Nirmatrelvir–ritonavir (Paxlovid [Pfizer]) is used as first-line therapy for nonhospitalized persons with Covid-191 on the basis of the results of the Evaluation of Protease Inhibition for Covid-19 in High-Risk Patients (EPIC-HR) trial, which showed that this medication reduced the risk of hospitalization or death by 88%.2 The EPIC-HR trial enrolled adults who had not received a SARS-CoV-2 vaccine and who were at high risk for progression to severe Covid-19. Given those results, the question arose as to whether nirmatrelvir–ritonavir conferred a benefit in persons who had been vaccinated or who did not have risk factors for severe disease. [New England Journal of Medicine]

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Poverty is among the most fundamental determinants of child well-being. Decades of rigorous studies illustrate its powerful and lasting effects on health and social outcomes.¹ Healthy and capable adults are foundational to any well-functioning society. Intergenerational poverty (in which low-income children remain low-income as adults) places a heavy burden on individuals, families, and society. Although child poverty decreased during the COVID-19 pandemic, it more than doubled recently due to expiration of multiple, wide-ranging federal relief programs,² demonstrating that policies to promote child well-being are effective at reducing poverty. Understanding the causes of intergenerational poverty and implementing programs/policies to reduce it would yield high payoffs for children and the nation. [JAMA Network] 

This Viewpoint summarizes a report from the National Academies of Science, Engineering, and Medicine (NASEM) released in September 2023 in response to a Congressional mandate to address intergenerational poverty.³ “Reducing Intergenerational Poverty” was written by an interdisciplinary committee of experts and practitioners. It tackles 4 tasks: (1) describing patterns of intergenerational economic mobility, (2) summarizing drivers of intergenerational poverty, (3) identifying policies/programs to reduce intergenerational poverty, and (4) highlighting high-priority gaps in data and research. Across these topics, the committee was encouraged to consider racial or ethnic disparities.

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Sendy Soto, a former official with the city’s Department of Housing and the co-chair of the housing committee in Johnson’s transition team, will take on the job next week. [WBEZ Chicago]

A leader in Mayor Brandon Johnson’s transition team was named Chicago’s first-ever chief homelessness officer on Monday.

Sendy Soto, a former official with the city’s Department of Housing and the co-chair of Johnson’s housing transition committee, will assume the role next week.

“My ask to each of you is simple: Share your ideas and hold me accountable,” Soto said Monday during the re-opening of an affordable housing complex in the Gold Coast. She officially starts next week.

“It is an immense honor to undertake this vital role on your behalf and gaining and keeping your trust is important to me.”

Among her first tasks will be developing a five-year plan in partnership with other city agencies to address the city’s homelessness crisis. But Soto did not offer up any specifics on how she would handle the issue.

Johnson created the position in October. It is funded by a grant from the Chicago Funders Together to End Homelessness.

Soto was a head of Johnson’s transition housing committee last year, which released a report during the summer that included recommendations for addressing and preventing homelessness. It set a goal of putting Chicago “on a path” to being a city “where housing is a human right,” though one of the steps — increase the real estate transfer tax and use the proceeds to address homelessness — was derailed when the Bring Chicago Home referendum was voted down last month.

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Food insecurity is a pervasive and persistent issue in the United States that disproportionately affects families with children and Black, Indigenous, and other people of color.¹ Food insecurity has been associated with psychological, cognitive, and behavioral health consequences in children, contributing to lifelong socioeconomic and health inequities.² Identifying pathways by which food insecurity affects children’s health is critical to informing intervention efforts to eliminate childhood food insecurity. We posit that toxic stress is a prominent pathway underlying food insecurity and children’s health and advocate for research, clinical, and policy approaches to better address the root causes of food insecurity and promote lifelong health. [JAMA Network]

Toxic stress refers to the biological response to experiencing a strong, frequent, or prolonged stressor without the buffering effect of a supportive environment. Risk factors of toxic stress have traditionally focused on adverse childhood experiences (ACEs) but have recently been expanded to include poverty, discrimination, and other chronic exposures.³ These experiences of adversity can lead to permanent changes in children’s brain structure and function, leading to impaired cognitive development, behavioral disorders, and sustained activation of the body’s stress responses, resulting in systemic inflammation and immune dysregulation.

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The majority of healthcare providers and payers are not ready to meet shifting health equity regulatory requirements, according to Ernst & Young's latest report. [Beckers Hospital Review]

To compile its "2024 Health Equity Outlook," the accounting firm surveyed 500 health equity leaders across stakeholder industries: providers, payers, life sciences, government, and nonprofit/community organizations. The respondent pool included 64 health systems, 14 physician groups, 11 hospitals, eight academic medical centers and three federally qualified health centers. Nearly 40% of respondents were directors, department leads or the equivalent, while 29% were C-suite executives and 28% were vice presidents. 

Most provider and payer respondents indicated that as of today, they could not meet health equity-related regulatory requirements introduced by CMS, the National Committee for Quality Assurance, The Joint Commission and the FDA last year. The new guidelines are multifaceted — asking hospitals to update various processes from data analytics to the C-suite — and the majority of providers say those upgrades are still a work in progress. 

The three new requirements that the most providers are able to meet today: improved language access (48% can meet this), a designated health equity executive leader (48%) and improved healthcare access (47%). However, the majority of providers are still developing or taking action on a defined plan to ensure future readiness — while a small percentage, 6% or less, report that they have no plan to meet each metric. 

