Category: Rehab News

Emily Tavis was on a first date in December when she looked up and realized they were driving past the downtown Kansas City, Missouri, intersection where a bullet ripped through her leg at last year’s Super Bowl victory parade.

“Oh f—,” Tavis said, bewildering her date.

She lives 35 miles away in Leavenworth, Kansas, and hadn’t yet returned to Union Station, where the mass shooting happened. She felt like crying. Or maybe it was a panic attack. She held up a finger signaling to her date that she needed a moment. That’s when it hit him, too.

“Oh crap, I didn’t even realize,” he said, and kept driving in silence.

Tavis sucked in her tears until the station was out of view.

“So anyway,” she said aloud, while thinking to herself, “way to go. Panic attack, first date.”

A year after the Feb. 14 shooting that killed one and injured at least 24 people, the survivors and their families are still reeling. Relationships have strained. Parents are anxious about their children. The generous financial support and well wishes that poured through in early days have now dried up. And they’re ambivalent about the team they all root for; as the Chiefs moved on to another Super Bowl, many wondered why their beloved team hasn’t acknowledged what they have all been going through.

“I can’t believe the Chiefs didn’t do anything for us,” said Jacob Gooch Sr., who was shot in the foot. The team, the owner family’s foundation, and the National Football League gave a combined $200,000 to a fund for survivors, but Gooch said no one from the organization reached out to his family, three members of whom were shot.

What’s happening to these families is far from unusual. Many survivors emotionally freeze as a coping mechanism to avoid fully feeling the trauma they suffered. But with time, survivors experience what therapists call “thawing,” and the intensity of what happened can suddenly overpower them like it did Tavis.

“Trauma pulls us into the past,” said Gary Behrman, a therapist who published a model of crisis intervention based on his work with witnesses of the 9/11 attacks in New York.

Sights, smells, sounds, tastes, and touches can all trigger flashbacks that shut down the brain like an overloaded circuit breaker. It’s a survival response, Behrman said; the brain is a friend.

The key to recovery is to help survivors find healthy ways to manage those triggers — when they are ready.

Survivors thaw at their own pace. Regaining control after a life-threatening event is a process that can take weeks, months, or years.

It can be hard not to feel forgotten when life carries on around them. As fans rallied around the Chiefs this season, survivors found it hard to watch the games. The Chiefs lost to the Philadelphia Eagles in Sunday’s Super Bowl. Philadelphia will hold its own parade on Friday, exactly one year after the shooting.

“It sucks because everybody else went on,” Jason Barton said. He performed CPR on a man he now thinks was one of the alleged shooters, his wife found a bullet slug in her backpack, and his stepdaughter was burned by sparks from a ricocheted bullet.

“If we were on the other side of that place, we would too,” he said. “It wouldn’t have affected us.”

A Trip Back to Union Station

Tavis isn’t the only survivor to have found herself unintentionally back at Union Station in the year since the shooting. Kids had field trips to Science City, located inside the station. Follow-up doctor visits were often on nearby Hospital Hill. An October dinner organized for survivors by a local faith-based group was less than a mile away, prompting one young survivor to decline the invitation.

Tavis had planned to return to Union Station as part of her healing process. She thought she would go on the one-year mark to have a moment alone to feel whatever emotions swept over her there.

Maybe God was showing her she was ready by placing her back there unexpectedly, her therapist told her. Maybe. But she didn’t feel ready in that moment.

Tavis wanted to see a therapist right after the shooting. But she didn’t seek one out until July, after the local United Way distributed financial assistance to survivors and relieved the months-long financial strain of lost work and medical bills incurred by many. Tavis and her partner at the time had taken out an extra credit card to cover expenses while they waited for the promised help.

After two months of visits, her therapist started prepping Tavis for eye movement desensitization and reprocessing, a technique to help trauma survivors. She now spends every other session making her way through a spreadsheet of memories from the parade, visualizing and reprocessing them one by one.

She’s nervous as the one-year mark approaches. It’s on Valentine’s Day, and she worries it’ll be depressing.

She decided to invite Gooch, her former partner, to come to Union Station with her that day. Despite everything, he’s the one who understands. They were at the parade together with their son and Jacob’s two older kids. Both Gooch Sr. and his older son, Jacob Gooch Jr., were also shot.

Trauma Changes Who We Are

Gooch Sr. hasn’t worked since the parade. His job required standing for 10-hour shifts four days a week, but he couldn’t walk for months after a bullet shattered a bone in his foot and it slowly fused back together. He hoped to go back to work in July. But his foot didn’t heal correctly and he had surgery in August, followed by weeks of recovery.

His short-term disability ran out, as did his health insurance through work. His employer held his job for a while before releasing him in August. He’s applied for other jobs in and around Leavenworth: production, staffing agencies, auto repair. Nothing’s come through.

“We’ve all gone through problems, not just me,” Gooch Sr. said. “I got shot in my foot and haven’t worked for a year. There are people that have been through much worse stuff over the past year.”

He feels good walking now and can run short distances without pain. But he doesn’t know if he’ll ever play football again, a mainstay of his life since he can remember. He played safety for the semiprofessional Kansas City Reapers and, before the parade, the 38-year-old was considering making the 2024 season his last as a player.

“A lot more than football has been stolen from me in this last year. Like my whole life has been stolen from me,” Gooch Sr. said. “I really hate that part of it.”

And those emotions are painfully real. Trauma threatens our beliefs about ourselves, said Behrman, the therapist. Every person brings their own history to a traumatic event, a different identity that risks being shattered. The healing work that comes later often involves letting go and building something new.

Recently Gooch Sr. started going to a new church, led by the husband of someone he sang with in a children’s choir growing up. At a Sunday service this month, the pastor spoke about finding a path when you’re lost.

“I’m looking for the path. I’m in the grass right now,” Gooch Sr. said at his home later that evening.

“I’m obviously on a path, but I don’t know where I’m headed.”

‘I Did the Best I Could’

Every day before Jason Barton goes to work, he asks his wife, Bridget, if he should stay home with her.

She’s said yes enough that he’s out of paid time off. Jason, who’s survived cancer and a heart attack, had to take unpaid leave in January when a bad case of the flu put him in the hospital. That’s real love, Bridget said with tearful eyes, sitting with Jason and her 14-year-old daughter, Gabriella, in their home in Osawatomie, Kansas.

Bridget has connected with the mother of another girl injured in the shooting. They’ve exchanged texts and voicemails throughout the year. It’s nice to have someone to talk to who gets it, Bridget said. They’re hoping to get the girls together to build a connection as well.

Except for a trip to therapy once a week, Bridget doesn’t leave the house much anymore. It can feel like a prison, she said, but she’s too scared to leave. “It’s my own internal hell,” she said. She keeps thinking about that bullet slug that lodged in her backpack. What if she’d been standing differently? What if they’d left 10 seconds earlier? Would things be different?

A Post-it note in her kitchen reminds her: “I’m safe. Gabriella is safe. I did the best I could.”

She carries a lot of guilt. About Jason staying home. About not leaving the house, even to see her grandkids. About wanting the family to go to the parade in the first place. At the same time, she knows she kind of thrived in the chaos after the shooting, taking charge of her daughter, talking to the police. It’s confusing.

The family has carried the trauma differently. In the six months after the parade, Jason watched reality TV shows that kept him out of his head — 23 seasons of “Deadliest Catch” and 21 seasons of “Gold Rush,” including spinoffs, he estimated. Lately he’s kept his mind occupied with a new hobby: building model cars and planes. He just finished a black 1968 Shelby Mustang, and next is an F4U-4 Corsair plane that Bridget got him.

Gabriella was unfazed about returning to Union Station for a class field trip to Science City, but she was startled when she saw a group of police officers inside the station. Her mom watched her location on her phone and texted her all day.

Gabriella took up boxing after the parade, then switched to wrestling. It had been going well, even felt empowering. But she’s stopped going, and Bridget thinks it’s partly due to the emotion of the anniversary — the first is always the hardest, her therapist said. Gabriella insisted that wrestling was just exhausting her.

Because they weren’t shot, the family didn’t benefit from resources available to other survivors. They understand that other families are recovering from bullet wounds or even mourning a death.

Still, it would be nice to have some acknowledgment of their emotional trauma. Their names have been in the news. You’d think the Chiefs would have at least sent a letter saying, “We’re sorry this happened to you,” Jason said.

Jason proposed to Bridget at a Chiefs game. Now watching games on TV triggers flashbacks.

“I want to be a part of Chiefs Kingdom again,” Bridget said, “but I just can’t. And that is a huge, really lonely feeling.”

