Health

(NEW YORK) — Adding to the many challenges parents faced during the COVD-19 pandemic, vaccines remain unavailable for young children leading to questions about the need for kids to wear masks.

The issue has come to a head as kids start to return to school and even different schools within the same school district may have different mask policies.

On the national level, the Centers for Disease Control and Prevention has said immunized adults and teens can go without a mask, including inside schools.

The public health agency has also said that schools can still embrace universal masking if they can’t verify vaccinations or have large numbers of students too young to qualify. Children under the age of 12 are currently not eligible for a COVID-19 vaccine.

At least eight states, including Arizona, Georgia and Texas, have banned mask mandates in schools.

Meanwhile, the American Academy of Pediatrics, an organization of nearly 70,000 pediatricians, this week called for schools to enforce universal masking mandates.

“AAP recommends universal masking because a significant portion of the student population is not yet eligible for vaccines, and masking is proven to reduce transmission of the virus and to protect those who are not vaccinated,” the AAP wrote in a statement. “Many schools will not have a system to monitor vaccine status of students, teachers and staff, and some communities overall have low vaccination uptake where the virus may be circulating more prominently.”

Good Morning America spoke with two pediatricians from Columbia University to help clarify for parents all the advice coming in on face masks and kids.

Here are their takeaways for parents.

1. All kids above age 2 should wear face masks at schools:

Both pediatricians, Dr. David Buchholz and Dr. Edith Bracho-Sanchez, agreed with the AAP’s recommendation that all people above age 2 should wear masks inside schools, regardless of vaccination status.

“It makes it simple and it makes it flawless and protects everybody,” Buchholz said of a universal policy. “Wearing a mask protects yourself and it also protects others. It’s a great benefit.”

Both Buchholz and Bracho-Sanchez pointed out that the AAP’s and CDC’s seemingly different policies can be explained by the focus of their work.

“The CDC is in general making recommendations for the whole country,” said Bracho-Sanchez. “The APA, they’re pediatricians and their first thought is what makes sense for children? They’re looking granularly at kids and what makes sense for them.”

2. Masks matter because kids are at risk for COVID-19:

“Our understanding of COVID-19 in children has changed dramatically [since the start of the pandemic] and it absolutely can be a very serious illness in children,” said Bracho-Sanchez. “Since the start of the pandemic, there have been over 4 million children who have contracted COVID-19 and hundreds who have unfortunately passed away from it and another large amount of children who are suffering long-term COVID-19 symptoms after having had the initial illness.”

COVID-19 cases have nearly tripled in the United States over two weeks, according to The Associated Press. The virus is also on the rise among children, with more than 23,000 new pediatric cases diagnosed in the U.S. last week, twice as many as the end of June, according to the AAP.

The CDC reports that among recent cases of COVID-19, 99.5% of hospitalizations are people who weren’t immunized.

In addition to protecting children from COVID-19, face masks also help prevent the spread of other viruses like respiratory syncytial virus (RSV) and influenza, noted Buchholz.

3. Masks allow children to learn in person:

After more than one year of learning entirely online for many students, wearing face masks is an easy measure that will allow kids to learn in person, according to Bracho-Sanchez.

“Children have absolutely suffered from being isolated from their peers, from their friends, from other people,” she said. “But that is because they have been away from other people, not because they have been wearing masks.”

“You can be around other people and socializing and wear masks, or not wear masks and potentially get very sick and have to go back to learning online,” added Bracho-Sanchez. “It’s in my mind a no-brainer. I would mask my own child. I would ask the adults around my child to wear masks.”

4. Masks should be used along with other safety practices:

In addition to supporting their kids in wearing face masks, parents should pay attention also to the other safety recommendations that have been in place throughout the pandemic, including hand washing and social distancing, according to both doctors.

They also urge parents to continue to screen themselves and their children for symptoms each morning and to stay home from school and-or work if they are sick.

5. Kids may have bigger feelings around returning to school:

Bracho-Sanchez said that parents will want to listen to their kids in case their possible resistance to or anger over having to wear a mask is about something deeper, like anxiety over returning to school.

“We are very focused on COVID and masking but this back-to-school season is going to be about so much more than COVID-19,” she said. “Some kids are really nervous. Some kids have truly fallen behind. Some kids have not been around people, so at the same time we’re having these conversations, we also have to remember that we have to protect children in so many ways.”

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(STANFORD, Calif.) — Stanford University reported at least seven confirmed cases of COVID-19 among fully vaccinated students this week.