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In March 2024, the Chicago Department of Public Health (CDPH) identified some cases of measles in Chicago. Illinois had five measles cases in 2023. Those cases were the first in the state since 2019, when the last measles case was identified in Chicago. As of this week, 52 cases have been reported. [CDC]

The City of Chicago has one of the highest measles, mumps and rubella (MMR) vaccination rates in the nation, meaning that most children and adults in Chicago are vaccinated and protected. Residents are encouraged to review their immunization records or contact their health care provider to make sure they are up to date on MMR vaccine. Immunization records recorded in the Illinois immunization registry, Illinois Comprehensive Automated Immunization Registry Exchange (I-CARE), can be accessed using the Illinois Department of Public Health Vax Verify portal.

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How will Medicare’s new health equity adjustment in the Hospital Value-Based Purchasing (HVBP) program, which assigns additional points to hospitals with more dual-eligible patients for providing high-quality care, affect hospital performance and payment adjustments? [JAMA Network]

In this cross-sectional study of 2676 hospitals participating in the HVBP program, health equity adjustment reclassified 119 of 1206 hospitals (9.9%) from receiving penalties to receiving bonuses. Safety net and high-proportion Black hospitals were significantly more likely to experience increased payment adjustments, as were hospitals located in rural areas and the South. The largest net-positive changes in total payment adjustments were $29.0 million among safety net hospitals and $15.5 million among high-proportion Black hospitals.

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When evolving data provided evidence for a potential causal relationship between vaccine receipt and a specific adverse event, the potential risk associated with the vaccine was quantified, other risk factors for the specific adverse event were identified (eg, age, sex), and the risks vs benefits were assessed.¹ On January 13, 2023, the FDA and the CDC issued a joint public communication² about the identification of a preliminary safety signal within the Vaccine Safety Datalink surveillance system for ischemic stroke within 21 days after receipt of a COVID-19 bivalent mRNA vaccine for individuals 65 years of age and older. This public communication² also specified that the safety signal indicating a potential increased risk of stroke appeared greater when the COVID-19 bivalent mRNA vaccines (also called boosters) were given concomitantly with either a high-dose or adjuvanted influenza vaccine than when given alone. [JAMA Network]

To further investigate this safety signal, the FDA conducted an analysis and Lu et al³ report the results in this issue of JAMA. The analysis used data from Medicare beneficiaries aged 65 years or older and assessed the risk of stroke after receipt of either brand of COVID-19 bivalent mRNA vaccine alone or when given concomitantly with a high-dose or adjuvanted influenza vaccine. Lu et al³ used a self-controlled case series design in which individuals act as their own controls. The temporal association between a transient exposure and an event is evaluated and all time-invariant confounding is eliminated.⁴ Among more than 5 million recipients of either brand of COVID-19 bivalent mRNA vaccine, the study identified 11 001 (0.20%) with a cerebrovascular outcome (nonhemorrhagic stroke, transient ischemic attack, or hemorrhagic stroke). The study found no increased stroke risk associated with either brand of COVID-19 bivalent mRNA vaccine when administered alone. The results from this large cohort are reassuring and are consistent with those reported from France⁵ and Israel.⁶ In addition, no safety signal has been issued by the European Medicines Agency.⁷

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A House committee approved a plan last week intended to help behavioral health providers better recruit and maintain staff. 

The legislation from Rep. Lindsey LaPointe, D-Chicago, would create a support grant program to cover providers' expenses related to recruiting, retaining and compensating licensed mental health and substance use disorder professionals. [Health News Illinois]

Another provision would reimburse costs associated with American Sign Language and foreign language interpretive services at mental health treatment and substance use disorder treatment programs

LaPointe told members of the House’s Mental Health & Addiction Committee that providers, specifically those serving Medicaid patients, need support.

“This bill is one tool in the toolbox to attempt to remedy that by creating a grant program for our providers to better recruit and retain the staff that we need to actually provide the support to people all around the state,” she said. 

The bill currently states recipients could receive up to $200,000 in grant funding for each mental health or substance use disorder professional employed, engaged or contracted.

Illinois Association for Behavioral Health CEO Jud DeLoss told committee members they are working on an amendment with clarifying language regarding the grant amount. 

That includes the dollar amount per position, what type of facilities are eligible, a cap on the number of grants an agency could receive and setting a retention period so an agency could not receive funds if an employee only briefly works there.

Additionally, DeLoss said they recently learned that funding for ALS and foreign language services may be eligible for Medicaid reimbursement, and they intend to transition the bill's language to that instead of state funding.

There is an incredible need for the legislation, DeLoss said. Along with the opioid and mental health crises that are driving up demand for services, providers simply have a hard time recruiting and maintaining staff.

“This would give them the option to use those funds in a very flexible manner to meet the needs of their communities and their patients,” he said.

The committee signed off on the plan along party lines. Rep. Jackie Haas, R-Kankakee, wanted to hear more from the Department of Human Services, which is tasked with overseeing the grant program.

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Nearly 108,000 Americans died of drug overdoses in 2022, according to final federal figures released Thursday by the CDC. [CDC]

Over the last two decades, the number of U.S. overdose deaths has risen almost every year and continued to break annual records -- making it the worst overdose epidemic in American history.

The official number for 2022 was 107,941, the CDC said, which is about 1% higher than the nearly 107,000 overdose deaths in 2021.

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