Biden administration moves forward on banning surprise medical bills

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(WASHINGTON) — The government took the first steps to end surprise medical billing on Thursday, getting the ball rolling on a law that was passed under former President Donald Trump’s administration and takes effect this January.

The law bans health care providers from issuing surprising bills that are shockingly high because patients unknowingly got out-of-network procedures even though they were at doctors’ offices or hospitals that take their insurance. One example of the practice is a patient getting surgery at a hospital that’s in-network but then being billed thousands of dollars because the anesthesiologist who put them under was out-of-network.

Starting in January, instead of being charged a high out-of-network rate without advanced notice, the new rule issued by the Department of Health and Human Services on Thursday mandates that hospitals and doctors’ offices notify patients when they’re receiving out-of-network care and charge people an in-network price for it. It also creates a complaint system to report surprise billing.

“It bans high out-of-network charges that come without advanced notice,” Health and Human Services Secretary Xavier Becerra said at a press conference on Thursday.

The enactment of this law is a big deal on both sides of the aisle. Becerra called it bipartisan hallmark legislation “only second to the Affordable Care Act” in the “major difference” it will make in Americans’ lives and healthcare. The bill, pushed by the Trump administration and written with Republican and Democrat input in Congress, was signed last year.

About one of every five trips to the emergency room and one of every six inpatient hospital stays result in care from an out-of-network provider and subsequent surprise medical bills, according to one 2020 study.

Thursday’s rule is the first of major regulatory interpretation of the new law and, along with future rules to come, will set the guidelines for how to eliminate surprise medical billing, both for patients and for health care providers.

“We’re striving to make everything as simple, straightforward and clear as we can so that everyone can assert their rights and know what they should and shouldn’t do,” Becerra said.

“But it’s all critical because it prevents people from being blindsided with some of these charges.”

Here’s what the first rule does:

  • It forces health care providers to give notice of out-of-network care and get consent for it. In emergency situations, patients would be billed in-network rates for care, regardless of whether it’s in-network under their health insurance plan. “Health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate,” HHS said in a statement.
  • It sets up an arbitration process for patients to report hospitals and doctors who issue surprise medical bills. The health care providers can then be billed thousands of dollars in fines if they continue to issue those surprise bills.
  • It sets up how much hospitals and doctors should be charging for out-of-network care in unexpected settings. It will be a standard, in-network rate, and while patients will still be responsible for paying it, rates aren’t expected to be as astronomically high. “Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates,” HHS said in the statement.

The rule also doesn’t address ambulance rides, which experts say remains a hole in surprise medical billing. Over half of all emergency ambulance rides were charged out-of-network rates in 2018, according to a Kaiser Family Foundation analysis of the data. Cynthia Cox, vice president of KFF, also pointed out on Thursday that patients might unknowingly give “consent” to hospitals for out-of-network charges by signing forms that are put in front of them.

“Still making my way through the rule, but there is some good and bad news for patients in here,” Cox tweeted. “The good includes that emergencies are defined broadly & retroactive ER coverage denial is no longer allowed. The bad is that some patients might inadvertently sign away their rights.”

Senior HHS officials described it as primarily focused on patients and their financial liabilities after surprise medical billing, acknowledging that many questions still need to be answered on how it will work for insurance companies and doctors offices or hospitals — clarity that is expected in future rules.

“We want to make sure that we put enough meat on this bone so that no one is surprised about how it needs to be implemented, not just the patients but also the providers and insurers. And so we certainly have to work on this whole issue of arbitration, and the cost, there will be a need to make further clarifications on definitions,” Becerra said.

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What the delta variant means for Americans this summer

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(NEW YORK) — The delta variant now makes up more than 26% of new COVID-19 cases in the U.S. and has been detected in all 50 states, according to data from the Centers for Disease Control and Prevention.

Just a month ago, the variant, which was first identified in India, made up just 3% of new cases in the U.S.

In response to the worldwide threat posed by the variant, which is believed to be both more transmissible and more virulent than other strains, the World Health Organization shifted guidance, and now recommends that vaccinated individuals wear masks indoors. In the U.S., the CDC stayed the course, with health officials continuing to assert that fully vaccinated Americans do not need to wear masks inside.

According to CDC Director Rochelle Walensky, the United States’ strong vaccination rate and its use of highly effective vaccines enables it to do things differently. By comparison, much of the world is unvaccinated and evidence suggests that certain vaccines developed outside of the U.S. are less effective than Pfizer, Moderna and Johnson & Johnson.

“The vaccinated, we believe, still are safe,” Walensky told ABC News’ Good Morning America.

Given differences in vaccinations rates at the local level, however, local officials should decide whether to require vaccinated people to wear masks again, Walensky added.

Already, Los Angeles has reversed its guidance. Although the county dropped its mask mandate earlier this month, as of this week, the Los Angeles County Department of Public Health “strongly recommends” unvaccinated and vaccinated people wear masks inside public places, like restaurants, stores and movie theaters.

With that context in mind, here’s how to approach masking this summer, as the delta variant continues to spread:

I’m fully vaccinated. Should I wear a mask indoors while at restaurants or shopping?

No, unless local officials recommend or require it. (A caveat: If wearing a mask makes you feel more comfortable, or if you’re immunocompromised, you’re under no obligation to take yours off.)

According to the best evidence we have, it’s safe for fully vaccinated people to forgo masks indoors this summer. If you’re fully vaccinated, meaning you’ve received both doses of the Pfizer or Moderna vaccine, or the one-dose J&J vaccine and the final dose has fully vested, “you are highly protected from the delta variant and to even higher degree, you’re protected from severe disease or hospitalization,” said Dr. Vivek Cherian, an internal medicine physician with the University of Maryland Medical System.

