New research adds to a growing body of evidence suggesting that COVID-19 infection can be hard on mental health.  [MedScape].

A UK study of more than 18 million adults showed an elevated rate of mental illness, including depression and serious mental illness, for up to a year following a bout of COVID-19, particularly in those with severe COVID who had not been vaccinated. 

Importantly, vaccination appeared to mitigate the adverse effects of COVID-19 on mental health, the investigators found. 

"Our results highlight the importance COVID-19 vaccination in the general population and particularly among those with mental illnesses, who may be at higher risk of both SARS-CoV-2 infection and adverse outcomes following COVID-19," first author Venexia Walker, PhD, with University of Bristol, Bristol, United Kingdom, said in a news release. 

The study was published online on August 21 in JAMA Psychiatry.

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The worst of the COVID-19 pandemic is behind us. Age-adjusted COVID-19 mortality rates peaked in 2021 at 104.12 per 100 000 population (per 100 000 hereafter) and fell to 44.45 per 100 000 in 2022.^1,2 Provisional data suggest that COVID-19 mortality rates in 2023 were below 15.00 per 100 000.² This progress is welcome but deceptive. The US mortality picture is hardly ideal. Like the sand revealed as the tide goes out, the receding COVID-19 pandemic draws attention to rising mortality rates from non-COVID causes, a trend that predates the pandemic. [JAMA Network]

After 2010, life expectancy flatlined in the US while continuing to increase in other high-income countries.³ The primary cause was rising mortality rates in midlife (individuals aged 25-64 years). In 2015, Case and Deaton were among the first to call attention to this trend, which they first observed in the middle-aged White population.⁴ Subsequent studies documented the trend among young adults (aged 25-44 years) and middle-aged adults (aged 45-64 years) and other racial and ethnic groups.⁵

The many factors responsible for this trend—ranging from the opioid epidemic and increasing obesity rates to intensifying economic precarity—continued claiming lives during the COVID-19 pandemic. Indeed, COVID-19 poured fuel on the fire, accelerating increases in non-COVID mortality. For example, drug overdose deaths in the US more than tripled between 2000 and 2019 (from 4.15 per 100 000 to 19.14 per 100 000, respectively)¹ and then soared during the pandemic, peaking in 2022 at 30.14 per 100 000.²

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The FDA granted emergency use authorization (EUA) for an updated Novavax COVID-19 vaccineopens in a new tab or window to protect against hospitalization and death from circulating variants. [MedPageToday]

The protein-based shot represents a non-mRNA option for the 2024-2025 season, and follows the agency's recent approvals and authorizations of the updated Moderna (Spikevax) and Pfizer-BioNTech (Comirnaty) vaccinesopens in a new tab or window.

"The COVID-19 vaccines have had a tremendous positive impact on public health and vaccination continues to be the most effective method for COVID-19 prevention," said Peter Marks, MD, PhD, director of the FDA's Center for Biologics Evaluation and Research in the announcement.

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• In 2021-2022, 23% of adults experienced a mental illness in the past year, equivalent to nearly 60 million Americans.
• More than 5% of the U.S. adult population (12.8 million people) reported experiencing serious thoughts of suicide. After slight decreases in suicide deaths in 2019 and 2020, the number of individuals who died by suicide in 2022 was the highest number ever recorded in the U.S.
• 13% of youth ages 12-17 reported experiencing serious thoughts of suicide. The percentage of youth reporting suicidal ideation was highest among youth who identified as Native Hawaiian or Other Pacific Islander (25%) and more than one race (20%).
• 1 in 5 youth had at least one major depressive episode (MDE) in the past year. Over half of them – nearly 3 million youth - did not receive treatment. Of those who did receive treatment, only 65% said it helped them.

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When pediatrician Eric Ball opened a refrigerator full of childhood vaccines, all the expected shots were there — DTaP, polio, pneumococcal vaccine — except one. [KFF Health News]

“This is where we usually store our covid vaccines, but we don’t have any right now because they all expired at the end of last year and we had to dispose of them,” said Ball, who is part of a pediatric practice in Orange County, California.

“We thought demand would be way higher than it was.”

Pediatricians across the country are pre-ordering the updated and reformulated covid-19 vaccine for the fall and winter respiratory virus season, but some doctors said they’re struggling to predict whether parents will be interested. Providers like Ball don’t want to waste money ordering doses that won’t be used, but they need enough on hand to vaccinate vulnerable children.

The Centers for Disease Control and Prevention recommends that anyone 6 months or older get the updated covid vaccination, but in the 2023-24 vaccination season only about 15% of eligible children in the U.S. got a shot.

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As updated coronavirus vaccines hit U.S. pharmacy shelves, adults without health insurance are discovering the shots are no longer free, instead costing up to $200. [The Washington Post]

The federal Bridge Access Program covering the cost of coronavirus vaccines for uninsured and underinsured people ran out of funding. Now, Americans with low incomes are weighing whether they can afford to shore up immunity against an unpredictable virus that is no longer a public health emergency but continues to cause long-term complications and hospitalizations and kill tens of thousands of people a year.

