contract or spread illnesses that typically incubate in classrooms. For example, according to CDC data, measles has essentially disappeared — 12 cases had been reported as of Aug. 19 this year, compared with 1,282 throughout 2019.

However, schooling will eventually resume in person, which will also bring back the risks of illnesses moving through classrooms, Beers said. And school systems may be less forgiving of children who enter the classroom without the needed vaccinations.

“What would be an immense shame is if schools reopen in person and children are back together and we start getting outbreaks of other diseases that are preventable based on immunizations,” he said.

School-based health centers in New York are actively contacting parents about vaccinations. In Cooperstown, Kjolhede reached out to every superintendent soon after the lockdown in March to ask if the clinic could remain open. All but one said no.

The staff then set up telehealth appointments and phoned students who needed in-person care to arrange visits — including those who needed a vaccine before the start of this school year, he said. Luckily, the health center that remained open had a door that allowed patients to enter the clinic without walking through the school.

Several hours away, Dr. Lisa Handwerker is grappling with how to tackle the problem that hundreds of students across her six school-based health clinics in New York City have missed a required vaccine.

The city’s health department gave her a list of students in her care who needed additional immunizations, she said. Over 400 children were missing the second dose to prevent meningococcal meningitis, generally given to teens and young adults ages 16 to 23. Because the department used data from the last academic year to compile the list, Handwerker has no information about new students. Some families left the city because of the lack of income and resources caused by the pandemic.

“We had difficulty with at least half of the kids on our vaccine list,” Handwerker said. “Then when we reached families, they were reluctant to leave their houses.”

A Shot at Normalcy

That wasn’t the case for Tracey Wolf, a mother of two who visited the doctor recently to get her son Jordan vaccinated for measles, mumps, rubella and HPV before starting the seventh grade. He will be attending middle school in Dunedin, Florida, in person, said Wolf, 38.

It seemed nonsensical to keep Jordan, 13, from his classmates when he already plays baseball and hangs out with his friends, she said. His grades also slipped last spring when the COVID threat transformed his classroom into a computer.

She also took her 6-month-old Ethan for his immunizations. When asked whether she was afraid of going into her doctor’s office, she replied, “Not more than going to the grocery store.”

Regardless of whether a child starts school at home or in the classroom, immunization experts stressed the importance of vaccinating a child on time. The schedules factor in a child’s stage of development to maximize the vaccine’s effectiveness. That said, it is preferable that children get their vaccines from their regular doctor to prevent lost immunization records and additional shots, said Beers.

Yet on Aug. 19, the Department of Health and Human Services released a statement allowing pharmacists to provide childhood immunizations for children ages 3 to 18.

When Tamarack Dispensary opened in the northwestern Montana city of Kalispell in 2009, medical marijuana was legal but still operating on the fringes of the conservative community.

Times have changed. Owner Erin Bolster no longer receives surprised or puzzled looks when she tells people what she does. Now, her business sponsors community events and was recently nominated as a top marijuana provider by a local newspaper.

“We’ve become a normal part of the community, and it feels good that the community has finally accepted us,” Bolster said.

How far that acceptance goes will be tested when voters in Montana and a handful of other states this fall decide whether to legalize recreational or medical marijuana. Five of the six states with ballot questions lean conservative and are largely rural, and the results may signal how far America’s heartland has come toward accepting the use of a substance that federal law still considers an illegal and dangerous drug.

Since Colorado first allowed recreational use of marijuana in 2014, 10 other states have done the same. Most are coastal, left-leaning states, with exceptions like Nevada, Alaska and Maine. An additional 21 states allow medical marijuana, which must be prescribed by a physician.

This year, marijuana advocates are using the November elections to bypass Republican-led legislatures that have opposed legalization efforts, taking the question straight to voters.

Advocates point to a high number of petition signatures and their own internal polling as indicators that the odds of at least some of the measures passing are good.

One unknown is what role the pandemic will play in the marijuana measures’ fate. Demand for marijuana appears to be rising with people feeling stressed and isolated by COVID-19 lockdown measures, according to a United Nations report on the implications of COVID policies on drug manufacturing, distribution and use. That increased use could work in advocates’ favor.

