Health expert Zeke Emanuel says 250,000 Americans could die of COVID by end of year – CBS News

Bioethicist Dr. Zeke Emanuel is predicting that up to 250,000 Americans could die directly from the coronavirus by the end of the year. In an interview with CBS News chief Washington correspondent Major Garrett, Emanuel, who is the vice provost for Global Initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, slammed the Trump administration’s response to the pandemic as “incompetent and pretty disastrous.”

“Before the year is out, we’ll probably have, I would think, between 220,000 and 250,000 Americans who died directly from COVID, not to mention those people who are dying indirectly,” Emanuel said in this week’s episode of “The Takeout” podcast. Emanuel singled out people with heart conditions or in need of cancer treatment who may not visit the doctor due to concerns about catching the virus as factors contributing to high indirect mortality rates.

“You’ll have a huge increase in mortality because of COVID, and that is, it seems to me, to be a failure,” Emanuel said. Emanuel is also a senior fellow for the left-leaning think tank Center for American Progress, and he is also on former Vice President Joe Biden’s campaign task force to address the coronavirus.

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Emanuel noted that several states have seen an uptick in cases in recent weeks, and that the daily death tolls are comparable to what they were at the onset of the pandemic in the U.S. in March.

“That’s not progress, that’s regression. In some ways, you can say we’ve wasted four months,” Emanuel said. He also shot down President Trump’s claim that 40 million people had been tested. Forty million tests have been administered, with some people receiving multiple tests.

“We were extremely slow to develop good testing, and we still don’t have the best testing that we should,” Emanuel said.

However, Emanuel and the Trump administration do agree on one point: Schools should be reopened safely in the fall.

“We need to open up primary and secondary schools in the fall. I think it’s really important. I think you can do it safely. But whenever I say it, I don’t mean ‘no COVID,’ I mean ‘you will get COVID and kids will get COVID,’ but you can do it in a way that tries to minimize those cases,” Emanuel said. “It’s not risk-free. Life is not risk-free. But I think it’s probably worth it.”

Emanuel bemoaned how wearing a mask has become politicized, in part because the president has largely avoided wearing a mask in public.

“I heard someone saying, ‘Oh only sissies wear masks.’ Baloney! You wear a mask because you don’t want to spread it to someone else, and you don’t want to catch it from someone else,” Emanuel said. “Will it absolutely protect you? No. Will it decrease your chance of getting COVID? Yes.”

For more of Major’s conversation with Emanuel, download “The Takeout” podcast on Art19, iTunesGooglePlaySpotify and Stitcher. New episodes are available every Friday morning. Also, you can watch “The Takeout” on CBSN Friday at 5pm, 9pm, and 12am ET and Saturday at 1pm, 9pm, and 12am ET. For a full archive of “The Takeout” episodes, visit www.takeoutpodcast.com. And you can listen to “The Takeout” on select CBS News Radio affiliates (check your local listings).  

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Texas attorney general says local health authorities cannot “indiscriminately” shut down schools

After Texas ordered schools to reopen their classrooms this fall, county and city public health officials began to push back.
After Texas ordered schools to reopen their classrooms this fall, county and city public health officials began to push back.
Miguel Gutierrez Jr./The Texas Tribune

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Local health officials do not have the authority to shut down all schools in their vicinity while COVID-19 cases rise, Texas Attorney General Ken Paxton said in nonbinding guidance Tuesday that contradicts what the Texas Education Agency has told school officials.

Shortly after Paxton’s announcement, the Texas Education Agency updated its guidance to say it will not fund school districts that keep classrooms closed because of a local health mandate, citing the attorney general’s letter. Districts can receive state funding if they obtain TEA’s permission to stay closed, as allowed for up to eight weeks with some restrictions.

The change represents an about-face for the agency, which previously said it would fund districts that remained closed under a mandate. It will impact schools in at least 16 local authorities, many in the most populous counties, that have issued school closure mandates in the past month.

Dallas County Judge Clay Jenkins, whose county is among those with a mandate to close schools, said local officials will continue to make decisions to keep students safe “regardless of what opinion General Paxton comes up with.”

“The only way that it would really screw things up is if Abbott tried to take away the control from the local groups,” Jenkins said.

The guidance is non-binding, but local health authorities could face lawsuits especially now that Paxton has weighed in. Paxton’s office declined to comment on whether it would sue local health officials that don’t retract mandates, saying it could not comment on hypothetical or potential litigation.

After Texas ordered schools to reopen their classrooms this fall, county and city public health officials began to push back, ordering all public and private schools in their areas to stay closed through August and in some cases September.

The officials cited a state law giving health officials authority to control communicable diseases. But Paxton said in the letter that “nothing in the law gives health authorities the power to indiscriminately close schools — public or private — as these local orders claim to do. … It does not allow health authorities to issue blanket quarantine orders that are inconsistent with the law.”

The governor’s executive order allowing all school districts to operate overrules local mandates to close, Paxton said. Local health officials have some authority to order schools closed if people in it are infected by COVID-19, but not as a preventive measure.

Earlier this month, Texas revised its statewide order that schools open classrooms to give officials more local flexibility on how long to continue with entirely remote education, especially in areas where the virus is spreading quickly.

The TEA’s previous guidance says that schools could ban in-person classes if ordered to do so “by an entity authorized to issue an order under state law.” And the agency confirmed to The Texas Tribune earlier this month that school districts under such mandates would not lose state funding if they closed classrooms. But it was confusing to education officials and school communities exactly which entities were allowed to issue orders, and when state guidance trumped local law.

Gov. Greg Abbott‘s office did not respond to a request to clarify this earlier this month.

The confusion resulted in anger and panic in some communities that wanted their schools to reopen. Families protested outside the Tarrant County administration building Monday demanding that officials allow their schools to hold in-person classes before Sept. 28, according to The Dallas Morning News.

Paxton said religious private schools were exempt from following the order in guidance released earlier this month.

Stacy Fernández contributed to this report.

This content was originally published here.

The Democrats’ Baffling Silence as Millions of Americans Lose Their Health Insurance

One of the many things that made the United States uniquely vulnerable to the coronavirus pandemic is the relationship between health care and employment in this country. About half of all Americans have employer-provided insurance; if you don’t, you are left to a mass of overlapping state and federal programs, though depending on where you live, you might find none of them overlap with you. It has been clear from the start that this patchwork health care nonsystem would cause unique problems fighting the coronavirus, and people are undoubtedly dead directly because of these problems. Months into the pandemic, the twin crises of Covid-19 and gaps in insurance are compounding each other: A new report from Families USA suggests that more than five million people have lost their insurance already; another report, from the Urban Institute, predicts another 10 million will lose their coverage by the end of the year.