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Health care has long been marked by disparities that affect different groups of people in various ways. Whether due to race, income, or geography, these disparities lead to unequal access to care and varying health outcomes. However, there is growing hope that artificial intelligence (AI) could be the tool we need to address these long-standing issues and create a more equitable health care system for all. [Newsweek]

Quality of care shouldn't be influenced by external factors like a patient's background or where they live. Instead, everyone could receive a treatment plan tailored to their unique health needs, informed by a deep understanding of their genetic makeup, medical history, and lifestyle. AI offers the potential to turn this vision into reality by enhancing the precision and personalization of health care.

The problem of health care inequality is multifaceted. Minority groups often experience poorer health outcomes, not because of inherent biological differences, but due to systemic barriers such as underrepresentation in clinical trials and limited access to quality care. For instance, African American women are statistically three to four times more likely to die from pregnancy-related complications than their white counterparts, as highlighted in a study published in The Lancet in 2019. AI, when properly implemented, can help overcome these challenges by providing data-driven insights that lead to more effective interventions.

AI's ability to analyze vast amounts of data quickly and accurately is one of its greatest strengths. By examining electronic health records (EHRs), genetic information, and even social factors, AI can identify patterns that might go unnoticed by human doctors. For example, AI can detect early signs of chronic conditions like diabetes, which disproportionately affects certain minority groups. The Centers for Disease Control and Prevention (CDC) reported that non-Hispanic Black adults (12.1 percent), adults of Hispanic origin (11.7 percent), and non-Hispanic Asian adults (9.1 percent), have diabetes at higher rates compared to non-Hispanic white adults (6.9 percent).

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ORLANDO, Fla. (AP) — Midwife Jennie Joseph touched Husna Mixon’s pregnant belly, turned to the 7-year-old boy in the room with them and asked: “Want to help me check the baby?”[AP]

Photo credit by John Rauox

With his small hand on hers, Joseph used a fetal monitor to find a heartbeat. “I hear it!” he said. A quick, steady thumping filled the room.

It was a full-circle moment for the midwife and patient, who first met when Mixon was an uninsured teenager seeking prenatal care halfway through her pregnancy with the little boy. Joseph has been on a decades-long mission to usher patients like Mixon safely into parenthood through a nonprofit that relies on best practices she learned in Europe, a place that experts say offers answers to an American crisis.

“I consider maternal health to be in a state of emergency here,” said Joseph, a British immigrant. “It’s more than frustrating. It’s criminal.”

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The US Supreme Court punctuated its term ending July 2024 with major rulings affecting federal agencies. The Court’s decision in Loper Bright Enterprises v Raimondo, jettisoning so-called Chevron deference toward agencies’ interpretations of statutes, and other cases have stirred doubts about whether agencies can continue to make bold, effective health policy.^1,2 These rulings have critical ramifications for health agencies, but the outlook is more complex than it might appear. [JAMA Network] . See Implications for Health Agencies below. 

Incursions Into Agency Authority

Loper Bright held that except where statutes give interpretive discretion to the executive branch, courts “under the [Administrative Procedure Act] may not defer to an agency interpretation of the law simply because a statute is ambiguous.” Instead, courts must independently determine the “best” interpretation.

Although that ruling garnered top headlines, other June 2024 decisions arguably rival its importance. In Corner Post v Board of Governors of the Federal Reserve System, the Court lengthened the time period when many agencies, including the US Food and Drug Administration (FDA) and Centers for Medicare & Medicaid Services (CMS), can be sued. The justices concluded that a “claim accrues” under the default statute of limitations not from when the agency makes a decision but from “when the plaintiff is injured by final agency action.” Now, new plaintiffs can challenge old agency actions. In Securities and Exchange Commission (SEC) v Jarkesy, the Court concluded that the Seventh Amendment’s jury protections preclude the SEC from seeking civil penalties for securities fraud through in-house proceedings. This could spell the end of US Department of Health and Human Services (HHS) agencies imposing civil monetary penalties—eg, fines for “information blocking” and violating the Health Insurance Portability and Accountability Act—without having to go through court proceedings.³ In Ohio v Environmental Protection Agency (EPA), the Court blocked the EPA from implementing a new ozone standard because the agency had insufficiently addressed a particular concern raised in the public comment period. This sounds a warning to all agencies engaged in notice-and-comment rulemaking that not scouring comments (which can number in the tens of thousands) and responding appropriately could be a consequential misstep.

These rulings follow decisions in 2022 adopting the major questions doctrine, which requires clear congressional authorization for agencies to act on issues that courts find to be of great economic and political significance. This powerful, destabilizing doctrine felled the Occupational Safety and Health Administration’s COVID-19 vaccinate-or-test mandate and the Centers for Disease Control and Prevention’s eviction moratorium, among other policies, and lower courts have held that even modest actions like requiring masks on public transit trigger the doctrine.

Implications for Health Agencies > 

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