All seven students were symptomatic, according to the school.

“As you have seen in the national news, cases of COVID-19 have been ticking upward,” Stanford University officials said in a letter to students on Thursday. “We are seeing some of this in our own community, where we are experiencing an increase in the number of student COVID cases, including among fully vaccinated individuals.”

Although the chances of contracting the novel coronavirus after being fully vaccinated are very rare, so-called breakthrough cases are still possible. Although COVID-19 vaccines have shown to be highly effective, they do not block the virus 100% of the time, meaning that some breakthrough infections occur after vaccination. This is normal and expected, and it’s not proof that the vaccines aren’t working, experts said.

However, health officials and experts alike have warned that new, more contagious variants of the novel coronavirus may be more effective at evading vaccines.

Stanford University officials said “vaccination continues to be our best defense against severe COVID-19 infection.” Face masks, physical distancing and regular hand washing “remain powerful ways to prevent the transmission of COVID-19,” officials added.

All students, faculty, staff, contractors and visitors are required to wear face coverings in spaces that are open to the public on the Ivy League school’s 8,180-acre campus in Stanford, California, about 20 miles northwest of San Jose. Face coverings in crowded indoor spaces on campus are recommended.

Stanford University recently loosened its COVID-19 testing requirements for fully vaccinated students who are living on campus or are coming to campus frequently this summer. Those individuals are no longer required to test weekly for COVID-19 or complete daily submissions on the school’s “Health Check” tool if they are verified as being fully vaccinated against the disease.

Overall, Stanford University has reported at least 257 confirmed cases of COVID-19 since the start of the pandemic. Some 8,300 students are fully vaccinated against the disease, while 330 are partially vaccinated, according to data posted on the school’s website.

Stanford University’s Vaden Health Services is connecting with each student who tests positive for COVID-19 to identify and notify their close contacts, who will be encouraged to get tested as soon as possible. Students who test positive will be provided with medical care and isolation space, according to the school.

“Again, vaccinations are effective at preventing severe illness. However, we need everyone to be vigilant,” Stanford University officials warned in the letter Thursday. “The variants remain of concern.”

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(NEW YORK) — In Wyoming’s Teton County, nearly 60% of residents are fully vaccinated — almost double the statewide vaccination rate.

It’s an effort that has been noticed in the state, which has one of the lowest vaccination rates in the country and where several counties have fewer than 30% of their population inoculated, state data shows.

“We have spoken to some of our other counties in Wyoming because they wanted to know what we were doing,” Rachael Wheeler, the public health response coordinator at the Teton County Health Department, told ABC News.

As the highly transmissible delta variant has quickly spreads throughout the United States — now making up over 80% of new cases — regions with high vaccination rates are expected to fare better, medical experts say.

ABC News spoke to Wheeler and officials in two other counties leading their states in COVID-19 vaccinations about their campaigns, what they’ve done and where they go from here.

McKinley County, New Mexico

McKinley County, which includes part of the Navajo Nation reservation, was one of the hardest-hit regions in New Mexico early in the pandemic.

For Adam Berry, emergency manager for the county, that may have helped drive vaccinations to where, as of Monday, over 94% of residents ages 18 and up have received at least one dose, according to the latest state health department data. Statewide, that number is 72.2%.

“The spring of 2020 was our first wave; we had a pretty good surge,” Berry said. “We had the highest case number in the state, especially per capita, for several weeks and months, before things tapered off late summer.”

There was a longer, second surge in the winter that filled Gallup hospitals and mortuaries to capacity, he said.

“There’s very few people in the county that don’t know at least one person that was sick, if they weren’t sick themselves,” he said. “Many people know one or more people that unfortunately died due to COVID-19. So I think it’s very personal for a lot of people.”

Berry said there was a little hesitancy in the beginning, but that “it didn’t take very long at all for a lot of people to start lining up to get the vaccine.” Being able to protect themselves and their family, as well as safely see people they had not seen in a while, were big motivators, he said.

The vaccination effort has involved coordination among the county’s emergency management and public health offices, state health department, health care providers, community partners and federal agencies, including the Indian Health Service.

“It was definitely a big community effort. Everybody does their part to try to get as many people vaccinated as possible,” said Berry, a volunteer paramedic who also helped administer vaccines when clinics were short-staffed.

One thing that worked to the county’s advantage in administering the vaccine is having a significant percentage of the county served by the Indian Health Service, he said. Nearly 80% of the county’s residents are Native American, according to the U.S. Census.