‘There Is a Word Called “Resilience”’

One evening last October, survivors gathered with their families at a Mexican restaurant in downtown Kansas City.

Some came dressed in their Sunday best, some in red football jerseys. All ages, toddlers to 70-somethings, some from Missouri, some from Kansas. Some spoke only Spanish, some only English. Most of the two dozen people had never met before. But as they talked, they discovered the shooting that binds them also gave them a common language.

Two young boys realized they’d tossed a football during the jubilation before the violence erupted. A woman in her early 70s named Sarai Holguin remembered watching them play on that warm February day. After a blessing and dinner, Holguin, who was shot in the knee and has had four surgeries, stood to address the room.

“I was the first victim taken to the medical tent,” she said in Spanish, her words translated by a relative of another survivor. She saw everything, she explained, as, one by one, more survivors were brought to the tent for treatment, including Lisa Lopez-Galvan, a 43-year-old mother who was killed that day.

Yet in that tragedy, Holguin saw the beauty of people helping one another.

“This showed us that humanity is still alive, that love is still alive. There is a word called ‘resilience,’” Holguin said, the translator stumbling to understand the last word, as people in the audience caught it and shouted it out. “Resilience.”

“This word helps us overcome the problems we face,” Holguin said. “To try to put the tragic moment we all lived behind us and move on, we must remember the beautiful moments.”

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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More than 80 domestic cats, among many other types of mammals, have been confirmed to have had bird flu since 2022 — generally barn cats that lived on dairy farms, as well as feral cats and pets that spend time outdoors and likely caught it by hunting diseased rodents or wild birds.

Now, a small but growing number of house cats have gotten sick from H5N1, the bird flu strain driving the current U.S. outbreak, after eating raw food or drinking unpasteurized milk. Some of those cats died.

The strain of bird flu currently circulating has not adapted to efficiently spread among people. And there have been no known cases of cat-to-human transmission during the current outbreak of H5N1.

Still, there’s always been the risk that cats, which are arguably only semi-domesticated, could bring home a disease from a midnight prowl.

“Companion animals, and especially cats, are 100% a public health risk in terms of the risk of zoonotic transmission to people,” said virologist Angela Rasmussen, who studies disease progression in emerging viruses at the University of Saskatchewan’s Vaccine and Infectious Disease Organization.

This is because we snuggle with and sleep in bed with our cats. When we’re not looking, cats drink from our water glasses and walk on kitchen counters. So, cat owners should be aware of the ongoing spread of bird flu. “By reducing the risk to your cats, you reduce the risk to yourself,” Rasmussen said.

Rasmussen doesn’t think pet owners should be afraid their cats will give them bird flu but said taking precautions is good for pets, and for public health.

Signs of bird flu in cats include runny nose and discharge around the eyes, explained Michael Q. Bailey, president-elect of the American Veterinary Medical Association.

H5N1 also causes neurological problems like dizziness and seizures, which are symptoms of rabies, too. Rabies is almost always fatal, and it poses a threat to human health, so any animal suspected of having the viral disease must be euthanized. Bailey encourages people to ensure pets are up-to-date on their vaccinations.

Veterinarian Jane Sykes, who specializes in infectious diseases in cats and dogs at the University of California-Davis School of Veterinary Medicine, said people should not assume it’s bird flu if their cat is sick — even if their animal spends time outdoors or eats a raw diet. Upper-respiratory illnesses are common in cats, while H5N1 is “still pretty rare.”

Sykes gives her indoor cat, Freckles, regular kibble exclusively. She told NPR and KFF Health News she has no concerns about Freckles getting H5N1 because the heating process of making dry or canned pet food kills viruses.

More Cases in Cats, More Risk to Humans

Some people feed their pets raw meat or unpasteurized milk because they think it’s a more nutritious or natural diet. The American Veterinary Medical Association’s website discourages this due to foodborne pathogens like salmonella and listeria, and now the highly pathogenic H5N1.

By keeping pets healthy, veterinarians play an essential role in protecting humans from zoonotic diseases. The American Veterinary Medical Association says the risk of H5N1 spilling over from a pet to a person is “considered extremely low, but not zero.”

State and local public health agencies, including those in Los Angeles County and Washington state, have issued similar warnings against raw food diets for pets.

Concerns for human health are partly why the FDA announced last month it is now requiring cat and dog food companies to update their safety plans to protect against bird flu.

This came after the Oregon Department of Agriculture discovered a cat that was “strictly an indoor cat” had contracted H5N1 and died after consuming a frozen turkey product made by the raw pet food brand Northwest Naturals. It stated that “tests confirmed a genetic match between the virus in the raw and frozen pet food and the infected cat.”

Northwest Naturals voluntarily recalled that batch of its frozen turkey-based product. The company told KFF Health News and NPR that the recall involved “a small product run” and that it has concerns about the accuracy of the Oregon Agriculture Department’s testing.

Los Angeles County’s public health department said five cats from two households tested positive for bird flu after drinking unpasteurized raw milk from the Raw Farm dairy in California’s Central Valley.

Raw Farm voluntarily recalled its milk and cream after retail products tested positive for H5N1, but it denies any food safety issues, calling the concern “a political issue.”

Veterinarians also warn pet owners not to allow cats unsupervised time outside as there’s the risk of them getting H5N1 by interacting with other animals that might carry the disease.

“This is a very scary virus, given that it can infect so many different host species,” said Bruce Kornreich, director of Cornell University’s Feline Health Center.

At least one instance of a cat infecting a person with bird flu occurred in 2016. As NPR reported, a veterinarian in New York City caught the virus after having close contact with infected cats. The vet experienced mild symptoms and quickly recovered.

In that case, the strain of bird flu was H7N2, not the H5N1 that is now circulating in the U.S.

H7N2 is a very different type of virus, Sykes explained. But she said it shows that cat-to-human transmission of avian influenza is theoretically possible.

There isn’t a lot of research on transmission of bird flu from companion animals like cats or dogs to humans, though Rasmussen agreed it’s definitely a concern: The more infections you have in animals, “the more your luck is potentially going to run out.”

Most people who have caught H5N1 are agricultural workers who had direct contact with infected poultry or cattle. Of at least 67 confirmed human cases of H5N1 in the U.S., there’s been one fatality in an immunocompromised person who had contact with birds.

In general, zoonotic disease researchers want more H5N1 surveillance in companion animals of all types. Even if the human death toll of H5N1 remains relatively low, it remains a public health risk.

Chances for Mutation

Part of the concern with this H5N1 outbreak is that bird flu viruses change. Just a few mutations could make this strain adept at spreading between people. And the more people who catch H5N1, the more likely it would adapt to be more efficient, said Suresh Kuchipudi, a virologist at the University of Pittsburgh School of Public Health, where he researches zoonotic diseases. Kuchipudi has studied H5N1 in cats.

Another concern is something called reassortment. If an animal or person is infected with two viruses at once, the viruses can trade genetic material, creating something new. This is common in influenza, so virologists are on the lookout for a case in which the bird flu reassorts to make a virus that’s far more contagious, and potentially more virulent.

Virologist Rasmussen is way more worried about this happening in pigs. Human respiratory physiology is more like that of swines than felines. So far, the current outbreak of H5N1 has not reached commercial hog operations. Rasmussen hopes it stays that way.

Kuchipudi said that reassortments are relatively rare events, but the outcome is completely unpredictable. Sometimes the results are benign, though it was likely a reassortment that involved an avian virus that led to the 1918 flu pandemic, which killed an estimated 50 million people. In the century since, virologists have established a global surveillance network to monitor influenza viruses. Scientists say continued investment in this network is key to preparing for and hopefully preventing another pandemic.

Winter is “reassortment season” because of all the influenza viruses circulating, Rasmussen said. A reassortment in cats could technically be possible since these pets occasionally get seasonal flu, but it’s highly unlikely. Rather, Rasmussen said, it’s more likely that a cat would pass H5N1 to a human who already has seasonal flu, and then a reassortment happens in the sick person. While the risk isn’t zero, Rasmussen doubts this will happen. It would depend on how ill the human was, and how much virus they’re exposed to from their cat.

“Unless the cat is really shedding a ton of virus, and you’re kind of making out with the cat, I think it would be hard,” she said.

Rasmussen and Kuchipudi caution there isn’t enough research to know for sure how much virus cats shed, or even how they shed the virus.

The Centers for Disease Control and Prevention was poised to release a new study about H5N1 in cats, but that was delayed when the Trump administration paused the Morbidity and Mortality Weekly Report. That investigation, revealed through emails obtained by KFF Health News in a public records request, found that house cats likely got bird flu from dairy workers.

