by Vinay Prasad, MD, MPH  

Over the last week, the topic of COVID-19 booster shots -- a third dose of mRNA vaccine for healthy Americans -- has been thrust into the spotlight. The surgeon general, CDC director, Anthony Fauci, MD, and President Biden have announced that they wish for boosters to be available by late September for healthy adults who are 8 months out from their original two-dose series. While this will be contingent on an FDA evaluation to determine the "safety and effectiveness of the third dose," a clear path forward has already been set. And just like everything else throughout the course of the pandemic, the choice has been made with a dearth of data and an abundance of political pressure. (MedPage Today)

Diminishing vaccine effectiveness supposedly makes the case for boosters. But there are two big questions here: First, what is current vaccine effectiveness? And second, what justifies boosters? Let's consider these in turn.

What Is Vaccine Effectiveness Now?

We have to be honest, many vaccine effectiveness studies are poorly done. All studies compare the rate of getting a breakthrough infection among vaccinated people against the rate of infection in unvaccinated people. But there are some issues with this approach. First, as time goes on, more unvaccinated people have had and recovered from COVID-19 (and these individuals may be less likely to go on to get a shot). This means that their risk of getting COVID-19 a second time is far less than the typical unvaccinated person who has never been sick. Even if vaccines "work" as well as before, this factor alone will result in the appearance of diminishing vaccine effectiveness. 

Full article here

A study published in Pediatric Dentistry  May 2021) details an overall decline in emergency department visits for pediatric patients seeking nontraumatic dental care since the Affordable Care Act was enacted, although these visits from children from lower socioeconomic backgrounds increased. ( 8.27.2021)

Researchers examined nontraumatic dental care visits to emergency departments in the U.S. among people 20 years old and younger between 2010 and 2017 using data from the Nationwide Emergency Department Sample, the largest all-payer emergency department database in the U.S.

Results of the study show that nontraumatic emergency department visits decreased from 103.1 to 89.3 per 10,000 visits between 2010 and 2017. However, emergency department visits for nontraumatic dental care by pediatric Medicaid patients increased from 51 percent to 65.3 percent from 2010 to 2017. The odds of these visits were higher among uninsured patients and Medicaid enrollees ages 15-20 years old, but were lower among patients who lived in wealthier ZIP codes.

The study concluded that these emergency department visits for nontraumatic dental care by pediatric patients decreased over time following implementation of the Affordable Care Act, but that emergency care continued to be utilized at higher rates for children of low socioeconomic status. 

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Is the current COVID-19 surge a "pandemic of the unvaccinated?" No, according to Rhea Boyd, MD, MPH, pediatrician and co-developer of the "The Conversation: Between Us, About Us" project to encourage more people of color to get vaccinated.

"This is not a pandemic of the unvaccinated," Boyd said Wednesday at a virtual event sponsored by the Alliance for Health Policy. Instead, "what we really exposed during the vaccination distribution effort is just how unequal the United States is" when it comes to getting access to COVID-19 vaccines. She presented data from the New York Times and the Kaiser Family Foundation showing that vaccine distribution was worse in Southern states, which also are where more Black and Latinx people live (the conversation is a joint project of the Kaiser Family Foundation and the Black Coalition Against COVID).

Full article here

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A top official at the World Health Organization said misinformation surrounding COVID-19 vaccines has gotten worse in recent weeks. Meanwhile, hospitals navigate vaccine hesitancy and attempt to halt the spread of incorrect medical information, according to an Aug. 24 CNBC report.

(Becker's Health IT 8.25.2021)

Six things to know:

1. 1. U.S. Surgeon General Vivek Murthy, MD, declared COVID-19 misinformation a "serious public health threat" in July. Many public health leaders blame conspiracy theorists for enforcing so much distrust in the vaccines.
      
      
   2. Maria Van Kerkhove, PhD, infectious disease epidemiologist and technical lead on COVID-19 at the WHO, said Aug. 23 that misinformation has gotten worse in the last four weeks. "The amount of misinformation that is out there seems to be getting worse, and I think that's really confusing for the general public," she said
      
      
   3. A small number of medical professionals have enforced some vaccine misinformation on social media outlets, such as TikTok and Doximity.
      
      
   4. Doximity is a social media platform used by 80 percent of U.S. physicians and has 1.8 million users. CNBC reported that the platform is riddled with misinformation, though Doximity's CEO, Jeff Tangney, told CNBC that less than 0.1 percent of its members have posted medical misinformation. The CEO did say there was an uptick in comments that had to be removed because they violated community guidelines.
      
      
   5. The Federation of State Medical Boards warned July 29 that physicians and other healthcare professionals could be at risk of losing their medical licenses if they spread COVID-19 vaccine misinformation on social media, online and in the media.
      
      
   6. Several hospital employees have gone viral over TikToks they have posted spreading inaccurate medical data. A surgical technologist at Marietta, Ga.-based Wellstar Healthcare System is "no longer employed" with the health system after comparing vaccine mandates to the Holocaust, WSB-TV reported Aug. 22.
   
   

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Many children's hospitals in the South and Midwest have reported an uptick in pediatric cases over the past six weeks as the delta variant rapidly spread among unvaccinated people. Facilities in these regions are preparing for a potential spike in cases linked to school reopenings by hiring more nurses, updating discharge protocols and improving room cleaning efficiency, among other efforts. 