It is easy to look at any issue plaguing America, from the coronavirus and health care to crumbling schools or roads, and say that the Republicans are standing in the way of progress, which they are. But there’s another dynamic at play with health care. It plainly doesn’t matter very much to our leaders—whether it’s Nancy Pelosi or Donald Trump—whether people have insurance and whether they get health care. Once a government gets used to a situation where tens of millions of people don’t have health insurance, which has always been the case in the U.S., how do we get our leaders to care when another five or 10 million are added to that number? Once you have accepted that some people don’t get to have health care, as if they’re just part of the scenery, why would another five million people at risk of financial ruin or death spur action?

The Trump administration’s response to the health insurance crisis has been predictably nonexistent. The Los Angeles Times noted Tuesday that the Trump administration has not made any sort of push to stem the loss of health insurance, with no effort to encourage people to sign up for Affordable Care Act marketplace coverage, for example. Larry Levitt, executive vice president of the Kaiser Family Foundation, told the paper that this is because the ACA is such a “political football,” adding, “what you’d normally think would be good government simply isn’t happening.” Expecting Republicans to practice good government is like expecting a dog to practice good hygiene.

On the Democratic side, there has been a range of proposals, but none that have been advocated for very forcefully. The Heroes Act, a $3 trillion stimulus bill passed by the House that was never intended to survive whole in the Senate, would fully subsidize Cobra, the program that allows laid-off workers to keep their employer-provided insurance. This usually comes at a laughably unaffordable cost, as employees must pay both their portion and the employer’s portion of the premium, but the Democratic bill would pay insurers to make it free for ex-employees instead. The left-wing criticism of this is that it provides a huge giveaway to insurers, who charge far more than they need to in premiums to rake in massive profits, instead of expanding government health insurance to laid-off people. (And, of course, many employer-sponsored insurance plans are too expensive for people to use even if their premiums are paid, because of high deductibles and co-insurance.)

That’s all true, but put that aside for a moment and think strategically. Even if making Cobra free for ex-workers were the best possible thing Democrats could get out of the Senate, why roll it into this bill that will never pass? Minimizing the loss of health insurance is among the most urgent tasks of this pandemic, along with controlling the spread of disease, providing economic relief, and preventing a wave of evictions. (Not on the list: getting bailout funds to lobbyists.)

If the Democrats wanted to run on health care against Trump, which worked in 2018 and which Joe Biden has shown an interest in doing despite struggling to articulate basic facts about his health care plan, this would be a perfect time to introduce a bluff-calling bill. Expanding Cobra is the barest minimum the government could do to provide health insurance in this crisis; Republicans don’t even have a counterproposal, because they fundamentally do not want more people to have health insurance. Expanding Cobra is such a centrist, even right-wing idea that Republican strategists write in their memos that Republicans should do it, because the alternative is expanding Medicaid, which is increasingly popular. And we can’t have that.

The Democrats could cut and paste the Cobra segment of the Heroes Act, introduce a stand-alone bill, call it the Health Access Protection Act or something suitably Third Way–ish, and dare the Republicans to vote against keeping laid-off workers on their health insurance—if, that is, they really believed in and wanted this solution to happen. There’s plenty of money for ads on the Democratic side, still. You could argue that splitting off any one part of the bill would damage the chances for success on the overall bill, or you could see the Democrats’ inability to capitalize on the fact that more than five million people have lost their health insurance as further evidence that they do not understand what a crisis American health care was already in long before the first Covid-19 case.

The lack of urgency that has characterized the federal response to this crisis—in 10 days, the expanded unemployment benefits expire, and we have no idea whether anything will be done to extend them—is simply a continuation of how the government has tolerated the obvious failures of the system up to this point. People without health insurance, like those with insurance, have bodies that break down, stop working, throw out weird symptoms and lumps and fluids, produce anxiety or depression. When these things happen to uninsured people, they often end up going to the emergency room, and rack up bills that they can’t pay, costing hospitals and the government money and often ruining their lives.

A person without health insurance can still catch the coronavirus, infect others, and get dangerously or fatally sick, without knowing that they are supposed to be able to go to the doctor about that for free: The Department of Health and Human Services reported last week that it has paid out far fewer claims for Covid-19 testing and treatment for the uninsured than it expected. Everything about the health care system is complicated, hostile, and potentially ruinous for people without health insurance, so it’s not surprising if a lot of people couldn’t shake that experience off within a matter of weeks and months. It’s true that our health care system was not designed to handle a pandemic, but it would be more accurate to say that our system was not designed to provide health care to people en masse, whether that is regular checkups or chemotherapy.

All of this would be fixed by passing Medicare for All, which Democratic voters like and which gets favorability ratings comparable to or better than the Affordable Care Act’s. It would not pass the Senate, of course, but it would provide a club to beat Republicans with. Barring a sudden change of heart on single-payer, it would still be easy and beneficial for Democratic leadership to do anything at all to show they care about people who have lost their health insurance. Propose a bill. Hold a press conference. Take a camera and go to a hospital, a homeless shelter, or a McDonald’s and talk to uninsured people who would tell you that yes, actually, I would like it if Mitch McConnell would allow me to have health insurance. All of this would be better than nothing, as inadequate as expanding Cobra would be. But Democrats won’t do these things, because they don’t really care. Once you’ve accepted 27 million uninsured, what’s another five million lives?

This content was originally published here.

As Pandemic Toll Rises, Science Deniers in Louisiana Shun Masks, Comparing Health Measures to Nazi Germany

Science denial in America didn’t begin with the Trump administration, but under the leadership of President Trump, it has blossomed. From the climate crisis to the COVID-19 pandemic, this rejection of scientific authority has become a hallmark of and cultural signal among many in conservative circles. This phenomenon has been on recent display in Louisiana, where a clear anti-mask sentiment has emerged in the streets and online even as COVID-19 cases rise.
“Are you a masker or a free breather?” Pastor Tony Spell asked the crowd while speaking from the bed of a pickup truck at a July 4 “Save America” rally in Baton Rouge. At the end of March Spell gained international attention for his refusal to stop his church’s services despite Gov. John Bel Edwards’ stay-at-home order, which was issued to slow the Louisiana’s rapid rise in COVID-19 cases.
 
“It has never been about a virus — it is about destroying America,” Spell claimed, before equating a government whose public health measures restrict church gatherings and require protective face coverings in public to Germany under Hitler. A crowd of less than 200 roared in agreement at the rally that was held across from the governor’s mansion. 

Pastor Tony Spell
Pastor Tony Spell speaking at the “Save America” rally in Baton Rouge on July 4.

Attendees of a "Save America" rally in Baton Rouge on July 4
Attendees of the “Save America” rally in Baton Rouge on July 4 including one holding a fan.

