Cannabis users are at increased risk of severe Covid, study finds

Intensive care (Photo by Matt Miller, Washington University)

Kentucky Health News

Use of cannabis, commonly called marijuana, is linked to increased risk of serious illness for those with Covid-19. So says a study in the American Medical Association journal JAMA Network Open by researchers at the Washington University in St. Louis.

“There’s this sense among the public that cannabis is safe to use, that it’s not as bad for your health as smoking or drinking, that it may even be good for you,” Dr. Li-Shiun Chen, a professor of psychiatry and senior author of the study, said in a university news release.

“I think that’s because there hasn’t been as much research on the health effects of cannabis as compared to tobacco or alcohol. What we found is that cannabis use is not harmless in the context of Covid-19. People who reported . . . current cannabis use, at any frequency, were more likely to require hospitalization and intensive care than those who did not use cannabis.”

Cannabis use differed from tobacco smoking in one key measurement: survival. While smokers were significantly more likely to die of Covid-19 than nonsmokers — a finding that fits with numerous other studies — the same was not true of cannabis users, the news release said.

“The independent effect of cannabis is similar to the independent effect of tobacco regarding the risk of hospitalization and intensive care,” Chen said. “For the risk of death, tobacco risk is clear but more evidence is needed for cannabis.”

The researchers analyzed the health records of 72,501 people seen for Covid-19 at BJC HealthCare hospitals and clinics in Missouri and Illinois during the first two years of the pandemic. They "found that people who reported using any form of cannabis at least once in the year before developing Covid-19 were significantly more likely to need hospitalization and intensive care than were people with no such history," the release says. "This elevated risk of severe illness was on par with that from smoking."

The records contained demographic characteristics; medical conditions; use of substances including tobacco, alcohol, cannabis and vaping; and hospitalization, admittance to an intensive-care unit, and survival.

"Covid-19 patients who reported that they had used cannabis in the previous year were 80% more likely to be hospitalized and 27% more likely to be admitted to the ICU than patients who had not used cannabis, after taking into account tobacco smoking, vaccination, other health conditions, date of diagnosis, and demographic factors," the release says. "For comparison, tobacco smokers with Covid-19 were 72% more likely to be hospitalized and 22% more likely to require intensive care than were nonsmokers, after adjusting for other factors. These results contradict some other research suggesting that cannabis may help the body fight off viral diseases such as Covid-19.

Chen said, “Most of the evidence suggesting that cannabis is good for you comes from studies in cells or animals. The advantage of our study is that it is in people and uses real-world health-care data collected across multiple sites over an extended time period. All the outcomes were verified: hospitalization, ICU stay, death. Using this data set, we were able to confirm the well-established effects of smoking, which suggests that the data are reliable.”

The release says, "The study was not designed to answer the question of why cannabis use might make Covid-19 worse. One possibility is that inhaling marijuana smoke injures delicate lung tissue and makes it more vulnerable to infection, in much the same way that tobacco smoke causes lung damage that puts people at risk of pneumonia, the researchers said. That isn’t to say that taking edibles would be safer than smoking joints. It is also possible that cannabis, which is known to suppress the immune system, undermines the body’s ability to fight off viral infections no matter how it is consumed, the researchers noted."

“We just don’t know whether edibles are safer,” said first author Nicholas Griffith, MD, a medical resident at Washington University, who was a medical student therev when he led the study. “People were asked a yes-or-no question: ‘Have you used cannabis in the past year?’ That gave us enough information to establish that if you use cannabis, your health-care journey will be different, but we can’t know how much cannabis you have to use, or whether it makes a difference whether you smoke it or eat edibles. Those are questions we’d really like the answers to. I hope this study opens the door to more research on the health effects of cannabis.”

National Institutes of Health boss, at UK, says U.S. is better set for next pandemic but needs more 'really snappy real-time data'

National Institutes of Health Director Dr. Monica Bertagnolli spoke at UK. (WUKY photo by Josh James)

Kentucky Health News

The new director of the National Institutes of Health said at the University of Kentucky on June 10 that the U.S. hasn’t fully recovered from the Covid-19 pandemic, and long Covid remains a problem, but the nation is readier for the next pandemic than it was for the last one.

"We're better prepared, but we're not at all complacent about how awful pandemics are and the great suffering that comes from this, and the need to be constantly ready to spring into action," Dr. Monica Bertagnolli told Josh James of WUKY.

"We really hadn't before had a good, real-time feedback link with really snappy real-time data," she said, noting that she is starting a new reporting network for doctors to share such information.

"That data – both its reliability and collection – was one of the themes of Bertagnolli’s talk at UK," James reports. "She said the pandemic showed medical officials the necessity of creating a more responsive data ecosystem running all of the time, not just during major health emergencies."

Asked about efforts to combat distrust toward medical authorities, Bertagnolli said part of the solution is delivering tangible results for patients. She pointed to recent polling from the Pew Research Center about who people trust the most when it comes to medical information.

"The very highest trust was with their primary-care providers," she said, "which is why we're launching this new primary-care research network, because we want to put the research into the hands of people who are trusted, so that everybody can have the benefit."

Fauci, facing Congress for first time since retirement, distances himself from aide who used personal emails for business

Dr. Anthony Fauci (Photo by Francis Chung, Politico)

Kentucky Health News

Dr. Anthony Fauci defended his actions during the Covid-19 pandemic before House lawmakers Monday and distanced himself from an aide accused of misconduct, Politico's Carmen Paun reports.

Fauci pushed back on claims by Republicans on the House Select Subcommittee on the Coronavirus Pandemic that he tried to squelch the theory that the virus spilled over from a lab in Wuhan, China.

Fauci said that the theory isn’t a conspiracy theory, and that he has kept an open mind on the pandemic's origins, but has endorsed a theory that the disease came from an animal.

He said the research his agency funded at the lab couldn’t have created Covid. The Department for Health and Human Services has stripped the EcoHealth Alliance, the U.S. research group that collaborated on virus studies with Wuhan, and its president of federal funding.

Fauci, 83, was director of the National Institute of Allergy and Infectious Diseases from 1984 to 2022, and chief medical adviser to President Biden from 2021 to 2022

Democrats and Republicans on the panel recently blasted longtime Fauci adviser David Morens, whom HHS put on leave for using personal email for official business. Emails the subcommittee released last month show Morens trying to shield correspondence.

In his first public Capitol Hill testimony since leaving the federal government, Fauci said Morens wasn’t part of his inner circle. “Despite his title, and even though he was helpful to me in writing scientific papers, Dr. Morens was not an adviser to me on institute policy or other substantive issues,” Fauci said.

UK has a new group to research infectious diseases, including treatment and prevention through community engagement

By Lindsay Travis
University of Kentucky

A new partnership between researchers at the University of Kentucky will combat the threat of infectious diseases through research directed at prevention and treatment.