Scientists and public health agencies should question previously held assumptions about bird flu, Kuchipudi urged. He noted that 20 years ago nobody would have predicted that bird flu would infect dairy cattle as it is now.

Dogs Seem To Fare Better

The FDA says other domesticated animals, including dogs, can get bird flu infections. There are no confirmed cases of H5N1 among dogs in the U.S., though in other countries they have died from the virus.

There’s some disagreement and an overall lack of research on whether cat biology makes them more susceptible to H5N1 than other mammals, including humans, pigs, or dogs.

But cat behaviors, such as their love of dairy and predation of wild birds, put them at higher risk, Kuchipudi said. Also, living in groups might play a role as there are more feral cat colonies in the U.S. than packs of stray dogs.

There’s very little people can do about the H5N1 circulating in wild birds. As Rasmussen explained, “It’s flying around in the skies. It’s migrating north and south with the seasons.”

But she said there’s a lot people can do to keep the virus out of their homes.

That includes limiting a pet’s exposure to H5N1 by not feeding them raw food or unpasteurized milk, and trying to keep them from interacting with animals like rodents and wild birds that could be infected with the virus.

This article is from a partnership that includes NPR and KFF Health News.

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One August afternoon in 2023, Angela Martin’s cousin called with alarming news. Martin’s 74-year-old aunt had been mauled by four dogs while out for a walk near her home in rural Purlear, North Carolina. She was bleeding heavily from bites on both legs and her right arm, where she’d tried to protect her face and neck. An ambulance was on its way.

“Tell them she’s on Eliquis!” said Martin, a nurse who lived an hour’s drive away in Winston-Salem. She knew the blood thinner could lead to life-threatening blood loss.

When the ambulance arrived, the medics evaluated Martin’s aunt and then did something few emergency medical services crews do: They gave her a blood transfusion to replace what she’d lost, stabilizing her sinking blood pressure.

The ambulance took her to the local high school, and from there a medical helicopter flew her to the nearest trauma center, in Winston-Salem. She needed more units of blood in the helicopter and at the hospital but eventually recovered fully.

“The whole situation would have been different if they hadn’t given her blood right away,” Martin said. “She very well might have died.”

More than 60,000 people in the U.S. bleed to death every year from traumatic events like car crashes or gunshot wounds, or other emergencies, including those related to pregnancy or gastrointestinal hemorrhaging. It’s a leading cause of preventable death after a traumatic event.

But many of those people likely wouldn’t have died if they had received a blood transfusion promptly, trauma specialists say. At a news conference last fall, members of the American College of Surgeons estimated that 10,000 lives could be saved annually if more patients received blood before they arrived at the hospital.

“I don’t think that people understand that ambulances don’t carry blood,” said Jeffrey Kerby, who is chair of the ACS Committee on Trauma and directs trauma and acute care surgery at the University of Alabama-Birmingham Heersink School of Medicine. “They just assume they have it.”

Of the more than 11,000 EMS agencies in the U.S. that provide ground transport to acute care hospitals, only about 1% carry blood, according to a 2024 study.

The term “blood deserts” generally refers to a problem in rural areas where the nearest trauma center is dozens of miles away. But heavy traffic and other factors in suburban and urban areas can turn those areas into blood deserts, too. In recent years, several EMS agencies throughout the country have established “pre-hospital blood programs” aimed at getting blood to injured people who might not survive the ambulance ride to the trauma center.

With blood loss, every minute counts. Blood helps move oxygen and nutrients to cells and keeps organs working. If the volume gets too low, it can no longer perform those essential functions.

If someone is catastrophically injured, sometimes nothing can save them. But in many serious bleeding situations, if emergency personnel can provide blood within 30 minutes, “it’s the best chance of survival for those patients,” said Leo Reardon, the Field Transfusion Paramedic Program director for the Canton, Massachusetts, fire department. “They’re in the early stages of shock where the blood will make the most difference.”

There are several roadblocks that prevent EMS agencies from providing blood. Several states don’t allow emergency services personnel to administer blood before they arrive at the hospital, said John Holcomb, a professor in the division of trauma and acute care surgery at UAB’s Heersink School.

“It’s mostly tradition,” Holcomb said. “They say: ‘It’s dangerous. You’re not qualified.’ But both of those things are not true.”

On the battlefields in the Middle East, operators of military medical facilities would maintain that only nurses and doctors could do blood transfusions, said Randall Schaefer, a U.S. Army trauma nurse who was deployed there and now consults with states on implementing pre-hospital blood programs.

But in combat situations, “we didn’t have that luxury,” Schaefer said. Medical staff sometimes relied on medics who carried units of blood in their backpacks. “Medics can absolutely make the right decisions about doing blood transfusions,” she said.

A quick response made a difference: Soldiers who received blood within minutes of being injured were four times as likely to survive, according to military research.

Civilian emergency services are now incorporating lessons learned by the military into their own operations.

But they face another significant hurdle: compensation. Ambulance service payments are based on how far vehicles travel and the level of services they provide, with some adjustments. But the fee schedule doesn’t cover blood products. If EMS responders carry blood on calls, it’s usually low-titer O whole blood, which is generally safe for anyone to receive, or blood components — liquid plasma and packed red blood cells. These products can cost from $80 to $600 on average, according to Schaefer’s study. And payments don’t cover the blood coolers, fluid warming equipment, and other gear needed to provide blood at the scene.

On Jan. 1, the Centers for Medicare & Medicaid Services began counting any administration of blood during ambulance pre-hospital transport as an “advanced life support, level 2” (ALS2) service, which will boost payment in some cases.

The higher reimbursement is welcome, but it’s not enough to cover the cost of providing blood to a patient, which can run to more than $1,000, Schaefer said. Agencies that run these programs are paying for them out of their own operating budgets or using grants or other sources.

Blood deserts exist in rural and urban areas. Last August, Herby Joseph was walking down the stairs at his cousin’s house in Brockton, Massachusetts, when he slipped and fell. The glass plate he was carrying shattered and sliced through the blood vessels in his right hand.

“I saw a flood of blood and called my cousin to call 911,” Joseph, 37, remembered.

The ambulance team arrived in just a few minutes, evaluated him, and called in the Canton-based Field Transfusion Paramedic Program team, which began administering a blood transfusion shortly thereafter. The program serves 30 towns in the Boston area. Since the transfusion program began last March, the team has responded to more than 40 calls, many of them related to car accidents along the ring of interstate highways surrounding the area, Reardon said.

Brockton has a Level 3 trauma center, but Joseph’s injuries required more intensive care. Boston Medical Center, the Level 1 trauma center where the EMS team was taking Joseph, is about 23 miles from Brockton, and depending on traffic it can take more than a half hour to get there.

Joseph was given more blood at the medical center, where he remained for nearly a week. He eventually underwent three surgeries to repair his hand and has now returned to his warehouse job.

Although Boston has several Level 1 trauma centers, the region south of the city is pretty much a trauma desert, said Crisanto Torres, one of the trauma surgeons who cared for Joseph.

Boston Medical Center partners with the Canton Fire Department to operate the field transfusion program. It’s an important service, Torres said.

“You can’t just put up a new Level 1 trauma center,” he said. “This is one way to blunt the inequity in access to care. It buys patients time.”

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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Desde 2022, entre tantos otros mamíferos, ha habido más de 80 casos confirmados de gatos domésticos con gripe aviar: generalmente gatos de granero que vivían en granjas lecheras, gatos salvajes y mascotas que pasan tiempo al aire libre y probablemente la contrajeron al cazar roedores o aves silvestres enfermas.

Ahora, un pequeño pero creciente número de gatos domésticos se han enfermado con H5N1, la cepa de gripe aviar protagonista del brote actual en el país, después de comer alimentos crudos o beber leche sin pasteurizar. Algunos de ellos murieron.

La cepa de gripe aviar que circula actualmente no se ha adaptado para propagarse de manera eficiente entre las personas. Y no se han conocido casos de transmisión de gato a humano durante el brote actual de H5N1.

Aun así, siempre ha existido el riesgo de que los gatos, que posiblemente solo estén semi domesticados, puedan traer a casa una enfermedad al acecho nocturno.

“Los animales de compañía, y especialmente los gatos, son un riesgo para la salud pública en un 100% en términos de riesgo de transmisión zoonótica a las personas”, dijo la viróloga Angela Rasmussen, que estudia la progresión de la enfermedad en virus emergentes en la Vaccines and Infectious Disease Organization de la Universidad de Saskatchewan.