On July 8, another conservative voice, Louisiana State Representative Danny McCormick, posted a video on Facebook making a similar comparison to Nazi Germany. “This isn’t about whether you want to wear a mask or you don’t want to wear a mask — this is about your right to wear a mask or not,” McCormick said. “This is about liberty. Your body is your private property … People who don’t wear a mask will be soon painted as the enemy — just as they did the Jews in Nazi Germany. Now is the time to push back before it is too late.”

 At a press conference the day after McCormick posted his video, Gov. Edwards announced that the state had lost its previous gains against the coronavirus. 

McCormick’s statements come about six months into a public health crisis that has infected 71,884 Louisiana residents and killed 3,247, as of July 9. Despite the pandemic’s accelerating and deadly spread, the complaints by McCormick, Pastor Spell, and the others joining them at a handful of protests in Baton Rouge  illustrate a pervasive disdain for science held by many associated with the Republican Party. 

Louisiana State Rep. Danny McCormick
State Representative Danny McCormick at an “End the Shutdown” protest in Baton Rouge, Louisiana, on April 25.

State Rep. Danny McCormick's talking points at an "end the shutdown" rally in Louisiana
State Representative Danny McCormick’s talking points on an index card he held while making a speech during an “End the Shutdown” rally in Baton Rouge on April 25.

A DeSmog investigation found that a number of groups behind protests against pandemic stay-home orders are also part of the climate change countermovement, a term coined by sociologist Robert Brulle. U.S. Sen. Sheldon Whitehouse (D-RI) has called this network of individuals and organizations disputing climate science the “web of denial.”

April and May rallies in Louisiana pushing to open the state followed larger rallies in Idaho, Michigan, and North Dakota. Helping tie together what Trump has called the “liberate” movement is the State Policy Network (SPN). As DeSmog has reported, SPN is “a network of state-level conservative think tanks advancing pro-corporate agendas, [and] has received money from the likes of the Koch family, the Devos family, the Mercer Family Foundation, and others.” 

Woman with a COVID-19 denial sign at an "end the shutdown" rally in Baton Rouge
Woman with a Covid-19 denial sign at an “End the Shutdown” protest in Baton Rouge, Louisiana, on April 25.

Woman with a COVID-19 denial sign targeting Bill Gates, a common target of the right wing
Woman with a Covid-19 denial sign sporting a message for Bill Gates, a common target of the right wing, at an “End the Shutdown” protest in Baton Rouge, Louisiana, on April 25.

At an April 25 “End the Shutdown” rally in Baton Rouge, rally-goers, led by Rep. McCormick, marched from the State Capitol building to the nearby lawn across from the governor’s mansion to express their anger with his handling of the crisis. In a speech, McCormick offered talking points to counter Gov. Edwards’ emergency orders meant to address the COVID-19 pandemic. The talking points mirrored a memo sent by GOP political operative Jay Connaughton to Republican State Sen. Sharon Hewitt and shared with GOP state legislators. Hewitt is one of Louisiana’s top conservative leaders. In 2018 she was named “National Legislator of the Year” by the American Legislative Exchange Council (ALEC).

Veronica Lemoa, a stay-at-home mom, at the "end the shutdown" protest on April 25 in Baton Rouge
Veronica Lemoa, a stay-at-home mother, at an “End the Shutdown” protest on April 25, 2020 in Baton Rouge, Louisiana. 

Young girl at an "Open Louisiana" event in Baton Rouge May 2
Young girl at an “Open Louisiana” event in Baton Rouge on May 2 across from the Governor’s Mansion. 

Despite President Trump’s praise for Gov. Edwards, a Democrat, for his handling of the pandemic, anti-mask protesters are equating the governor’s stay-at-home order and mask mandate with the first step to tyranny. Spell, who was arrested for defying the mask mandate, did not stop with his sharp criticism of the governor — and also had some for Trump. While he is glad the Trump administration deemed churches “essential,” in order to reopen them, Spell proclaimed that he doesn’t need the president’s permission, and warned: “If they can give you your right to go to church, then they can take from you your right to go to church.”


Pastor Tony Spell speaking on the July 4 at rally in Baton Rouge. 

At the July 4 rally, many expressed their support for Trump, and saw the upcoming presidential election as the most important in their lifetime. They labeled those who wear protective face coverings “sheep.” Out of the less than 200 rally-goers, I saw only two people with face masks. One was worn by a man that had the words “Dixie Beer” painted on it, which was expressing his disdain over the decision by the owner of the New Orleans beer company to change the beer’s name in response to anti-racism demonstrations. The other mask I noticed at the rally was worn on a woman’s arm. 

The only man wearing a face mask at a "save America" rally on July 4
The only man wearing a mask on his face at a “Save America” rally in Baton Rouge on July 4. He expressed his displeasure that the owner of Dixie Beer is changing the New Orleans beer’s name. 

Woman with a mask on her arm at the "save America" July 4 rally
Woman wearing a face mask on her arm at the “Save America” rally in Baton Rouge on July 4. 

In an April 1 op-ed in Newsweek, Rochester Institute of Technology philosophy professor Lawrence Torcello, and Pennsylvania State University climate scientist Michael E. Mann wrote: “Unfortunately, President Trump has again emerged as a leading source of disinformation. Having called COVID-19, as he previously did with climate change, a ’hoax,’ he now resorts to calling COVID-19 the ‘Chinese Virus.’ In the case of both COVID-19 and climate change, he has outsourced policy decision-making to science deniers. In both cases he is as wrong as he is xenophobic — and in both cases his predictable disinformation endangers lives.”

In February, before the first COVID-19 cases were identified in Louisiana, Gov. Edwards finally broke away from Trump on espousing climate science denial. 

Louisiana will not just accept or adapt to climate change impacts,” Edwards stated at a news conference in Baton Rouge. “Louisiana will do its part to address climate change.” In a reversal of his previous statements that questioned humans’ well-established role in driving the climate crisis, he said, “Science tells us that rising sea level will become the biggest challenge we face, threatening to overwhelm our best efforts to protect and restore our coast. Science also tells us that sea level rise is being driven by global greenhouse gas emissions.”

But Sharon Lavigne, founder of RISE St. James, a community group fighting petrochemical industry expansion in Louisiana’s Cancer Alley, doubts his sincerity. “If the governor is serious about reducing carbon emissions, he needs to pull the plug on Formosa.” Plastics giant Formosa is poised to start building a petrochemical complex in St. James Parish that has received permits to spew the emissions equivalent of 2.6 million cars. 

Petrochemical companies are one of Louisiana’s top producers of carbon dioxide, one of the globe-warming gases linked to human-caused climate change. However, the governor has not walked back his support of Formosa’s project. 

