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INSTITUTE OF MEDICINE OF CHICAGO

  • 3 Feb 2022 6:30 PM | Anonymous

     

    Gov. JB Pritzker rolled out a $45.4 billion budget proposal Wednesday, with a specific focus on addressing the state’s healthcare workforce and behavioral health.

     

    His proposal creates a $25 million program to help community colleges train nurses, technicians and other high-demand healthcare personnel. It also allocates $180 million through the Department of Healthcare and Family Services for providers in the Medicaid program to direct toward staff bonuses, continuing education, staff retention and recruitment.

    The Department of Public Health would receive an extra $10 million to hire 175 staff to survey and monitor nursing homes and assisted living facilities, and for epidemiologists and infectious disease specialists.

    It also includes $500 million for HFS’ proposed rate reform for long-term care facilities, which the agency says will maximize federal dollars to boost staffing and improve quality.

    Pritzker is also proposing to eliminate licensure fees for 470,000 nurses, physicians, pharmacists, pharmacy technicians, respiratory care workers, social workers and other healthcare workers in the coming fiscal year, something officials said could reduce expenses for providers by $21 million.

    “Let’s recognize the burden our healthcare workers have borne and give them a much-needed reprieve,” he said.

    Other pieces include $2.5 million for a collaboration between IDPH and education agencies to certify academic-based training programs for community health workers and a $2 million increase in scholarships for nurses.

    The budget also increases funding and support for behavioral health services in Illinois. That includes $140 million to HFS for behavioral health rate payments and $150 million to fully implement a program for children with serious mental illnesses.

    It also allocates $70 million to the Department of Human Services for the creation of the 988 hotline number for those in a mental health crisis, which is set to go live nationally this July.

    Pritzker also announced he will appoint a chief behavioral health officer to oversee and coordinate behavioral health services in Illinois.

    “I'm confident the chief behavioral health officer will succeed in streamlining and coordinating these services across state agencies,” he said.

    Rep. Deb Conroy, D-Villa Park, told Health News Illinois she was thankful for the decision.

    “(Pritzker’s) commitment to promoting mental health will help thousands of struggling Illinoisans,” Conroy said. “The focus of this officer will emphasize Illinois’ commitment to creating a continuum of care and mental health and addiction.”

    Other provisions in the budget include:

    ·    Maintaining $2 billion in federal funding and adding $20 million to IDPH for public health preparedness and COVID-19 response activities at the state and local health department level for vaccination efforts, contact tracing, testing and laboratory services.

    ·    $1 million for Alzheimer’s disease outreach, research, care and support.

    ·    $1 million for sickle cell prevention, care and treatment.

    ·    $3 million for technology improvements at IDPH laboratories.

    ·    $96.4 million to provide services to more individuals with disabilities needing assistance to stay in their homes through the Home Services Program and strengthens the program through provider wage increases.

    ·    $2.5 million for the Community Health Worker certification program.

    ·    An additional $100.7 million for the Department of Aging’s Community Care Program to accommodate caseload growth and utilization. 

    ·    $14 million to fund a rate increase for CCP providers starting in 2023.

    ·    $17.5 million to operate the new 200-bed Chicago Veterans’ Home.

    Healthcare associations across the spectrum heaped praise on the governor's spending plan, specifically as it relates to workforce challenges.

    “The governor’s budget proposal importantly allocates resources to begin addressing healthcare staffing shortages, which have been worsened by the pandemic," Illinois Health and Hospital Association CEO A.J. Wilhelmi said in a statement. "We support the governor’s proposed funding for programs designed to help bring more workers into healthcare professions, and to help recruit and retain healthcare workers."

    The Illinois Primary Health Care Association said they looked forward to working with policymakers “on efforts to improve providers’ ability to recruit, retain and develop healthcare workers.”

    Illinois State Medical Society President Dr. Regan Thomas said they appreciated Pritzker acknowledging the challenges faced by the workforce, as well as addressing the state’s reimbursement backlog.

    “For many years medical practices serving state employees and retirees struggled as they waited months and months for reimbursement,” he said. “The length of delayed reimbursement has improved in recent years and with this budget, if approved, should go away.”

    The Illinois Nurses Association said they support Pritzker’s efforts to ease the costs of obtaining a nursing license and investments in programs to increase the state’s healthcare workforce.