Las personas duermen con sus gatos. Los gatos beben de los vasos de agua humanos y caminan sobre la mesada de la cocina. Por eso, los dueños de gatos deben ser conscientes de la propagación continua de la gripe aviar. “Al reducir el riesgo para sus gatos, se reduce el riesgo para tí mismo”, dijo Rasmussen.

Rasmussen no cree que los dueños de mascotas deban tener miedo de que sus gatos les transmitan la gripe aviar, pero dijo que tomar precauciones es bueno para las mascotas y para la salud pública.

Los síntomas de la gripe aviar en los gatos incluyen secreción nasal y alrededor de los ojos, explicó Michael Q. Bailey, presidente electo de la American Veterinary Medical Association.

El H5N1 también causa problemas neurológicos como mareos y convulsiones, que comparte con los síntomas de la rabia. La rabia es casi siempre mortal y supone una amenaza para la salud humana, por lo que cualquier animal sospechoso de tener esta enfermedad viral debe ser sacrificado. Bailey anima a las personas a asegurarse de que sus mascotas estén al día con sus vacunas.

La veterinaria Jane Sykes, que se especializa en enfermedades infecciosas en gatos y perros en la Facultad de Medicina Veterinaria de la Universidad de California-Davis, dijo que las personas no deben asumir que se trata de gripe aviar si su gato está enfermo, incluso si su animal pasa tiempo al aire libre o come una dieta cruda. Las enfermedades de las vías respiratorias superiores son comunes en los gatos, mientras que el H5N1 es “todavía bastante raro”.

Sykes le da a su gato, Freckles, alimento para mascotas. Dijo a NPR y KFF Health News que no le preocupa que Freckles contraiga el H5N1 porque el proceso de calentamiento para hacer alimentos secos o enlatados para mascotas mata los virus.

Más casos en gatos, más riesgo para los humanos

Algunas personas alimentan a sus mascotas con carne cruda o leche no pasteurizada porque creen que es una dieta más nutritiva o natural. El sitio web de la American Veterinary Medical Association desaconseja esta práctica debido a los patógenos transmitidos por los alimentos, como la salmonella y la listeria, y ahora el altamente patógeno H5N1.

Al mantener sanas a las mascotas, los veterinarios desempeñan un papel esencial en la protección de los humanos contra las enfermedades zoonóticas. La asociación afirma que el riesgo que el H5N1 se transmita de una mascota a una persona se considera “extremadamente bajo, pero no cero”.

Las agencias de salud pública estatales y locales, incluidas las del condado de Los Ángeles y del estado de Washington, han emitido advertencias similares sobre alimentar a las mascotas con alimentos crudos.

Las preocupaciones por la salud humana son en parte la razón por la que la Administración de Drogas y Alimentos (FDA) anunció el mes pasado que ahora exige a las empresas de alimentos para perros y gatos que actualicen sus planes de seguridad para protegerse contra la gripe aviar.

Esto se produjo después que el Departamento de Agricultura de Oregon descubriera que un gato que era “estrictamente de interior” había contraído H5N1 y había muerto después de consumir un producto de pavo congelado elaborado por la marca de comida cruda para mascotas Northwest Naturals. Afirmó que “las pruebas confirmaron una coincidencia genética entre el virus en la comida cruda y congelada para mascotas y el gato infectado”.

Northwest Naturals retiró voluntariamente ese lote de su producto a base de pavo congelado. La empresa dijo a KFF Health News y NPR que el retiro del mercado involucraba “una pequeña producción de producto” y que tenía inquietudes sobre la precisión de las pruebas del Departamento de Agricultura de Oregón.

El departamento de salud pública del condado de Los Ángeles dijo que cinco gatos de dos hogares dieron positivo en la prueba de gripe aviar después de beber leche cruda no pasteurizada de la lechería Raw Farm en el Valle Central de California.

Raw Farm retiró voluntariamente su leche y crema después que los productos minoristas dieran positivo en la prueba de H5N1, pero niega cualquier problema de seguridad alimentaria, calificando la preocupación como “un problema político”.

Los veterinarios también advierten a los dueños de mascotas que no permitan que los gatos pasen tiempo sin supervisión al aire libre, ya que existe el riesgo de que contraigan el H5N1 al interactuar con otros animales que podrían transmitir la enfermedad.

“Este es un virus muy aterrador, dado que puede infectar a muchas especies diferentes de huéspedes”, dijo Bruce Kornreich, director del Centro de Salud Felina de la Universidad Cornell.

Al menos un caso de un gato que infectó a una persona con gripe aviar ocurrió en 2016. Como informó NPR, un veterinario de la ciudad de Nueva York contrajo el virus después de tener contacto cercano con gatos infectados. El veterinario experimentó síntomas leves y se recuperó rápidamente.

En ese caso, la cepa de gripe aviar era H7N2, no el H5N1 que ahora circula en el país.

La mayoría de las personas que han contraído el H5N1 son trabajadores agrícolas que tuvieron contacto directo con aves de corral o ganado infectados. De al menos 67 casos humanos confirmados de H5N1, ha habido una muerte en una persona inmunodeprimida que tuvo contacto con aves.

En general, los investigadores de enfermedades zoonóticas quieren una mayor vigilancia del H5N1 en animales de compañía de todo tipo. Incluso si el número de muertes humanas por H5N1 todavía es relativamente bajo, sigue siendo un riesgo para la salud pública.

Posibles mutaciones

Parte de la preocupación con este brote de H5N1 es que los virus de la gripe aviar cambian. Sólo unas pocas mutaciones podrían hacer que esta cepa sea capaz de propagarse entre personas. Y cuantas más personas se contagien del H5N1, más probable es que se adapte y se vuelva más eficiente, dijo Suresh Kuchipudi, virólogo de la Facultad de Salud Pública de la Universidad de Pittsburgh, donde investiga enfermedades zoonóticas. Kuchipudi ha estudiado el H5N1 en gatos.

Los Centros para el Control y la Prevención de Enfermedades (CDC) estaban a punto de publicar un nuevo estudio sobre el H5N1 en gatos, pero eso se retrasó cuando la administración Trump detuvo el Informe Semanal de Morbilidad y Mortalidad.

Esa investigación, revelada a través de correos electrónicos obtenidos por KFF Health News en una solicitud de registros públicos, encontró que los gatos domésticos probablemente contrajeron la gripe aviar de los trabajadores de las lecherías.

Los científicos y las agencias de salud pública deberían cuestionar las suposiciones previas sobre la gripe aviar, instó Kuchipudi. Señaló que hace 20 años nadie habría predicho que la gripe aviar infectaría al ganado lechero de la forma en que lo hace ahora.

Los perros parecen tener mejor suerte

La FDA dice que otros animales domésticos, incluidos los perros, pueden contraer infecciones de gripe aviar. No hay casos confirmados de H5N1 entre perros en los EE. UU., aunque en otros países han muerto a causa del virus.

Hay cierto desacuerdo y una falta general de investigación sobre si la biología de los gatos los vuelve más susceptibles al H5N1 que otros mamíferos, incluidos los humanos, los cerdos o los perros.

Pero los comportamientos de los gatos, como su amor por los productos lácteos y la depredación de aves silvestres, los ponen en mayor riesgo, dijo Kuchipudi. Además, vivir en grupos podría desempeñar un papel, ya que hay más colonias de gatos salvajes en los que grupos de perros callejeros.

Hay muy poco que la gente pueda hacer sobre el H5N1 que circula en las aves silvestres. Como explicó Rasmussen, “Está volando por los cielos. “Está migrando de norte a sur con las estaciones”.

Pero dijo que hay muchas cosas que la gente puede hacer para mantener el virus fuera de sus hogares.

Eso incluye limitar la exposición de una mascota al H5N1 no alimentándola con alimentos crudos o leche no pasteurizada, y tratar de evitar que interactúe con animales como roedores y aves silvestres que podrían estar infectados con el virus.

Este artículo es parte de una asociación que incluye a NPR y KFF Health News.

Esta historia fue producida por KFF Health News, conocido antes como Kaiser Health News (KHN), una redacción nacional que produce periodismo en profundidad sobre temas de salud y es uno de los principales programas operativos de KFF, la fuente independiente de investigación de políticas de salud, encuestas y periodismo. 

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A measles outbreak is growing in a Texas county with dangerously low vaccination rates.

In late January, two school-age children from Gaines County were hospitalized with measles. Since an estimated 1 in 5 people with the disease end up in the hospital, the two cases suggested a larger outbreak.

As of Feb. 6, there were 12 confirmed cases and health officials expected an additional six, said Zach Holbrooks, executive director of the South Plains Public Health District, which includes Gaines. The department is investigating many other potential cases among close contacts, he said, in hopes of treating people quickly and curbing the spread of the virus.