“A lot of other counties in New Mexico are dependent on local health care systems and private physicians to vaccinate the bulk of their populations,” he said. “We were fortunate in that aspect that we have a large presence of Indian Health Service facilities to help take care of that population, which allowed for vaccines to come in directly from the federal government to that site.”

The Indian Health Service held drive-thru events at the Fire Rock Casino in Church Rock and did outreach to the Navajo Nation “to make it more convenient” to get the vaccine, Berry said.

The county has lately been focused on bringing people back for their second dose if needed, as well as vaccination efforts in those ages 12 to 16.

Since May 24, the county has reported only three COVID-19 deaths, and the seven-day average of new cases is three, down from a peak of 109 in mid-November, state data shows.

There’s still a lot of mask-wearing, though life has started to “look a little more normal,” Berry said. “We’ve come a long way in the last year.”

Lamoille County, Vermont

There’s stiff competition to be the top county for vaccinations in Vermont, which has the highest vaccination rate in the country.

At the moment, Lamoille County holds that distinction, with over 85% of residents ages 12 and up having received at least one dose, according to state data.

“When we saw those numbers we were very happy about it,” Aaron French, director of the Morrisville Office of Local Health in Lamoille County, told ABC News. “Every county’s working really hard.”

Part of that effort has included reaching Lamoille County’s more rural residents, who may be less inclined to drive to a vaccination clinic out of town.

“I grew up in one of those small towns, and I said, ‘Why don’t we talk to the town … and set something up, and if we only get five people, we’ll get five people,'” French said.

On a recent weekend, the office brought nurses to two towns and was able to vaccinate around 10 people.

“We were happy with that,” French said. “And we’ll continue to do that.”

Health officials have also connected with local churches, schools, manufacturers and ski resorts as part of the vaccination efforts to reach the community and workforce.

As COVID-19 cases rise throughout the United States, Vermont officials said this week they have seen a small increase in the state, likely due to the delta variant, but community spread remains low due to the high vaccination rates.

Lamoille County has had two COVID-19 cases in the last two weeks, state data shows.

French said people in the county have trusted the local department of health and state department of health throughout the pandemic, which has also been a major factor in their vaccination success.

“They needed to hear from people that they could trust, and I think those local people were their local doctors and their commissioner of public health, who’s a physician, and their governor,” he said. “We have a number of federally qualified health care centers around here, and those physicians and nurse practitioners are very well-trusted, so their messaging out to the community and their patients were really important and helpful.”

Lamoille County’s lowest vaccination rates are among those ages 18 to 29, with over 58% of that population vaccinated, state data shows. That is one area the county is focusing on, French said.

The local health office has held clinics at skate parks, fairs and race tracks in the state, and health officials look to continue to do efforts like that to continue to bring numbers up.

“There’s plenty of opportunity and we’re just going to keep plugging away at it,” French said. “I do think we can get higher than that.”

Teton County, Wyoming

There has been a partisan divide in COVID-19 vaccinations, with Democrats more likely to report getting the vaccine than Republicans. Teton County is an outlier in Wyoming as a “blue dot in a red state,” though Wheeler doesn’t think that “can account for everything.”

One major factor that helped Teton County achieve its vaccination rate — which is the highest in the state, and higher than the national average — started with the logistics of the rollout itself.

“We were very easily able to ramp up and hire a lot of additional vaccine staff when our demand was high,” Wheeler said.

That meant hiring anyone from nurses to administer the vaccines to staff to help manage the different schedules. The county also had a lot of volunteer help at vaccine clinics, from checking people in to observing for emergency response, she said.

Teton County was also one of a handful of counties in Wyoming that had an ultra-cold freezer needed at first to store the Pfizer vaccine, the first to be issued an emergency use authorization.

“That was really helpful early on to be able to accept all different types of vaccines that were approved under the EUA at that time,” Wheeler said.

When the county expanded its eligibility to schools and child care providers, the health department held special clinics on the weekends to accommodate them. “That seemed very successful, and they were very appreciative of that,” Wheeler said.

Once students were eligible, the health department held an in-school vaccine clinic before the school year let out that reached over 500 students, Wheeler said.

To reach the broader community, the health department repurposed a public transit system bus into a mobile vaccine clinic, which has been used to bring doses to worksites, like the county’s trash transfer station, and, lately, parks.

“Our goal is to reduce any barriers that there might be for people to get the vaccine,” Wheeler said.