A study the British government conducted in April and May, which analyzed more than 12,000 sequenced COVID-19 cases, found that two doses of Pfizer were 88% effective against symptomatic disease from the delta variant. Preliminary data released by Moderna, which has not yet been peer-reviewed, found that the vaccine was highly effective against the delta variant, but did not indicate an exact efficacy number. Like Pfizer, Moderna was slightly less effective against delta than against the original virus strain. Although more research needs to be done on J&J and the delta variant, preliminary research shows the vaccine performed well against the delta variant, the company said Thursday.

The guidance is completely different if you’re unvaccinated or partially vaccinated. In those instances, “there is a good chance you’re actually going to catch this variant,” Cherian said. “There’s no question that in those circumstances you want to be wearing a mask.”

In his own life, Cherian, who lives outside of Baltimore, wears a mask inside stores to set an example for his children, who are both under the age of 12 and too young to be vaccinated. When he shops alone, however, he goes maskless.

“We’re not really changing anything that we’re saying,” he said of the delta variant. “Yes, this is a little bit more serious, but only for individuals who are incompletely vaccinated, and especially for the unvaccinated. For the fully vaccinated, the story hasn’t really changed at all for you.”

Got it. So then why did Los Angeles strongly recommend masks for vaccinated people?

Los Angeles’ choice may be primarily about protecting the unvaccinated.

According to a statement issued by the Los Angeles County Department of Public Health on Wednesday, the department “strongly recommends everyone, regardless of vaccination status, wear masks indoors in public places as a precautionary measure.” The department acknowledged that “fully vaccinated people appear to be well protected from infections with Delta variants.”

“We have always said that this virus is an opportunist,” Walensky said. “We are still seeing uptick in cases in areas of low vaccination and in that situation, when you’re suggesting that policies be made at the local level, and those masking policies are really intended to protect the unvaccinated, the vaccinated we believe still are safe.”

Dr. Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security, pushed back on Los Angeles’ masking decision.

“The delta variant treats the vaccinated person very differently than it treats someone who’s not vaccinated,” he said. “I’m not sure why the Los Angeles County Health Department would treat people as if they’ve not been vaccinated when they have.”

For counties with very low vaccination rates, or for businesses, it might make operational sense to require masks for everyone, he added, in order to avoid having to figure out everyone’s vaccination status and ask the vaccinated to put on masks.

“My understanding is that Los Angeles County is not a low vaccination county,” Adalja added.

Indeed, Los Angeles’ vaccination rate appears to be in line with the national average. Sixty-eight percent of residents ages 16 and older have received at least one dose of the vaccine in Los Angeles County, according to the health department. Nationally, 64% of people ages 12 and older have gotten at least one dose, according to the CDC.

Rates are lower for younger Angelenos, with just 36% of those between the ages of 12 and 15 having received at least one dose.

I got the J&J vaccine. Am I safe to take my mask off inside?

People who got the J&J vaccine can behave the same way as those who received Pfizer or Moderna, health experts said.

“There’s no data to show that breakthrough infections with delta are more common with the J&J vaccine or that they’re more severe,” Adalja said.

And while scientists want to see more data from J&J, Adalja doesn’t think there’s enough evidence to support getting a Pfizer or Moderna booster shot to “top off” the J&J vaccine just yet.

Importantly, he thinks the public is looking at the vaccines wrong.

“This COVID zero idea keeps creeping into people’s minds,” he said. “People are still very focused on cases and not necessarily focused on severe disease, hospitalization and death. If you’re a fully vaccinated individual and you get a breakthrough with the delta or any of the other variants, it’s likely to be clinically meaningless.”

COVID is now an endemic respiratory virus in the U.S., Adalja stressed, and Americans need to learn to treat it that way.

“We’ve got to figure out a sustainable way to teach people to risk calculate and be able to cope with the fact that this is a new infectious disease that we have,” he said.

Copyright © 2021, ABC Audio. All rights reserved.

Dozens of states end daily COVID-19 data reports, causing experts to fear hidden outbreaks

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(NEW YORK) — After 16 months of coronavirus-related restrictions and requirements — mask mandates, social distancing, extensive state of emergencies — nearly every jurisdiction in the country has now moved to ease up or, for some, completely lift them.

The move comes as many communities attempt to begin to return to some sense of pre-pandemic normalcy, following a 95% drop in the number of cases since the beginning of the year when infections peaked at over 250,000 cases a day.

Less than 12,000 patients are hospitalized with the virus across the country — a stark difference from the early months of 2021, when 10 times that amount were hospitalized nationwide.

Despite the hopeful news, health experts suggest that current metrics do not tell the full story of the United States’ continued struggle with COVID-19.

According to an ABC News survey of state COVID-19 information dashboards, more than two dozen states have now either opted to no longer offer daily statistical coronavirus updates or plan to end daily reports in the coming weeks, a choice which has been a source of great concern for health experts as the more virulent delta variant spreads.

“Without real-time reporting, we are essentially flying blind as to the state of the pandemic. Lack of timely surveillance data will create blind spots and potentially a false sense of security as we struggle with vaccination uptake and the rise of new variants,” said Dr. John Brownstein, chief innovation officer at Boston Children’s Hospital and an ABC News contributor.

Some of these states have moved to offer only weekday updates, others are reporting metrics every few days, and a few are now only offering weekly breakdowns. While state officials insist they will continue to monitor data, the frequency of public updates will be limited.

The importance of daily data cannot be overstated, said Beth Blauer, executive director of the Centers for Civic Impact at Johns Hopkins University, in a post earlier this month. Data provided by the states has “led to major policy decisions across all levels of government and influenced the behavior and decisions of many Americans.”