The CURE-KY team: Front row left to right: Vincent Venditto,

Steven Van Lanen, Ilhem Messaoudi, Rebecca Dutch. Back

row: Feng Li, David Burgess, Beth Garvy, Richard Greenberg.

Not pictured: Krystle Kuhs. (UK photo by Jeremy Blackburn)

The Consortium for Understanding and Reducing Infectious Diseases in Kentucky (CURE-KY) will foster multidisciplinary collaborations to address the burden of infectious diseases in the state and beyond.

“I am thrilled by the boundless possibilities our collaborative efforts promise at the University of Kentucky,” said Ilhem Messaoudi, founder of CURE-KY and chair of the Department of Microbiology, Immunology, and Molecular Genetics in the College of Medicine. “With a steadfast commitment to advancing knowledge and fostering transdisciplinary alliances, we aim to propel infectious-disease research to new heights, creating a healthier Kentucky and nurturing future scientific leaders.”

She added, “We have an excellent team of scientists here at UK and on our leadership team. Together we can tackle infectious diseases from an array of perspectives to make a difference in the health of our community.”

CURE-KY grew from, and took most of its acronym from, UK’s Covid-19 Unified Research Experts Alliance. It has experts from the College of Medicine, College of Public Health, College of Pharmacy, Martin-Gatton College of Agriculture, Food and Environment and the Markey Cancer Center.

It will focus on research in five areas: microbial pathogenesis; vaccines, therapeutics and antimicrobial resistance; public health and community engagement; animal health; and engineering and systems. IT will also work to address vaccine hesitancy and misinformation to foster trust between Kentuckians and the scientific community.

“From studying prevention, control and understanding transmission dynamics to assessing risk, promoting health equity and engaging communities in disease-control efforts, this work is critical toward our goal of creating a healthier Kentucky,” said Public Health Dean Heather Bush.

Dr. B. Mark Evers, Markey director, said “Kentucky is home to the highest cancer rates in the country, including several cancers caused by infectious diseases such as HPV and hepatitis C. . . . By better understanding and combating diseases that can lead to cancer, CURE-KY will contribute to this mission and make progress toward our ultimate goal of conquering cancer in the commonwealth.”

More information about CURE-KY and upcoming events is on on its website.

Kentuckians’ access to mental-health care lags behind the nation. Paying providers more would help, psychologists say in report.

By Sarah Ladd

Kentucky Lantern

Kentuckians are far more likely to pay out of pocket for mental and behavioral health services than for surgical or other medical care, except for care in outpatient facilities, where the state is doing better than most states. 

This insight comes from a recent American Psychological Association report, which examined health-insurance claims made by millions of Americans who sought care. The report showed that as Covid-19 peaked in the state, the number of Kentuckians forced to go out of their insurance network for acute inpatient care also increased.

Eric Russ

Eric Russ, the executive director of the Kentucky Psychological Association, told the Lantern the actual numbers are likely higher than the report reflects because not everyone who seeks out-of-network care will file an insurance claim.

Overall, the report shows that Americans were 10.6 times more likely to go out of their insurance network for psychological care than they were for medical care. The paper cites lower reimbursement rates for mental health care providers as a major culprit.

The report’s findings are “gravely disappointing,” Arthur C. Evans Jr., CEO of the APA, said in a statement. “The federal parity law, the Mental Health Parity and Addiction Equity Act, passed in 2008 and it has still not achieved its goal of equitable access to care for mental health patients.”

“The fact that so many patients are forced to go out of network to receive mental health and substance use care is unacceptable,” said Evans.

The report recommends that states and health-insurance plans expand their behavioral-health networks by raising reimbursement rates, “as they do for medical/surgical providers.” Having access to more in-network providers, the report says, would ease the financial burden on patients who now, if they cannot afford to pay out of pocket, may go without care.

Covid-19 was ‘a sledgehammer’

The report showed that from 2019 to 2021, out-of-network use of inpatient behavioral-health care increased from 2.5% to 4.0% in Kentucky. That’s much higher than the 0.4% reported in 2019 and 0.2% in 2021 for medical and surgical care.

In 2021, Kentuckians were 17.2 times more likely to get out-of network care for behavioral health than they were for medical or surgical care. But the percent of Kentuckians going out of network for outpatient behavioral care care decreased from 2019 to 2021 — 11% to 5%.

“One thing we’ve seen out of Covid is an increase in behavioral health needs,” Russ said. Even before the pandemic, there was an increased need for mental health support. “And then Covid just took a sledgehammer to everybody’s mental health.”

Because there were not enough in-network providers, Kentuckians had to look elsewhere for help, a burden Russ said “falls harder on minority populations.”

“Structural discrimination puts minority populations at an increased risk of mental-health issues generally,” he said. “And then the clinical field tends to be a pretty white-dominated field,” which makes it more difficult to find providers who are culturally competent to treat someone from a particular background or identity.

 
Lack of access is ‘demoralizing’

Usually when people seek care for a mental-health issue, they’ve often already been struggling for a while, Russ said.

“Usually they’ve been feeling down, depressed, anxious, having relationship problems, having eating disorders for quite a long time before they even start seeking treatment,” he said. “When you start looking, finally ready to get help, and then call your insurance company or call your primary-care provider and say, ‘Hey, where do I go?’ And they give you a list of providers and everybody’s full and you can’t get in — that’s incredibly demoralizing.”

This can add to the stigma that already surrounds mental health issues, Russ said. It can also put people’s well being in jeopardy while they wait for help. This can be worse for people with conditions like ADHD (attention deficit hyperactivity disorder), who may already struggle with organization and time management.

Kentucky is doing slightly better than other states in some categories, the data show. 

In particular, the report shows Kentucky was among the states where outpatients were least likely to seek out-of-network behavioral health care, compared to medical-surgical care in such facilities, with only 13 states having a better score than Kentucky in this category.  But Kentuckians were still twice as likely to seek out-of-network behavioral-health care in an outpatient facility as they were to go out of network for outpatient medical-surgical care. 

Kentucky also showed slightly better scores than 12 other states when it came to getting out-of-network behavioral-health care, compared to medical-surgical care for inpatient facilities (17.2 times)  and for office visits with a clinician (4.9 times).  

“No one is doing well,” though, Russ said. “We have room to go before we have something that looks like real parity between our mental-health and medical systems.”

Kentucky Health News contributed to this story. 

Drug-overdose death rates were more common among service-industry employees before pandemic, but not afterward

By Allison Rogers

University of Kentucky

Drug-overdose deaths spiked following Kentucky’s Covid-19 stay-at-home and business-closure orders in 2020, but the industries that suffered the most overdose deaths were surprising, according to research conducted by the Kentucky Injury Prevention and Research Center at the University of Kentucky College of Public Health.

In the years leading up to the study, Kentucky’s service-industry employees experienced the most drug-overdose deaths. However, workers outside service industries were more likely to die by drug overdose in the months following the Covid-related shutdowns of 2020, the researchers found.