Beyond vaccine access, the county hired an agency to help with its messaging around the COVID-19 vaccine. “They helped us have a more focused campaign that was consistent and looked really professional,” Wheeler said.

Currently, the health department is holding a “Shots for Swag” campaign, in which residents who have received at least one dose of the vaccine can win prizes.

Through the ad agency, the health department also filmed a video featuring local doctors answering common questions about the vaccine, such as around variants, fertility and pregnancy, that “put a more local perspective to it,” Wheeler said.

The health department also partnered with several community nonprofits, including Voices JH, which helped reach immigrants in the Latino and Eastern European communities in the county with resources on vaccination.

Local health officials are anticipating renewed demand for the vaccine as new age ranges become eligible, and possibly when a vaccine has full FDA approval.

For now, they’re planning to bring the mobile vaccine clinic to events throughout the summer and remind employers about the service. From July 1 to July 15, the county reported 31 new COVID-19 cases, 26 of which were in unvaccinated people and included workplace “clusters,” the health department said this week.

“We’re still messaging to everyone that the best defense is getting vaccinated,” Wheeler said. “It’s how you’re going to protect not only yourself, but your family, friends, co-workers, neighbors, community members.”

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(ATLANTA) — During the last year and a half, immunocompromised people have been at extremely high risk for the virus. And for many, the COVID vaccine didn’t change that.

That’s why a group of independent Centers for Disease Control and Prevention experts at a Thursday meeting largely voiced support for allowing immunocompromised people to talk to their doctors about getting a third shot, a booster, that could increase their antibody response to vaccines.

But the advisory committee didn’t make a formal recommendation, saying more data was needed and, ultimately, regulatory allowance from the Food and Drug Administration.

About 2.7% of U.S. adults are considered immunocompromised, an umbrella category that includes cancer patients, transplant recipients, people with HIV and patients on high-dose steroids.

“We long for a fuller life,” said Phil Canudo, a kidney transplant recipient from Akron, Ohio, who told the CDC advisory committee on Thursday that he had no antibody response after two Pfizer shots.

“I can’t wait to see my stepdaughter’s new Colorado home,” he said, choking up. “I want to eat a medium rare steak at the Diamond Grill.”

Canudo, who spoke before the CDC advisory panel during the public comment period, said he’d been told he still must behave as if he’s not vaccinated.

“I urge you, beg you even, to recommend that we be able to receive a third vaccine dose,” he said. “The benefit could open up the world to us again.”

At the same time, pressure is mounting as other countries, including France and Israel, already have approved boosters for those who are immunosuppressed. In the U.S., debate over booster shots for the general public has ratcheted up as the delta variant wreaks havoc.

Data presented at the meeting said a booster shot could increase antibodies in an immunocompromised person by up to 50%.

Dr. Sara Oliver, an epidemiologist with the CDC who presented the findings, also explained how immunocompromised people are a priority group for booster research because they’re at greater risk of serious COVID-related consequences.

For example, in one U.S. study, 44% of hospitalized breakthrough cases were immunocompromised people. An Israeli study found it was around 40%. Breakthrough cases, which are expected, refer to people who test positive for COVID-19 while fully vaccinated. The vaccines are highly effective against severe disease and hospitalization, but it’s possible for people to develop mild or asymptomatic illness even when vaccinated.

“We want to vaccinate. During this entire conference, we’ve been saying, vaccinate, vaccinate, vaccinate,” said Dr. Pablo Sanchez, a member of the panel. “These people want to be vaccinated, they’re not vaccine hesitant. And it seems to me that we should promote that.”

He argued that the FDA should “at least allow it while we obtain more data” because “we really need to help this population out more.” Patients, Sanchez argued, could end up taking matters into their own hands.

Phil, of Akron, said he planned to do just that.

“Hundreds of us lie to pharmacies and immunization sites about our previous vaccinations, trying to get an extra unauthorized dose,” he told the committee. “I know that’s what I’ll be doing if additional doses are not sanctioned.”

Another ACIP member, Dr. Sandra Fryhofer, a liaison of the American Medical Association, pointed out that there are millions of excess vaccine doses right now that aren’t being taken advantage of in the U.S.

At the same time, there are immunocompromised patients doing “all they can” and still not getting protection.

“I really do share the concerns that have been expressed by our ACIP members about, you know, our patients, right now, they’re immunocompromised, that are doing all they can do by getting vaccinated, by having their close contacts vaccinated, and it’s not enough that they’re still not protected,” Fryhofer said.

