Long Covid — the name adopted for cases of prolonged symptoms after an acute bout of Covid-19 — is an umbrella diagnosis covering a broad range of clinical presentations and abnormal biological processes. Researchers haven’t yet identified a single or defining cause for some of the most debilitating symptoms associated with long Covid, which parallel those routinely seen in other post-acute infection syndromes. These include overwhelming fatigue, post-exertional malaise, cognitive deficits (often referred to as brain fog), and extreme dizziness. [STAT]

Given the current gaps in knowledge, some neurologists, psychiatrists, and other clinicians in the United States, United Kingdom, and elsewhere have suggested that an existing diagnosis known as functional neurological disorder (FND) could offer the best explanation for many cases of this devastating illness.

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In a show of political and private force after a horrifically violent extended holiday weekend in Chicago, civic leaders joined Gov. J.B. Pritzker, Mayor Brandon Johnson and state legislative leaders to announce progress in their commitment to funding community-level violence prevention programs. [Chicago Tribune]

The Chicago business community has raised $100 million to support on-the-ground programs, which typically take the form of nonpolice interventions in communities at risk of violence, in a first-of-its-kind effort from the Civic Committee of the Commercial Club of Chicago. In addition, $175 million in state funding for those programs has begun to be distributed, Pritzker said.

The gathering of CEOs, philanthropic leaders, police and violence interrupters came after more than 100 people were shot in Chicago over the extended Fourth of July weekend. Nineteen people died, including an 8-year-old and two family members in a mass shooting in the South Side Greater Grand Crossing community.

Thirteen speakers lined up inside a downtown office building to praise the funding effort, but many acknowledged it’s not enough and that more needs to be done.

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The most recent edition of Women's Health In Focus at NIH explores women and mental health across the lifespan. The feature story highlights several areas of research on the biological and social drivers of women's mental health.  [NIH]

Letter from the Editor...

More than 1 in 4 women have a mental health disorder, compared to fewer than 1 in 5 men.1 For several mental health disorders, the sex differences are stark: women have roughly double the lifetime risk for depression, anxiety, post-traumatic stress disorder, and eating disorders. Biological sex differences—including in genetics, gene expression, brain development and architecture, and hormones—may contribute to this greater prevalence of these disorders among women. Gendered power dynamics, early life experiences, and other social determinants of health also affect women’s mental health and can interact in complex ways with biological sex differences. In this issue of In Focus, we highlight several areas of research on the biological and social drivers of women’s mental health throughout the life course. The feature story describes how leading experts in the field are working to unravel the complex web of genetic, social, hormonal, and neurobiological influences on mental health disorders. The story highlights several important areas of research: the long-term consequences of early life adversity; the development and evolution of a community engaged postpartum mental health intervention for low-income women; the complex relationship between menopause and mental health; and how decades of NIH-led research on neurobiological effects of female reproductive hormones led to novel medications for postpartum depression.

For our Women in Science interview, we speak with Jill Goldstein, Ph.D., M.P.H., the founder and executive director of the Innovation Center on Sex Differences in Medicine at Massachusetts General Hospital (ICON-✘), about her decades-long efforts to understand the early life antecedents of sex differences in brain- and heart-related disorders and to drive innovative solutions and industry partnerships that promote women’s health through research on biological sex differences.

This issue also spotlights several recent ORWH events and research articles relevant to women’s health. In addition, we are delighted to share several new NIH resources regarding women’s health. Please feel free to share In Focus with your colleagues.

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Why do people use drugs? It’s one of those neglected questions with answers right in front of our noses. We just refuse to look. [Scientific American and Kaisier Health News]

Getting high—and overdosing—is after all, as American as apple pie. Over 46 million people in the U.S. have an alcohol- or drug-use disorder. Everyone knows someone who died, or who lost a son or daughter, mother or father, to a drug overdose, one of the 100,000-plus now yearly recorded nationwide.

Lost in today’s raging debate over drug policy and how to curb this spiraling mortality is the deep malaise that lies at the root of substance use in America. We are stuck on a loop, veering from “drug war” to legalization to backlash against legalization, without a record of improving lives and setting people on a successful path of recovery. And that’s because we are frankly unwilling to fix the economic cruelty that drives and keep people locked in dangerous drug use.

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The federal government last week signed off on Illinois’ 1115 waiver application that targets social determinants of health and behavioral health. [Health News Illinois]

The Centers for Medicare and Medicaid Services approved the plan, which supports programs for treating substance use disorders, offering employment support for people with disabilities, violence prevention and intervention, housing and nutrition.

CMS continues to review three requests related to a grant program to fund safety-net hospitals, the redirection of some disproportionate share hospital funding to fund strategies and interventions for improving the health of underserved communities, and funding for social determinants of health assessments and training of community health workers.

It encouraged Illinois to “explore using the approved (health-related social needs) services and … infrastructure to achieve the policy goals” of programs still under review.

The approval is effective through June 2029.

Department of Healthcare and Family Services Director Lizzy Whitehorn said in a statement that the approved plan “transforms and advances our state’s vision of an equitable and sustainable healthcare delivery system.”

“We thank … CMS for recognizing the connection between health-related social needs and healthcare outcomes,” she said. “The new services will be designed to bring sustainable, community-driven solutions to some of our most vulnerable residents and incorporate non-traditional providers into the Medicaid program.”

The agency said additional details will be announced later this month.

The announcement drew praise from Illinois’ two senators, who wrote to CMS Administrator Chiquita Brooks-LaSure this spring to urge approval.