Public health practitioners warn such outbreaks will become more common because of scores of laws around the U.S. — pending and passed — that ultimately lower vaccine rates. Many of the measures allow parents to more easily exempt their children from school vaccine requirements, and a swell of vaccine misinformation has led to record rates of exemptions.

As Robert F. Kennedy Jr., one of the most influential purveyors of dangerous vaccine misinformation, prepares to take the helm of the Department of Health and Human Services, researchers say such bills have a higher chance of passing and that more parents will refuse vaccines because of false information spread at the highest levels of government.

“Mr. Kennedy has been an opponent of many health-protecting and life-saving vaccines, such as those that prevent measles and polio,” scores of Nobel Prize laureates wrote in a letter to the Senate. Having him head HHS, they wrote, “would put the public’s health in jeopardy.”

Most people who aren’t protected by vaccination will get measles if exposed. Gaines County has one of the lowest rates of childhood vaccination in Texas. At a local public school district in the community of Loop, only 46% of kindergarten students have gotten vaccines against measles, mumps, and rubella. Vaccination rates may be even lower at private schools and within homeschool groups, which don’t always report the information.

Holbrooks’ team is scrambling to track transmission, ensure that kids and babies seek prompt care, and offer measles vaccines to anyone who hasn’t yet gotten them.

“We are going to see more kids infected. We will see more families taking time off from work. More kids in the hospital,” said Rekha Lakshmanan, chief strategy officer for The Immunization Partnership in Houston, a nonprofit that advocates for vaccine access. “This is the tip of the iceberg.”

As a rule, at least 95% of people need to be vaccinated against measles for a community to be well protected. That threshold is high enough to protect infants too young for the vaccine, people who can’t take the vaccine for medical reasons, and anyone who doesn’t mount a strong, lasting immune response to it.

Measles is extremely contagious, so health workers preemptively treated infants too young to be vaccinated who had shared the emergency room with children later diagnosed with the virus, said Katherine Wells, public health director in Lubbock, Texas. Some children from Gaines were hospitalized in that county. The disease can cause severe complications, and about one of every thousand children with measles die.

An outbreak among a largely unvaccinated population in Samoa in 2019 and 2020 caused 83 deaths, mainly among children, and more than 5,700 cases. Kennedy, who peddles misinformation about measles vaccines, had visited the island earlier on a trip arranged by a Samoan anti-vaccine influencer, according to a 2021 blog post by Kennedy.

Without evidence, Kennedy cast doubt on the fact that measles caused the tragedy in Samoa. “We don’t know what was killing them,” he said at his first confirmation hearing. Samoa’s top health official denounced this evasion as “a complete lie,” in an interview with The Associated Press.

Last school year, the number of kindergartners exempted from a vaccine requirement — 3.3% — was higher than ever reported before, according to the Centers for Disease Control and Prevention. Numbers were far higher than that in Gaines County, where nearly 1 in 5 children in kindergarten had a vaccine exemption for philosophical or religious reasons in 2023-24.

Over the past couple of years, several states have allowed more parents to obtain exemptions. Already, about 25 bills have been filed in the 2025 Texas legislative session that could limit vaccination in various ways.

“We’re seeing a level of momentum this legislative session that we’ve never seen in the past,” Lakshaman said. Changes are afoot at the local level, too. For example, a school board in the Houston area voted to remove references to vaccines in its curriculum. “There is a top-down and bottom-up assault on these protections,” Lakshaman said.

About 80% of the public believes that the benefits of the measles, mumps, and rubella vaccines outweigh the risks, according to a 2025 KFF poll.

“Lawmakers who put forth dangerous policies need to know the people they hear from don’t represent the majority,” Lakshaman said. Her group offers resources on its website to help people influence decisions on vaccination policies.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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Greg Herbruck knew 6.5 million of his birds needed to die, and fast.

But the CEO of Herbruck’s Poultry Ranch wasn’t sure how the family egg producer (one of the largest in the U.S., in business for over three generations) was going to get through it, financially or emotionally. One staffer broke down in Herbruck’s office in tears.

“The mental toll on our team of dealing with that many dead chickens is just, I mean, you can’t imagine it,” Herbruck said. “I didn’t sleep. Our team didn’t sleep.”

The stress of watching tens of thousands of sick birds die of avian flu each day, while millions of others waited to be euthanized, kept everyone awake.

In April 2024, as his first hens tested positive for the highly pathogenic avian influenza H5N1 virus, Herbruck turned to the tried-and-true U.S. Department of Agriculture playbook, the “stamping-out” strategy that helped end the 2014-15 bird flu outbreak, which was the largest in the U.S. until now.

Within 24 to 48 hours of the first detection of the virus, state and federal animal health officials work with farms to cull infected flocks to reduce the risk of transmission. That’s followed by extensive disinfection and months of surveillance and testing to make sure the virus isn’t still lurking somewhere on-site.

Since then, egg farms have had to invest millions of dollars into biosecurity. For instance, employees shower in and shower out, before they start working and after their shifts end, to prevent spreading any virus. But their efforts have not been enough to contain the outbreak that started three years ago.

This time, the risk to human health is only growing, experts say. Sixty-six of the 67 total human cases in the United States have been just since March, including the nation’s first human death, reported last month.

“The last six months have accelerated my concern, which was already high,” said Nahid Bhadelia, an infectious diseases physician and the founding director of Boston University’s Center on Emerging Infectious Diseases.

Controlling this virus has become more challenging, precisely because it’s so entrenched in the global environment, spilling into mammals such as dairy cows, and affecting roughly 150 million birds in commercial and backyard flocks in the U.S.

Because laying hens are so susceptible to the H5N1 virus, which can wipe out entire flocks within days of the first infection, egg producers have been on the front lines in the fight against various bird flu strains for years. But this moment feels different. Egg producers and the American Egg Board, an industry group, are begging for a new prevention strategy.

Many infectious disease experts agree that the risks to human health of continuing current protocols are unsustainable, because of the strain of bird flu driving this outbreak.

“The one we’re battling today is unique,” said David Swayne, former director of the Southeast Poultry Research Laboratory at the USDA’s Agricultural Research Service and a leading national expert in avian influenza.

“It’s not saying for sure there’s gonna be a pandemic” of H5N1, Swayne said, “but it’s saying the more human infections, the spreading into multiple mammal species is concerning.”

For Herbruck, it feels like war. Ten months after Herbruck’s Poultry Ranch was hit, the company is still rebuilding its flocks and rehired most of the 400 workers it laid off.

Still, he and his counterparts in the industry live in fear, watching other farms get hit two, even three times in the past few years.

“I call this virus a terrorist,” he said. “And we are in a battle and losing, at the moment.”

When Biosecurity Isn’t Working … or Just Isn’t Happening

So far, none of the 23 people who contracted the disease from commercial poultry have experienced severe cases, but the risks are still very real. The first human death was a Louisiana patient who had contact with both wild birds and backyard poultry. The person was over age 65 and reportedly had underlying medical conditions.

And the official message to both backyard farm enthusiasts and mega-farms has been broadly the same: Biosecurity is your best weapon against the spread of disease.

But there’s a range of opinions among backyard flock owners about how seriously to take bird flu, said Katie Ockert, a Michigan State University Extension educator who specializes in biosecurity communications.

Skeptics think that “we’re making a mountain out of a molehill,” Ockert said, or that “the media is maybe blowing it out of proportion.” This means there are two types of backyard poultry enthusiasts, Ockert said: those doing great biosecurity, and those who aren’t even trying.

“I see both,” she said. “I don’t feel like there’s really any middle ground there for people.”

And the challenges of biosecurity are completely different for backyard coops than massive commercial barns: How are hobbyists with limited time and budgets supposed to create impenetrable fortresses for their flocks, when any standing water or trees on the property could draw wild birds carrying the virus?

Rosemary Reams, an 82-year-old retired educator in Ionia, Michigan, grew up farming and has been helping the local 4-H poultry program for years, teaching kids how to raise poultry. Now, with the bird flu outbreak, “I just don’t let people go out to my barn,” she said.

Reams even swapped real birds with fake ones for kids to use while being assessed by judges at recent 4-H competitions, she said.

“We made changes to the fair last year, which I got questioned about a lot. And I said, ‘No, I gotta think about the safety of the kids.’”

Reams was shocked by the news of the death of the Louisiana backyard flock owner. She even has questioned whether she should continue to keep her own flock of 20 to 30 chickens and a pair of turkeys.