    “We welcome the governor’s support and are looking forward to working with him to help build the nursing workforce of the future,” they said in a statement.

    Community Behavioral Healthcare Association CEO Marvin Lindsey said a $140 million investment to rebuild the state’s behavioral health workforce “represents a historic financial investment in the care for individuals working to overcome mental health and substance use challenges.”

    Illinois Behavioral Healthcare Association CEO Jud DeLoss echoed that sentiment.

    “Depression, suicide, alcohol abuse and opioid overdoses have all soared during the COVID-19 pandemic, so Illinois behavioral health system needs every possible extra dollar to combat the behavioral health pandemic swamping the state,” he said.

    Illinois’ long-term care associations were also generally supportive.

    “Programs such as front-line worker license fee waivers, nurse scholarships and funding community colleges to expand the number of those who can serve as front-line workers are welcome initiatives,” said LeadingAge Illinois CEO Angela Schnepf. “However, these need to coincide with legislation supporting the creation of CNA intern and medication aides positions in senior living communities so that a career ladder can be made available to keep these workers in the healthcare field.”

    Matt Hartman, executive director of the Illinois Health Care Association, said he appreciates the allocation for rate reform, and he hopes long-term care is included “in a significant way” when it comes to workforce.

    “Nursing home reimbursement should be focused on quality outcomes for the residents receiving care in the bed, with an emphasis on appropriate staffing,” he said. “Similarly, the focus on and dedication of funding to workforce development in the governor’s budget is welcome at a time when our sector has been decimated by staffing shortages.”

    The Health Care Council of Illinois said Pritzker’s proposals are “concrete steps” that will help alleviate workforce shortages seen across nursing homes. They added they will work with the administration on the release of additional federal relief funds for the industry.

    “Lastly, HCCI remains committed to working with all stakeholders to enact a new reimbursement system focused on staffing and quality of care that will help stabilize the industry,” they said in a statement. “HCCI’s mission is to pass legislation that will prevent nursing home closures, save critical healthcare jobs and prevent the disruption of resident care.”

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  • 2 Feb 2022 5:35 PM | Anonymous

    The first case of a new subvariant of omicron has been detected in Illinois, though officials said it remains too early to know how it will impact the state’s declining COVID-19 metrics. [Health News Illinois 2.2.2022]

    BA.2, a sub-lineage of the omicron variant, was detected by Northwestern Medicine’s Center for Pathogen Genomics and Microbial Evolution in an individual who tested positive for COVID-19 on Jan. 18.

    “Now the question is whether the new subvariant will extend the tail of cases infected with omicron,” Ramon Lorenzo-Redondo, the bioinformatics director at the center, said in a statement.

    He said case numbers have plateaued in countries where the new variant is more prevalent, though it remains to be seen whether Illinois or the United States will follow the same trend. Early studies suggest BA.2 could be more easily transmissible than the original omicron strain, although they haven’t found it causes different symptoms or more severe disease. 

    Meanwhile, Illinois COVID-19 hospitalizations have dropped below 4,000 for the first time since mid-December.

    As of Sunday, 3,870 Illinoisans were in the hospital with COVID-19, down 78 from Saturday and down 1,368 from the prior week.

    Of the patients in the hospital, 684 were in intensive care units, down 22 from Saturday and down 221 from the prior week. There were 406 patients on ventilators, the same as Saturday and down 135 from the prior week.

    There were 6,664 new COVID-19 cases and 28 deaths reported on Monday.

    The new cases bring the state total to 2,920,971, while the death toll increased to 30,913.

    The seven-day average for new cases on Tuesday was 11,873, down 13,179 from the prior week. The seven-day average for daily deaths is 108, down 12 from the prior week.

    The seven-day statewide positivity rate for cases as a percent of total tests is 7.2 percent. The seven-day statewide test positivity using the number of COVID-19 positive tests over total tests is 9.1 percent.

    Eighty percent of eligible Illinoisans ages 5 and older have received at least one dose of a COVID-19 vaccine, while 70.3 percent are fully vaccinated.

     Illinois vaccinators have administered 20,520,124 COVID-19 vaccines, per state data, including 3,876,831 booster doses. The seven-day average of doses administered is 34,851.  