The study was published in the peer-reviewed journal Injury Prevention in 2023 and funded by the National Institute of Occupational Safety and Health, part of the Centers for Disease Control and Prevention.

Graph by Kentucky Injury Prevention Research Center

Analyzing drug-overdose death certificates and toxicology tests from 2018 through 2021, researchers found a significant increase in deaths rates for both sectors. In 2019, the rate per 100,000 employees was 46.7 and 45.7 for service and non-service industries, respectively. In 2021, those rates were 76.2 and 81.9.

Service occupations with the highest drug-overdose death rates were restaurant wait staff (10%), cooks (7%), landscaping and groundskeeping workers (6%) and auto-service technicians and mechanics (6%). Among non-service-industry jobs, overdose deaths occurred most often among construction laborers (15%), carpenters (7%) and freight, stock and material movers and hand occupations (7%).

From 2018 through 2021, there were 1,789 drug overdose deaths among service-industry workers in Kentucky, compared to 2,838 for non-service workers.

Terry Bunn, lead author of the study and director of the injury-prevention center, said “Service-related industry employees may have been more resilient and adaptable to changes in employment status compared to non-service-related industries and could find employment in other essential industry sectors during the pandemic such as the home improvement and building materials industry and the grocery store industry sector.”

Fentanyl was the most commonly identified drug in overdose deaths in both industry groupings, with 44% of identified substances among service-related industry deaths and 48% of identified substances among non-service-related deaths. The second most common drug with elevated frequencies detected in drug-overdose deaths was methamphetamine, with 24% of identified substances among service-related industry deaths and 28% of identified substances among non-service-related industry deaths.

Bunn hopes the results will alert employers in all industries to the need for a plan to handle on-site drug overdoses and substance use. “It is important for businesses to know about local community resources for timely linkage to substance use disorder treatment and to recovery support services as well as availability of on-site naloxone,” she said.

Repeat Covid-19 shots help ward off variants, even other viruses

Photo illustration

Kentucky Health News

The virus that caused the Covid-19 pandemic is still here, sending thousands of Americans to hospitals each week and regularly spinning off new variants that can evade immune defenses, so public-health agencies recommend annual updates of vaccinations.

Some scientists have worried that the success of the first vaccines may undermine the utility of annual updates, much as the annual flu shot can interfere with immune responses in subsequent years, but a new study shows that Covid-19 vaccines don't do that, and actually "promote the development of broadly inhibitory antibodies," says a news release from Washington University School of Medicine in St. Louis, where the study was conducted.

Everyone who is 65 and over, or has medical conditions that make them more vulnerable, is advised to get a Covid-19 booster this spring.

The study, available online in the peer-reviewed scientific journal Nature, shows that people repeatedly vaccinated for Covid-19 — initially getting shots aimed at the original SARS-CoV-2 variant, followed by boosters and updated vaccines targeting variants — generated antibodies capable of neutralizing a wide range of virus variants and even some distantly related coronaviruses.

"The findings suggest that periodic re-vaccination for Covid-19, far from hindering the body’s ability to recognize and respond to new variants, may instead cause people to gradually build up a stock of broadly neutralizing antibodies that protect them from emerging SARS-CoV-2 variants and some other coronavirus species as well, even ones that have not yet emerged to infect humans," the release says.

“The first vaccine an individual receives induces a strong primary immune response that shapes responses to subsequent infection and vaccination, an effect known as imprinting,” said Dr. Michael S. Diamond, senior author of the study. “In principle, imprinting can be positive, negative or neutral. In this case, we see strong imprinting that is positive, because it’s coupled to the development of cross-reactive neutralizing antibodies with remarkable breadth of activity.”

Imprinting is the natural result of how immune-system memory works. A first vaccination triggers the development of memory immune cells. When people receive a second vaccination quite similar to the first, it reactivates memory cells elicited by the first vaccine. These memory cells dominate and shape the immune response to the subsequent vaccine.

The study suggests that regular re-vaccination with updated Covid-19 vaccines against variants might give people the tools to fight off not only the variants represented in the vaccines, but also other variants and related coronaviruses, possibly including ones that have not yet emerged.

“At the start of the Covid-19 pandemic, the world population was immunologically naïve, which is part of the reason the virus was able to spread so fast and do so much damage,” said Diamond, a professor of molecular microbiology, pathology and immunology. “We do not know for certain whether getting an updated Covid-19 vaccine every year would protect people against emerging coronaviruses, but it’s plausible. These data suggest that if these cross-reactive antibodies do not rapidly wane — we would need to follow their levels over time to know for certain — they may confer some or even substantial protection against a pandemic caused by a related coronavirus.”

As new Covid-19 variants become dominant and boosters are needed, vaccine misinformation continues; here are the facts

Photo from Getty Images via Kentucky Lantern

By Sarah Ladd
Kentucky Lantern

In the last month, new Covid-19 variants emerged as the dominant strain in the United States.

Covid-19 vaccines are still recommended for protection against the virus, and everyone who is 65 and over, or had medical conditions that make them more vulnerable, is advised to get a Covid-19 booster this spring.

The Cabinet for Health and Family Services says the KP.2 variant has already been confirmed in the state. Kentucky does not have any KP1.1 cases, cabinet spokesman Brice Mitchell said. These variants are in a group called FLiRT, after letters in the names of the individual mutations.

“These variants are not thought to cause more severe disease but do have some mutations in the spike protein that may make them more resistant to immunity conferred by vaccines and prior infections,” Mitchell said.

Kentucky has low levels of emergency-department visits and hospitalizations for Covid-19, but Mitchell said the state Department for Public Health “continues to recommend that all Kentuckians six months of age and older remain up-to-date with their Covid-19 vaccinations.”

A spokesperson for the Centers for Disease Control and Prevention told the Lantern that the CDC “continues to encourage Americans to get vaccinated, as the Covid-19 vaccination continues to be the best way to protect against serious illness.”

Despite that advice, not everyone is convinced. In the fourth year of Covid-19 — and about three and a half years since the vaccines arrived — misinformation about them persists, even among elected officials.

During the 2024 legislative session, vaccine misinformation — specifically around the Covid-19 shots — found its way onto the Kentucky Senate floor and into committee meetings. The Lantern consulted the CDC, the Food and Drug Administration and other sources in response to several vaccine claims made by lawmakers this year:

 

Claim: “The deaths and adverse events recorded to the Vaccine Adverse Events Report System that are submitted to this (Covid) vaccine total more than all other vaccines combined, since the CDC implemented the reporting system in 1990.”

Response: This claim has been debunked multiple times by multiple sources.

After Covid-19 vaccines became available, adverse reactions reported to the Vaccine Adverse Event Reporting System did increase, the CDC says, in part because so many people — more than 80% of Americans — received the shot. The 675 million doses of Covid-19 vaccine that have been administered in the U.S. are more than other types of vaccines. Also, under the emergency authorization for the Covid-19 vaccine, the FDA required health-care providers to report any adverse reaction in a patient even if it’s unclear the vaccine was the cause.