“But I love ’em. At my age, I need to be doing it. I need to be outside,” Reams said. “That’s what life is about.” She said she’ll do her best to protect herself and her 4-H kids from bird flu.

Even “the best biosecurity in the world” hasn’t been enough to save large commercial farms from infection, said Emily Metz, president and CEO of the American Egg Board.

The egg industry thought it learned how to outsmart this virus after the 2014-15 outbreak. Back then, “we were spreading it amongst ourselves between egg farms, with people, with trucks,” Metz said. So egg producers went into lockdown, she said, developing intensive biosecurity measures to try to block the routes of transmission from wild birds or other farms.

Metz said the measures egg producers are taking now are extensive.

“They have invested hundreds of millions of dollars in improvements, everything from truck washing stations — which is washing every truck from the FedEx man to the feed truck — and everything in between: busing in workers so that there’s less foot traffic, laser light systems to prevent waterfowl from landing.”

Lateral spread, when the virus is transmitted from farm to farm, has dropped dramatically, down from 70% of cases in the last outbreak to just 15% as of April 2023, according to the USDA.

And yet, Metz said, “all the measures we’re doing are still getting beat by this virus.”

The Fight Over Vaccinating Birds

Perhaps the most contentious debate about bird flu in the poultry industry right now is whether to vaccinate flocks.

Given the mounting death toll for animals and the increasing risk to humans, there’s a growing push to vaccinate certain poultry against avian influenza, which countries like China, Egypt, and France are already doing.

In 2023, the World Organization for Animal Health urged nations to consider vaccination “as part of a broader disease prevention and control strategy.”

Swayne, the avian influenza expert and poultry veterinarian, works with WOAH and said most of his colleagues in the animal and public health world “see vaccination of poultry as a positive tool in controlling this panzootic in animals,” but also as a tool that reduces chances for human infection, and chances for additional mutations of the virus to become more human-adapted.

But vaccination could put poultry meat exporters (whose birds are genetically less susceptible to H5N1 than laying hens) at risk of losing billions of dollars in international trade deals. That’s because of concerns that vaccination, which lowers the severity of disease in poultry, could mask infections and bring the virus across borders, according to John Clifford, a former chief veterinary officer of the USDA. Clifford is currently an adviser to the USA Poultry and Egg Export Council.

“If we vaccinate, we not only lose $6 billion potentially in exports a year,” Clifford said. “If they shut us off, that product comes back on the U.S. market. Our economists looked at this and said we would lose $18 billion domestically.”

Clifford added that would also mean the loss of “over 200,000 agricultural jobs.”

Even if those trade rules changed to allow meat and eggs to be harvested from vaccinated birds, logistical hurdles remain.

“Vaccination possibly could be on the horizon in the future, but it’s not going to be tomorrow or the next day, next year, or whatever,” Clifford said.

Considering just one obstacle: No current HPAI vaccine is a perfect match for the current strain, according to the USDA. But if the virus evolves to be able to transmit efficiently from human to human, he said, “that would be a game changer for everybody, which would probably force vaccination.”

Last month, the USDA announced it would “pursue a stockpile that matches current outbreak strains” in poultry.

“While deploying a vaccine for poultry would be difficult in practice and may have trade implications, in addition to uncertainty about its effectiveness, USDA has continued to support research and development in avian vaccines,” the agency said.

At this point, Metz argued, the industry can’t afford not to try vaccination, which has helped eradicate diseases in poultry before.

“We’re desperate, and we need every possible tool,” she said. “And right now, we’re fighting this virus with at least one, if not two, arms tied behind our back. And the vaccine can be a huge hammer in our toolbox.”

But unless the federal government acts, that tool won’t be used.

Industry concerns aside, infectious diseases physician Bhadelia said there’s an urgent need to focus on reducing the risk to humans of getting infected in the first place. And that means reducing “chances of infections in animals that are around humans, which include cows and chickens. Which is why I think vaccination to me sounds like a great plan.”

The lesson “that we keep learning every single time is that if we’d acted earlier, it would have been a smaller problem,” she said.

This article is from a partnership that includes Michigan Public, NPR, and KFF Health News.

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Valentino Valdez was given his birth certificate, his Social Security card, a T-shirt, and khaki pants when he was released from a Texas prison in 2019 at age 21. But he didn’t have health insurance, mental health medications, or access to a doctor, he said.

Three years later, he landed in an inpatient hospital after expressing suicidal thoughts.

After more than a decade cycling through juvenile detention, foster care placements, and state prisons, Valdez realizes now that treatment for his mental health conditions would have made life on his own much easier.

“It’s not until you’re put in, like, everyday situations and you respond adversely and maladaptive,” he said, “you kind of realize that what you went through had an effect on you.”

“I was struggling with a lot of mental stuff,” said Valdez, now 27.

For years, people like Valdez have often been left to fend for themselves when seeking health care services after their release from jail, prison, or other carceral facilities. Despite this population’s high rate of mental health problems and substance use disorders, they often return to their communities with no coverage, which increases their chances of dying or suffering a lapse that sends them back behind bars.

A new federal law aims to better connect incarcerated children and young adults who are eligible for Medicaid or the Children’s Health Insurance Program to services before their release. The goal is to help prevent them from developing a health crisis or reoffending as they work to reestablish themselves.

“This could change the trajectory of their lives,” said Alycia Castillo, associate director of policy for the Texas Civil Rights Project. Without that treatment, she said, many young people leaving custody struggle to reintegrate into schools or jobs, become dysregulated, and end up cycling in and out of detention facilities.

Medicaid has historically been prohibited from paying for health services for incarcerated people. So jails, prisons, and detention centers across the country have their own systems for providing health care, often funded by state and local budgets and not integrated with a public or private health system.

The new law is the first change to that prohibition since the Medicare and Medicaid Act’s inception in 1965, and it came in a spending bill signed by President Joe Biden in 2022. It took effect Jan. 1 this year, and requires all states to provide medical and dental screenings to Medicaid- and CHIP-eligible youths 30 days before or immediately after they leave a correctional facility. Youths must continue to receive case management services for 30 days after their release.

More than 60% of young people who are incarcerated are eligible for Medicaid or CHIP, according to a September 2024 report from the Center for Health Care Strategies. The new law applies to children and young adults up to age 21, or 26 for those who, like Valdez, were in foster care.

Putting the law into practice, however, will require significant changes to how the country’s thousands of correctional facilities provide health care to people returning to communities, and it could take months or even years for the facilities to be fully in compliance.

“It’s not going to be flipping a switch,” said Vikki Wachino, founder and executive director of the Health and Reentry Project, which has been helping states implement the law. “These connection points have never been made before,” said Wachino, a former deputy administrator of the Centers for Medicare & Medicaid Services.

The federal CMS under the Biden administration did not respond to a question about how the agency planned to enforce the law.

It’s also unclear whether the Trump administration will force states to comply. In 2018, President Donald Trump signed legislation requiring states to enroll eligible youths in Medicaid when they leave incarceration, so they don’t experience a gap in health coverage. The law Biden signed built on that change by requiring facilities to provide health screenings and services to those youths, as well as ones eligible for CHIP.

Even though the number of juveniles incarcerated in the U.S. has dropped significantly over the past two decades, more than 64,000 children and young adults 20 and younger are incarcerated in state prisons, local and tribal jails, and juvenile facilities, according to estimates provided to KFF Health News by the Prison Policy Initiative, a nonprofit research organization that studies the harm of mass incarceration.

A ‘Neglected Part of the Health System’

The federal Bureau of Justice Statistics estimates that about a fifth of the country’s prison population spent time in foster care. Black youths are nearly five times as likely as white youths to be placed in juvenile facilities, according to the Sentencing Project, a nonprofit that advocates for reducing prison and jail populations.

Studies show that children who receive treatment for their health needs after release are less likely to reenter the juvenile justice system.

“Oftentimes what pulls kids and families into these systems is unmet needs,” said Joseph Ribsam, director of child welfare and juvenile justice policy at the Annie E. Casey Foundation and a former state youth services official. “It makes more sense for kids to have their health care tied to a health care system, not a carceral system.”

Yet many state and local facilities and state health agencies nationwide will have to make a lot of changes before incarcerated people can receive the services required in the law. The facilities and agencies must first create systems to identify eligible youths, find health care providers who accept Medicaid, bill the federal government, and share records and data, according to state Medicaid and corrections officials, as well as researchers following the changes.

In January, the federal government began handing out around $100 million in grants to help states implement the law, including to update technology.

Some state officials are flagging potential complications.

In Georgia, for example, the state juvenile justice system doesn’t have a way to bill Medicaid, said Michelle Staples-Horne, medical director for the Georgia Department of Juvenile Justice.

