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February 2021

U.S. Senate bill would support campaigns to address COVID-19 disparities

As public health officials across the country struggle to get vaccination shots to the people hardest hit by the coronavirus pandemic, a Senate bill aims to address health inequities among communities disproportionately affected by the virus (Source: “Senate bill aims to reduce health disparities related to Covid-19,” NBC News, Feb. 25).

The COVID-19 Health Disparities Action Act, introduced Thursday by Sens. Bob Menendez, D-N.J., and Ben Cardin, D-Md., would support targeted and "culturally competent" public awareness campaigns about vaccines and preventive measures in underserved communities, such as wearing masks and maintaining social distance.

The bill would direct the Department of Health and Human Services, acting through the Centers for Disease Control and Prevention, to develop public awareness campaigns to address disparities in testing, hospitalizations and deaths among racial and ethnic minority groups. It would also instruct the health department to create grant programs for community-based public awareness campaigns about vaccinations, testing and preventative measures.

Report outlines state efforts to address racial disparities in maternal mortality

A new resource details efforts in states across the country to address racial disparities in maternal mortality (Source: “State Maternal Mortality Review Committee Membership and Recommendations,” National Academy for State Health Policy, Feb. 18).

The United States faces a growing maternal mortality crisis with a maternal death rate that is higher than other developed countries. Additionally, Black women are two-to-three times more likely to die from pregnancy-related causes than non-Hispanic white women.

To better understand the root causes of these deaths and develop recommendations to improve health outcomes, many states have formed maternal mortality review committees (MMRCs). The report includes charts and maps that describe each state’s MMRC membership and recommendations.

Using patient feedback in healthcare artificial intelligence could reduce health disparities

A study of a healthcare artificial intelligence program that inputs patient responses rather than information from doctors found that the new approach could reduce racial disparities (Source: “New Algorithms Could Reduce Racial Disparities in Health Care,” Wired, Jan. 25, 2021).

Health diagnostic software typically learns from doctors by digesting thousands or millions of x-rays or other data labeled by expert humans until it can accurately flag health problems by itself. A study published last month in the journal Nature Medicine took a different approach—training algorithms to read knee x-rays for arthritis by using patients as the AI arbiters of truth instead of doctors. The results revealed that radiologists may be missing important details when it comes to reading Black patients’ x-rays.

The algorithms trained on patients’ reports did a better job than doctors at accounting for the pain experienced by Black patients by discovering patterns of disease in the images that humans usually overlook.

“This sends a signal to radiologists and other doctors that we may need to reevaluate our current strategies,” says Said Ibrahim, a professor at Weill Cornell Medicine, in New York City, who researches health inequalities, and who was not involved in the study.

Algorithms designed to reveal what doctors don’t see, instead of mimicking their knowledge, could make health care more equitable. In a commentary on the new study, Ibrahim suggested it could help reduce disparities in who gets surgery for arthritis. African American patients are about 40 percent less likely than others to receive a knee replacement, he says, even though they are at least as likely to suffer osteoarthritis. Differences in income and insurance likely play a part, but so could differences in diagnosis.

Study: 40% of vaccine trials over past decade did not report race of participants

An analysis of the demographics of a decade’s worth of vaccine clinical trials has found that more than 40% did not record participants’ race and about 65% did not report their ethnicity (Source: “‘A massive gap in information’: Most vaccine clinical trials fail to report data on participants’ ethnicity or race,” Stat News, Feb. 19).

“This is a massive gap in information, and if we want to improve enrollment in clinical trials and we want to see diversity in clinical trials, we need the data,” said Steven Pergam, a vaccine and infectious disease expert at the Fred Hutchinson Cancer Research Center in Seattle and an author on the paper. “It’s amazing that we don’t have the data.”

The lack of diversity in the 230 vaccine trials that were examined (encompassing about 220,000 people) drew attention last year as several COVID-19 vaccine trials had difficulty enrolling people of color. Watching that struggle unfold as the pandemic devastated the country, and communities of color in particular, spurred researchers to investigate how representative vaccine clinical trials have been historically.

The findings, published earlier this month in the journal JAMA Network Open, indicate that racial and ethnic disparities have long plagued vaccine clinical trials and provide insight into the importance of diminishing those gaps going forward.

Experts offer varying explanations for recent drop in COVID-19 cases

In recent weeks, the rate of newly recorded COVID-19 infections has plummeted from coast to coast and the worst surge yet is finally relenting (Source: “Four reasons experts say coronavirus cases are dropping in the United States,” Washington Post, Feb. 14).

But scientists are split on why, exactly, it is happening.

Some point to the quickening pace of coronavirus vaccine administration, some say it’s because of the natural seasonal ebb of respiratory viruses and others chalk it up to social distancing measures.

And every explanation is appended with two significant caveats: The country is still in a bad place, continuing to notch more than 90,000 new cases every day, and recent progress could still be imperiled, either by new fast-spreading virus variants or by relaxed social distancing measures.

A former director of the Centers for Disease Control and Prevention endorsed the idea that Americans are now seeing the effect of their good behavior — not of increased vaccinations.