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  • 1 Feb 2022 5:07 PM | Anonymous

    “A people who don’t make provision for their own sick and suffering are not worthy of civilization.”
    –Daniel Hale Williams

    The son of a barber, Daniel Hale Williams founded the first black-owned hospital in America, and performed the world's first successful heart surgery, in 1893. Williams was born in 1858 in Hollidaysburg, Pennsylvania, the fifth of seven children. After his father died, his mother, Sara Price Williams, moved the family several times. Young Daniel started as a shoemaker, but quickly knew he wanted more education. He completed secondary school in Wisconsin. At age 20, Williams became an apprentice to a former surgeon general for Wisconsin. Williams studied medicine at Chicago Medical College. [Columbia |Surgery- New York Presbyterian ] 

    After his internship, he went into private practice in an integrated neighborhood on Chicago's south side. He soon began teaching anatomy at Chicago Medical College and served as surgeon to the City Railway Company. In 1889, the governor of Illinois appointed him to the state's board of health.

    Determined that Chicago should have a hospital where both black and white doctors could study and where black nurses could receive training, Williams rallied for a hospital open to all races. After months of hard work, he opened Provident Hospital and Training School for Nurses on May 4, 1891, the country's first interracial hospital and nursing school.

    One hot summer night in 1893, a young Chicagoan named James Cornish was stabbed in the chest and rushed to Provident. When Cornish started to go into shock, Williams suspected a deeper wound near the heart. He asked six doctors (four white, two black) to observe while he operated. In a cramped operating room with crude anesthesia, Williams inspected the wound between two ribs, exposing the breastbone. He cut the rib cartilage and created a small trapdoor to the heart.

    Underneath, he found a damaged left internal mammary artery and sutured it. Then, inspecting the pericardium (the sac around the heart) he saw that the knife had left a gash near the right coronary artery. With the heart beating and transfusion impossible, Williams rinsed the wound with salt solution, held the edges of the palpitating wound with forceps, and sewed them together. Just 51 days after his apparently lethal wound, James Cornish walked out of the hospital. He lived for over 20 years after the surgery. The landmark operation was hailed in the press.

    In 1894, Dr. Williams became chief surgeon of Freedmen's Hospital in Washington, D.C., the most prestigious medical post available to African Americans then. There, he made improvements that reduced the hospital's mortality rate. In 1895, he helped to organize the National Medical Association for black professionals, who were barred from the American Medical Association. Williams returned to Chicago, and continued as a surgeon. In 1913, he became the first African American to be inducted into the American College of Surgeons.

    As a sign of the esteem of the black medical community, until this day, a "code blue" at the Howard University Hospital emergency room is called a "Dr. Dan." In words that could later be said of Vivien Thomas, a colleague wrote, "His greatest pride was that directly or indirectly, he had a hand in the making of most of the outstanding Negro surgeons of the current generation."

    Dr. Williams died in 1931. The Daniel Hale Williams Medical Reading Club in Washington, D.C., commemorates his achievements.

    Excerpt from PBS American Experience “Partners of the Heart.”

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  • 31 Jan 2022 5:55 PM | Anonymous

    Join this virtual session on Feb. 25, 2022: Mental Health During The COVID Pandemic: A Status Report. 

    We will have a dynamic overview of the mental health consequences of the COVID pandemic. First, we present studies on increasing mental illness prevalence and the developing mental health provider gap. Secondly,  Aunt Martha's Health and Wellness, a leading provider in the State of Illinois, will present their experience with the demand and provision of services. Finally, we will examine some of the best emerging practices nationally and regionally implemented by municipal governments, health systems, or other care providers.


    Speakers

    Maurice Lemon, MD, MPH, Co-Chair of the Program Committee and Billings Fellow 

    Wanda Parker, EdD, Clinical Director, Aunt Martha's Health and Wellness 

    Karen BatiaPhD, Consultant, Health Management Associates 

    More details and to register, visit this page.

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  • 28 Jan 2022 5:25 PM | Anonymous

    Deaths among middle-age U.S. adults have increased substantially this century, reversing decades of progress. [ Melanie Padgett Powers The Nation's Health January 2022, 51 (10) 16]

    Among the primary drivers are drug poisonings, alcohol-related causes, suicide and cardiometabolic diseases, which include cardiovascular disease, diabetes and chronic kidney failure, according to a March consensus study report from the National Academies of Science, Engineering and Medicine.