Blauer urged officials to “stay the course of daily reporting, and not allow their data to go ‘stale’ by releasing it infrequently.”

One of the states that has moved to shift to a more infrequent reporting schedule is Florida. Although it is still reporting the highest total number of coronavirus cases in the country, earlier this month it became the first large state to end its daily coronavirus report, and move to a weekly model.

“Florida has transitioned into the next phase of the COVID-19 response,” a spokesperson from the Florida Department of Health said in a statement to ABC News, stressing that the department remains committed to infectious disease control, surveillance and prevention.

The erratic data reporting comes as a growing list of states see upticks in their COVID-19 case metrics. In the last seven days, 19 states have reported an increase of 10% of more in their daily case average. Several states, including Alabama and Nevada, have seen their case metrics double over the last two weeks, although numbers still remain significantly lower than at their peak earlier this winter.

Some health experts are concerned that the lack of daily data, which plays a critical role in determining response to the virus, could mask potentially dangerous new outbreaks, particularly in areas of low vaccination rates.

“I’m extremely concerned that we’re repeating history,” said Maureen Miller, an infectious disease epidemiologist at Columbia University, pointing to the U.S.’s “failure to react” in early 2020, when the virus was first spreading across the globe.

“We saw it coming yet failed to react and prepare in a meaningful way. Now we’re watching the delta variant charge through countries like Israel and the U.K., which have much higher vaccination rates than the U.S. Why we think this variant won’t wreak havoc in the U.S. is beyond me,” she said.

Falling coronavirus metrics have led some officials to declare victory against the virus; however, a number of experts suggest the country’s current COVID-19 figure may be higher than reported.

“With fewer public health departments reporting daily, we risk relying on data that represents a distorted view of the true burden of illness. An undercount in cases undermines the legitimacy of public health reporting and may mask any early indications of a surge, especially in unvaccinated populations,” said Brownstein.

National data has been impacted as well. The Centers for Disease Control and Prevention aggregates state data as it is released, and thus, the agency’s totals are often impacted by delays in state updates. Additionally, the agency is no longer offering case and death data updates on weekends.

In recent months, as officials have reallocated resources and efforts to state vaccination drives, testing levels have also plummeted.

The nation is now recording around 600,000 coronavirus tests a day, significantly lower than the nearly two million tests a day the U.S. was reporting at the beginning of the year, another cause for concern for health officials who have repeatedly warned that drops in testing could lead to missed infections and subsequent spread.

“While we realized the value of testing and reporting at scale far too late in the pandemic, we are now repeating these mistakes by winding down public health efforts far too soon,” added Brownstein.

Even so, many states continue to close testing sites, including Iowa, which will cease operations of its statewide testing program later this month. Less than 50% of Iowa’s total population is fully vaccinated.

In other states, like Utah, health officials are still urging residents to get tested, as the state faces renewed concerns over rising coronavirus cases, with a 73% increase in cases over the last four weeks.

The number of people getting tested for COVID-19 has decreased dramatically in recent months, the Utah Department of Health reported on Tuesday, from over 32,000 weekly cases in mid-November, to approximately 5,900 tests conducted the week of June 14.

“The pandemic isn’t over yet. In fact, now that new variants are circulating and some are even more transmissible, finding out if you’re positive and isolating can prevent you from exposing others,” the department said in a press release on Tuesday.

Earlier this week, the CDC reported that the highly infectious delta variant, which has been found in all 50 states, is now estimated to account for 26.1% of new cases across the country.

It is still unclear exactly how widespread the delta variant is, because U.S. genomic sequencing also remains low across the country.

“I am disappointed that we’re not treating this adversary with the respect it deserves,” Miller said. “Now, when cases are low and traditional outbreak investigations and contact tracing could be a reality, we’re dropping the ball.”

Despite health officials’ pleas for more Americans to get vaccinated to curtail the spread of the delta strain and other concerning variants, the U.S. continues to struggle with falling vaccination numbers.

Over 45% of the total population has still yet to be vaccinated with their first dose of a COVID-19 vaccine, and according to CDC Director Dr. Rochelle Walensky, approximately 1,000 counties in the U.S. have vaccination coverage of less than 30%.

Current evidence suggests that full dosage of the mRNA COVID-19 vaccines is effective against the delta variant. According to a recent U.K. study, two doses of the Pfizer vaccine offered 88% protection, and earlier this week, Moderna had released new preliminary data, not yet peer reviewed, in which the company’s vaccine appeared to work against all concerning variants, including the delta variant.

In an effort to prevent potential outbreaks, the White House COVID-19 response team reported on Thursday that it would be intensifying efforts in some high-risk communities to help states prevent, detect and respond to hotspots among the unvaccinated by mobilizing COVID-19 surge response teams to be at the ready to deploy federal resources and, where needed, federal personnel.

Miller asserted, however, that the country’s current vaccination level “absolutely” does not provide enough protection to have shifted into a new phase of less testing and surveillance of the virus.

“Denial didn’t work when it first came to the U.S. or last summer when it hit the South or last winter when it hit everywhere. Sadly, it’s places with low vaccination rates that will bear the brunt of this round of infections. These are the same places that will lack testing. They won’t know that it’s hit them until it’s too late,” Miller concluded.

Copyright © 2021, ABC Audio. All rights reserved.

Girls open lemonade stand to honor late sister and raise awareness for organ donation

Courtesy Monica Madsen

(NEW YORK) — Two girls set up a lemonade stand to raise money for organ donations in honor of their late sister.

Makenzie Madsen was born with congenital heart disease and received a heart transplant at 17 months old. In 2019, her heart and kidneys started shutting down and she was taken to the hospital, where she went into cardiac arrest. She waited there for almost a year for a new heart and kidney transplant when she died on July 13, 2020, at age 14. Now, her sisters, Myleigh, 9, and Makayla, 7, have set up a lemonade stand in her honor.