The Vaccine Adverse Event Reporting System is a voluntary early-warning system. Anyone may enter information about side effects or other adverse reactions after a vaccine; the reports are not verified, but scientists use the data to spot worrisome patterns that merit investigation.

"Anti-vaccination fringe groups have attempted to spin false stories using VAERS data, adding to misinformation about the safety of Covid-19 vaccinations," says the Johns Hopkins Bloomberg School of Public Health.

A study published in the Journal of the American Medical Association in March found that the more likely a state was to vote Republican, the more likely its vaccine recipients or their clinicians reported adverse effects from Covid-19 vaccines. These results suggest that either the perception of vaccine effects or the motivation to report them was associated with political inclination.

Claim: “Covid-19 vaccines caused “unprecedented rise in sudden cardiac events, miscarriages and stillbirths, blood clots, myocarditis in youth, and sudden deaths among all ages.”

Response: Receiving the shot does not increase the risk of death from non-Covid causes. That conclusion is based on safety monitoring after more than 675 million doses of vaccine have been administered.

Covid-19 vaccination during pregnancy is safe and not linked to an increased risk of miscarriage or stillbirth, according to CDC safety monitoring and research. It has identified four rare but serious types of adverse events following Covid-19 vaccination. Two of them — thrombosis and Guillain-Barré Syndrome — were associated with vaccines that have been discontinued in the U.S. and are no longer available.

About 5 people per 1 million doses of vaccine have experienced anaphylaxis, a severe, potentially life-threatening allergic reaction that requires immediate emergency medical treatment. It can occur after any medication or vaccination.

Also, an increased risk of myocarditis – inflammation of the heart – is associated with the Pfizer and Moderna vaccines. Varying by age and sex, the rates of myocarditis after vaccination range from zero to 188 per 1 million doses. Research has found that the risk of myocarditis is higher following a Covid infection than after a Covid vaccine, according to the CDC.

CDC and FDA have detected no unusual or unexpected patterns indicating Covid-19 vaccines are causing or contributing to any other serious medical conditions.

Vaccination against Covid-19 reduces the risks of dying from Covid and suffering long Covid. The most common vaccine side effects are usually mild, such as soreness in the area where the shot was given.

Claim: “Pet vaccines are actually safer than people vaccines.”

Response: Animal and human vaccines undergo different approval processes. The U.S. Department of Agriculture’s Animal and Plant Health Inspection Service regulates veterinary vaccines and the Food and Drug Administration regulates human vaccines.

According to a 2014 paper in the National Library of Medicine, the two “differ markedly.” Vaccine effectiveness is more highly studied in human vaccines than in animal ones, that study found.

What the FDA says: The FDA “takes its responsibility for ensuring the safety, effectiveness and manufacturing quality of all vaccines approved or authorized for emergency use in the U.S. very seriously,” a spokesperson said.

All ingredients in new vaccines are looked at for safety and effectiveness. The “rigorous and extensive” approval process includes lab work, animal studies and human clinical trials.

“Highly trained FDA scientists and physicians thoroughly evaluate the information in a marketing application,” the FDA said, before ever approving shots for public distribution. Both pet and human vaccines are safe.

Falling immunization rates pose threats to Kentucky and the rest of nation; immunization climate remains 'turbulent,' observer says

Foundation for a Healthy Kentucky photo

By Melissa Patrick

Kentucky Health News

The immunization crisis in Kentucky is not just a Kentucky issue, but is happening nationwide.

"It's not going to take long before we see the effects of falling rates of immunizations. We're seeing some decrease across the board, again, from coast to coast, border to border," said Dr. Christopher Bolling, who represented the Kentucky Chapter of the American Academy of Pediatrics on a May 8 webinar hosted by the Foundation for a Healthy Kentucky titled “Tackling the Immunization Crisis.”

Bolling said many people have a "false view" that nothing will happen because of these falling immunization rates because it's been so long since we've seen the illnesses that they protect against.

As a recent example, on May 7, the Lexington-Fayette County Health Department reported another cases of pertussis, or whooping cough. It was the city's third case since late April. Since April 1, cases have also been confirmed in Boyd, Jessamine, Logan, Pulaski and Warren counties.

Brice Mitchell, spokesperson for the state Cabinet for Health and Family Services, told Kentucky Health News that there were 84 confirmed cases of pertussis in Kentucky in 2023, and 32 confirmed so far in 2024 -- about the same rate, but dependent on confirmations that may be delayed.

Looking forward during the webinar, Bolling said it's important to not let the controversies surrounding the Covid-19 vaccine influence people's decisions to get vaccinated against other diseases.

"We really do not want to see it start affecting other vaccines as well," he said. 

Looking at Kentucky's vaccination rates, he said that with the exception of young children's diphtheria, tetanus and pertussis vaccines, Kentucky's vaccination rates are lower than the national averages. 

In particular, Bolling pointed to Kentucky's low measles-mumps-rubella vaccination rate. He said Kentucky's rate is 90.1%, the national rate is 93.1% and the level to achieve herd immunity is 95%. 

"So we are susceptible," he said. Herd immunity is the level needed to protect people who can't or won't be vaccinated for various reasons.

Bolling offered suggestions for health-care providers and others for how to talk to people about immunizations and fight misinformation. He said it's important to always remember that behavior changes must be self-motivated.

"The choices they make are going to be based on their own values, their own standards, and their own understanding," he said. "So you really want to evoke within them things that are going to help them make good decisions." 

Kelly Taulbee, director of communications and development at Kentucky Voices for Health, called the current climate around immunizations a "turbulent space." 

"Something to keep in context is you have entire families that don't talk to each other anymore, friends that have lost connection simply because of the positions they took during the pandemic on immunizations," she said. 

Taulbee stressed that the importance of keeping an eye on policies that would hurt the state's immunization rates, pointing to eight bills that were filed in the 2024 legislative session that did not pass. 

Jessy Sanders, health communicator program manager for the Kentucky Rural Health Association's Immunize Kentucky Coalition, announced their upcoming events. Symposiums will be held in Hazard May 17, Somerset Aug. 8 and Paducah Aug. 23, and the 2024 Immunization Summit will be held Oct. 9. 

2% fewer Ky. children were on Medicaid a year after pandemic re-enrollment began; total enrollment, including adults, dropped 9.5%

Top half of Georgetown University table, adapted by Ketucky Health News; to enlarge, click on it.

By Melissa Patrick
Kentucky Health News

Medicaid enrollment of Kentucky's children fell 1.6 percent since the continuous-coverage protections of the pandemic were lifted last year. That was one of the smallest declines in the nation.

Coverage of U.S. children fell 10% in the "unwinding" process, says the report from the Georgetown University Center for Children and Families, based on data from the Centers for Medicare and Medicaid Services.