In South Dakota, suspending someone’s Medicaid or CHIP coverage while they are incarcerated instead of just ending it is a challenge, Kellie Wasko, the state’s secretary of corrections, said in a November webinar on the new law. That’s a technical change that’s difficult to operationalize, she said.

State Medicaid officials also acknowledged that they can’t force local officials to comply.

“We can build a ball field, but we can’t make people come and play ball,” said Patrick Beatty, deputy director and chief policy officer for the Ohio Department of Medicaid.

States should see the law as a way to address a “neglected part of the health system,” said Wachino, the former CMS official. By improving care for people transitioning out of incarceration, states may spend less money on emergency care and on corrections, she said.

“Any state that is dragging its feet is missing an opportunity here,” she said.

‘Our System Is Making People Worse’

The Texas Department of Family Services took custody of Valdez when he was 8 because his mother’s history of seizures made her unable to care for him, according to records. Valdez said he ran away from foster care placements because of abuse or neglect.

A few years later, he entered the Texas juvenile justice system for the first time. Officials there would not comment on his case. But Valdez said that while he was shuffled between facilities, his antidepressant and antipsychotic medications would be abruptly stopped and his records rarely transferred. He never received therapy or other support to cope with his childhood experiences, which included sexual abuse, according to his medical records.

Valdez said his mental health deteriorated while he was in custody, from being put in isolation for long periods of time, the rough treatment of officials, fears of violence from other children, and the lack of adequate health care.

“I felt like an animal,” Valdez said.

In August, the U.S. Department of Justice released a report that claims the state exposes children in custody to excessive force and prolonged isolation, fails to protect them from sexual abuse, and fails to provide adequate mental health services. The Texas Juvenile Justice Department has said it is taking steps to improve safety at its facilities.

In 2024, 100% of children in Texas Juvenile Justice Department facilities needed specialized treatment, including for problems with mental health, substance use, or violent behavior, according to the department.

Too often, “our system is making people worse and failing to provide them with the continuity of care they need,” said Elizabeth Henneke, founder and CEO of the Lone Star Justice Alliance, a nonprofit law firm in Texas.

Valdez said trauma from state custody shadowed his life after release. He was quick to anger and violence and often felt hopeless. He was incarcerated again before he had a breakdown that led to his hospitalization in 2022. He was diagnosed with post-traumatic stress disorder and put on medication, according to his medical records.

“It helped me understand that I wasn’t going crazy and that there was a reason,” he said. “Ever since then, I’m not going to say it’s been easy, but it’s definitely been a bit more manageable.”

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

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Un brote de sarampión está diseminándose en un condado de Texas que tiene tasas de vacunación peligrosamente bajas.

A fines de enero, dos niños escolares del condado de Gaines fueron internados con sarampión. Ya que se estima que 1 de cada 5 personas con la enfermedad termina en el hospital, los dos casos sugirieron un brote más grande.

Al 7 de febrero, había 14 casos confirmados y seis probables, informó Zach Holbrooks, director ejecutivo del Distrito de Salud Pública de South Plains, que incluye a Gaines. Agregó que el departamento está investigando muchos otros casos potenciales entre contactos cercanos, con la esperanza de tratar a las personas rápidamente y frenar la propagación del virus.

Profesionales de salud pública advierten que estos brotes se volverán más comunes: decenas de leyes en todo Estados Unidos —pendientes y aprobadas— podrían seguir reduciendo las tasas de vacunación.

Muchas de las medidas permiten a los padres eximir más fácilmente a sus hijos de los requisitos de vacunación escolar, y una oleada de desinformación sobre las vacunas ha llevado a tasas récord de exenciones.

Mientras Robert F. Kennedy Jr., uno de los más influyentes diseminadores de desinformación peligrosa sobre las vacunas, se prepara para tomar el mando del Departamento de Salud y Servicios Humanos (HHS), investigadores dicen que estos proyectos de ley tienen más posibilidades de aprobarse, y que más padres rechazarán las vacunas por la información falsa difundida en los niveles más altos del gobierno.

“El señor Kennedy se ha opuesto a muchas vacunas que protegen la salud y salvan vidas, como las que previenen el sarampión y la polio”, escribieron decenas de premios Nobel en una carta al Senado. Tenerlo al frente del HHS, escribieron, “pondría en peligro la salud pública”.

La mayoría de las personas que no están protegidas por la vacunación contraerán sarampión si se exponen. El condado de Gaines tiene una de las tasas más bajas de vacunación infantil en Texas. En un distrito escolar público local en la comunidad de Loop, solo el 46% de los alumnos de kinder han sido vacunados contra el sarampión, las paperas y la rubeola.

Las tasas de vacunación pueden ser incluso más bajas en las escuelas privadas y en los grupos de educación en el hogar, que no siempre informan sobre inmunizaciones.

El equipo de Holbrooks está trabajando para rastrear la transmisión, garantizar que los niños y los bebés busquen atención médica inmediata, y ofrecer vacunas contra el sarampión a cualquiera que aún no las haya recibido.

“Vamos a ver más niños infectados. Veremos más familias teniendo que tomarse días en el trabajo. Más niños en el hospital”, dijo Rekha Lakshmanan, directora de estrategia de The Immunization Partnership en Houston, una organización sin fines de lucro que aboga por el acceso a las vacunas. “Esta es la punta del iceberg”.

Como regla general, al menos el 95% de las personas deben vacunarse contra el sarampión para que toda una comunidad esté bien protegida. Ese umbral es lo suficientemente alto como para proteger a los bebés que son demasiado pequeños para vacunarse, a las personas que no pueden hacerlo por razones médicas, y a cualquiera que no desarrolle una respuesta inmunitaria fuerte y duradera a la vacuna.

El sarampión es extremadamente contagioso, por eso se trató preventivamente a los bebés demasiado pequeños para ser vacunados que habían estado en la misma sala de emergencias que los niños a los que luego se les diagnosticó el virus, dijo Katherine Wells, directora de salud pública en Lubbock, Texas. Algunos niños de Gaines fueron internados en ese condado. La enfermedad puede causar complicaciones graves y aproximadamente uno de cada 1.000 niños con sarampión muere.

Un brote entre una población en Samoa en 2019 y 2020, que no estaba mayormente vacunada, causó 83 muertes, principalmente entre niños, y más de 5.700 casos. Kennedy, que difunde información errónea sobre las vacunas contra el sarampión, había visitado la isla anteriormente en un viaje organizado por un influencer antivacunas samoano, según una publicación de 2021 del blog de Kennedy.

Sin pruebas, Kennedy puso en duda el hecho de que el sarampión fuera el causante de la tragedia en Samoa. “No sabemos qué los estaba matando”, dijo en su primera audiencia de confirmación. El principal funcionario de salud de Samoa denunció esto como “una mentira absoluta”, en una entrevista con The Associated Press.

El año escolar pasado, el número de niños de kinder exentos de un requisito de vacuna (3,3%) fue el más alto en la historia, según los Centros para el Control y Prevención de Enfermedades (CDC). Las cifras fueron mucho más altas que las del condado de Gaines, donde casi 1 de cada 5 niños en kinder tuvo una exención de vacunas por razones filosóficas o religiosas en 2023-24.

En los últimos años, varios estados han permitido que más padres obtengan exenciones. Ya se han presentado alrededor de 25 proyectos de ley en la sesión legislativa de Texas de 2025 que podrían limitar la vacunación de diversas formas.

“Estamos viendo un momentum en esta sesión legislativa que nunca hemos visto en el pasado”, dijo Lakshaman. También se están produciendo cambios a nivel local. Por ejemplo, una junta escolar en el área de Houston votó para eliminar las referencias a las vacunas en su plan de estudios. “Hay un ataque de arriba hacia abajo y de abajo hacia arriba contra estas protecciones”, dijo Lakshaman.

Alrededor del 80% del público cree que los beneficios de as vacunas contra el sarampión, las paperas y la rubeola supera a los riesgos, según una encuesta de KFF de 2025.

“Los legisladores que proponen políticas peligrosas deben saber que las personas a las que escuchan no representan a la mayoría”, dijo Lakshaman. Su grupo ofrece recursos en su sitio web para ayudar a las personas a influir en las decisiones sobre las políticas de vacunación.

Esta historia fue producida por KFF Health News, conocido antes como Kaiser Health News (KHN), una redacción nacional que produce periodismo en profundidad sobre temas de salud y es uno de los principales programas operativos de KFF, la fuente independiente de investigación de políticas de salud, encuestas y periodismo. 