“We just talked about what we could do because her anniversary is coming up,” the girls’ mother, Monica Madsen, told ABC News’ Good Morning America.

The idea was inspired by Makenzie herself, who would often set up a table and chair outside of their West Jordan, Utah, home to sell everything from baked goods to snow cones while growing up.

“She just loved to bake and cook,” Madsen said. “She even made her own snow cone flavors out of Kool-Aid.”

While she leaned toward making sweets, Madsen said Makenzie didn’t have a sweet tooth or like to eat them.

“I think she just loved interacting with people and seeing people smile,” she said.

The stand’s design is also an ode to Makenzie.

“Teal was our older sister’s favorite color,” Myleigh told GMA. “The other stripe is pink — Makayla’s favorite colors.”

Myleigh and Makayla want to use the stand to raise awareness on the importance of organ donation and how it can save lives.

“They want to open people’s eyes and hope people understand how important it is to say yes to organ donation,” their mother said. “They don’t want other kids to feel this — if their siblings have been waiting for a transplant and they didn’t make it. That’s what they talked to me about.”

According to data from the U.S. Department of Health and Human Services, around 17 people die each day while waiting for an organ transplant in the U.S. The average wait time for one is three to five years and, at the time of publication, the current amount of people on the waitlist for a heart is 3,601. For a kidney, that number soars to 90,567.

So far, the family has raised approximately $6,000 and will be donating all of the proceeds to DonorConnect, a nonprofit organization that assists families in the Mountain West with the organ donation process.

Myleigh said that she and her sister want to “get even more money to help other kids.”

In addition to lemonade, the girls are making cake pops to sell and will also try their hand at cotton candy.

“We’ve just tried to keep her spirit alive,” Madsen said. “She’s up there cheering them on and helping them out and rallying people to go see the stand.”

The family will be wrapping up the lemonade stand for the summer shortly, but plan to continue every year just like they said Makenzie would have.

Copyright © 2021, ABC Audio. All rights reserved.

J&J vaccine seems to stand up against Delta variant, preliminary research suggests

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(NEW YORK) — In reassuring news for the more than 12 million Americans vaccinated with Johnson & Johnson, a new study indicates the single-shot vaccine will likely offer good protection against the delta variant, according to the company.

The highly transmissible delta variant is now predicted to become the dominant strain in the United States.

The findings are preliminary but promising. In a laboratory experiment, researchers analyzed the blood of 10 people who had been vaccinated with the single-shot Johnson & Johnson vaccine, and tested it against multiple concerning variants, including delta.

They found that the vaccine appeared to work against new variants, as indicated by so-called “neutralizing antibody titers” and other indications of immune system response.

Prior data has indicated that other vaccines, including those made by Pfizer and Moderna, are likely to hold up against the delta variant. But some experts worried the Johnson & Johnson vaccine, which unlike the others, only includes one dose, might not fare as well.

“I would say it’s reassuring,” Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center, who helped lead the research, told ABC News. “We found the J&J vaccine induces neutralizing antibodies.”

In fact, Barouch said another reassuring finding of the study was that people vaccinated with the Johnson & Johnson shot appeared to have a strong immune system response up to eight months later.

“We saw surprisingly good durability of responses,” Barouch said. “We followed these individuals for eight months, and over eight months, the antibody and T cell responses were very stable.”

A growing body of evidence suggests that COVID-19 vaccines may offer longer-lasting protection than some scientists initially anticipated. That’s because other parts of the immune system, cells called memory B cells, continue to mature over time, and retain their ability to fight infection.

Barouch cautioned there are limitations to this research, which offers researchers helpful clues from laboratory experiments rather than real-world evidence from thousands of people.

“Our findings show that a single shot of the J&J vaccine raises robust neutralizing antibody levels against the delta variant. Our study does not show clinical protection,” he said.

But for those who were vaccinated with the single-shot Johnson & Johnson vaccine, this study is a reassuring indication that the vaccine is likely to work just as well against the delta variant as it does for other circulating variants.

Copyright © 2021, ABC Audio. All rights reserved.

Arkansas braces for 3rd COVID-19 surge as vaccination rate slows

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(LITTLE ROCK, Ark.) — As COVID-19 vaccination rollouts continue and the U.S. returns to a semblance of normality, Arkansas officials are warning of a third surge following a spike in cases.

Arkansas, which never issued an official stay-at-home order during the pandemic, reported 686 new probable and confirmed COVID-19 cases Wednesday — the largest one-day increase in more than four months.

The state’s COVID-19 hospitalizations also rose by 19 to 325, and deaths increased by four to 5,909.

Gov. Asa Hutchinson said in a statement that “the high number of cases today makes it clear that the delta variant is increasing the spread of the virus” in the state.

So far, 34.3% of the state’s population has been fully vaccinated, according to the Centers for Disease Control and Prevention.

Hutchinson touted the effectiveness of vaccines during a Tuesday coronavirus briefing, saying 90.5% of current active cases in the state are among the unvaccinated, who, officials noted, also account for 98.3% of Arkansas’ 3,765 hospitalizations and 99.6% of the deaths since Jan. 26.

University of Arkansas for Medical Sciences Chancellor Dr. Cam Patterson said at the press conference that the delta variant is driving up case numbers.

The delta variant, first detected in the state on May 1, makes up more than 25% of infections in the state and is projected to make up more than half of all infections within a matter of weeks, Patterson added.

“We have to be concerned that this would be a trend that could continue, and if it does, it would appear that we may be in the third surge of COVID-19 here in the state of Arkansas,” he said.

