Some health systems have decided that providing hospital-at-home care "might not be worth it," NBC News reported. [Becker's]

While "hospital at home" has exploded in popularity in recent years, particularly since CMS started reimbursing for it, some systems have been reluctant to partake in the trend because the CMS waiver expires at the end of 2024, according to the Feb. 7 story.

"For many hospitals, it seems like it might not be worth it," Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, told the news outlet. Some commercial payers are also waiting on the government's next move before deciding whether to reimburse for the care model.

Hospital-at-home leaders told Becker's for a December story that the uncertainty is causing some health systems to take a wait-and-see approach, but most of them expect Congress to extend the waiver or make it permanent.

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Illinois and Cook County have pledged a combined $250 million to help support shelters and healthcare services for asylum seekers coming to the region, Gov. JB Pritzker and county board President Toni Preckwinkle said Thursday. [Health News Illinois]

The funds are intended to address the $321 million cost to maintain shelters and services this calendar year, according to estimates from recent discussions between the state, county and city of Chicago.

"With thousands of asylum seekers continuing to come to Chicago in desperate need of support and with Congress continuing to refuse to act — it is clear the state, county and city will have to do more to keep people safe," Pritzker said in a joint statement. "I'm thankful to President Preckwinkle for working with us to help close this budget gap and maintain critical services in the year ahead."

The city of Chicago was not included in the release. A spokeswoman for Pritzker directed questions on how it plans to cover the remaining shortfall to Mayor Brandon Johnson’s office.

Johnson told reporters Thursday there is "no disconnect" between him and the state and county. 

When pressed about the city's financial commitment to asylum seekers, Johnson said that additional details need to be clarified, but they are "committed to the mission."

"It's not just simply about finding financial resources, it's about building an entire operation," he said. "For the first time in the history of the world, a local municipality has been asked to establish, build, maintain and operate a migrant resettlement."

The city's current budget allocates more than $150 million to support temporary shelter, food and other necessities for asylum seekers — an amount officials have acknowledged is well short of the actual expected cost.

Of the state and county funding announced Thursday, $182 million will come from Pritzker’s proposed budget for the coming fiscal year. The rest will come through the Cook County Board of Commissioners.

Preckwinkle said the funds will maintain shelter capacity, as well as the continuation of wraparound and healthcare services.

“As critical funding for this ongoing humanitarian crisis stalls in Congress, Cook County stands committed to the well-being of the region," she said.

The joint statement noted that Cook County Health has been the primary healthcare provider for new arrivals, having served more than 25,000 patients and provided for nearly 70,000 visits.

Illinois previously pledged a total of $638 million to help address the asylum seeker response, while Cook County pledged more than $100 million in its current fiscal year budget.

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Does exposure to mRNA COVID-19 vaccination during pregnancy increase the risk of adverse events in newborn infants? 

Findings  In this population-based cohort study from Sweden and Norway that included 94 303 infants exposed to COVID-19 vaccination during pregnancy and 102 167 control infants born between June 2021 and January 2023, vaccination during pregnancy was associated with lower odds of neonatal intracranial hemorrhage, cerebral ischemia and hypoxic-ischemic encephalopathy, and neonatal mortality. [JAMA]

Meaning  In this large population-based study, vaccination of pregnant individuals with mRNA COVID-19 vaccines was not associated with increased risks of neonatal adverse events in their infants.

Abstract

Importance  Better knowledge about neonatal adverse events after COVID-19 vaccination during pregnancy could help address concerns about vaccine safety.

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Millions of people deal with Covid-19 symptoms long after their initial infections. Two new studies – one looking at pregnant people and the other on children – give a better look at the burden from this health problem that doctors say often goes under the radar. [CNN Health]

The first study says that 1 in 10 people who had Covid when they were pregnant will develop long-term symptoms. The results were shared Monday at the Society for Maternal-Fetal Medicine’s annual meeting in National Harbor, Maryland.

The researchers used data from the National Institutes of Health’s Recover Initiative, a project created to determine the long-term effects of Covid in adults and children. Of the 1,503 people who were pregnant in the dataset, 9.3% reported having symptoms six months or more after they were infected. The most common symptom was a feeling of being tired after light physical or mental activity. Some also reported dizziness.

