The city and state are in the planning stages to combine Chicago’s legacy homeless shelter system with its system for migrants, according to government officials, and turn it into a unified shelter structure, an idea advocates for the homeless have long championed. [Chicago Tribune]

The “One System Initiative” will shift a “permanent shelter management to the non-profit workforce,” Illinois Department of Human Services spokesperson Daisy Contreras said in a statement. Currently, the city contracts with Favorite Healthcare Staffing, whose sizable overtime has contributed to tens of millions of dollars in city payments to the firm staffing the city’s migrant shelters.

The state’s office to prevent and end homelessness will lead the initiative with more than 25 community-based agencies participating, Contreras said. Planning sessions are set to begin at the end of April and go through the spring. 

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In part two of this exclusive video interview, MedPage Today editor-in-chief Jeremy Faust, MD, talks with Monica Bertagnolli, MD, the 17th director of the National Institutes of Health (NIH), about the day-to-day work at the NIH on pandemic preparedness, the importance of looking for new approaches to testing, and the status of long COVID research. [MedPage Today]

Faust: Hello, this is Jeremy Faust, editor-in-chief of MedPage Today. We're joined today by Dr. Monica Bertagnolli. All right, I'd like to talk a little bit about the NIH and pandemic preparedness. Broadly speaking, is this something that the NIH is thinking about? Obviously there was some involvement, obviously during the pandemic, of the COVID-19 pandemic, including the NIH was hosting guidelines for COVID clinical policies and that sort of thing. What's the day-to-day work at the NIH on pandemic preparedness like?

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Citing the changing needs of incoming migrants to Chicago, the Cook County Board of Commissioners Thursday approved a transfer of $70 million originally dedicated to providing them health care to instead cover costs of food service for new arrivals. [Chicago Tribune]

The funding represents the majority of the $100 million Board President Toni Preckwinkle dedicated in her $9.6 billion 2024 budget to the county’s Disaster Response and Recovery Fund. The remaining $30 million was allocated toward “municipal or local government costs” related to incoming migrants and “other disasters that may happen in 2024.”

Cook County legal counsel Laura Lechowicz Felicione said last year’s migrant health care expenses, which totaled $25 million, were covered by surplus dollars and “various expense lines, mostly in salaries and wages.”

“We expect that we’ll be able to cover that expense again this year” using the surplus, she said. That frees up the $70 million to reimburse the city of Chicago for costs related to feeding asylum-seekers in intake or shelters. The resolution leaves room for the money to also be used to support other “costs related to funding operations for the new arrivals.”

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A disease originating in a remote area halfway around the world can travel to the U.S. in as little as 72 hours.[KFF Health News and NPR]

That's why the Biden administration has launched a new effort to improve the ability of the U.S. to prevent, detect and respond to the spread of infectious diseases.

While the U.S. has long been the global leader in health security, the White House's new Global Health Security Strategy, announced today, strives to make the country even better prepared for future pandemics, outbreaks and biological threats regardless of where they occur. However, experts in the field worry the new strategy does not go far enough and financial realities will limit the effort's impact.

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Advocates joined Gov. JB Pritzker Monday to call on lawmakers to approve a $10 million investment in the upcoming budget to help eliminate medical debt for 340,000 low-income Illinoisans. [Health News Illinois]

Pritzker told reporters at a press conference in Chicago that a statewide program could relieve an estimated $1 billion in medical debt.

“As we continue to negotiate and pass a balanced budget, this low-cost program to eliminate medical debt will alleviate a major burden on families across Illinois,” he said.

The program would work with the recently renamed Undue Medical Debt, a New York-based nonprofit that has been working to wipe out medical debts since it got its start in 2014.

Pritzker plans the initial investment to be part of a four-year effort that would, in total, erase an estimated $4 billion of medical debt for over 1 million Illinoisans.

The proposal would mimic an initiative from Cook County, which county board President Toni Preckwinkle said Monday has aided more than 200,000 residents in eliminating nearly $350 million of debt.

“Medical debt relief is a crucial step, and it is part of a broader, equitable strategy to enhance the financial stability and support the holistic well-being of Illinois residents,” she said.

Fourteen percent of Illinoisans have medical debt in collections, according to Pritzker’s office. However, that number jumps to nearly 20 percent in Black and Brown communities.

State leaders were joined by Loyola Medicine CEO Shawn Vincent, who recently announced his health system will forgive over $112 million in medical debt. The move will affect more than 60,000 Illinoisans.

“This initiative underscores our dedication to alleviating the burden of medical debt on our patients in the communities that we serve,” he said.

The press conference comes after a recent report found that medical debt relief did not improve the mental health or the credit scores of debtors, on average. Those whose bills had been paid were just as likely to forgo medical care as those whose bills were left unpaid.

Pritzker noted Monday that the study’s findings were compiled from 2018 to 2020, and that the results “were not indicative” of what is now being seen with the organization. He said larger municipalities have made efforts to address medical debt and have received positive feedback.

“There has been a lot of improvement in the program, and we're really pleased to continue the progress,” he said.

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Experts worry a recent rise in long COVID cases — fueled by a spike in winter holiday infections and a decline in masking and other measures — could continue into this year. [MedScape]

A sudden rise in long COVID in January has persisted into a second month. About 17.6% of those surveyed by the Census Bureau in January said they have experienced long COVID. The number for February was 17.4.

Compare these new numbers to October 2023 and earlier, when long COVID numbers hovered between 14% and 15% of the US adult population as far back as June 2022.