The work to assess additional studies is ongoing, and the next step would be for the FDA to issue regulatory guidance.

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(WASHINGTON) — The Centers for Disease Control and Prevention is sticking with its guidance for now that only unvaccinated people need to wear masks to be safe, CDC Director Rochelle Walensky told reporters on Thursday.

Asked about The Washington Post report that administration officials are rethinking its messaging on masks, Walensky said “we are always looking at the data as the data come in.”

But she said the CDC guidance hasn’t changed and suggested that — for now — there’s no need.

“Fully vaccinated people are protected from severe illness, and we’ve always said that communities and individuals to make the decisions that are right for them based on what’s going on in their local areas,” she said.

She later added: “In areas that have high and low amounts of vaccination … if you’re unvaccinated, you should absolutely be wearing a mask. If you’re vaccinated, you have exceptional levels of protection from that vaccine, and you may choose to add an extra layer of protection by putting on your mask and that’s a very individual choice.”

Jeff Zients, the White House coordinator on COVID-19, said any public health guidance is up to the CDC.

“We will follow the science,” he said.

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(LAS VEGAS) — With coronavirus infections on the rise again in the U.S., hospitals across the country are trying to meet the needs of thousands of patients who are testing positive for COVID-19, and are in need of medical care.

One state that has seen a rapid increase in COVID-19 cases and hospitalizations has been Nevada, where case levels have swelled by nearly 200% in the last month, the state’s highest level since February, according to the U.S. Centers for Disease Control and Prevention.

“Basically, we’re reliving 2020 in 2021,” Dr. Angie Honsberg, medical director for the intensive care unit at University Medical Center told ABC News. “We, unfortunately, are back to having a very high number of COVID patients. We have had a break for the last two and a half months and unfortunately, now we’re back to feeling like we were back in January in February when close to half of our ICU was critically ill patients with COVID respiratory failure.”

Since mid-June, the average number of patients being admitted to the hospital each day with COVID-19 in Nevada has tripled, according to the CDC. This marks the highest number of patients seeking care in more than five months.

Although hospitalization levels in Nevada and nationwide remain significantly lower than at their peak in January, as of Wednesday, 38 states and territories are reporting an increase of 10% or more in hospital admissions over the last week, with nearly 22,000 patients hospitalized around the country, the CDC said.

In light of the state’s recent viral resurgence, Nevada joined a growing list of states on Chicago’s travel advisory list, which will require travelers to either quarantine for 10 days or present a negative COVID-19 test result.

The majority of the state’s infections, according to the CDC, appear to be coming from Clark County, home to Las Vegas, where cases have been steadily increasing since June. In the last week, hospital admissions there have increased by more than 16%.

“Sadly, we’re reliving a lot of what we experienced last year, in the recent weeks,” Dr. Luis Medina-Garcia, an infectious disease physician at UMC, told ABC News. “As businesses reopened, and there’s more traffic of tourists to our city, this increased exposure has resulted in new cases of COVID-19 almost exclusively in the unvaccinated population.”

Thus, with cases increasing, last week, the Southern Nevada Health District also announced it would recommend both unvaccinated and vaccinated people wear masks in crowded indoor public places, “where they may have contact with others who are not fully vaccinated.”

Health experts say the likely driving force behind the significant increase in cases across the country has been the highly infectious delta variant, which is now estimated to account for more than 83% of all new cases.

Although it is still unknown whether the delta variant is potentially more dangerous, this strain of the virus is more efficient at transmitting the disease, and Honsberg said it appears to more virulent, with patients becoming sicker faster.

“The current group of patients seems to get sick quicker than the patients that we saw with the earlier COVID outbreak and we’re also seeing, for the most part, a younger group of patients,” Honsberg said.

Some of the patients have very severe pneumonia, Honsberg added.

A similar message is conveyed by Robin Ringler, charge nurse in UMC’s Medical ICU, who said that the patients she is seeing in the ICU are very sick, many struggling to breathe, and on ventilators.

In fact, she said, some of these patients are so sick “that the doctors currently are talking about doing tracheostomy on them, and that is going to keep them on the ventilator for prolonged periods of time because they cannot breathe on their own.”

Ringer’s team is now anticipating more COVID-19 ICU admissions, with a growing number of COVID patients appearing in the emergency room.

“In the last two weeks, we’ve had a real increase in COVID infections in the hospital. Our COVID numbers have gone up so high. They’ve almost, I think they quadrupled from two weeks ago,” Ringler said. “The number of patients seeking treatment has been getting higher every week.”