“I don’t think the vaccine is having much of an impact at all on case rates," Tom Frieden said in an interview Sunday on CNN. “It’s what we’re doing right: staying apart, wearing masks, not traveling, not mixing with others indoors.”

1 in 3 Ohio nursing homes is facing staffing shortage, AARP dashboard reports

Over one-third of Ohio nursing homes and long-term care facilities faced a shortage of direct care workers in January, according to new data released this week (Source: “Staff shortages plague 1 in 3 Ohio nursing homes; nearly 1 in 4 in Kentucky struggle too,” Cincinnati Enquirer, Feb. 15).

The data is part of the AARP COVID-19 Dashboard, which uses information reported each week by nursing homes to the Centers for Disease Control and Prevention and released by the Centers for Medicare & Medicaid Services.

Long-term care facilities have made up almost half of Ohio’s COVID-19 deaths, despite combined resident and staff cases comprising only 8% of the state's total cases. 

And the solutions available to nursing homes to curb these shortages, such as bringing in temporary workers or extending hours of current staff, could potentially spread COVID-19 to both residents and staff, one expert said.

CDC: Life expectancy in U.S. drops by a full year in first half of 2020

Life expectancy in the United States dropped a staggering one year during the first half of 2020 as the coronavirus pandemic caused its first wave of deaths, health officials are reporting (Source: “US life expectancy drops a year in pandemic, most since WWII,” Kaiser Health News, Feb. 17).

Minorities suffered the biggest impact, with Black Americans losing nearly three years and Hispanics, nearly two years, according to preliminary estimates Thursday from the Centers for Disease Control and Prevention.

This is the first time the CDC has reported on life expectancy from early, partial records; more death certificates from that period may yet come in. It’s already known that 2020 was the deadliest year in U.S. history, with deaths topping 3 million for the first time.

Mental health demands rise as states face tighter budgets

States across the U.S., facing COVID-19 related budget shortfalls, are also contending with increased demand for mental health services as a result of the pandemic (Source: “As Demand for Mental Health Care Spikes, Budget Ax Set to Strike,” Kaiser Health News, Feb. 5).

A Kaiser Family Foundation poll found that demand for mental health services rose from 1 in 3 people in March to more than half of people surveyed in July.

The full extent of the mental health crisis and the demand for behavioral health services may not be known until after the pandemic is over, mental health experts said. That could add costs that budget writers have not anticipated.

“It usually takes a while before people feel comfortable seeking care from a specialty behavioral health organization,” said Chuck Ingoglia, president and CEO of the nonprofit National Council for Behavioral Health in Washington, D.C. “We are not likely to see the results of that either in terms of people seeking care — or suicide rates going up — until we’re on the other side of the pandemic.”

ACEs cost Ohio $10 billion a year in healthcare costs, new HPIO analysis finds

First-of-its kind analysis by the Health Policy Institute of Ohio has found that if adverse childhood experiences (ACEs) are eliminated, more than $10 billion in annual healthcare and related expenses could be avoided in Ohio.

The analysis is included in a new HPIO policy brief, Adverse Childhood Experiences (ACEs): Economic Impact of ACEs in Ohio. The study also found that focusing action on reducing ACEs, particularly those associated with behavioral health, can yield significant savings. For example, more than $4.5 billion in annual spending to treat depression in Ohio is attributable to ACEs.

“The research is clear that ACEs result in both significant health and economic impacts,” the brief states. “Economic costs from ACEs are incurred across the public and private sectors, including substantial costs to the healthcare system. The economic burden of ACEs also impacts the state child protection, behavioral health, criminal justice and education systems, as well as private sector businesses. By preventing and mitigating the impacts of ACEs, policymakers and others can put Ohio on a path towards improved health value.”

The brief is the second in three planned briefs as part of HPIO’s Ohio ACEs Impact Project. In August 2020, HPIO released the first brief, Adverse Childhood Experiences (ACEs): Health impact of ACEs in Ohio.

Ohio begins adding 4k deaths to COVID-19 totals following data collection error

Ohio Department of Health officials announced this week that they had overlooked about 4,000 deaths that occurred over the past several months and would begin reporting them to the public this week (Source: “Ohio Begins Adding In 4,000 Overlooked Covid Deaths,” New York Times, Feb. 12).

The first 650 or so of Ohio’s older deaths were reported Thursday, accounting for about 17% of all coronavirus deaths announced nationwide that day. On Friday the Ohio Department of Health reported about 2,500 additional deaths. The backlog in Ohio was expected to inflate the national death average in the coming days.

“You’ll see a jump today, tomorrow, maybe the next day,” Gov. Mike DeWine said at a news conference on Thursday. “We’re not sure exactly how many days it’s going to take, but you’re going to see a distorted number.”

During a routine employee training event, Ohio health officials discovered that thousands of deaths, some of which dated back to October, had not been properly merged between one reporting system and another, according to an ODH press release. “This was a failure of reconciliation not taking place,” Gov. DeWine said, “so we’re getting that straightened out.”