Kentucky hasn't started the re-enrollment process for children yet because, unlike most states, it worked with the federal government to delay the restart of renewals for children until this September. So did North Carolina.

"The story of Georgetown's report is an incredible good news story that speaks to how well Kentucky did things for kids," said Priscilla Easterling, outreach coordinator for Kentucky Voices for Health, a coalition of health-care advocacy groups.

Nationwide, 4.16 million children were dropped from from Medicaid and the Children's Health Insurance Program, and most would likely still be eligible, says the report. The numbers do not reflect individual children, but the change in total enrollment, which fluctuates from month to month for various reasons.

In Kentucky, 10,477 fewer children were covered than the 648,865 who were enrolled in either Medicaid or KCHIP before the unwinding -- the gradual resumption of annual Medicaid coverage renewals. Renewals in Kentucky began in April 2023.

Overall, Kentucky's Medicaid rolls have declined 9.5 percent in the last year. The number enrolled in April was 1,561,400. County-by-county figures are available from the Cabinet for Health and Family Services.

Cabinet spokesperson Brice Mitchell told Kentucky Health News in an email that Kentucky was the first state to request and get approval to automatically grant children 12 months of continuous coverage, without needing to go through a renewal during the unwinding. 

"The state sought this flexibility to ensure our children kept access to the coverage they need and deserve," Mitchell said. 

The only way a child may be disenrolled during the 12-month continuous coverage period is if the child turns 19, a parent or guardian requests disenrollment, or if the child moves out of state, Mitchell said. 

Easterling said it is expected that the children's renewal period that begins in September will go smoothly since the state will have already processed the adult renewals. 

She also noted that it would be great if the state took advantage of an existing program that would allow continuous coverage for children up to age 3 as some other states have done.  

"We know that kids losing coverage and being uninsured negatively impacts their health and their family's finances, with the risk of big medical bills . . . that a family can't afford to pay," Easterling said.

Bird flu is bad for livestock; it's not a dire threat to most of us - yet

Getty Images

By Amy Maxmen
KFF Health News

Headlines are flying after the U.S. Department of Agriculture confirmed that the H5N1 bird flu virus has infected dairy cows around the country. Tests have detected the virus among cattle in nine states, mainly in Texas and New Mexico, and most recently in Colorado, said Nirav Shah, principal deputy director at the Centers for Disease Control and Prevention, at a May 1 event held by the Council on Foreign Relations.

A menagerie of other animals have been infected by H5N1, and at least one person in Texas. But what scientists fear most is if the virus were to spread efficiently from person to person. That hasn’t happened and might not. Shah said the CDC considers the H5N1 outbreak “a low risk to the general public at this time.”

Viruses evolve and outbreaks can shift quickly. “As with any major outbreak, this is moving at the speed of a bullet train,” Shah said. “What we’ll be talking about is a snapshot of that fast-moving train.” What he means is that what’s known about the H5N1 bird flu today will undoubtedly change.

With that in mind, KFF Health News explains what you need to know now.

Who gets the bird flu? Mainly birds. Over the past few years, however, the H5N1 bird flu virus has increasingly jumped from birds into mammals around the world. The growing list of more than 50 species includes seals, goats, skunks, cats, and wild bush dogs at a zoo in the United Kingdom. At least 24,000 sea lions died in outbreaks of H5N1 bird flu in South America last year.

What makes the current outbreak in cattle unusual is that it’s spreading rapidly from cow to cow, whereas the other cases — except for the sea-lion infections — appear limited. Researchers know this because genetic sequences of the H5N1 viruses drawn from cattle this year were nearly identical to one another.

The cattle outbreak is also concerning because the country has been caught off guard. Researchers examining the virus’s genomes suggest it originally spilled over from birds into cows late last year in Texas, and has since spread among many more cows than have been tested. “Our analyses show this has been circulating in cows for four months or so, under our noses,” said Michael Worobey, an evolutionary biologist at the University of Arizona in Tucson.

Is this the start of the next pandemic? Not yet. But it’s a thought worth considering because a bird flu pandemic would be a nightmare. More than half of people infected by older strains of H5N1 bird flu viruses from 2003 to 2016 died. Even if death rates turn out to be less severe for the H5N1 strain currently circulating in cattle, repercussions could involve loads of sick people and hospitals too overwhelmed to handle other medical emergencies.

Although at least one person has been infected with H5N1 this year, the virus can’t lead to a pandemic in its current state. To achieve that horrible status, a pathogen needs to sicken many people on multiple continents. And to do that, the H5N1 virus would need to infect a ton of people. That won’t happen through occasional spillovers of the virus from farm animals into people. Rather, the virus must acquire mutations for it to spread from person to person, like the seasonal flu, as a respiratory infection transmitted largely through the air as people cough, sneeze, and breathe. As we learned in the depths of covid-19, airborne viruses are hard to stop.

That hasn’t happened yet. However, H5N1 viruses now have plenty of chances to evolve as they replicate within thousands of cows. Like all viruses, they mutate as they replicate, and mutations that improve the virus’s survival are passed to the next generation. And because cows are mammals, the viruses could be getting better at thriving within cells that are closer to ours than birds’.

The evolution of a pandemic-ready bird flu virus could be aided by a sort of superpower possessed by many viruses. Namely, they sometimes swap their genes with other strains in a process called reassortment. In a study published in 2009, Worobey and other researchers traced the origin of the H1N1 “swine flu” pandemic to events in which different viruses causing the swine flu, bird flu, and human flu mixed and matched their genes within pigs that they were simultaneously infecting. Pigs need not be involved this time around, Worobey warned.

Will a pandemic start if a person drinks virus-contaminated milk? Not yet. Cow’s milk, as well as powdered milk and infant formula, sold in stores is considered safe because the law requires all milk sold commercially to be pasteurized. That process of heating milk at high temperatures kills bacteria, viruses, and other teeny organisms. Tests have identified fragments of H5N1 viruses in milk from grocery stores but confirm that the virus bits are dead and, therefore, harmless.

Unpasteurized “raw” milk, however, has been shown to contain living H5N1 viruses, which is why the FDA and other health authorities strongly advise people not to drink it. Doing so could cause a person to become seriously ill or worse. But even then, a pandemic is unlikely to be sparked because the virus — in its current form — does not spread efficiently from person to person, as the seasonal flu does.

What should be done? A lot! Because of a lack of surveillance, the U.S. Department of Agriculture and other agencies have allowed the H5N1 bird flu to spread under the radar in cattle. To get a handle on the situation, the USDA recently ordered all lactating dairy cattle to be tested before farmers move them to other states, and the outcomes of the tests to be reported.

But just as restricting covid tests to international travelers in early 2020 allowed the coronavirus to spread undetected, testing only cows that move across state lines would miss plenty of cases.