The increases are a discouraging development, said Ringler, when vaccines were introduced, and cases began to decline, her team thought they may have been finally out of the woods.

According to the White House COVID-19 Task Force, nearly all of these patients, 97%, are unvaccinated.

Just 43% of Nevada residents have been fully vaccinated against COVID-19, “which is a growing concern for us, when our data shows that about 85% of our COVID-19 patients are without a history for vaccination,” added Alma Angeles, director of Critical Care Services at Sunrise Hospital and Medical Center in Las Vegas.

“We’ve had many patients that have told us that they wish they had been vaccinated. Sadly, it’s too late by the time they get to us,” Dr. Luis Medina-Garcia, an Infectious Disease Physician at UMC, told ABC News. “The death toll from this disease is unbearable. It is unspeakable the loss of life, health, and outcomes that we have had to go through. It’s just sad to see people getting sick, for no good reason.”

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(WASHINGTON) — Puerto Rico could lose Medicaid funding in less than two months, putting at risk roughly 1.5 million people — nearly half the island’s population — unless Congress acts quickly.

As COVID-19 continues to batter the island — with at least 2,561 deaths among 141,905 confirmed cases, according to World Health Organization data — several U.S. representatives have teamed up to propose the Supporting Medicaid in the U.S. Territories Act.

“Territories get less funding through Medicaid than states do, and it has led to all sorts of adverse health outcomes, debt and a sub-standard of living in those areas,” Rep. Darren Soto, D-Fla., told ABC News in an interview. Puerto Rico was getting “far less than many states, and that led to an erosion of their health care system.”

The territory’s annual Medicaid needs are predicted to reach about $3 billion, but due to restrictions in the Social Security Act Section 11108, Puerto Rico has instead only been given roughly $375 million in Medicaid for the year, Puerto Rican Gov. Pedro Pierluisi told ABC News.

Puerto Rico, by statute, is only set to receive 55% of what is needed to fund Medicaid each year from the federal government, according to the think tank Center on Budget and Policy Priorities. But since the island’s federal block grant is small and often exhausted, CBPP reports that some years the Medicaid program is funded at less than 20%. Whatever the federal government doesn’t pay for, the island is responsible.

“The funding is not the same we would be getting as a state,” Pierluisi said. “You cannot plan or budget reasonably when you are facing this [Medicaid] cliff every couple of years.”

The new bill states that it would extend the federal Medicaid funding to account for 76% of what is needed for five years, offering much relief during the island’s ongoing economic crisis. Mississippi, the poorest U.S. state, also gets 76%.

But with a 43.5% poverty — more than twice that of Mississippi — and higher rates of diabetes, hypertension, asthma and more, Puerto Ricans need reliable health coverage perhaps more than ever.

Roughly 46% of the island’s population relies on Medicaid, according to the Medicaid and CHIP Payment and Access Commission, and almost 44% of Puerto Ricans live in poverty.

“We need that money to provide good medical and hospital services to our population,” said Jorge Galva, executive director of the Puerto Rico Health Insurance Administration. “There is a dire need to provide the full complement of Medicaid services.”

Providing care, Galva added, is made even more difficult as thousands of physicians and other health professionals continue migrating to the U.S. mainland, where they typically receive better pay and enjoy a higher standard of living.

Even with an increased amount of Medicaid funding for Puerto Ricans, Galva said, this wouldn’t be enough to help the island offer some of the federally mandated services, like nursing home care, home health care and nonemergency medical transportation.

“Over the years,” Galva continued, “the gap between the cap on the federal funds for our Medicaid program and the needs of the program grew bigger and bigger and bigger. As a territory, and under the present state of the law, Congress is fully allowed to discriminate and make differences between the treatment to territories and states.”

Local officials are calling on lawmakers to address what’s seen as the U.S. neglecting Puerto Rico because it’s a territory, not a state.

“It’s a matter of fairness and equity that we receive funding in parity with the states and allow Puerto Rico to provide its medically indigent population with all the services they need and deserve,” Galva said.

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The anesthesia medication ketamine is showing increased promise as a treatment for people experiencing depression who haven’t found relief with other prescription medications.

Though ketamine is known for its recreational use as a party drug, it can also be prescribed legally by doctors. In recent years, ketamine has become more accessible for those struggling with depression. In 2015, there were fewer than 60 ketamine clinics in the U.S. Three years later, there were more than 300, according to the journal of Psychiatry and Clinical Neurosciences.