Edwards was the first governor in the country to point out that African Americans are being disproportionately impacted by the pandemic. But he has yet to address the impact which ongoing pollution from the petrochemical industry plays in the poor health of predominantly Black communities living near existing plants, or future ones, such as Formosa’s in St. James Parish.

Many U.S. leaders have failed to take to heart scientists’ warnings that half-measures to combat climate change and the COVID-19 pandemic won’t work. Meanwhile, temperatures across America are hitting new record highs, and cases of the coronavirus continue to rise exponentially, leading top U.S. infectious disease official Dr. Anthony Fauci to advise states “having a serious problem” with a surge in coronavirus cases to “seriously look at shutting down.” 

Protester across from the Louisiana Governor's Mansion on May 2
Protester across from the Governor’s Mansion in Baton Rouge on May 2 with a protest sign against Anthony Fauci, Bill Gates, and the “New World Order.”  

Protesters across from the Louisiana Governor's Mansion on May 2
Protesters across from the Governor’s Mansion in Baton Rouge on May 2.   

As with climate change, theoretical models have proven essential for anticipating what is likely to happen in the future. In the case of coronavirus, the initial spread of this virus is occurring at an exponential rate as models predicted,” Torcello and Mann pointed out in their Newsweek op-ed. “This means we can anticipate that larger sums of people will become infected in the coming weeks. We know the majority of those infected by COVID-19 will experience mild or no symptoms while remaining highly contagious, and we know that for others, COVID-19 will create the need for ventilators and other emergency medical supports that we do not yet have in sufficient supply. It is worth emphasizing: The fact that most people will experience mild symptoms is irrelevant to a crisis, like COVID-19, which is grounded in the math of large numbers.”

In his 1995 book The Demon-Haunted World, astronomer and science writer Carl Sagan presaged, with trepidation, an America wherein “our critical faculties in decline, unable to distinguish between what feels good and what’s true, we slide, almost without noticing, back into superstition and darkness…a kind of celebration of ignorance.”

After viewing some of my photos from the recent “Save America” rally, Mann wrote in an email: “These people, sadly, are the purest embodiment of Sagan’s chilling prophecy.”

Protester across from the Governor’s Mansion on May 2 with a protest sign that is a variation of the Gandsen Flag. 
Protester across from the Governor’s Mansion on May 2 with a protest sign that is a variation of the Gandsen Flag. 

Trump supporters at a rally across from the Governor’s Mansion on July 4.
Trump supporters at a rally across from the Governor’s Mansion on July 4.

Protesters at an “End the Shutdown" event in Baton Rouge on April 25 march from the Capital Building to the Governor’s Mansion nearby. 
Protesters at an “End the Shutdown” event in Baton Rouge on April 25 march from the Capital Building to the Governor’s Mansion nearby. 

Main image: Woman holding an anti-mask sign at a July 4 “Save America” rally in Baton Rouge. Credit: All photos and video by Julie Dermansky for DeSmog

This content was originally published here.

Millions Have Lost Health Insurance in Pandemic-Driven Recession – The New York Times

The White House and Congress have done little to help. The Trump administration has imposed sharp cuts on the funding for outreach programs that assist people in signing up for coverage under the health law. And while House Democrats have passed legislation intended to help people to keep their health insurance, the bill is stuck in the Republican-controlled Senate.

Rather than expand access to subsidized insurance under the Affordable Care Act, Mr. Trump has promised to directly reimburse hospitals for the care of coronavirus patients who have lost their insurance. But there is little evidence that has begun.

“Helping people keep their insurance through a public health crisis surprisingly has not gotten much attention,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. “This is the first recession in which the A.C.A. is there as a safety net, but it’s an imperfect safety net.”

The Families USA study is a state-by-state examination of the effects of the pandemic on laid-off adults younger than 65, the age at which Americans become eligible for Medicare. It found that nearly half — 46 percent — of the coverage losses from the pandemic came in five states: California, Texas, Florida, New York and North Carolina.

In Texas alone, the number of uninsured jumped from about 4.3 million to nearly 4.9 million; three out of every 10 Texans are uninsured, the research found. In the 37 states that expanded Medicaid under the Affordable Care Act, 23 percent of laid-off workers became uninsured; the percentage was nearly double that — 43 percent — in the 13 states that did not expand Medicaid, which include Texas, Florida and North Carolina.

Five states have experienced increases in the number of uninsured adults that exceed 40 percent, the analysis found. In Massachusetts, the number nearly doubled, rising by 93 percent — a figure Mr. Dorn attributed to a large number of people losing employer-based coverage there. Across the country as a whole, more than one in seven adults — 16 percent — is now uninsured, the analysis found.

To generate the estimates, Mr. Dorn examined the number of laid-off workers in each state and calculated how many had become uninsured based on coverage patterns since 2014, when the central provisions of the Affordable Care Act went into effect. The underlying data for those patterns comes from work published by the Urban Institute in April.

This content was originally published here.

Health Service Blames ‘Error’ After Telling 600,000 Healthy People They’d Had COVID-19

More than 600,000 military-connected Americans affiliated with the Tricare health plan were told in error Friday that they had been diagnosed with COVD-19.

The individuals and families were in the military health system’s East Region, according to Military.com.

The foul-up began when beneficiaries received an email that began with some very jarring news.

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“As a survivor of COVID-19, it’s safe to donate whole blood or blood plasma, and your donation could help other COVID-19 patients,” the email stated.

The email then went on to explain itself.

“Your plasma likely has antibodies (or proteins) present that might help fight the coronavirus infection. Currently, there is no cure for COVID-19. However, there is information that suggests plasma from COVID-19 survivors, like you, might help some patients recover more quickly from COVID-19,” it said.

A few hours later, Humana Military, which manages Tricare across 31 states and the District of Columbia, tried to calm the waters it had roiled.

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“In an attempt to educate beneficiaries who live close to convalescent plasma donation centers about collection opportunities, you received an email incorrectly suggesting you were a COVID-19 survivor. You have not been identified as a COVID-19 survivor and we apologize for the error and any confusion it may have caused,” Humana’s email said.

According to Military Times, Marvin Hill, Humana’s corporate communications lead, said the company apologized “for the confusion caused by the original message.”

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The initial, potentially panic-inducing message went to some of those living near a plasma collection facility and was not based “on any medical information or diagnosis,” Hill said.

Plasma from individuals who have had COVID-19, which is called “convalescent plasma,” can be used as a possible treatment for the disease.

“As a part of an effort to educate military beneficiaries about convalescent plasma donation opportunities, Humana was asked to assist our partner, the Defense Health Agency. Language used in email messages to approximately 600k beneficiaries gave the impression that we were attempting to reach only people who had tested positive for COVID-19. We quickly followed the initial email with a clear and accurate second message acknowledging this. We apologize,” Hill said in a statement, Military Times reported.