    Life expectancy progress in the U.S. stalled in 2010 then fell between 2014 and 2017, the longest sustained decline in a century.

    Report committee members examined mortality trends from 1990 through 2017 for people ages 25-64 by age, sex and geography. While they also looked at information by race and ethnicity, data on mortality trends among Asian Americans and American Indians and Alaska Natives was lacking.

    The committee found that since 2010, death rates either leveled off or increased. Three groups had higher all-cause mortality rates in 2017 than they did 27 years before: white males ages 25-44, white females ages 25-44 and white females ages 45-54.

    Drug poisonings were the largest contributor to all-cause mortality, according to Darrell Gaskin, PhD, MS, a professor at Johns Hopkins Bloomberg School of Public Health who served on the report committee. They increased in every demographic group studied and in every state, especially in Appalachia and parts of the Northeast. The largest increases were among white males ages 25-44, urban residents, people with lower education levels, and urban Black men ages 55-64.

    The committee pointed to two themes underlying the increases: increased availability and increased vulnerability. The rise in drug poisoning deaths — which encompasses drug overdoses — is connected to the emergence of opioids being prescribed for non-cancer pain, coupled with opioid overprescribing and regulatory failures, Gaskin said during APHA’s 2021 Annual Meeting and Expo in October.

    “The pharmaceutical industry had convinced the regulators that addiction would not be a problem with this pain treatment,” he said. “Unfortunately, the technology they used to develop these opioid treatments was easily defeated by users.”

    The second wave of the opioid crisis began as policymakers and regulators placed restrictions on opioid prescribing, which caused many users to transition to heroin and fentanyl. A third wave of the crisis began when illegal drug suppliers began to mix other drugs with fentanyl. Overdoses spiked, and in 2010, fentanyl deaths surpassed heroin deaths.

    Despite all this, the problem is bigger than the opioid crisis, Gaskin said. Deaths from cocaine and methamphetamine use also increased in the 2010s, as did alcohol use, linked to price decreases, increased availability, deregulation and flavored beverages.

    “This trend in working-age increased mortality is a uniquely American phenomenon,” said Steven Woolf, MD, MPH, a professor at Virginia Commonwealth University who also served on the report committee. “It’s not happening in other high-income countries, so there’s a real need for cross-national research to understand ‘what is it about America that is responsible for this particular phenomenon?’”

    For more information on “High and Rising Mortality Rates Among Working-Age Adults,” visit www.nap.edu.

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  • 27 Jan 2022 5:36 PM | Anonymous

    Sports betting exploded in Maryland in 2020, thanks to a new state law that allowed a range of online and in-person betting options at sport stadiums, horse racing tracks, state fairgrounds and six casinos, including one on a riverboat. [ Aaron Warnick The Nation's Health January 2022, 51 (10) 20]

    The Maryland law is not an outlier. Across the U.S., states are looking for new revenue sources and betting companies are ready to set up shop. But mental health and addiction professionals worry the expansion could create or worsen gambling disorders, which already affect millions of Americans. In a given year, about 2% of people in the U.S. engage in problem gambling behaviors.

    “In my view, the relationship between gambling and public health is similar to its relationship with alcohol,” said Rachel Volberg, PhD, a gambling addiction researcher at the University of Massachusetts Amherst’s School of Public Health and Health Sciences. “Gambling for the most part now is a legal but risky consumer product.”

    In 2018, the U.S. Supreme Court overturned a federal law that prohibited most states from legalizing sports betting. Since then, all but a few states have considered allowing the practice. In under two years, the number of states with legal sports betting accelerated from one to 31, in addition to the District of Columbia.

    Many people who live where sports gambling is now legal are eager to place bets. A September 2021 survey from the American Gaming Association found that a record-high 45.2 million Americans planned to bet on professional football during the 2021-2022 season — an increase of 36% over last season. Nearly 20 million adults planned to place a bet online, a 73% increase from 2020, the survey found.

    Sports betting can be done anywhere in a legal jurisdiction, from a sports bar to the dinner table, all on a smartphone or other mobile device. Casino and sports-adjacent brands are investing in internet and mobile platforms as well as sleek advertising campaigns featuring celebrities and professional athletes.

    “Everyone now has a casino in their pocket,” Keith Whyte, director of the National Council on Problem Gambling, told The Nation’s Health.