Generic ketamine isn’t specifically approved as a depression treatment, but U.S. doctors are often allowed to prescribe Food and Drug Administration-approved medicines “off-label” for another use.

A growing body of evidence has shown ketamine, which has been used since the 1970s in the field of anesthesia, can be successful in treating depression and suicidal behaviors. In fact, ketamine is part of a growing field of research into whether drugs that have traditionally been viewed as illegal psychedelics or party drugs could, in certain contexts, help people with depression, post-traumatic stress disorder and other behavioral health and psychiatric disorders.

In 2019, the FDA approved Spravato, a ketamine-related nasal spray drug, given in conjunction with antidepressants that has been shown to help people with treatment-resistant depression. But many clinics offer generic ketamine, often in the form of intravenous infusions.

Dr. Steven Mandel, founder and president of Ketamine Clinics Los Angeles, said because ketamine is already a low-cost generic drug, it’s unlikely that a pharmaceutical company would pay for the process that would be needed to get the drug approved specifically as a depression treatment.

“For a medicine like ketamine that is already approved and available, adding a new indication for the treatment of depression would probably cost tens of millions — if not hundreds of millions — of dollars,” Mandel said. “No one wants to spend that money.”

But ketamine’s unique status can create problems for patients. Ketamine’s use for depression is off-label and it is typically not covered by health insurances. Because of this, “there are some access issues,” said Dr. Panagiota Korenis, a psychiatrist and associate professor at the Albert Einstein College of Medicine.

“It’s often limited to a subset of the population that can pay out of pocket or be a part of a trial,” she said.

There are also certain risks associated with ketamine.

“It is a drug that can be abused potentially,” said Korenis, who noted that patients typically need to be treated in the clinic and typically cannot take multiple doses of the medication home with them.

Nevertheless, Korenis is hopeful ​that ketamine may prove itself as another powerful option for those with depression.

“Ketamine certainly is being shown to be a medication of interest and one that has potential for the future,” said Korenis.

Experts debate whether ketamine is a psychedelic and able to produce similar altered states of consciousness as MDMA and psilocybin, which have shown healing properties in some studies.

But many clinics are opting to administer ketamine in a manner similar to psychedelics in clinical trials. Ketamine-assisted psychotherapy, or KAP, is a combination of ketamine and therapy that is similar to psychedelic-assisted therapy used in recent carefully controlled clinical trials.

For example, MDMA, also known as molly or ecstasy, is a psychedelic drug that is now being studied in controlled therapy settings as a possible treatment for PTSD. But no psychedelic treatments are FDA-approved, meaning doctors cannot administer them outside of a clinical trial. MDMA is illegal for recreational use in the U.S.

For those who are unable to get into a clinical trial of psychedelics like MDMA and psilocybin, KAP may be the closest legal equivalent.

“Ketamine works for depression and suicidality — it works quickly, it’s safe,” said Mandel. “For the other medicines, we just don’t know. They seem to have great early promise, but we do need a lot more data and a lot more time before we can fully embrace them.”

Psychedelics like MDMA and psilocybin may require a couple of more years until they receive FDA approval, according to Rick Doblin, Executive Director of the Multidisciplinary Association for Psychedelic Studies. In the meantime, Mandel hopes more patients learn about ketamine as an option for depression.

“Ketamine should be available to anyone suffering from these afflictions,” said Mandel.

Nicholas Nissen, M.D., is an author, host of the “Brain Health with Dr. Nissen” podcast and a contributor for the ABC News Medical Unit.

 

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(WASHINGTON) — With more than 161 million people now fully vaccinated in the U.S., experts say we are bound to see reports of breakthrough infections, meaning people test positive for COVID-19 while fully vaccinated.

These breakthrough COVID-19 cases aren’t proof the vaccines aren’t working, experts said, but are normal and expected. All evidence suggests that even in the face of the new, highly-transmissible delta variant, COVID vaccines are still working as they should to dramatically decrease the risk of hospitalization and death.

“When you hear about a breakthrough infection, that doesn’t necessarily mean the vaccine is failing,” Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said before Congress on Tuesday.

COVID-19 vaccines are highly effective, but they do not block the virus 100% of the time, meaning that some breakthrough infections occur after vaccination.

“I think people need to appreciate when you talk about breakthrough infections that the original data from the clinical trial — the efficacy data was based on preventing clinically apparent disease, not preventing infection, such as a symptomatic infection,” Fauci said.