Mississippi and Nebraska voters will decide on medical marijuana measures.

South Dakota will be the first state to vote on legalizing both recreational and medical marijuana in the same election.

Montana, Arizona and New Jersey, all medical marijuana states, will consider ballot measures in November to allow recreational sales, a move opponents consider evidence of a slippery slope.

“This is how all these states have gotten recreational marijuana. They start with medical,” said Ed Langton, a member of the Mississippi Board of Health, who opposes his state’s legalization efforts.

If all or most of the ballot questions pass, that will leave only a handful of states that have not legalized marijuana in some way, potentially putting pressure on federal lawmakers to change national policy. For now, growers and sellers can’t use banks or credit cards or export their products.

The Marijuana Policy Project is helping to coordinate the Montana legalization effort. Its deputy director, Matthew Schweich, said the organization does so only when polling suggests at least half of voters would support the measure.

“It’s becoming normalized for people,” Schweich said. “People know that other states are legalizing it and the sky has not fallen.”

An effort to legalize marijuana in rural, conservative states would have been an uphill battle even a few years ago. But several factors have worked toward changing attitudes there, Schweich said.

They include a gradually increasing acceptance in red states of neighbors that have legalized recreational pot — and seeing the tax revenue that legal marijuana brings. But perhaps the biggest catalyst toward normalizing pot use is having an established medical marijuana program, Schweich said.

After 15 years, Montana’s medical cannabis program is firmly rooted and has survived several legislative attempts to restrict it or shut it down. According to the Montana Department of Public Health and Human Services, more than 500 marijuana providers were serving 38,385 people as of July, which represents nearly 4% of the state’s population.

A survey conducted by the University of Montana earlier this year found that 54% of respondents thought marijuana should be legalized for recreational use, up from 51% the year before. Six years earlier, a Montana State University-Billings poll found that 60% of residents were against legalization.

Changing attitudes could also stem from states’ changing demographics. An analysis of census data by the Montana Free Press in 2019 found that 53% of Montanans 25 and older were born outside the state.

Among them is Brandon Powers, who moved to Montana from Missouri last year. Powers supports legalization and believes its passage will depend largely on who turns out.

“If people like me dominate the polls, then it will pass. But if people like my neighbor who thinks ‘the [marijuana] they have today is just too powerful’ dominate the polls, then it will fail,” he said.

In Mississippi, 20 medical marijuana bills have failed over the years in the Statehouse. This year, 228,000 state residents signed petitions in support of a medical marijuana initiative to allow possession of up to 2.5 ounces of marijuana to treat more than 20 qualifying medical conditions.

In response, lawmakers put a competing measure on the ballot that would restrict marijuana use to terminally ill patients and require them to use only pharmaceutical-grade marijuana products.

Jamie Grantham, spokesperson for Mississippians for Compassionate Care, called the measure an effort by the state to split the vote and derail legalization efforts.

“I’m passionate about this because it’s a plant that God made and it can provide relief for those who are suffering,” said Grantham, who described herself as a conservative Republican. “If this is something that can be used to help relieve someone’s pain, then they should be able to use it.”

But opposition is starting to build. Langton, the Mississippi Board of Health member, is working with Mississippi Horizon, a group fighting legalization. Langton said he opposes the original initiative because he believes it’s “overly broad” and would allow dispensaries within 500 feet of schools and churches. It could also put Mississippi on a path toward legalized recreational use, he said.

He added: “They say that marijuana is a natural plant, but poison ivy is natural, too. Just because something is natural doesn’t mean it is good for you.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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This story can be republished for free (details).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lifting Restrictions for Summer’s End

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

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

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

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

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

Schooling Screws Up COVID Circles

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Immediate Action

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

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

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

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

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

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

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

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

Consumer and Worker Protections

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

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

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

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

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

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

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

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

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

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

Lessons Learned

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Círculo vicioso: escuelas y COVID

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

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

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

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

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

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

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

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

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

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

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

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

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

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