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Have you recovered from #COVID19 and live near @FtBraggNC? Your plasma could help save a life. The @WomackAMC is holding blood drives July 27-31.

Donors are needed to fuel a study about the effectiveness of convalescent plasma.

“Our goal is to encourage all personnel who have fully recovered from COVID-19 to donate their convalescent plasma as a way to help their friends, family, or colleagues who may be suffering from the disease now or who may contract the disease in the future. The need is now,” Army Col. Audra Taylor, chief of the Armed Services Blood Program, told Military Times.

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The U.S. Food and Drug Administration approved convalescent plasma as an investigational therapy in March for those hospitalized with the illness, and more than 35,000 patients in the U.S. have received it.

To date, there have been “encouraging reports and a lot of mechanistic reasoning that in fact convalescent plasma may be helpful,” said Dr. Janet Woodcock, director of the Center for Drug Evaluation and Research at the Food and Drug Administration, according to Military Times.

“These studies are being done as we speak … we need donors. Blood drives are ongoing, and the U.S. government will be trying to accelerate these drives for convalescent plasma,” Woodcock said.

We are committed to truth and accuracy in all of our journalism. Read our editorial standards.

This content was originally published here.

How to Destroy a National Health Service | The Nation

British Prime Minister Boris Johnson claps his hands outside 10 Downing Street during the weekly “Clap for our Carers” applause for the NHS and key workers on the front lines of the coronavirus. (Wiktor Szymanowicz / Barcroft Media via Getty Images)

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Soon after Covid-19 started to sweep through the United Kingdom in March, thousands of residents began appearing at their windows every Thursday to applaud the National Health Service. While the pandemic has evidently caused a wave of renewed appreciation for the NHS, the universal health care system has been a source of immense British pride for over 70 years. What many Britons fail to realize, however, is that some of the past and present government officials clapping alongside them, including Prime Minister Boris Johnson, have had a hand in the decades-long efforts to privatize their beloved NHS.

Founded in 1948 by the Labour Health Minister Aneurin Bevan, the NHS rose from the ashes of World War II as part of a welfare state designed to slay the “five giant evils” outlined by the economist William Beveridge: want, disease, ignorance, squalor, and idleness. As Bevan envisioned the NHS, it would provide world-class medical care that was always “free at the point of delivery” for everyone, including nonresidents, overturning a system in which the majority, especially women and children, could not afford health care. With these principles at its core, the 1946 National Health Service Act lay the foundation for a radical redistribution of wealth by funding the service through a progressive tax on income.

In its original iteration, the government transferred ownership of all existing hospitals in Britain to the NHS, which then employed staff, using taxpayer money, to deliver services without charging out-of-pocket fees. Some charges were implemented soon after its founding, including fees for dentures and glasses, as well as prescription payments brought in by Winston Churchill. Although many conservatives, including Churchill, opposed the idea of a fully public service, the story of the private sector’s incursion into Britain’s health service started on Margaret Thatcher’s watch.

“The privatization of the NHS began in the 1980s,” says Professor Allyson Pollock, author of NHS plc: the Privatisation of Our Health Care, “and it’s been an incremental process over several decades where there’s been an ideological commitment to the private sector despite great opposition from the public.”

Although Thatcher promised Britons the NHS was “safe with us,” it has since been revealed that she commissioned an American right-wing think tank to draw up privatization plans, including a proposal that promised it “would, of course, mean the end of the National Health Service.” Thatcher, much like her American counterpart Ronald Reagan, was a staunch believer in free market principles and aimed to introduce them into everything from housing to hospitals. While she was ultimately prevented by its immense popularity from privatizing the NHS outright, her government began to chip away at the foundation of the public health service to create an opening for the private sector.

Low-wage services such as catering and cleaning were the first to be outsourced in 1983. These may seem irrelevant to health outcomes, but they serve as an example of the dangers outsourcing can represent to public health. In 2016, a University of Oxford study revealed that the deadly MRSA “superbug” was more than twice as prevalent in hospitals that had replaced in-house cleaning staff with low-cost contractors that were able to slash prices by underpaying staff and providing worse labor conditions.

“Our study finds that contracting out NHS services may save money, but this at the price of increasing risks to patients’ health,” said the study’s co-author David Stuckler. “When these full costs are taken into account, contracting may prove to be a false economy.”

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Though Bevan’s design for universal health care began to erode under Thatcher, it was New Labour’s Tony Blair who swung the NHS’s doors wide open for private industry. When first elected in 1997, the Blair government promised to increase NHS spending to reach the EU average and initially seemed poised to reverse some of the previous governments’ privatization attempts. But in 2001, with another election on the horizon, Blair decided to finish what Thatcher started and turn the UK’s health sector into a competitive market.

New Labour brought in lucrative contracts with independent sector treatment centers (ISTCs) to perform “elective” procedures, paid for at inflated rates with taxpayer money, while leaving more expensive, complex surgeries to the NHS.

“Tony Blair dictated that 1 percent of the budget must be given to private contracts to support his experiment,” says Dr. Tony O’Sullivan, a retired pediatrician and cochair of the campaign group Keep Our NHS Public.

“He used the pressure of waiting lists at the time,” he adds. “Instead of investing even more in the health service, he insisted that ISTCs would be used to take people off waiting lists. That’s the way he forced the door open to allow more clinical services to be provided by the private sector.”

By 2006, Blair was openly boasting as he introduced partnerships with nearly a dozen private health care firms that 40 percent of the public health service would soon be privately run “under the NHS banner.” All of this was done under the guise of shorter waiting times and increased choice. Perhaps one of New Labour’s worst legacies, under both Blair and his successor Gordon Brown, was the expansion of public hospitals built using £11.4 billion ($14 billion) from private finance initiatives whose fees and borrowing costs will ultimately cost taxpayers more than eight times the initial outlay—and have already bankrupted several NHS hospitals.

As the NHS was grappling with the damage inflicted by Blair and the center-left Labour party, David Cameron and his coalition government arrived on the scene to fully dismantle NHS core principles and structures.

Eighty-four percent of us want the NHS to be in public hands, and yet it is being privatized as quietly as possible,” says Cat Hobbs, the founder of We Own It, an organization that campaigns for public ownership of services. “That’s been the case for some time, but it’s gotten much worse since 2012 with the Health and Social Care Act, which created new markets in the NHS and really ramped up the privatization.”

The legislation Hobbs mentions relieved the head of the Department of Health and Social Care of the legal duty to provide care for UK residents within its first two pages. The rest of the lengthy document is dedicated to creating an incredibly complex bureaucracy that not only delocalized funding decisions, but allowed larger portions of taxpayer funds designated for the NHS, which annually amount to roughly £112 billion ($137 billion), to be funneled toward the private sector. This takes numerous forms. One example is illustrated in John Pilger’s documentary The Dirty War on the NHS, which shows how private ambulances may carry the blue-and-white NHS logo, but often fail to meet the service’s necessarily stringent standards.