Hospitals see more younger patients

Doctors in Arkansas told ABC News that the highly transmissible new variant, low vaccination rates and infrequent mask-wearing are fueling the surge.

Hospitals are seeing more and younger patients arrive, many with more severe symptoms, Dr. Jason McKinney, a pulmonologist and the ICU medical director at Mercy Hospital Northwest Arkansas, told ABC News. He said this isn’t because younger people are more susceptible to the virus but because more older people have been vaccinated.

“Most definitely we are seeing the beginning of a third surge,” McKinney said. “And as far as our inpatient load of COVID, we’re at about 30% of where we were previously. And so that makes me very concerned, because we’re very early on.”

As of Thursday, Mercy Hospital Northwest was treating about 16 COVID-19 patients at the hospital.

“The misconception of younger people is that if I’m at low risk of dying, I’d rather risk getting the disease and just be sick than get the vaccine,” he said, referring to people in their 20s to 50s. “COVID is often a virus that keeps on giving after you’ve gotten rid of it. And the amount of chronic fatigue, the neurologic problems, the vascular problems, cardiac problems and the pulmonary problems that people suffer from this disease long term, it’s scary.”

Last week, UAMS Medical Center in Little Rock reopened a unit for COVID-19 patients after shuttering it in April.

Dr. Steppe Mette, CEO of UAMS Medical Center, told ABC News that the hospital has seen a “300 to 400% increase in the number of patients with COVID just over the last three to four weeks.”

“So,” he added, “we’re back to hospitalization numbers that we haven’t seen since February or March. And that’s happening around the state.”

UAMS last reported having 22 COVID-19 patients in hospital beds and nine in the ICU. Around the city, there are over 100 hospitalized with the virus, Mette added. Previously “about a quarter of our patients hospitalized in the ICU, and now we’re running more like 50 to 70% in the ICU.”

Failed incentives

The vaccination rate in Arkansas, one of the lowest in the U.S., has slowed further despite the introduction of several incentive efforts.

Last month, the state launched a million-dollar vaccine incentive program, giving out Arkansas Lottery Scholarship $20 scratch-off tickets or a $20 gift certificate for the Arkansas Game & Fish Commission for new first doses, but it’s failed to bring up vaccination numbers.

Only 2,482 lottery tickets and 926 Game & Fish Licenses have been given out as part of the program, a Health Department spokeswoman told ABC News.

Data from Johns Hopkins shows that the state’s seven-day average vaccination rate sunk from 27,298 on April 1 to 4,591 on June 30.

Mette said while earlier in the year there were issues of accessibility, now the real battle is vaccine refusal.

“It’s more that there is a resistance, refusal or hesitancy to get a vaccine,” Mette said. “It’s more that they’ve been influenced by somebody else, that the vaccines are not safe, or they’re not necessary, or that the pandemic isn’t even anything real or to worry about it. That degree of resistance is pretty concerning.”

Stepping backwards

In a bid to curb an outbreak, some facilities have stopped in-person visitations, an echo of earlier on in the pandemic.

The Conway Human Development Center, a state-run residence for people with disabilities, stopped visitations after 20 staffers and 13 residents tested positive for the virus within a two-week period, according to ABC Little Rock affiliate KATV.

Under the state’s recently passed “No Patient Left Alone Act” visitors will be allowed if a resident requires emergency care or hospice care.

Baxter Regional Medical Center in north Arkansas tried to ban visitations at its emergency department last week only to walk that back after realizing it could no longer enforce it.

“We’ve been through a lot over the past year and a half,” McKinney said. “We’re worried that we’re looking at a similar situation where we’ve all been working extra days and nights and taking care of a high volume of patients. We’re very worried that we’re going back in that situation.”

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The boarding crisis: Why some kids are waiting days in the ER for psychiatric ward beds

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(NEW YORK) — When Carly Birmingham, a 7th grader from Massachusetts who identifies as nonbinary, was depressed and experiencing suicidal thoughts last fall, their mother drove to a local hospital emergency department at 2 a.m. hoping for immediate help.

But Carly says they ended up spending 14 days waiting for a psychiatric inpatient bed (seven in the emergency department (ED) and seven in a patient room) at Boston Children’s Hospital in what doctors and other experts describe as a troublesome and increasing practice that leads in many cases to substandard care for vulnerable patients — boarding.

“After a few days, I almost regretted [going to the hospital]. We were there, we were getting no sleep, and I wasn’t even getting any help. I was just sitting there waiting for a bed. And we didn’t know how long it was gonna take,” Carly, of Arlington, Massachusetts, told ABC News. Boston Children’s declined comment about Birmingham’s care citing privacy laws.

While there is no standard definition for boarding, the American College of Emergency Physicians describes it as the practice of holding patients in the ED after they have been evaluated because no inpatient beds are available or are awaiting transfer to another facility, which can result in lengthy wait times, possibly increased suffering among patients and strains overburdened EDs.

Boarding is a longstanding crisis in EDs across the country that some doctors interviewed by ABC News say has only worsened during the pandemic, especially in pediatric units. The coronavirus crisis has led to a surge in pediatric patients, like Carly, some of whom end up waiting days, if not weeks, for a spot in limited psychiatric wards.

The shortage of available psychiatric beds is also happening in the middle of a global pandemic, during which COVID-19 patients have died in hallways waiting for beds in overwhelmed hospitals.

While ED visits for other medical causes for children declined in the early stages of the pandemic, the number of children’s mental health-related ED visits rose 24% among 5 to 11-year-olds and surged 31% among 12 to 17-year-olds in April 2020 through October, compared to that period in 2019, according to a November Centers for Disease Control and Prevention report.

The pandemic also saw a rise in ED visits for suspected suicide attempts among young people. Among teen girls such visits were up 51% from February to March earlier this year compared to 2019, according to a June CDC report.