Despite many high-profile cases of breakthrough infections with mild or no symptoms, including among Olympic athletes and some politicians, the overall number is very low compared to the number of people vaccinated.

And the number of people who have been hospitalized or died after being fully vaccinated is even lower, according to the U.S Centers for Disease Control and Prevention (CDC) and state health departments. This demonstrates that vaccinated people are far less likely to die of COVID-19 compared to unvaccinated people.

That doesn’t mean severe illness as the result of an infection isn’t possible, but this tends to happen in people who are elderly or otherwise immune-compromised, experts said.

“Out of 157 million fully vaccinated in the US, there were 4,909 hospitalizations and 988 deaths,” Dr. Carlos del Rio, infectious disease physician and professor of Medicine in the Division of Infectious Diseases at Emory University School of Medicine, said during a press briefing on Monday.

“Of course we will see some breakthrough infections that lead to severe illness, more in vulnerable populations with underlying chronic conditions who couldn’t mount a response to vaccines because they couldn’t,” Dr. John Brownstein, an infectious disease epidemiologist at Boston’s Children’s Hospital and an ABC News contributor, told ABC News.

Although studies on this aren’t completed, Fauci said last week that the risk of a vaccinated person spreading COVID to someone else is assuredly far less than an unvaccinated person spreading COVID.

“You could make a reasonable assumption that the rate of transmissibility from the asymptomatic vaccinated person to an uninfected person would be less likely than if the person was unvaccinated,” Fauci said at a White House COVID-19 Response Team briefing last week.

The overall number of breakthrough infections is rising, but that could be because more people overall are getting vaccinated, resulting in more breakthrough cases, Dr. Shobha Swaminathan, an associate professor and infectious disease expert at the Rutgers New Jersey Medical School, told ABC News.

“As the number of infections in the U.S. increases, there may be a slight increase in the number of ‘breakthrough’ infections,” Swaminathan said. “However, the majority of infections continue to be reported among those who have not been vaccinated.”

Experts said the delta variant could be contributing to these cases, but for now, research is ongoing.

“If it causes an increased rate of breakthrough infections, that’s unknown,” adds Brownstein.

But experts feel reassured by what they do know, that even with the highly-transmissible delta variant sweeping the country, more than 99% of COVID-19 deaths are among people who are unvaccinated.

 

Alexis E. Carrington, M.D. is an ABC News Medical Unit Associate Producer and a rising dermatology resident at George Washington University. Sony Salzman is a Coordinating Producer for ABC News Medical Unit.

 

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(NEW YORK) — With many students heading back to school soon, researchers are gathering information that can help schools set COVID protocols.

Some devices being studied are portable air purification units, which could add a layer of protection and slow the spread of aerosols and droplets in a classroom setting. In fact, New York City plans to have such devices in its classrooms.

Good Morning America got an exclusive look at testing by the Mayo Clinic and the University of Minnesota at the Well Living Lab to examine these devices.

“I think it just provides another layer of security for people,” Dr. Bruce Johnson of the Mayo Clinic told GMA.

In its study, a team of more than 20 researchers built an experimental “classroom.” They rigged up a mannequin in the center to spray out a neon-colored solution to mimic how a sick student might spread particles as they breathe.

Then, researchers measured what was collected on 70 surfaces all over the room, such as desks, chairs and iPad, to see how the droplets spread with and without air purification.

“We’re able to say at each point in the room — how quickly are particulars depositing on different surfaces,” researcher Dr. Zachary Pope said.

Researchers also found that using portable air purifiers to supplement a classroom HVAC system, it may result in up to five times lower particle concentration in the air, improving air quality throughout the room, not just near the unit.

The study from the Mayo Clinic and the University of Minnesota drew similar results to a study from the Centers for Disease Control and Prevention conducted earlier this month.

The agency now recommends schools should “filter and/or clean the air in the school by improving the level of filtration as much as possible.”

“I think they [parents] should be put at ease in the sense that we have solutions available,” Hogan said. “There’s a lot of information that is — now available to school administrators and they should be comfortable with the fact that they’re looking into it. And hopefully will be able to implement these solutions.”

For teachers or parents looking to invest in an air filter system, researchers said that any portable air filtration system will do the job. But a quick skim through the product specifications will show how many square feet the product will cover to ensure that it covers enough units of the entire room.

If an air filtration system is beyond your budget, another option would be to update your HVAC system or open a window to add that layer of protection.

 

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