    One investor is Caesars Entertainment, which has pledged $1 billion toward its digital products. Much of the spending will be for ads during NFL games. On Nov. 9, the company announced a partnership with former football players Peyton and Eli Manning, who will appear in advertisements and live events promoting sports betting.

    One concern is that flashy, high-budget ad campaigns from gambling companies are now more common and targeting youth. According to Yale Medicine, which conducts research on gambling, as many as 7% of youth develop a gambling disorder, compared with about 1% of adults. Gambling can hold a special allure for disadvantaged youth, Volberg said.

    Among those that are tackling the problem is the Massachusetts Department of Public Health’s Office of Problem Gambling Services, which funds youth-serving organizations to integrate underage gambling prevention. Youth in the programs are paid to use photography to document how gambling impacts their community.

    The program empowers youth to “showcase their findings to community members and influencers to motivate and enact policy change,” according to presenters who spotlighted the work at APHA’s 2021 Annual Meeting and Expo in October.

    Figure

    Casino and sports-adjacent brands are investing in internet and mobile platforms as well as sleek advertising campaigns.

    Photo by Hirurg, courtesy iStockphoto

    Working to prevent problem gambling

    More than a dozen states now receive at least 10% of their general revenue from in-state gambling, according to the National Council on Problem Gambling.

    A portion of gambling taxes is directed to preventive organizations, including the National Council on Problem Gambling and its state affiliate associations. The council operates a national gambling hotline, and many state universities and health departments run treatment and prevention efforts, ranging from support groups, addiction treatment centers and outreach to at-risk people.

    The most common approach for prevention advocates is not to call for prohibition outright, but rather push for a share of the gaming tax revenue to be directed to treatment and prevention efforts.

    Chartered in 2012, the University of Maryland’s Center on Excellence on Problem Gambling has grown with the increasing need, said Blair Inniss, JD, MA, government relations director. And data soon to be published by the center shows that problem gambling has risen in Maryland since 2018, when the federal ban lifted but betting was still illegal in the state, she told The Nation’s Health.

    As an example of how widespread sports betting could become in Maryland, Inniss pointed to a survey given three years before the state legalized sports betting. It showed that while the state lottery was No. 1 for gambling, sports betting came in at No. 4.

    “And let’s remember, that was in 2017, so respondents were admitting to illegal sports betting,” said Innis, who presented about the Maryland center’s work during APHA’s Annual Meeting. “That’s how we can be so certain that number is going to increase once it becomes legal and easily accessible.”

    About 2 million U.S. adults are estimated to have severe gambling problems or addiction, according to the National Council on Problem Gambling. Up to 6 million more may have mild or moderate problems.

    According to the American Psychiatric Association, gambling disorder involves “repeated problematic gambling behavior that causes significant problems or distress.” The disorder is classified as a behavioral addiction in the American Psychiatric Association’s diagnostic manual.

    Problem gambling is more common in men, people of color and in those with mood or personality disorders. People with psychiatric disorders such as major depression are much more likely to develop gambling problems, according to a 2008 study.

    Medication and therapy can help, but fewer than 10% of people with a gambling disorder seek treatment, according to the American Psychiatric Association.

    For more on problem gambling, visit www.ncpgambling.org and bit.ly/APAgambling.

    • Copyright The Nation’s Health, American Public Health Association
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  • 26 Jan 2022 5:29 PM | Anonymous

    When COVID-19 safety measures led schools and workplaces to close in spring 2020, 25% of households with children experienced food security. [ Mark Barna The Nation's Health January 2022, 51 (10) 17]

    In response, the U.S. Department of Agriculture issued a series of waivers and flexibilities that allowed school districts and other local sponsors to continue operating child nutrition programs through school systems. The waivers reduced longstanding barriers in child nutrition efforts, dramatically increasing participation in the summer school meals program, according to research presented at APHA’s 2021 Annual Meeting and Expo in October.

    Research conducted in Maryland, North Carolina and New York during the first six months of the COVID-19 pandemic found that participation in school meal programs lagged in spring but increased dramatically in summer. In Maryland, for example, which has about 1,500 schools and 1 million students, school meal programs served 6.5 million additional meals in summer 2020. The increase represented a 210% jump over summer 2019.

    Eligibility waivers made the difference, researchers said. USDA waived its requirement that meals be served in group settings, which meant families could take advantage of grab-and-go drive-up services and pre-order meals. The agency also extended the hours meals could be available. Many states, meanwhile, took advantage of the federal option of expanding the geographic region where students could get meals.