There is no nationwide data on mental health boarding numbers or wait times, however doctors in New York, Massachusetts and Colorado have painted similar pictures of inundated EDs.

Feeling ‘punished’ waiting for an inpatient bed

Dr. Amanda Stewart, an attending physician in the emergency department of Boston Children’s Hospital, where Carly was treated, said the hospital saw a surge in psychiatric cases in early spring 2021 and “we’re definitely not out of the woods.”

“Unfortunately, there’s a higher number of boarding behavioral health patients. We routinely have children that stay over 100, sometimes up to 200 hours in the ER,” Stewart told ABC News.

In Massachusetts, the number of all patients boarding in emergency rooms increased by 200 to 400% in June 2020 compared to the same month the previous year, the Massachusetts Department of Mental Health told ABC News. The department did not comment on the status of ED boarding in the state.

Carly said the wait in the noisy, bustling ED was agonizing. They said they spent seven days in the ED, then seven days in a patient room at Boston Children’s, before Carly finally got an inpatient psychiatric bed, where they were treated for two weeks.

“What Carly said to me is, ‘I feel like I’m being punished for having feelings,'” their mother Gail McCabe said.

“Carly slept on a stretcher. I slept on a stretcher for the seven nights that we were there. Carly actually started to have some visual hallucinations because of sleep deprivation one time,” McCabe said of their time in the ED. “You are pretty much sitting there staring at the wall for the whole entire time.”

Stewart said there are several causes for the surge in pediatric psychiatric patients at the hospital: the loss of mental health resources offered in-person at schools and at clinics with the shift to online learning and teletherapy, changes to social activities, school stress, and worries over COVID-19. Those stressors coupled with a limited number of beds dedicated to pediatric psychiatric care created a “bottleneck” in the ED.

McCabe said that when Carly arrived at the ED, there were about 25 other kids waiting for inpatient beds.

But Boston Children’s only has 16 inpatient psychiatric beds, and 12 acute residential treatment beds, according to Dr. Patricia Ibeziako, the associate chief for clinical services in the Department of Psychiatry and Behavioral Sciences at Boston Children’s Hospital. Now, the hospital is planning to add 12 more inpatient psychiatric beds, Ibeziako added.

Pandemic led to psychiatric bed closures

Long boarding times for pediatric psychiatric patients are also being seen in New York City as well, according to Dr. Adjoa Smalls-Mantey, an ABC News medical unit contributor and New York-based psychiatrist who works in several emergency room settings with adults and children.

“In March, April and May [of 2020], there was a decrease in the volume of people presenting with psychiatric complaints and I’ll attribute that to people being just scared to leave their homes with lockdown orders. But then by the time we got to the winter, it felt like people were waiting in the emergency room, for a day, maybe even two days to get a bed,” she said.

“For children, the wait is still long, I saw children one week and then I came back the next week for a shift and they were still there,” she added.

Smalls-Mantey said that during the pandemic some psychiatric beds had been converted into general medicine or ICU beds to focus on COVID-19. At one hospital where she works, both psychiatric units closed so patients were transferred to psychiatric units at other hospitals.

New York state’s Office of Mental Health told ABC News that 871 psychiatric hospital beds were repurposed due to COVID and so far 444 of those have reopened. The OMH said that despite the bed closures psychiatric inpatient admissions in NY are only at approximately 85% capacity, so the shortage of beds hasn’t prevented anyone from receiving needed care.

She said to curb the long wait times, hospital systems need to “reopen the beds that were closed.”

“The onus is on the healthcare systems to devote resources to helping people that are reaching out for help, because we have said, ‘Ask for help.’ So now that people are asking, the healthcare system needs to show up and do that,” Smalls-Mantey said.

A ‘pediatric mental health state of emergency’

In Colorado, physicians are also reeling from the “unprecedented” spike in pediatric psychiatric patients that led Children’s Hospital Colorado to declare a “pediatric mental health state of emergency” in May.

“We too, have seen an influx, particularly from January through May of this year, in unprecedented volumes. We’re seeing increases of upwards 70 to 90% from our 2019 volumes,” Jason Williams, the operations director for the Pediatric Mental Health Institute at Children’s Hospital Colorado told ABC News.

According to Williams, the wait for juveniles to be placed in an inpatient bed pre-pandemic was about eight hours. For the past two months, the wait has been upwards of 20 hours, he said.

Children’s Hospital Colorado has 18 general psych inpatient beds and 4 neuropsychiatric specialty care inpatient beds and they’ve been at 98% capacity for the last 18 months, Williams added.

He said he believes the state has a “broken system” equipped with fewer pediatric psychiatric beds, an issue shared across much of the nation.

Williams said the patients coming in are typically 12-years-old and up, mostly females, and most presenting suicidal ideation or suicidal attempts.

“We are seeing more severity in that patient population than we would have seen pre-pandemic, with kids making more lethal attempts on their lives,” he said.

Children’s Hospital Colorado CEO Jena Hausmann said the state’s mental health services are “not enough” in a May news release, calling for reform.

“It has been devastating to see suicide become the leading cause of death for Colorado’s children,” Hausmann said. “For over a decade, Children’s Colorado has intentionally and thoughtfully been expanding our pediatric mental health prevention services, outpatient services and inpatient services, but it is not enough. Now we are seeing our pediatric emergency departments and our inpatient units overrun with kids attempting suicide and suffering from other forms of major mental health illness.”

Colorado’s Department of Health did not respond to ABC News’ request for comment on boarding.

Surge in mental health needs and boarding

Mental health care in the U.S. has dramatically changed over time.