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Confusion continues to reign at the Department of Health and Human Services, where policies seem to be changing at a breakneck pace even before a new secretary or other senior officials are confirmed by the Senate. Some federal grantees report payments are still paused, outside communications are still canceled, and many workers are being threatened with layoffs if they don’t accept a buyout offer that some observers call legally dubious.

 Meanwhile, that new HHS secretary may soon arrive, given the Senate Finance Committee approved Robert F. Kennedy Jr.’s nomination this week on a party-line vote — including an “aye” vote from Sen. Bill Cassidy (R-La.), a doctor who had strongly condemned Kennedy’s anti-vaccine activism.

 This week’s panelists are Julie Rovner of KFF Health News, Alice Miranda Ollstein of Politico, and Lauren Weber of The Washington Post.

Among the takeaways from this week’s episode:

• In Washington, the Trump administration’s federal funding freeze, buyout offers to scores of federal workers, and disabling of federal agency websites have left more questions than answers. A tangle of legal issues and lack of communication have only served to sow confusion around the nation and globe for health providers, researchers, and foreign aid groups — to name a few.
• As the Trump administration runs through many of the disruptive policy changes prescribed last year in the Heritage Foundation’s presidential transition playbook, Project 2025, some people are asking: Where are the Democrats? Lawmakers have taken up mostly individual efforts to question and protest the administration’s changes, but, thus far, Democrats are still pulling together a unified approach in Washington to counter the Trump administration’s break-it-to-change-it approach.
• Faced with threats to crucial federal funding, some in the health industry are falling in line with President Donald Trump’s executive orders even as they’re challenged in the courts. Notably, some hospitals have stopped providing treatment to transgender minors in Democratic-run states such as New York.
• Meanwhile, a doctor in New York is facing a criminal indictment over providing the abortion pill to a Louisiana patient. The doctor is protected by a state shield law, and the indictment escalates the interstate fight over abortion access. And a Trump order barring federal funding from being used to pay for or “promote” abortions is not only rolling back Joe Biden-era efforts to protect abortion rights, but also going further than any modern president to restrict abortion — after Trump repeatedly said on the campaign trail that abortion policy would be left to the states.

Also this week, Rovner interviews KFF Health News’ Julie Appleby, who reported the latest “Bill of the Month” feature about a young woman, a grandfathered health plan, and a $14,000 IUD. If you have an outrageous or baffling medical bill you’d like to share with us, you can do that here.

Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too: 

Julie Rovner: The New York Times’ “How R.F.K. Jr. and ‘Medical Freedom’ Rose to Power,” on “The Daily” podcast.  

Lauren Weber: CNN’s “Human Brain Samples Contain an Entire Spoon’s Worth of Nanoplastics, Study Says,” by Sandee LaMotte.  

Alice Miranda Ollstein: The Washington Post’s “Did RFK Jr. or Michelle Obama Say It About Food? Take Our Quiz,” by Lauren Weber. 

Also mentioned in this week’s podcast:

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To hear all our podcasts, click here.

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For more than a decade, Kaiser Permanente has been under the microscope for shortcomings in mental health care, even as it is held in high esteem on the medical side.

In 2013, California regulators fined the insurer $4 million for failing to reduce wait times, giving patients inaccurate information, and improperly tracking appointment data. And in 2023, KP agreed to pay $50 million, the largest penalty ever levied by the state’s Department of Managed Health Care, for failing to provide timely care, maintain a sufficient number of mental health providers, and oversee its providers effectively.

Now, Kaiser Permanente is back in the hot seat as mental health workers in Southern California wage a strike that’s in its fourth month. KP therapists and union representatives accuse the HMO giant of saddling workers with excessive caseloads and often forcing patients to wait twice as long as the state allows for follow-up appointments. They say that the staff is burned out and that this work environment makes it hard to recruit clinicians, exacerbating the staffing problem.

KP rebuffs these claims, saying the union is parading out old problems, seeking to create “an inaccurate and outdated perception” of KP’s care. They say the union’s pay demands are “in direct contrast to our commitment to providing quality, affordable care.”

Kaiser Permanente — the largest commercial health plan in California, with about 9 million members — is far from alone in struggling to provide adequate mental health care. A pandemic-induced shortage of health care workers has created obstacles for all health plans in recent years, on top of a preexisting scarcity. Moreover, many therapists decline to contract with insurers. And lingering bias in the health care system against mental health services — and patients — may also be at play.

Federal and state laws require health plans to provide mental health care on par with medical care. But many people who have sought therapy can vouch that those measures, known as mental health parity laws, do not seem to be followed consistently. You can spend hours or even days calling every therapist allegedly in your insurance company’s network and come away empty-handed.

Secret-shopper surveys of 4,300 randomly selected outpatient providers listed as accepting new patients showed that “an alarming proportion” of them were unresponsive or unreachable, according to a federal government report issued last month. And while that was true for medical providers, it was consistently worse for mental health and substance abuse care, according to the report.

In California, state regulators have been conducting behavioral health care investigations of the insurance companies they regulate to help identify the extent and causes of delays in care.

So far, the DMHC has investigated nine health plans (not including KP) and found dozens of violations related to appointment availability, timely access, quality of care, and patient appeals, department spokesperson Rachel Arrezola says. The agency also has identified numerous “barriers” that do not necessarily break the law but may make it more difficult for patients to get care, she says.

Mark Peterson, a professor at UCLA’s Luskin School of Public Affairs, notes that the open-ended nature of therapy can conflict with health plans’ focus on their bottom lines. “It may be once a week, it may be more than once a week and go on for years,” Peterson says.

For insurers, he says, the question is, “How do you put an appropriate limit on that?”

And the unwillingness of many therapists to accept insurance companies’ payment rates, or to abide by their restrictions, often leads them to decline participation in health plan networks and charge higher rates. That, Peterson says, makes therapy financially inaccessible for a lot of people seeking it.

Even if you have some coverage for therapy outside your health plan network, your insurer will pay only a percentage of the rate that it recognizes as legitimate. “If your therapist is charging $300 an hour, and your insurance company only recognizes $150 an hour, and they only pay 50% of what they recognize, now you’ve got a quarter coverage of your therapy,” Peterson says.

Since Kaiser Permanente is a closed system and patients don’t get reimbursed for care outside the network, access problems for its patients can be “highly pronounced,” Peterson adds.

In California, KP has accounted for over $54 million of the $55.7 million in mental-health-related fines the DMHC has levied on insurers in the past two decades. That includes the $50 million fine imposed in 2023, which was part of a settlement in which KP agreed to fix deficiencies the department found and to invest an additional $150 million in projects intended to enhance access to mental health care, not just for KP members, around California.

Officials at the National Union of Healthcare Workers, which represents some 2,400 KP mental health workers in the ongoing Southern California contract talks, say the HMO could easily invest enough to become a paragon of high-quality mental health care if it wanted to.

Greg Tegenkamp, the lead union negotiator, says KP could “lead the way to do the right thing.”

Kaiser Permanente says it already is doing the right thing, even as it acknowledges past shortcomings. In a recent statement, it said it has invested over $1 billion in new treatment spaces and more mental health providers since 2020.

“We’ve grown our workforce and increased our network of skilled therapists so that any Kaiser Permanente member who needs an appointment is able to get timely, high-quality, clinically appropriate care,” the company says.

In addition to higher wages and lower patient loads, workers want more time to complete follow-up tasks outside sessions and the reinstatement of a pension that was eliminated for those hired in Southern California after 2014.

Kaiser Permanente says that it already pays its mental health workers in Southern California about 18% above the market rate and that the current proposal would raise pay even more. KP recently raised its proposed wage increase by a modest amount, according to union officials.

KP refutes reports from workers about long wait times for patients seeking mental health appointments. It says the average wait time is 48 hours for urgent appointments and six business days for nonurgent ones, “which is better than the state’s requirement” of no more than 10 days.

But workers say KP patients still face long delays for follow-up appointments.

“It’s really hard for our patients to get regular, frequent appointments,” says Kassaundra Gutierrez-Thompson, a KP therapist in Southern California who is on strike. Gutierrez-Thompson says she’s seen it from both sides, since she is also a patient who sees a KP psychiatrist for depression and recently faced a big rescheduling delay after one of her appointments was canceled without notice.

As a provider, Gutierrez-Thompson says, she and her colleagues are expected to see patients “back-to-back-to-back.” She says some of her colleagues developed urinary tract infections when they couldn’t get to the bathroom. One even started wearing adult diapers, she says.

“The working conditions are like a factory,” Gutierrez-Thompson says. “We do such human work, but they would love for us to be robots with no needs and just see patients all day.”

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