The Census Bureau and the Centers for Disease Control and Prevention (CDC) regularly query about 70,000 people as part of its ongoing Pulse Survey.

It's Not Just the Federal Numbers

Independently, advocates, researchers, and clinicians also reported seeing an increase in the number of people who have developed long COVID after a second or third infection.

John Baratta, MD, who runs the COVID Recovery Clinic at the University of North Carolina, said the increase is related to a higher rate of acute cases in the fall and winter of 2023.

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A virtual program led by Cook County Health physicians, virtual participants will learn about creating  a birth plan with your care team, steps to care for yourself during pregnancy and what to expect after delivery. 

April 15, 1:00 PM 

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You may be interested in IOMC's video on Maternal & Child Health,  visit here. 

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Since October 2023, an average of 200 mpox cases have been detected every month. This is still a fairly low rate of transmission, but experts worry this could be a harbinger of a larger surge in the summer when travel and socializing pick up.  [The Hill]

Health experts monitoring the trend are calling for targeted action.  

“I would encourage them to continue to provide the information so that people have the information to make decisions about their preventative health care, and also to increase their communication efforts,” Brian Hujdich, executive director of the National Coalition for LGBTQ Health, told The Hill.  

The virus spread through the social networks of men who have sex with men during the summer of 2022, and it still appears to mainly be spreading through this demographic. 

According to Hujdich, the continued presence of mpox in the U.S. reflects the inequitable access that different communities have to immunization. He attributed this to the fact that the mpox vaccine was only available through public health agencies up until recently, meaning factors such as distance from a clinic or supply stood in the way. 

The federal government has signaled an awareness of the current trend, with an interagency initiative promoting mpox vaccination in the works. 

“CDC is collaborating with federal partners and advocacy groups to think about summer opportunities to promote vaccine awareness and uptake, as well as to increase awareness of ongoing mpox risks in the United States,” a Centers for Disease Control and Prevention (CDC) spokesperson told The Hill in a statement. 

“The ‘Summer of Pride’ Initiative for LGBTQI+ Events started in 2023, and will continue into 2024. It is being developed out of HHS’s Office of the Assistant Secretary for Health.  Planning is in the early stages." 

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By Asif, Hassaan BS¹; McNeer, Jennifer L. MD, MS²; Ghanayem, Nancy S. MD, MS³; Cursio, John F. PhD⁴; Kane, Jason M. MD, MS

Research funded by The Portes Foundation.

Dr. Jason Kane, MD, MS is a Fellow of the Institute of Medicine of Chicago. 

OBJECTIVES: 

To characterize trends in noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) use over time in children with hematologic malignancy admitted to the PICU with acute respiratory failure (ARF), and to identify risk factors associated with NIV failure requiring transition to IMV.

DESIGN: 

Retrospective cohort analysis using the Virtual Pediatric Systems (VPS, LLC) between January 1, 2010 and December 31, 2019.

SETTING: 

One hundred thirteen North American PICUs participating in VPS.

PATIENTS: 

Two thousand four hundred eighty children 0–21 years old with hematologic malignancy admitted to participating PICUs for ARF requiring respiratory support.

INTERVENTIONS: 

None.

MEASUREMENTS AND MAIN RESULTS: 

There were 3013 total encounters, of which 868 (28.8%) received first-line NIV alone (NIV only), 1544 (51.2%) received first-line IMV (IMV only), and 601 (19.9%) required IMV after a failed NIV trial (NIV failure). From 2010 to 2019, the NIV only group increased from 9.6% to 43.1% and the IMV only group decreased from 80.1% to 34.2% (p < 0.001). The NIV failure group had the highest mortality compared with NIV only and IMV only (36.6% vs. 8.1%, vs. 30.5%, p < 0.001). However, risk-of-mortality (ROM) was highest in the IMV only group compared with NIV only and NIV failure (median Pediatric Risk of Mortality III ROM 8.1% vs. 2.8% vs. 5.5%, p < 0.001). NIV failure patients also had the longest median PICU length of stay compared with the other two study groups (15.2 d vs. 6.1 and 9.0 d, p < 0.001). Higher age was associated with significantly decreased odds of NIV failure, and diagnosis of non-Hodgkin lymphoma was associated with significantly increased odds of NIV failure compared with acute lymphoid leukemia.

CONCLUSIONS: 

For children with hematologic malignancy admitted to the PICU with ARF, NIV has replaced IMV as the most common initial therapy. NIV failure rate remains high with high-observed mortality despite lower PICU admission ROM.

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Our story begins 160 years ago, during the Civil War era. Elizabeth Blackwell, MD, the first woman to earn a medical degree in the U.S., had graduated only 15 years earlier, in 1849. Blackwell was exceptional; most institutions at the time barred women from higher education and professional work. With a few exceptions, women largely couldn’t vote, take legal action, or own property. [Chicago Health]

Life looks vastly different for women in the U.S. now, though many states have banned access to sexual and reproductive medical care for women. And while more women are practicing medicine today, they remain devalued among their male counterparts by nearly every metric and measurement, including pay equity and leadership roles.

“Getting consultants and patients to believe that I, as a young woman, hold the same amount of knowledge as someone more senior-appearing and masculine-presenting is often challenging, regardless of how many times I assure them that I am indeed a physician,” says Nikki Alberti, MD, an emergency and internal medicine resident at the University of Illinois Chicago. “I truly believe that as the number of women in medicine continues to rise, this culture change will happen.”

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