The summertime rise in COVID cases and hospitalizations is making some Americans rethink if the pandemic is over, but it isn't persuading them to start wearing masks again or test for the virus, according to the latest Axios-Ipsos American Health Index. [Axios]

The big picture: Economic and political turmoil, along with unease about developments like AI, have left many Americans numb to public health threats, though issues like the opioid crisis and shortage of cancer drugs are still registering.

• Gun violence, which ranked as the top threat to public health when we asked the question in May, has dropped to No. 3 behind opioids and obesity, with noticeably fewer Democrats listing it as their top concern.

What they found: On COVID, 50% somewhat or strongly agree the pandemic is over, compared to 62% in May.

• The percentage of people who wear a mask some or all of the time has dropped by half over the past six months, to 15%.
• 69% say contracting COVID poses small or no risk to their health and well-being.
• 95% say they've taken one or fewer COVID tests at home in the past week.

What they're saying: "The concern about rising COVID cases is mixed, but what's more clear is that there's really no behavioral change," said Mallory Newall, vice president at Ipsos. "Moreover, the perceived level of risk of contracting COVID remains low — on par with getting a tick or mosquito bite."

The public's awareness of other health issues is comparatively low. Fewer than half say they're somewhat or very familiar with record-high drug overdose deaths, the ongoing shortages of some cancer drugs or the Food and Drug Administration's approval of over-the-counter birth control. Still, they said they cared about those issues when asked about them.

• In sizing up what most concerns them, the perceived threat of gun violence appears to be more acutely tied to specific events like widely covered mass shootings while opioid misuse or obesity is more of a constant worry.
• "It's still definitely a top-tier concern, but lacks the consistent focus we see with opioids," Newall said.
• Where a person lives is a big factor: Substantially more people in rural areas rank opioids and fentanyl as a top concern than those in urban and suburban areas, who are likelier to rank firearms high on their list.

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Seven Illinois groups receive $1.4 million to increase health screenings for children | Several Illinois groups will receive nearly $1.4 million in federal funds to increase screenings and follow-up services for children 5 and under. [Health News Illinois]
 
The seven health centers will each receive $200,000 from the U.S. Department of Health and Human Services’ Health Resources and Services Administration.
 
The funds are part of $30 million awarded by the agency to 151 centers across 39 states and Puerto Rico.
 
“Health centers provide many kinds of support, including screening of young children and connecting them to appropriate services,” HHS Secretary Xavier Becerra said in a statement. "We urge Congress to fund health centers in a sustainable way, so more Americans benefit from this support."
 
See the full list of recipients here.

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Acrocyanosis, venous pooling of blood in the legs that causes them to turn blue, may be yet another symptom of long COVID, according to a case report published in The Lancet.

The case report features a 33-year-old man who for 6 months experienced blue legs after 10 minutes of standing, accompanied by a heavy, itching sensation. The legs returned to a normal color after 2 minutes of lying down.

The man had never experienced blue legs until his long-COVID diagnosis and subsequent diagnosis of postural orthostatic tachycardia syndrome (POTS), a condition that causes an abnormal increase in heart rate on standing. When lying down, the man's pulse was 68 beats per minute, but upon standing for 8 minutes, his pulse increased to a maximum of 127 beats per minute.

The authors of the report said there have been documented cases of acrocyanosis among children experiencing post-viral illness, but few cases have yet to be connected to long COVID.

"Patients experiencing this may not be aware that it can be a symptom of Long Covid and dysautonomia and may feel concerned about what they are seeing. Similarly, clinicians may not be aware of the link between acrocyanosis and Long Covid," senior author Manoj Sivan, MD, said in a University of Leeds press release.

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Researchers said the increase in maternity deserts and poor access to care is in part due to obstetric  wards.  A whopping 5.6 million birthing people are finding themselves without access to maternity care as the prevalence of maternity deserts continues to grow, according to reports from the March of Dimes. 

These care access issues are compounded by the social determinants of health that also impact maternal health outcomes, the report authors said.

Illinois Report - download here.

Summary of the USA  Report- click here.

Report Shows 4% Drop in Birthing Hospitals with Nearly 6 Million Women Living in Areas with No or Limited Access to Care

The March of Dimes report comes as the healthcare industry grapples with a fraught maternal health problem.

Separate studies have found that the US has the worst maternal health outcomes and worst maternal health equity out of the developed world. On top of that, the Supreme Court’s reversal of Roe v. Wade has called into question overall access to all kinds of reproductive healthcare, not just abortion.

Now, March of Dimes is outlining the state of birthing and maternity care access, particularly by shining a light on maternity care deserts.

“A person’s ability to have a healthy pregnancy and healthy birth should not be dictated by where they live and their ability to access consistent, quality care but these reports shows that, today, these factors make it dangerous to be pregnant and give birth for millions of women in the United States,” Dr. Elizabeth Cherot, March of Dimes president and chief executive officer, stated publicly.