Such limited testing won’t reveal how the virus is spreading among cattle — information desperately needed so farmers can stop it. A leading hypothesis is that viruses are being transferred from one cow to the next through the machines used to milk them.

To boost testing, Fred Gingrich, executive director of a nonprofit organization for farm veterinarians, the American Association of Bovine Practitioners, said the government should offer funds to cattle farmers who report cases so that they have an incentive to test. Barring that, he said, reporting just adds reputational damage atop financial loss.

“Outbreaks have a significant economic impact,” Gingrich said. “Farmers lose about 20% of their milk production in an outbreak because animals quit eating, produce less milk, and some of that milk is abnormal and then can’t be sold.”

The government has made H5N1 tests free for farmers, Gingrich added, but hasn’t budgeted money for veterinarians who must sample the cows, transport samples, and file paperwork. “Tests are the least expensive part,” he said.

If testing on farms remains elusive, evolutionary virologists can still learn a lot by analyzing genomic sequences from H5N1 viruses sampled from cattle. The differences between sequences tell a story about where and when the current outbreak began, the path it travels, and whether the viruses are acquiring mutations that pose a threat to people. The research has been hampered by the USDA’s slow and incomplete posting of genetic data, Worobey said.

The government should also help poultry farmers prevent H5N1 outbreaks since those kill many birds and pose a constant threat of spillover, said Maurice Pitesky, an avian disease specialist at the University of California-Davis.

Waterfowl like ducks and geese are the usual sources of outbreaks on poultry farms, and researchers can detect their proximity using remote sensing and other technologies. By zeroing in on zones of potential spillover, farmers can target their attention. That can mean routine surveillance to detect early signs of infections in poultry, using water cannons to shoo away migrating flocks, relocating farm animals, or temporarily ushering them into barns. “We should be spending on prevention,” Pitesky said.

OK, it’s not a pandemic, but what could happen to people who get this year’s H5N1 bird flu? No one really knows. Only one person in Texas has been diagnosed with the disease this year, in April. This person worked closely with dairy cows, and had a mild case with an eye infection. The CDC found out about them because of its surveillance process.

Clinics are supposed to alert state health departments when they diagnose farmworkers with the flu, using tests that detect influenza viruses, broadly. State health departments then confirm the test, and if it’s positive, they send a person’s sample to a CDC laboratory, where it is checked for the H5N1 virus, specifically. “Thus far we have received 23,” Shah said. “All but one of those was negative.”

State health departments are also monitoring around 150 people, he said, who have spent time around cattle. They’re checking in with these farmworkers via phone calls, text messages, or in-person visits to see if they develop symptoms. And if that happens, they’ll be tested.

Another way to assess farmworkers would be to check their blood for antibodies against the H5N1 bird flu virus; a positive result would indicate they might have been unknowingly infected. But Shah said health officials are not yet doing this.

“The fact that we’re four months in and haven’t done this isn’t a good sign,” Worobey said. “I’m not super worried about a pandemic at the moment, but we should start acting like we don’t want it to happen.”

Fact Check: Contrary to social-media posts, there is still no evidence that Covid-19 vaccines increase your risk of cancer

By Catalina Jaramillo
FactCheck.org

It has not been shown that Covid-19 vaccines cause or accelerate cancer. Yet opponents of the vaccines say a new review article “has found that Covid-19 mRNA vaccines could aid cancer development.” That statement is based mainly on misinterpretation of a study on mRNA cancer vaccines in mice.

Clinical trials, involving thousands of people, and multiple studies have shown that the mRNA Covid-19 vaccines from Pfizer/BioNTech and Moderna are safe. Hundreds of millions of doses have been administered under close monitoring systems that have found serious side effects are rare. Studies have also shown that the vaccines work very well in preventing severe Covid-19 disease and death, saving millions of lives across the globe.

 
There is no evidence to support a link between Covid-19 vaccines and cancer, as we’ve reported. Both the National Cancer Institute and the American Cancer Society have stated there’s no information that suggests COVID-19 vaccines cause cancer, make it more aggressive or lead to recurrence of cancer.

Yet, vaccine opponents falsely claim a review article published in April proves the contrary.

“A review in the International Journal of Biological Macromolecules has found that Covid-19 mRNA vaccines could aid cancer development,” reads an April 16 Facebook post by America’s Frontline Doctors, a group that has repeatedly spread misinformation about the pandemic -- and whose founder was sentenced to 60 days in prison for entering the U.S. Capitol during the Jan. 6 riot. Other posts made similar, baseless claims.

Messenger RNA, or mRNA, vaccines work by instructing a small number of a person’s cells to make specific proteins, which then prompt the body to mount an immune response. They use N1-methylpseudouridine, a modification naturally found in some RNA molecules, to allow the mRNA to deliver its message to the cell without being destroyed by an innate immune response.

The review paper being cited is based on other published articles and does not contain original research. Experts told us that it misleads by misinterpreting several studies and the role of N1-methylpseudouridine in vaccines. The authors also refer to an unreliable review article, written by authors known for spreading misinformation, that falsely claimed the mRNA Covid-19 vaccines impair the immune system and increase the risk of cancer, as we have explained.

One of the most important misrepresentations, and one that the authors heavily rely on, is based on the findings of a study on mRNA cancer vaccines in mice. The study looked at the efficacy of mRNA cancer vaccines with different degrees of N1-methylpseudouridine modification in a mouse melanoma model. According to the review, the study found that “adding 100% of N1-methyl-pseudouridine (m1Ψ) to the mRNA vaccine in a melanoma model stimulated cancer growth and metastasis, while non-modified mRNA vaccines induced opposite results, thus suggesting that Covic-19 mRNA vaccines could aid cancer development.”

But that’s not what the study found.

“Our results did not show, suggest or indicate that modified mRNA promotes tumor growth/metastasis,” Tanapat Palaga, professor of microbiology at the Chulalongkorn University in Thailand and the corresponding author of that study, told us in an email.

What the study actually showed is that both unmodified mRNA and modified mRNA induced immune responses against the tumor antigens, but only the unmodified mRNA reduced cancer growth and metastasis, while the modified mRNA didn’t. The study was published in 2022 and co-authored by Drew Weissman, who won the 2023 Nobel Prize with Katalin Karikó for discovering this mRNA modification that eventually led to the mRNA Covid-19 vaccines.

Dr. James A. Hoxie, an emeritus professor of medicine at the University of Pennsylvania and co-director of the Penn Institute of RNA Innovation (directed by Weissman), told us those findings are relevant for scientists who are studying ways in which mRNA cancer vaccines can elicit immune responses needed to prevent or delay cancer progression. (See “Social Media Posts Misinterpret Biden on mRNA Cancer Vaccines” for more information about mRNA cancer vaccines.)

“But that is a far cry from saying that the vaccine that was used to prevent Covid-19 disease causes cancer,” he said. Implying that by regulating the innate immune system, which is something scientists working in immunotherapies are trying to understand, “you’re leaving yourself open for cancer risk — that is ludicrous.”