In the 1960s, deinstitutionalization was a government policy that moved mental health patents out of state-run institutions into community-based mental health centers. In part, the effort tried to target the negative effective of coercive hospitalization, except for high risk cases, but it also reduced the availability of long-term inpatient care beds across the country, according to a 2019 report in the Western Journal of Emergency Medicine.

In June 2016 there were 37,679 staffed psychiatric beds in state hospitals nationwide, which came out to about 12 beds per 100,000 of the population, according to the Treatment Advocacy Center (TAC), a national nonprofit focused on improving mental health care. That was a 17% drop from the 2010 bed numbers, the group reported.

Massachusetts has 608 public psychiatric beds, Colorado has 543, and New York State has 3,217, all as of 2016, per the TAC. The group says a minimum of 50 beds per 100,000 people is considered necessary to provide minimally adequate treatment for individuals with severe mental illness.

A 2020 study by the American Academy of Pediatrics found that among youth requiring inpatient psychiatric care, 23% to 58% experienced boarding and average durations ranged from 5 to 41 hours in EDs and 2 to 3 days in inpatient units. The study found that risk factors that led to longer boarding times included if patients came in during non-summer months (meaning during the school year), if they were younger and if they exhibited suicidal or homicidal ideations.

The study stated pediatric mental health boarding is experienced by at least 40,000 to 66,000 youth admitted to hospitals each year.

During the pandemic, use of telehealth services among Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries increased 2,700% from March to October last year compared to 2019, showing there was a demand for mental health services.

Yet at the same time, some vulnerable younger Americans went without mental health services. A May report by the Centers for Medicare & Medicaid Service found a 34% decline in the number of primary and preventative mental health services utilized by children under age 19, which amounts to 14 million fewer mental services for kids, compared to the same time period in 2019.

This can eventually lead to kids coming into ED’s in more serious states of mental crisis.

Studies say once in the ED, waiting for so long for care can have serious consequences.

A 2011 study by the Society for Academic Emergency Medicine found that mortality increased with increased boarding time and patients who boarded in 12 hours or more had a 4.5% greater chance of in-hospital mortality.

ACEP said that those who are boarded are “less likely to be receiving optimal treatment for their mental health conditions while in the ED” and are more likely to require chemical and physical restraints. The group also cites the risk of medication errors, such as when patients are not given medications they take at home during their boarding time.

Changes in the works

In Colorado, Williams said an issue is a lack of residential treatment centers, which is the next level of care for kids who leave inpatient units. As a result, children are often sent out of state for care.

But changes appear to be afoot. On Monday, Gov. Jared Polis signed four new laws that will boost mental and behavioral health services in the state, which includes $2.5 million for elementary school programs and $5 million for youth residential help and therapeutic foster care using funds from the American Rescue Act.

President Joe Biden’s American Rescue Plan Act provided funding to address mental health and substance abuses challenges.

In Boston, leaders at Boston Children’s have worked with local lawmakers and started community service efforts to improve mental health resources at schools and training at primary care centers to equip doctors to manage acute problems early on.

Massachusetts has also launched the Roadmap for Behavioral Health Reform, which will create a new centralized service for people to call or text to get connected to mental health and addiction treatment and expand access to treatment at primary care offices. It will also create more inpatient psychiatric beds for pediatric and adult patients.

“There’s a lot of stigma associated with mental illness. And the more we can address this and bring other people to the table, such as private health insurance to actively engage in these efforts, that will really help in developing best practices for improving care for this patient population,” Ibeziako, with Boston Children’s Hospital, said.

For Carly and their mother, they want mental health to be paid attention to just as much as other health concerns.

“When you’re waiting, and you see other kids with medical problems like, ‘oh, I broke a leg,’ everybody’s on it, everyone’s taking care of it. And you have a psychiatric issue, it’s ‘oh, you’re going to have to wait for X amount of days.’ It makes these kids and their families feel like their mental health isn’t important,” McCabe said. “As a nation, kids should be our most important focus.”

If you are struggling with thoughts of suicide or worried about a friend or loved one, help is available. Call the National Suicide Prevention Lifeline at 1-800-273-8255 [TALK] for free, confidential emotional support 24 hours a day, 7 days a week. You can also reach the Trevor Project at 1-866-488-7386 or the Crisis Text Line by texting “START” to 741741.

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New postpartum depression treatment shows promising results

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(NEW YORK) — A new pill is bringing hope for mothers struggling with postpartum depression.

On Wednesday, scientists from The Feinstein Institutes for Medical Research announced that results from phase 3 of a clinical trial for the drug, zuranolone, are showing promising results.

The findings, which were published in the Journal of the American Medical Association (JAMA) Psychiatry, show that after two weeks of daily treatment using zuranolone, women treated with the medication had a “statistically significant reduction in their core symptoms of depression compared to women who received a placebo.”

The placebo-controlled clinical trial, which was led by Kristina Deligiannidis, MD., looked at 153 randomized patients from 33 centers across the U.S. It was given to female patients between the ages of 18 and 45 with perinatal major depressive episodes for 14 days.

The patient’s depressive symptoms were scored at various points in the study for 45 days. Of the 153 randomized patients, 76 people were given the placebo and 77 were given zuranolone orally, nightly for two weeks during the trial.

At day 45, 53% of women who received zuranolone were in full remission of clinical depression versus 30% who received the placebo.

“These encouraging results are an important step in efforts to develop a novel treatment option for patients who suffer from this prevalent condition,” said Dr. Deligiannidis in a statement.

If approved, zuranolone would be the first pill to treat postpartum depression. It would also be much handier than other treatments.

Currently, there’s only one drug on the market that’s approved by the Food and Drug Administration to treat postpartum depression, which affects one out of eight women in the U.S., and it’s only available through infusion, which can be cumbersome for newborn mothers to receive.