    Figure

    USDA eligibility waivers for the federal school meals program increased student participation, serveral studies say.

    Photo by Wavebreakmedia, courtesy iStockphoto

    The highest increase in summer meal program participation occurred in June and August.

    School meal participation is associated with improved food security, dietary quality and academic performance, said Susan Gross, PhD, MPH, an associate scientist and nutritionist at Johns Hopkins Bloomberg School of Public Health who co-authored the Maryland study. USDA waivers allowed for innovation in preparing and distributing meals to meet student needs. Availability and accessibility of meals improved participation.

    “We see now that out-of-school meal time is a really crucial time,” said Gross, an APHA member.

    APHA has repeatedly called for expanding children’s access to school meals. The Association is a member of the National Alliance for Nutrition and Activity coalition, which advocates for child nutrition programs that protect and strengthen evidence-based nutrition standards for school meals and other foods sold in schools. Through the coalition and separately, APHA has supported strengthening, protecting and expanding access to school nutrition programs.

    In April, USDA announced an extension of school meal waivers through the 2021-2022 school year. Four months later, Johns Hopkins and Maryland Hunger Solutions issued a brief saying the USDA waivers issued in response to the COVID-19 pandemic should be made permanent.

    “Program flexibilities provided by COVID-19-related nationwide waivers have reduced longstanding barriers to (summer food service program) participation while simultaneously reducing the administrative burden on sponsors, increasing participation numbers and making the SFSP more efficient and effective in addressing food insecurity,” the policy brief said.

    • Copyright The Nation’s Health, American Public Health Association
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  • 25 Jan 2022 3:50 PM | Anonymous

    U.S. Sen. Dick Durbin, D-Ill., is calling on the state’s healthcare providers to promote federal scholarship and loan repayment funding for healthcare workers. [Health News Illinois 1.25.2022]

    In a letter sent last week to over a dozen state health associations, Durbin said the funding is available as part of $1 billion allocated in the American Rescue Plan’s National Health Service Corps and Nurse Corps programs.

    “The pandemic has underscored the long-term challenges in our healthcare delivery system, and it is my hope that this significant new funding and emphasis on recruiting a diverse workforce can help begin to close gaps and promote equity,” Durbin said in the letter.

    There were more than 800 trained professionals providing care in urban and rural parts of Illinois through the programs last fall, according to Durbin’s office. 

     The programs provide scholarship and loan repayment options to qualified primary care medical, dental and behavioral health clinicians.

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  • 24 Jan 2022 5:30 PM | Anonymous

    Disasters are an important public health issue; however, there is scarce evidence to date on what happens when communities and populations experience more than one disaster. This scoping review identifies literature on the effects of multiple disasters published until Aug 2, 2021, 1425 articles were identified, of which 150 articles were included. We analysed direct and indirect public health implications of multiple disasters. Our analysis suggests that exposure to multiple disasters can affect mental health, physical health, and wellbeing, with some evidence that the potential risks of multiple disaster exposure exceed those of single disaster exposure. We also identified indirect public health implications of multiple disaster exposure, related to changes in health-care facilities, changes in public risk perception, and governmental responses to multiple disasters. We present findings on community recovery and methodological challenges to the study of multiple disasters, and directions for future research.  [Lancet Public Health 1.19.2022] 

    Download full article here> 

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  • 21 Jan 2022 5:03 PM | Anonymous

    NEW YORK (AP) — Three studies released Friday offered more evidence that COVID-19 vaccines are standing up to the omicron variant, at least among people who received booster shots.

    [The Journal of the American Medical Association published the third study, also led by CDC researchers. It looked at people who tested positive for COVID-19 from Dec. 10 to Jan. 1 at more than 4,600 testing sites across the U.S.] 

    They are the first large U.S. studies to look at vaccine protection against omicron, health officials said.

    The papers echo previous research — including studies in Germany, South Africa and the U.K. — indicating available vaccines are less effective against omicron than earlier versions of the coronavirus, but also that boosters doses rev up virus-fighting antibodies to increase the chance of avoiding symptomatic infection.

    The first study looked at hospitalizations and emergency room and urgent care center visits in 10 states, from August to this month.

    Full article here> 

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