Other private companies that eat into NHS funds are consulting firms like Deloitte and PWC that slithered into the newly minted Clinical Commissioning Groups that decide how much funding health care providers receive. Providers include a slew of private hospitals and general practices run by, among others, Virgin Care, an arm of billionaire Richard Branson’s Virgin empire, as well as over a hundred NHS Foundation Trusts that are also able to contract services from the for-profit sector.

The Health and Social Care Act ultimately paved the way for vulnerable members of British society, such as the homeless, elderly, and undocumented migrants, to fall through the cracks of health care coverage. Dr. Bob Gill, creator of “The Great NHS Heist,” believes there are two motives underpinning privatization efforts.

“There’s a belief amongst our ruling classes that health care should not be a right; it should not be available to everybody,” says Gill. “But there’s also the element of private gain.”

As the 2012 legislation was being debated in the halls of Parliament, a Mirror investigation revealed that at least 40 members of the House of Lords had financial ties to companies that stood to gain from the reforms. It’s not just British politicians and companies that have profited from changes to the health service, however. American think tanks, insurance companies and consulting firms, as well as pharmaceutical manufacturers, have also been present at every step Britain has taken towards privatization. US companies such as UnitedHealth, Hospital Corporation of America, and the Acadia Group have been operating within the NHS and profiting from British taxpayers for several decades now. But when British health care advocates warn about the “Americanization” of the NHS, they aren’t just concerned about an increased presence of companies from across the Atlantic. Many, such as Gill and Hobbs, are terrified that the UK’s National Health Service will be transformed into an American-style health insurance system where access to care is largely dependent on wealth.

Even a cursory comparison of the two systems reveals the very real basis for such fears. In 2018, the United States spent over 17 percent of its GDP—-about $10,000 per capita—on health care, making it the most expensive system in the world. Yet 27.5 million Americans remained uninsured as the coronavirus pandemic hit, a number that’s rising alongside record unemployment. In the same year, the UK’s health care costs amounted to $4,000 per person, and while even insured Americans still pay out-of-pocket fees, most of the British public receive care covered nearly in full by their taxes. Although some politicians have toyed with ideas like “top-up fees” and monthly “membership charges,” none have succeeded in changing the basic funding model. It is this fact that likely makes the piecemeal privatization of the NHS difficult to discern on a day-to-day basis.But what hasn’t escaped Britons’ notice is the underfunding that has led to hospital bed shortages and reduced staff and services, especially under post-2008 austerity measures.

While overall funding has increased every year since 1948, the rise in spending has slowed and varied depending on the party in power. Since the 1980s, Tories have increased annual health spending by less than the previous average of 4 percent, including a shocking low of less than 1 percent from 2010–15. Labour governments from 1997–2010, on the other hand, raised the yearly increase to 6 percent. The UK now spends nearly a 10th of its GDP on health care, but where that money is spent is part of the problem. When you factor in the hundreds of non-NHS, privately run services that operate under the logo, it turns out 18 percent of the NHS budget already goes to for-profit companies every year. There’s also a vicious cycle in which funding cuts lead to increased outsourcing, in turn creating the false economy Stuckler highlighted in his 2016 study. Additionally, administrative costs, which originally made up about 8 percent of NHS spending, are estimated to have more than doubled since privatization efforts began.

NHS funding is so important to Britons that during the 2016 referendum on EU membership, former mayor of London Boris Johnson successfully led the “Leave” campaign by coasting around the UK on a red bus with a misleading slogan emblazoned on its side: “We send the EU £350 million a week. Let’s fund the NHS instead.” Johnson, who became prime minister in 2019, seems to want to make good on his promise to increase NHS funding, pledging to raise spending by £34 billion ($42 billion) in the next four years. However, as news emerged in recent weeks that Johnson’s government was fast-tracking private contracts as part of the UK’s Covid-19 response, including with for-profit giants like Deloitte, SERCO, and the American company Palantir, it became apparent the latest prime minister is just as devoted to transferring public wealth to private pockets as his predecessors were.

During the December snap election that cemented Johnson’s rise to power, Labour Party leader Jeremy Corbyn presented the public with leaked documents from US-UK trade talks that implied the NHS would be “on the table” in post-Brexit negotiations, as President Donald Trump once let slip. Johnson has continually declared that “the NHS is not for sale” and denied that American companies will be granted greater access. But the Mirror has once again exposed a number of ties between the private health care industry and Tory officials; meanwhile, several members of Johnson’s cabinet, including Secretary of State Dominic Raab, authored a manifesto that proposed increased privatization of the NHS. US companies, who have been greedily eyeing the NHS for decades, see a US-UK trade deal as a golden opportunity.

As the coronavirus pandemic claims more lives in Britain than anywhere else in Europe, and Brexit and a US-UK trade deal loom large, Britons need to think long and hard about what kind of NHS will protect them in a future that could be riddled with public health crises. Dr. John Lister, cofounder of the Health Campaigns Together initiative, believes that despite private companies’ shambolic involvement in the Covid-19 response, an opportunity is emerging amid the chaos as NHS debts are scrapped and Health and Social Care Act structures are suspended for the sake of efficiency.

“There’s going to be a good case after the pandemic to say, ‘Let’s not go back to December 2019,’” says Lister. “‘Let’s increase funding and put in some more sensible structures that are going to make the NHS a public service that we can all be even more proud of.’”

At least one thing should have been made abundantly clear since March: America’s entirely privately run, insurance-based health system, which has led to the worst coronavirus death rates in the world, is hardly a model to aspire to. In fact, it is Americans who should look to Bevan’s vision for a health care system that is up to the task.

“Society becomes more wholesome, more serene, and spiritually healthier,” the Labour health minister wrote in 1952, “if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide.”

This content was originally published here.

Airway Perspective on AAO Obstructive Sleep Apnea and Orthodontics White Paper – Spear Education

Author’s note: The topic of the impact of tooth extraction on the airway can be very contentious. My hope is this article serves as a tool to allow collegial discourse between restorative dentists concerned with airway and the orthodontists who they look to for solutions.

Recently, I had a new patient come to see me “looking for some veneers.” She had four bicuspids removed for orthodontics in the early 1970s and was given a headgear, but routinely found it on the floor at night. Also, her tonsils and adenoids were removed when she was very young due to recurrent infections.

She complains of a lifetime of poor sleep and never feeling refreshed. She is on multiple high blood pressure medications and has reflux. Ten years ago, she was snoring so badly her husband requested a sleep study.