Palaga told us, “I believe that the authors of this review article intentionally or [unintentionally] misinterpret our results and tried to twist the conclusion to support their agenda.”

There are no studies supporting a link between N1-methylpseudouridine and cancer in animals or mice, experts told us.

There is also no evidence mRNA Covid-19 vaccines impair, much less suppress, the immune system, as we’ve reported. In fact, the vaccines enhance immunity by teaching the immune system how to identify and fight the coronavirus.

N1-methylpseudouridine and its role in mRNA vaccines

To understand the role of N1-methylpseudouridine we have to look back at the history of mRNA vaccines.

Normally, when a cell encounters a foreign RNA, a molecule present in most living organisms and viruses, it activates a strong innate immune response against the molecule.

This was a problem for scientists trying to use mRNA as a therapeutic, since the goal was for the cell to receive the instructions carried by the mRNA and produce certain proteins. Until the mid-2000s, Karikó, Weissman and others observed that if they attached certain chemical modifications found in some kinds of natural RNA molecules, such as pseudouridine, into one of the four bases of mRNA, they could blunt that innate immune response and, at the same time, increase the mRNA’s capacity to translate its code for the cell to make the desired proteins.

Later, scientists found N1-methylpseudouridine, another modification naturally found in some kinds of RNA molecules, worked better than pseudouridine.

The modification is not “suppressing” the immune system, Hoxie told us — it just allows for certain parts of the immune system not to activate temporarily “in order to get the desired effect.”

Jordan L. Meier, senior investigator at the National Cancer Institute who has studied the role of N1-methylpseudouridine in Covid-19 vaccines, told us the authors of the review paper misrepresent what N1-methylpseudouridine, which is abbreviated as m1Ψ, does.

The review “incorrectly” confuses “m1Ψ’s ability to hide from the immune system with an ability to weaken or disable it,” he told us in an email.

To explain it, Meier compared the mRNA modification to a spy using a disguise in order to pass security guards.

“The authors are essentially suggesting that the disguise somehow makes the guards less able to do their jobs going forward,” he wrote. “In reality, once the disguised person is through, the guards remain just as vigilant and capable as before.”

The review, he added, doesn’t provide evidence that N1-methylpseudouridine “leaves the immune system any worse off for future threats.”

 
Misrepresented studies in the review paper

Similarly, the review misleads by cherry-picking or misrepresenting figures and tables of this and other papers.

For example, in the study by Palaga, Weissman and others using a mouse melanoma model (in which malignant cells from a tumor are given to a mouse), scientists found that relative to mice that received no vaccine (and instead received a saline solution) no increase in tumor growth or decrease in survival occurred when animals were vaccinated with a modified mRNA vaccine.

However, when animals received a vaccine containing unmodified mRNA, the study showed a decrease in tumor growth and an increase in survival compared with the control group that received the saline solution. In other words, the study found that the unmodified mRNA generated immune responses that decreased tumor growth and improved survival, while, similar to the control group, the modified mRNA had no effect on the tumor.

Table 1 of the review, however, incorrectly says the study found that the modified mRNA vaccine “increases tumor growth” and “decreases survival.”

Hoxie said, “This is simply not true and is a gross misrepresentation of the data that paper actually shows. The modified RNA had no effect on the tumor, and results using that vaccine were the same as using a saline solution.”

The tumor growth in mice receiving the modified mRNA was “increased relative to the unmodified vaccine, but it was identical to when there was no intervention,” Hoxie said. “Animals that received the modified mRNA vaccine died at the same rate and with the same amount of tumor as did animals that received the saline solution. The fact tumor progression in this model was reduced with the unmodified mRNA vaccine is the key point of this paper and indicated that in this model immune responses to unmodified mRNA may have anti-tumor activity, an important finding for the cancer immunotherapy field.”

The review also refers to a study that has been extensively misinterpreted to falsely claim that the Pfizer/BioNTech mRNA Covid-19 vaccine causes what vaccine opponents called “turbo cancer.” The study describes one mouse that died from a lymphoma after 14 mice were given a high dose of the vaccine. The review paper reproduces images from the study that show dissected mice and compares the organs of the mouse that died with one with a normal anatomy.

As we explained, and as the authors of that paper noted in an addendum, there is no such thing as “turbo cancer,” and, more importantly, the case report does not demonstrate a causal relationship between the lymphoma and the vaccine.

Meier told us the review also wrongly refers to a study published in 2016 to support its thesis that modified mRNA vaccines turn off an immune sensor known as RIG-I.

“In reality, this study only showed m1Y mRNAs are unable to activate RIG-I and did not test inhibition. In other words, what was shown was that m1Y is a strong camouflage, not that it is an immune suppressor,” he wrote.

FactCheck.org is a nonpartisan, nonprofit organization at the University of Pennsylvania that monitors the factual accuracy of public statements.

Respiratory-virus activity ticks up a bit, but hospital admissions fall; flu remains driver for respiratory admissions, ER visits in Ky.

State Department for Public Health graphs, adapted by Kentucky Health News

By Melissa Patrick
Kentucky Health News

The state Department for Public Health says respiratory virus activity ticked up a bit in Kentucky in the last week of March, but remained at a relatively low level, while hospitalizations for respiratory disease declined but remained at a level that the department considers moderate. 

In the week ended March 30, emergency-room visits for influenza, Covid-19 and respiratory syncytial virus (RSV) increased almost 5% to 1,796. Of those, 1,508 were for the flu. 

But in that same week, hospital admissions for the diseases dropped 19%, to 233.  Of those, 135 were for flu, 85 were for Covid-19 and 13 were for RSV. 

In the week ended March 30, every Kentucky county had a low rate of Covid-19 hospital admissions, considered to be less than 10 admissions per 100,000 people by the Centers for Disease Control and Prevention. 

The state reported 1,431 laboratory-confirmed cases of the flu in the week ended March 30, showing the first uptick in confirmed flu cases since mid-February. The state reported 857 lab-confirmed cases of Covid-19, which have declined for seven weeks in a row.  

The Kentucky Respiratory Disease Dashboard is now reporting Kentucky monthly death information for all Kentuckians since October 2023 as well as a separate category for those 65 and older during the 2023-24 respiratory season. 

The dashboard shows that since the flu season began in October,  there have been a total of 524 deaths attributed to Covid-19, with 447 of them in people 65 and older. One Covid-19 victim and one flu victim were children. There have been 121 flu-related deaths, with 74 in people 65 and older. Ten deaths have been attributed to co-infection, with two of in people 65 and older.

Paxlovid is effective against Covid-19, but many people eligible for it are not getting it; it's free to Medicare and Medicaid beneficiaries

Getty Images

By Dr. Nicholas Van Sickels

University of Kentucky

A safe and effective medication designed to prevent mild to moderate Covid-19 infections from becoming more dangerous has been available for almost two years. But recent studies have shown many patients eligible for the drug – Paxlovid – haven’t been prescribed it.