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Has COVID replaced syphilis as the great imitator? At the turn of the 20th century, Sir William Osler was quoted as saying, "He who knows syphilis knows medicine." [Medscape]

If you have any doubts about the "imitator" analogy, simply use any broad search engine or AI portal and enter "what is the differential diagnosis of primary syphilis, or secondary syphilis, or tertiary syphilis?" A plethora of diseases across many body systems appears.

Another Great Pretender?

Did you or do you now have long COVID? How do you know? Do you even know what long COVID is? How would you diagnosis it?

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People who experience food insecurity are at greater risk of dying prematurely and living a shorter life after age 50, researchers say, underscoring how a fairly prevalent problem can impact individual health.[US News]

READ: 

Millions More Americans Were Food Insecure in 2022 Than 2021

The federal government says food insecurity refers to “limited or uncertain access to adequate food” – an economic and social condition that can lead to hunger. In an analysis published Monday in JAMA Internal Medicine, researchers found 78.4% of more than 57,400 U.S. adults included in the study were fully food secure, compared with 8.5% who had marginal food security, 7.4% who had low levels of food security and 5.6% who experienced very low food security.

Researchers also found estimated life expectancy at age 50 was 32.5 years among individuals with full food security, compared with 29.9 years among adults with marginal food security, 30 years among those with low food security and 28 years among individuals with very low food security.

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Healthcare workers have been at an increased risk for SARS-CoV-2 infection and mental distress such as anxiety and depression during the pandemic, according to new research. [Medscape]

In an analysis of administrative health records for about 3000 healthcare workers in Alberta, Canada, the workers were as much as twice as likely to become infected with SARS-CoV-2 compared with the overall population. The risk for infection was higher among healthcare workers in the first two waves of the pandemic and again during the fifth wave.

"Previous publications, including ours, suggested that the main problem was in the early weeks and months of the pandemic, but this paper shows that it continued until the later stages," senior author Nicola Cherry, MD, an occupational epidemiologist at the University of Alberta in Edmonton, Canada, told Medscape Medical News.

Wave Upon Wave

In the current study, the investigators sought to compare the risk for SARS-CoV-2 infection and mental distress among healthcare workers and among community referents (CRs). They examined the following waves of the COVID-19 pandemic:

• Wave 1: From March to June 2020 (4 months)
• Wave 2: From July 2020 to February 2021 (8 months)
• Wave 3: From March to June 2021 (4 months)
• Wave 4: From July to October 2021 (4 months)
• Wave 5 (Omicron): From November 2021 to March 2022 (5 months)

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What is the effectiveness of the bivalent COVID-19 vaccines among children and adolescents aged 5 to 17 years?  [JAMA Network]

Findings  In this prospective cohort study including 2959 participants aged 5 to 17 years, vaccine effectiveness against laboratory-confirmed SARS-CoV-2 infection was 54.0% and vaccine effectiveness against symptomatic COVID-19 was 49.4%.

Although rates of SARS-CoV-2–related hospitalizations and death among children and adolescents are lower than rates in adults,¹ severe disease can still occur and lead to hospitalization, life-threatening complications (such as multisystem inflammatory syndrome in children),^2-5 and postinfection sequelae.^6-8 As of December 31, 2023, there have been at least 911 COVID-19–associated deaths among individuals aged 5 to 17 years in the US.⁹

The Omicron variant was more transmissible and included lineages with greater potential to evade vaccine-induced immunity than previous variants.^10-12 To provide protection against the Omicron variant, the US Food and Drug Administration authorized use of the bivalent mRNA COVID-19 vaccine, which was composed of ancestral and Omicron BA.4/5 strains.¹³ On September 1, 2022, the bivalent mRNA COVID-19 vaccine was recommended for persons aged 12 years or older (to be administered ≥2 months after completion of any monovalent primary series or monovalent booster dose authorized by the Food and Drug Administration), and on October 12, 2022, the bivalent COVID-19 vaccine was recommended for children aged 5 to 11 years.^14,15

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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.

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One of the city’s leading social service organizations, beset by a pair of financial crises that last year engulfed its housing and health care divisions, could be on the verge of splitting up. [Chicago Tribune]

The turmoil at the Heartland Alliance, a sprawling nonprofit encompassing five divisions providing a vast array of social services, threatens to upend important safety net programs at a time when Chicago is experiencing an influx of migrants, many of whom need help with health care and housing.

Heartland Alliance’s housing division, which grappled with inflation and declining rent collections during the pandemic, ceased operations last spring and needs buyers for the roughly 1,000 affordable units it operated in Chicago and Wisconsin.

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