“Expanding the reach of Illinois’s health care network is key to making reliable behavioral health services more accessible to individuals across our state,” said Sen. Tammy Duckworth. “This action by CMS helps move our state forward and ensures that we’re helping bring essential health services to Medicaid beneficiaries across Illinois.”

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As Conspiracy Theories Abound, Can We Restore Trust in Public Health?  With the House still investigating the pandemic, its origins, and our government's responses -- and with perhaps the most well-known public health figure in the hot seat (Anthony Fauci, MDopens in a new tab or window) -- now seems a good time to reflect on how we might begin to restore our trust in public health.[MedPage Today]

Understanding the Root of Conspiracy Theories

In the mid-to-late 90s, I worked for a member of Congress who represented the high desert of California. If you have never visited this area, it is both beautiful and dangerous. Hot and dry with few people, it is home to two of the most famous military facilities in the world: Edwards Air Force Base and Naval Air Weapons Station at China Lake. Both are renowned, though one more than the other. While the Space Shuttle occasionally landed at Edwards, affording it more attention, China Lake is not as well-known. Yet, it is the home to the development and testing of some of the most advanced weapons in the military's arsenal.

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The Illinois Department of Public Health announced Wednesday an expanded list of high-risk for lead exposure ZIP codes. [IL-DPH and WGN] 

IDPH is recommending increased mandatory testing for lead exposure of children who live within those areas.

One hundred and forty-eight new zip codes, representing parts of 60 Illinois counties, have been added to the list this year, bringing the total of high-risk ZIP codes to almost 1,200.

See List here by Zip Code>

IOMC is working with the Lead Abatement Resource Center Foundation on providing efforts to the children, families and communities. More details soon. 

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Robert Bulanon glanced at the sky and frowned at the rain. He hurried into his home and emerged, holding an umbrella over his head, picking his way between a barbershop pole, a pair of bus seats, a wheelbarrow, a grill where another man was cooking beef stew, and other objects scattered along the embankment of the canal. [Chicago Tribune] 

Photo Vincent Alban /Chicago Tribune

Bulanon, 52, is one of about 20 people who live in a set of makeshift shelters along the North Shore Channel between Foster and Bryn Mawr avenues on Chicago’s Northwest Side. A ladder leaned against the chain link fence, separating the river embankment from athletic fields at Northside College Prep, a selective enrollment high school.

By July 30, the residents will no longer be able to call the longtime encampment home. The next day, city departments are scheduled to begin clearing the tents and items, officials said, offering the group non-congregate shelter placement at a downtown hotel. Notices will go up starting the first week of July. The idea of relocating them has been talked about for years.

“They said, ‘We’re here to help; we could send you somewhere, a shelter or something,’”  Bulanon recalled of his first interaction with the city.

Months after voters rejected the Bring Chicago Home referendum, which sought to raise millions for homelessness services by raising the city’s real estate transfer tax for property sales above $1 million, Chicago is at a critical juncture on how to address its rapidly growing homeless population.

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The US Department of Health and Human Services (HHS), through its Biomedical Advanced Research and Development Authority (BARDA), today announced that it has awarded Moderna $176 million to develop a prepandemic vaccine against H5 avian influenza. [Kaiser Health News & Univ. of MN]

In its announcement, HHS said the award helps bolster the nation's pandemic flu vaccine capacity, which currently relies on an older traditional vaccine platform. Moderna will leverage its domestic large-scale commercial mRNA vaccine manufacturing platforms and ongoing development of mRNA-based seasonal flu vaccines.

The award comes as officials confirm more H5N1 avian flu in US cattle and poultry.

Phase 3 trials could begin next year

Dawn O'Connell, JD, assistant secretary for preparedness and response at HHS, said the $176 million represents the base award and the agreement contains other options that allow the government to quickly pivot funding to other mRNA vaccines when new flu strains or other disease threats emerge. She said the H5 vaccine is in clinical development and that phase 3 trials could begin in 2025.

The award also includes an option for large-scale production and pandemic response. At today's briefing, Robert Johnson, PhD, director of medical countermeasures at BARDA, said it's too early to project production capacity. He said the number will depend on dosing information, which should be available later this year. 

Moderna said in a statement today that in 2023 it launched a phase 1/2 clinical trial of an investigational pandemic flu vaccine in healthy adults, which included candidates against H5 and H7 viruses, and results are expected this year. 

Meanwhile, fill-and-finish activity continues on vaccine from bulk stocks of candidate cell-based adjuvanted H5 vaccine made by CSL Seqirus, and O'Connell said the first of 4.8 million doses will be available in the middle of July, with production continuing through August. This is faster than the government had anticipated. 

Officials weigh early vaccine use for high-risk groups

As vaccine production and planning continues, federal officials are in ongoing discussions about how to best protect farm workers and others exposed to cattle.

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 A survey of low-income adults in four southern US states shows that nearly half of those disenrolled from Medicaid after COVID-19 pandemic protections ended had no insurance in late 2023, leading to struggles to afford healthcare and prescription drugs and threatening to broaden a gap that had narrowed during expanded governmental benefits. [University of MN] 

'These findings suggest that the recent unwinding of COVID-19 pandemic–related safety-net policies may worsen health care affordability and widen existing income-based inequities.'

The data were derived from 89,130 adult residents of Arkansas, Kentucky, Louisiana, and Texas participating in the National Health Interview Survey in 2019, 2021, and 2022. In 2023, states rechecked Medicaid eligibility after COVID-19 governmental protections expired, disenrolling millions. The average participant age was 48.0 years, and 51.6% were women.

Researchers from Beth Israel Medical Center and Harvard Medical School published the results late last week in JAMA Health Forum.

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