In a clinical trial, the orally taken medication reduced the risk of hospitalization and death by 86 percent. Paxlovid was fully approved by the Food and Drug Administration in May 2023 but has been available through an emergency-use authorization since 2022.

A pre-print study of over a million Covid-19 patients found that less than 10% of eligible patients were prescribed Paxlovid, also known as nirmatrelvir-ritonavir. The reasons behind the treatment’s slow uptake could include confusion over who’s eligible or even unfamiliarity with the drug.

How does it work? The antiviral drug works to stop the replication of the virus which causes Covid-19 at the cellular level. It comes as a dose pack; two of the pills are the active medicine, nirmatrelvir, and one is a “booster” medicine, ritonavir, which helps the nirmatrelvir maintain effective levels in the bloodstream.

Paxlovid is most effective when taken within five days of developing symptoms.

Who’s eligible? The treatment is designed for high-risk patients who have a mild or moderate case of Covid-19 but hope to avoid more severe consequences. You might be considered high-risk if you’re:

• Over 50
• Not up to date on COVID vaccinations
• Immunocompromised
• Pregnant
• Have any other medical conditions like diabetes, hypertension or asthma

A full list of medical conditions that may leave you at high-risk for a severe case of COVID-19 are listed on the CDC’s website here.

When should I ask my doctor about Paxlovid? If you are at high-risk for complications from Covid-19, it’s best not to wait before asking your doctor about Paxlovid. The treatment should be taken within five days of the onset of symptoms.

A study from the University of Hong Kong, which analyzed data from over 87,000 patients who took nirmatrelvir-ritonavir, found that earlier treatment within that five-day window leads to better outcomes.

The treatment will be free for Medicare or Medicaid beneficiaries through the end of 2024 via the U.S. government’s Patient Assistance Program. Those with private insurance can enroll in the Paxcess program to help lower out-of-pocket costs.

When you ask your health care provider about Paxlovid, make sure to update them on all other medications you are taking. While most medications are generally safe to take with Paxlovid, there are some which need dose adjustments or should be held during and for a short while after treatment. On very rare occasions, treatments other than Paxlovid are needed for people at high-risk for complications from Covid-19 who take certain medications.

How can I best protect myself from Covid-19? Improvements in how Covid-19 is prevented and treated have led to a relative relaxation in guidance on how to avoid the virus. In early March, the Centers for Disease Control and Prevention began to group its Covid-19 guidelines with other diseases caused by respiratory viruses such as flu and respiratory syncytial virus.

The basic guidelines around avoiding respiratory viruses include:

• Staying up to date on your immunizations
• Practicing good hygiene like proper handwashing or covering coughs
• Access cleaner air by opening windows or gathering outdoors

If you get sick with a respiratory virus, it’s best to stay home and away from others.

Nicholas Van Sickels, M.D., is director of infection prevention and control at UK HealthCare.

Government Accountability Office says Medicare and Medicaid each overpaid health-care providers by about $50 billion in 2023

UPDATE, April 10: The Oversight Subcommittee of the House Energy and Commerce Committee will hold a hearing Tuesday, April 16, "to discusss ways how to better monitor the programs, reports Amy Lotven of Inside Health Policy.

Inside Health Policy chart; Government Accountability Office data

Improper payments, mainly through overpayments, in Medicare and Medicaid are expected to total about $50 billion each for 2023, the federal Government Accountability Office says in its annual report on the topic. Both programs showed declines in improper payments from 2022: $11 billion in Medicare and about $30 billion in Medicaid, the latter due mainly to "the end of states’ Covid-19 flexibilities, including the suspension of eligibility determinations and provider enrollment requirements," reports Amy Lotven of Inside Health Policy.

The GAO estimated total improper federal payments in 2023 would be $236 billion, but noted that the projections "do not include certain programs that have been determined susceptible to improper payments: for example, the Temporary Assistance for Needy Families programs; and the government-wide total potentially does not represent the full extent of improper payments," Lotven reports.

About $175 billion of the improper payments are overpayments, "while $44.6 billion were labeled 'unknown,' meaning GAO was unable to determine whether they were proper or improper," Lotven writes. "$11.5 billion were underpayments and $4.6 billion were technically improper because they failed to follow all applicable regulations even though the recipient was entitled to the funding."

While improper Medicare payments declined overall, they increased in Medicare Advantage, the privately run version of the prohram, whoch now serves most Medicare beneficiaries. GAO estimated improper Advantage payments at $17 billion in 2023, up from $12.8 billion in 2022.

"In addition to reporting on federal programs with $5 billion or more in improper payments . . . the report also lists the 16 programs that have improper pay rates of 10 percent or more," Lotven notes. The refundable premium tax credits under the Affordable Care Act and the Children’s Health Insurance Program had rates of 26% and 12.8%, respectively; in dollars, they were $958 million and $2.1 billion.

Four-part series from PBS and KET tells the story of public health

To play the trailer for the series, click on the arrow button.

Kentucky Health News

"Public health saved your life today and you don't even know it."

That's the catchphrase of a PBS series that began on KET Tuesday night, about the history of public health and how it has extended Americans' life expectancy by 25 years in the last century with vaccinations, clean water, prenatal care, school lunches, restaurant inspections, workplace safety, and other measures that usually don't have high visibility but have become a key element of modern life.

That increased life expectancy "is the most impressive thing that we have ever done as a species," says Dr. Joshua Sharfstein, distinguished professor of practice at the Johns Hopkins Bloomberg School of Public Health in Baltimore and the main narrator of the four-part series, called "The Invisible Shield."

In recent decades, many Americans have taken public health for granted and have shifted from the idea that they should cooperate for health as members of a society to the notion that health decisions are a matter of choice for individuals and families. Experts say that resistance to vaccination, as well as obesity, drug overdoses and suicides, has led to U.S. life expectancy declining for the first time in a century, even before the pandemic, to the point that it is about four years less than other advanced countries. They also point to the fact that public health isn't a priority for government funding unless there is an emergency, like the Covid-19 pandemic, which plays a major role in the first episode.

Public health "is underfunded, undervalued and misunderstood putting our health at risk," the series website says. The site has a discussion guide, which says "The work of public health is made visible by public health emergencies (pandemics, outbreaks, etc.), when society depends on the expertise of people who previously were working in the background. This docuseries also highlights the role of public health professionals as the first line of defense during public health crises through their use of outbreak science, health patterns, and forecasting data. It surfaces the challenges in educating the public about the public health system. It hopes to encourage viewers to learn more about the various roles and jobs that exist in public health and to be a part of the invisible shield in the future."

The next episode of the series will premiere on KET at 10 p.m. Tuesday, April 9, but can be seen now on the KET website. The last two do not have airdates scheduled. KET says it plans to air the series on KET2, when all episodes are made available. Episodes can also be watched on the PBS website.