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Structural inequities and higher burden of social determinants of health are more than home-based care nurses can mitigate, researchers said.

Even with home-based care interventions, social determinants of health and structural barriers get in the way of good maternal health outcomes, a new Health Affairs study has found.  [Patient Engagement HIT]

The report, received under embargo, showed that a home-based nursing care program had a negligible impact on the health outcomes of pregnant, Medicaid-eligible people. That’s likely because structural barriers and other social determinants of health are likely more than nurses can mitigate.

These findings call into question the efficacy of home-based nursing care among pregnant populations and how such programs can be reshaped in the future.

The researchers zeroed in on the Nurse-Family Partnership (NFP) program, which offers home visits from a registered nurse to Medicaid-eligible pregnant people throughout their pregnancy and up to 24 months after delivery. NFP operates in 40 states and, as of 2020, has served more than 50,000 families. It also received additional funding as part of the American Rescue Plan Act of 2021.

As part of their home visits, NFP nurses use different patient-provider communication strategies to uncover targeted needs and to tailor healthcare and social services solutions. In addition, NFP nurses conduct mental health screenings, monitor pregnancy, and provide guidance on healthy behaviors related to exercise and nutrition.

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Medicaid Administrator Kelly Cunningham said last week they expect to have conversations in the coming months with federal partners regardingIllinois’ recently-submitted1115 waiver for behavioral health services.

The five-year extension application to the Centers for Medicare and Medicaid Services proposes 10 programs, including efforts to address food and nutrition services, employment assistance, non-medical transportation and community reintegration for previously incarcerated individuals.

While they await those negotiations with the federal agency, Cunningham told the Medicaid Advisory Board Friday that the next big step for the agency will be creating an implementation design for the initiatives. She said the agency will be working with stakeholders to help plan how to roll out the programs.

“It's really how do we design an implementation strategy so that these services and that this planning actually has the desired outcome in terms of improving health and addressing the needs of the Medicaid population," Cunningham said.

CMS said earlier this summer that they have extended the state’s demonstration through next June as the two sides negotiate over the current extension application.

The agency also said it is preparing to schedule a public hearing on changes to the Medicaid-like program for undocumented individuals ages 42 and older. The changes include a pause on new enrollees between the age of 42 and 64 and copays for hospital services not eligible for a federal match, such as $250 for inpatient hospitalizations and $100 for emergency room visits.

The changes also will pause enrollment in the program for those 65 and older once the total number of members reaches 16,500. Officials said last week it has yet to meet that threshold.

Laura Phelan, policy director at the department, said the details of the meeting “will be forthcoming.”

Additionally, she said work is underway to create a dashboard to track enrollment data on the program.

“Our goal is to make it consumer friendly and also easily consumable,” Phelan said.

 The committee also approved a motion for the department to respond by year’s end to a report created by the MAC’s community integration subcommittee. The report lays out short- and long-term recommendations to increase the number of seniors and persons with all types of disabilities receiving services in community settings.

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When Denver Health wanted to open an inpatient opioid detox unit specifically for teens, doctors there searched high and low for a model to copy. They didn’t find one. [KFF Health News]

Teens who land in emergency rooms with an opioid overdose generally receive naloxone to reverse the effects of dangerous drugs in their system and are sent home with a list of places they can go for follow-up care. But too often, those teens never seek additional help. They are left to suffer through the agony of withdrawal with no medications to ease their cravings. As a result, many, seeking relief, go back to opioids, often with tragic consequences.

Christian Thurstone, the director of behavioral health services at the Denver hospital, said six of his teen patients have died of fentanyl overdoses in the past two years. Denver Health has now opened what he believes to be the nation’s first adolescent inpatient detox unit.

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It’s estimated that at least 1 in 5 people with a SARS-CoV-2 infection never develop symptoms. Genetics might explain some of these asymptomatic cases, it turns out. In a new study appearing in Nature, people with a particular gene variant appeared to have preexisting T cell immunity to the virus, likely a holdover from previous bouts of the common cold. [JAMA Network]

Why This Is Important

Hollenbach and her coauthors note that many studies have looked at genetic factors in severe COVID-19 disease, but fewer have examined the underpinnings of asymptomatic or mild infection. Insight into factors that allow the immune system to quickly clear the virus could help scientists better understand the disease and improve immunotherapies and vaccines, they say.

Benjamin Solomon, MD, who was not involved with the work, is clinical director of the National Human Genome Research Institute, part of the US National Institutes of Health. “It’s interesting to see a major study focus on people on the less-affected end of the curve, as this can be clinically important and offer useful biological insights, but may be less studied than the other end of the curve,” Solomon wrote in an email.

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