The study diagnosed her with snoring and apnea. The treatment was UPPP (palatal surgery) and repair of a deviated septum. She feels that she can breathe better than before the surgery, but the symptoms never cleared. She still snores and has unrefreshing sleep.

My examination revealed multiple teeth with recession, some significant. Generalized pathologic wear and erosion. The maxillary anterior teeth were retroclined with lingual facets from pathway wear. The lower anteriors were over erupted. The tongue volume appeared normal, but the oral volume was limited. Her airway, on examination, was constricted with an exaggerated protective retraction of her tongue during examination of the oropharynx.

I thought to myself, “Could the removal of four teeth and subsequent retraction of the anterior teeth be culpable in her medical and dental history?”

The OSA and orthodontics relationship is relatively new

In 2019, the American Association of Orthodontists (AAO) released its “Obstructive Sleep Apnea and Orthodontics” white paper. It was the culmination of a two-year project by a panel of sleep medicine and dental sleep experts. They were tasked to produce guidelines for the role of orthodontists in the management of obstructive sleep apnea (OSA).

In the end, the group could not develop any formal OSA guidance for orthodontists. This is interesting given that orthodontists are charged with managing the anatomy of the airway and they work with medical providers on airway anatomy issues like cleft palates and orthognathic surgery.

While it was not stated in the paper, in my opinion, the reason for the lack of specificity of recommendations comes from the nature of the science that was being evaluated. When medical colleagues review dental literature, routinely they are struck by the poor quality of the data. Dental research is typically not well funded, the numbers of participants are limited, the follow-up is short, and it lacks untreated control subjects.

Orthodontics takes years to complete and many years to determine any impact. And finally, the relationship between OSA and orthodontics is a relatively new concept that has rarely been tested in sleep laboratories. Instead, most studies on airway change look at cephalometric or CBCT volumetric alteration and infer (all be it incorrectly) that bigger is better. The conclusions of the AAO white paper are, therefore, going to be constrained by this lack of quality evidence.

Bicuspid extraction addressed

Curiously, section 12 of the AAO white paper, “Fallacies About Orthodontics in Relation to OSA,” addresses the issue of bicuspid extraction. It begins, “Conventional orthodontic treatment never has been proven to be an etiologic factor in the development of obstructive sleep apnea. When one considers the complex multifactorial nature of the disease, assigning cause to any one minor change in dentofacial morphology is not possible.”

This conclusion is true, but the key word is “proven.” There is also a lack of proof orthodontics is not a factor in the development of OSA. The disease is multifactorial but minor changes in oral volume, vertical dimension, and mandibular protrusion have been shown to change the airway and sleep apnea significantly. To argue that removal of four teeth is an unremarkable change is, at least, questionable given available data.

The paper continues, “The specific effects on the dental arches and the muscles and soft tissues of the oral cavity following orthodontic extractions can differ significantly, depending on the severity of dental crowding, the amount of protrusion of the anterior teeth and the specific mechanics used to close the extraction spaces.”

Zhiai Hu1 published a systematic review evaluating the effect of teeth extraction on the upper airway. It included only seven articles. They were divided by the reason for treatment:

The Class I bimax group all had anterior tooth retraction without boney changes. Three of the four articles showed a reduction in upper airway dimension, the last showed a reduction but not to the level of significance.

The one article on crowding differed because the orthodontic technique allowed the molars to move forward ~3mm. That created an increase in the airway dimension.

Finally, the unspecified group did not provide a discussion of the direction of movement (retractive or molar movement) and found small increases for both extraction and non-extraction groups. A conclusion that can be reached from this review is if you retract the anterior teeth, the airway size reduces and if the molars move forward, the airway improves or remains the same.

Impact of volumetric change

The white paper goes on to state, “The impact that orthodontic treatment with or without dental extractions may have on the dimensions of the upper airway also has been examined directly, first with two-dimensional cephalograms and more recently with three-dimensional CBCT imaging…

“In discussing orthodontic treatment to changes in the dimensions of the upper airway, it also is helpful to understand that an initial small or subsequently reduced or increased size does not necessarily result in a change in airway function.”

This is one of the issues medicine has with dental literature. Dental researchers rarely study the actual impact of the volumetric change. It is not enough to say the space is smaller. It needs to be quantified with sleep data. It also needs to be followed over time.

However, Christian Guilleminault highlighted a reduction in the ideal size of the upper airway can lead to abnormal breathing over time, initially with flow limitation, then with a progressive worsening toward full-blown OSA.2> Rarely would testing at the completion of orthodontics demonstrate a compromise. It is the stressful breathing night after night that compromises the airway and makes people more prone to breathing issues during sleep.

Existing evidence suggests the opposite

The AAO white paper does highlight a paper that attempts to answer the question about compromise later in life.

“One such study assessed dental extractions as a cause of OSA later in life with a large retrospective examination of dental and medical records… The study concluded that the prevalence of OSA was essentially the same in both groups, and that dental extractions were not a causative factor in OSA.”

A.J. Larsen3 reviewed insurance records for 5,500 patients between the ages of 40-70. Dental radiographs determined if the subjects were missing four bicuspids or had a full complement of teeth. They matched the two groups for age, BMI, etc. Then they reviewed their medical records to see if the subject had received a diagnosis for apnea.

The results showed that 9.56% of the non-extraction and 10.71% of the extraction group had a diagnosis of OSA. This was not significantly different. Thus, the authors’ conclusion was there was not a relationship between OSA and premolar extractions.

It is currently estimated that 80-90% of OSA patients are undiagnosed. Larsen’s paper states because the subjects all have insurance, they would expect physicians would note the symptoms and get them a sleep study and diagnosis.

There is absolutely no evidence to support that assertion and the existing evidence suggests just the opposite. From pediatricians to primary care, physicians are not diagnosing apnea effectively. The conclusion of the article should be extraction and non-extraction individuals are underdiagnosed at almost the same rate.

Orthodontic literature is not conclusive

The AAO paper goes on to state, “Overall it can be stated that existing evidence in the literature does not support the notion that arch constriction or retraction of the anterior teeth facilitated by dental extractions, and which may (or may not) be the objective of orthodontic treatment, has a detrimental effect on respiratory function.”

Once again, it is true existing evidence does not support that position because there is no quality evidence at this time, not that the relationship does not exist. This should, in my opinion, be a call for more research rather than posturing the topic as a fallacy.

Orthodontic literature is not conclusive on whether premolar extractions impact the airway. A weakness of all the studies is they are based on CBCT or cephalometric radiographic measurements and not sleep data. How a patient uses the existing airway volume is more critical than the size and that’s never measured.

Is there ever a time when I agree with an orthodontic recommendation of extractions? Absolutely. I will, however, ask my specialist:

The most important take away should be the need to intervene earlier. Attempting to direct craniofacial development may keep us from ever needing to know the answer to, “Does the extraction of four bicuspids impact the airway?”