COVID-19 hospitalizations among children are at the highest level since HHS started tracking them last year, and some children's hospitals are preparing for surges to worsen as schools reopen, The Wall Street Journal reported Aug. 22.

Children's Hospital New Orleans has had up to 20 kids hospitalized with COVID-19 over the past three weeks, about half of whom didn't have underlying conditions, according to the hospital's Physician-in-Chief Mark Kline, MD. Last year, the hospital never saw more than seven pediatric hospitalizations at a time, and most involved kids with underlying health issues, Dr. Kline said. 

In preparation for a school-related surge, the hospital has hired about 150 new nurses to start over the next few weeks, converted more hospital beds to intensive care unit beds and expanded its emergency department to hold more patients who can't immediately be admitted, Dr. Kline said.

Full article here. 

U.S. Rep. Lauren Underwood, D-Naperville, unveiled new legislation this week to educate healthcare providers on evidence-based youth suicide prevention initiatives. 

From 2007 to 2017, the Centers for Disease Control and Prevention (CDC) reported that suicide rates among young Americans increased 56 percent.  

The Child Suicide Prevention and Lethal Means Safety Act (Download HB 5035) would invest in educating health care providers in evidence-based youth suicide prevention initiatives 

Suicide is currently the second leading cause of death for young people ages 10-24, and the COVID-19 pandemic threatens to accelerate these tragic trends. From 2007 to 2017, the Centers for Disease Control and Prevention (CDC) reported that suicide rates among young Americans increased 56 percent.  

Health care providers play a critical role in identifying young people who might be at risk for self-harm or suicide. However, many health care professionals do not receive the training and resources they need to identify and respond to warning signs for suicide among their patients. The Child Suicide Prevention and Lethal Means Safety Act would address this by providing evidence-based training on youth suicide prevention to current and future health care professionals.  Additionally, the bill creates a centralized database for that at-risk youth and their family members, medical and nursing schools, and health care professionals can turn to for best practices in lethal means safety and suicide prevention. 

In a new video, Underwood shares the story of Bill and Patti Hartmann from McHenry, IL who lost their son in 2008 to suicide. 

Click here to watch the video.  

“Since the start of the pandemic, I have met with students and families across the 14th District of Illinois, and I’ve heard so many tragic stories of young people struggling with new or worsening mental health challenges—even suicidal thoughts. And no matter who I’m talking to—whether it’s a farmer, parent, or a teacher —they have all told me about the need for action to keep our kids safe. That’s why I’m proud to introduce the Child Suicide Prevention and Lethal Means Safety Act,” said Rep. Underwood. “My legislation will expand access to evidence-based suicide prevention initiatives in communities like ours so that we can save lives and prevent these tragedies.” 

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Climate Change Report- The United Nations this month released a major climate change report, the first of its kind in eight years. The report outlines what scientists know about global warming and informs policy makers how to slow the planet’s rising temperatures. All of the world’s 195 countries participated in the report’s development, with hundreds of scientists assessing studies from around the world.

The report’s main conclusions — that humans are causing climate change, that temperatures will rise if we don’t cut emissions, and that weather is getting more extreme — didn’t surprise community health specialist Elena Grossman, MPH. Grossman is principal investigator at BRACE-Illinois, a CDC-funded project based at the University of Illinois Chicago that since 2012 has guided the state’s public health system in responding to climate change.

Full article here>

Download Regional Fact Sheet here> 

Download Slides here>

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Gov. JB Pritzker on Monday (8.16.2021) signed into law a legislative package aimed at addressing the cost of prescription drugs. 

One law establishes a prescription drug repository program, which will allow unexpired and unopened prescription and over-the-counter medications to be returned to pharmacies and reused for eligible populations.

"(The program) opens up another avenue for Illinois healthcare to be able to help those who are underinsured or unemployed and not able to afford their medication,” Garth Reynolds, executive director of the Illinois Pharmacists Association, said in a statement.

Pritzker also signed a proposal that requires pharmacies to provide customers with the retail price of a prescription drug, in writing and electronically, prior to purchase and make it clear if a customer's cost-sharing price for a prescription exceeds the current pharmacy retail price.

"(The bill) establishes truth and transparency for the pharmaceutical industry," said Senate sponsor Scott M. Bennett, D-Champaign.

Both laws take effect Jan. 1, 2022.

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Illinois is the first state to require regular Alzheimer’s disease training for licensed healthcare professionals, after Gov. JB Pritzker greenlit the proposal Monday at the Illinois State Fairgrounds in Springfield.

The law, effective Jan. 1, 2023, requires providers with direct patient interaction with adults older than 25 to complete at least a one-hour course in diagnosis, treatment and care of Alzheimer’s and other dementias.

"Early detection is key to treatment,” House sponsor Rep. Kathleen Willis. D-Northlake, said in a statement. She said 230,000 Illinois residents are living with Alzheimer’s.

And he approved a measure, effective immediately, requiring that long-term care facilities and hospitals, upon request, facilitate at least one daily phone or video call between a resident or patient and their family member during a public health emergency.

Delia Jervier, executive director of the Illinois chapter of the Alzheimer’s Association, said the laws will help address disparities in care, as Black and Latinx residents are more likely to develop Alzheimer's than their white counterparts.

“Illinois is leading the nation as we seek to be a dementia-capable state until a cure or prevention is found,” Jervier said.

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