Jeffrey Rouse, D.D.S., is a member of Spear Resident Faculty.

1. Hu Z, Yin X, Liao J, Zhou C, Yang Z, Zou S. The effect of teeth extraction for orthodontic treatment on the upper airway: a systematic review. Sleep and Breathing. 2015;19(2):441-451.

2. Guilleminault C, Huseni S, Lo L. A frequent phenotype for paediatric sleep apnoea: short lingual frenulum. ERJ Open Research. 2016;2(3):00043-02016.

3. Larsen AJ, Rindal DB, Hatch JP, et al. Evidence Supports No Relationship between Obstructive Sleep Apnea and Premolar Extraction: An Electronic Health Records Review. Journal of Clinical Sleep Medicine. 2015;11(12);1443-1448.

This content was originally published here.

Dr. Scott Atlas disputes COVID-19 fear mongering tactics from our health officials –

Dr. Scott Atlas disputes COVID-19 fear mongering tactics from our health officials

SAN DIEGO (KUSI) – As coronavirus cases continue to increase across the United States, health officials and Democrat politicians seem to be using that statistic to fear monger and justify closure orders.

Dr. Scott Atlas of the Hoover Institute, discussed why we don’t need to be scared of the increase spread of coronavirus on Good Morning San Diego with KUSI’s Paul Rudy.

Atlas said that he has done more than a superficial analysis of the numbers, and after analyzing them, he doesn’t get scared.

Explaining, “When you look all over at the states who are seeing a lot of new cases, you have to look at who is getting infected because we should know by now, that the goal is not to eliminate all cases, that’s not rational, it’s not necessary, if we just protect the people who are going to have serious complications. We look at the cases, yes there’s a lot more cases, by the way they do not correlate in a time sense to any kind of reopening of states. If you look at the timing, that’s just a misstatement, a false narrative. The reality is they may correlate to the new protests and massive demonstrations, but it’s safe to say the majority of new cases are among younger, healthier people.”

Furthermore, Dr. Atlas emphasized the fact that the death rates are not going up, despite the increase in cases. “And that’s what really counts, are we getting people who are really sick and dying, and we’re not, and when we look at the hospitalizations, yes, hospitals are more crowded, but that’s mainly due to the re-installation of medical care for non COVID-19 patients.”

Dr. Atlas used Texas of an example saying, “90+% of ICU beds are occupied, but only 15% are COVID patients. 85% of the occupied beds are not COVID patients. I think we have to look at the data and be aware that it doesn’t matter if younger, healthier people get infected, I don’t know how often that has to be said, they have nearly zero risk of a problem from this. The only thing that counts are the older, more vulnerable people getting infected. And there’s no evidence that they really are.”

Dr. Atlas then pointed out the hospitalization length of stay is about half of what it once was.

This content was originally published here.

Important Studies on Opioid Prescribing: Implications for Dentistry – TeethRemoval.com

Recently on this site several articles have appeared discussing opioid prescribing after wisdom teeth removal see for example the posts Do Oral Surgeons Give Too Many Opioids for Wisdom Teeth Removal? and Opioid Prescriptions From Dental Clinicians for Young Adults and Subsequent Opioid Use and Abuse. Very recently several interesting studies regarding opioid prescribing have published.

The first study is titled “Trends in Opioid Prescribing for Adolescents and Young Adults in Ambulatory Care Settings” written by Hudgins et al. appearing in Pediatrics in June 2019 (vol.143, no. 6, e20181578). The article explored opioid prescribing for adolescents (ages 13 to 17) and young adults (ages 18 to 22) receiving care in emergency departments and outpatient clinics. Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) and National Ambulatory Medical Care Survey (NAMCS) over the time period from January 1, 2005, to December 31, 2015 was used. It was found the most common conditions associated with opioid prescribing among adolescents visiting emergency departments was dental disorders (59.7%), clavicle fractures (47%) and ankle fractures (38.1%) and among young adults visiting emergency departments was dental disorders (57.9%), low back pain (38%), and neck sprain (34.8%). Thus in both cases when someone ages 13 to 22 goes to an emergency department because of a dental disorder they are nearly 60% likely to leave with an opioid prescription. Studies suggest that adolescents and young adults are the most likely to misuse and abuse opioid medications. Thus the authors imply it is possible that many of these opioids being prescribed for dental disorders are being used for non medical use.

An accompanying commentatory of the article by Hudgins also provides additional insights into the article titled “Opioids and the Urgent Need to Focus on the Health Care of Young Adults” written by Callahan also appearing in Pediatrics in June 2019 (vol. 143, no. 6, e20190835). Callahan says that research looking at young adults is often not available as they often get grouped into adolescents in studies. Callahan states:

“Efforts to improve research and health care for young adults are further hindered by (1) the lack of a consensus definition of young adulthood, (2) the false perception that young adults are healthy, (3) fragmented health insurance coverage during young adulthood, and (4) little organized advocacy on behalf of young adults.”

Callahan thus calls for more research tailored to young adults. Young adults are of course a target demographic for wisdom teeth surgery.

The second study is titled “Comparison of Opioid Prescribing by Dentists in the United States and England” written by Suda et al. appearing in JAMA Network Open in 2019 (vol. 2, no. 5,e194303). The article explored opioid prescribing differences by dentists in the United States of America and England. The authors looked at data from IQVIA LRx in the U.S. and the NHS Digital Prescription Cost Analysis in England. The authors found in 2016 dentists prescribed more than 11,440,198 opioid prescriptions in the U.S. and 28,082 opioid prescriptions in England. Dental prescriptions for opioids were 37 times greater in the US than in England. In the U.S. various opioids were prescribed including hydrocodone-based opioids (62.3% of time), codeine (23.2% of the time), oxycodone (9.1% of the time), and tramadol (4.8% of the time) whereas in England only the codeine derivative dihydrocodeine was prescribed. The authors state:

“The significantly higher opioid prescribing occurs despite similar patterns of receiving dental care by children and adults, no difference in oral health quality indicators, including untreated dental caries and edentulousness, and no evidence of significant differences in patterns of dental disease or treatment between the 2 countries.”

The authors in the article by Suda point out that the patients included in the study from England were limited to receiving medications from the U.K.’s National Health Service. However they feel that their study shows that U.S. dentists prescribe too many opioids and this practice is contributing to the opioid epidemic in the U.S.

In both studies above it seems that the authors feel that patients in the U.S. are receiving too many opioids for dental related issues and that other medications that can provide pain relief should be given. When opioids are given they should be prescribed in the shortest duration necessary to deal with the expected amount of pain the patient is dealing with. However, a limitation of both studies is the authors were unable to assess the appropriateness of the opioid prescriptions given.

This content was originally published here.