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Why the US isn’t following the World Health Organization’s mask guidance

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(NEW YORK) — The World Health Organization and the Centers for Disease Control and Prevention are out of step in their COVID-19 mask guidance, prompting confusion.

In light of sky-rocketing cases of the COVID-19 Delta variant around the globe, last week the WHO called for all vaccinated people to continue to wear masks.

The CDC, however, has not followed suit. The U.S. agency still sticks by its guidance — announced in May — for vaccinated people to relinquish their masks in indoor and outdoor settings, so long as it’s been two weeks after their last shot of the vaccine. Unvaccinated people are supposed to continue wearing their masks and social distancing.

Why is the WHO advising masks for vaccinated people?

At a press conference on Friday, the WHO said that the rise of new variants made it necessary to pull out all the stops against the virus, particularly in places that had let down their guard.

The WHO, which watches the pandemic with a global lens, was considering the large majority of the world that’s unvaccinated or has less-effective vaccines. The organization also pointed out the disparities in vaccination statuses. In comparison, the U.S. has only been able to lift restrictions on businesses, reopen cities and discontinue mask mandates because of its access to hundreds of millions of vaccines.

Dr. Tedros Adhanom Ghebreyesus, the director-general of the WHO, said it was now “even more urgent that we use all the tools at our disposal” in the global fight against the coronavirus.

Dr. Anthony Fauci, chief medical adviser to President Joe Biden, described the rest of the world as “fundamentally an unvaccinated planet” in an interview with ABC News on Tuesday, when he was asked about the daylight between the two organization’s guidance.

“There are some countries that are doing well, but many, many countries have very little vaccination,” Fauci said.

That means that even vaccinated people are potentially surrounded by high levels of COVID-19, including the rapidly spreading variant, which could increase the chance of breakthrough cases, especially in countries where the vaccines are less effective.

But in the U.S., the two most common vaccines have shown to work fairly well against the variant.

Current studies have shown that the full dosage of the mRNA COVID-19 vaccines — the Pfizer and Moderna shots — are effective against the Delta variant. According to a recent study out of the U.K., while a single dose of the Pfizer vaccine provided 33% protection against symptomatic disease from the Delta variant, two doses offered 88% protection. More studies are being done on the efficacy of the Johnson & Johnson vaccine against the Delta variant, though it has showed a strong response against past variants it was tested on.

The U.S. has pledged to share 80 million vaccines with the rest of the world by the end of June, though it’s currently behind on its timeline.

What has the CDC said in response?

Vaccinated people in the U.S. are still safe to the point that masks are not needed, CDC Director Rochelle Walensky said Wednesday on ABC’s Good Morning America.

“The vaccinated, we believe, still are safe,” Walensky said.

But Walensky hedged that her recommendation was broad — taking into account the entirety of the country, both where rates for fully vaccinated adults are above 70%, and where they’re below 40% — so she urged local public health departments to make their own decisions based on the variant spread in their own communities and the willingness of people to get the vaccine.

“We have always said that this virus is an opportunist and in areas where we still have rates of low vaccination, that is where the virus is likely to take hold,” Walensky said. “We are still seeing uptick in cases in areas of low vaccination.”

That’s exactly what Los Angeles did on Monday, when they announced a return to indoor masking for everyone, vaccinated or not, after discovering that cases of the Delta variant made up nearly half of all the cases sequenced in the county, or one in every five new infections.

About half of the county is fully vaccinated, according to the CDC.

The County of Los Angeles Public Health recommended masks for indoor shopping, movie theaters and workplaces — any public location where “you don’t know everyone’s vaccination status” — as an extra step to stop the spread, beyond vaccines.

“Until we better understand how and to who the Delta variant is spreading, everyone should focus on maximum protection with minimum interruption to routine as all businesses operate without other restrictions, like physical distancing and capacity limits,” the department wrote in a press release.

Fauci, like Walensky, encouraged the decision to be made locally “if they feel that the level of spread of the Delta variant is really profound in their particular region,” he said.

People can also think about their individual levels of comfort, particularly if they are elderly or immunocompromised, which can lessen the effectiveness of the vaccines and heighten the risk of COVID-19, he added.

If the data changes, the CDC will update its guidance, Fauci said.

“We know from good studies that the Delta variant is protected against by the vaccines that fundamentally are being used here. And that’s the reason why the CDC feels at this point they should not change their recommendation,” he said.

“But right now the recommendation remains the same. These are very, very effective vaccines. So if ever there was a clarion call of why one should get vaccinated, it’s the threat of the Delta variant, because if you are unvaccinated, you clearly are at risk from a problematic virus that’s spreading more rapidly,” he added.

The vaccination rate nationwide has fallen by 20% in the last week. Currently, about 66% of all adults in the U.S. over 18 have received one shot and that rises to 88% for seniors over 65.

The states with the lowest vaccination rates are Mississippi, Louisiana, Wyoming and Alabama, where 50% or less of adults have gotten one shot of the vaccine, about 15% less than the nation as a whole.

That said, Walensky was still supportive of a celebratory Independence Day weekend, which she said was well-deserved after 16 months of fear and pain.

“I think we have a lot to be grateful for come July Fourth,” she said.

“Vaccinated people can take off their masks and celebrate July 4th and feel safe in doing so, see each other and smile again. And then we will have to continue the hard work we’re doing to get people vaccinated,” she said.

Where exactly is the Delta variant spreading in the US?

Unfortunately, it’s everywhere. The Delta variant has been found in all 50 states, as of Wednesday. Some places have more cases than others — and it’s very clear why: Low vaccination rates.

As of June 19, the highly transmissible variant accounts for 26.1% of new cases, up from approximately 3% of new cases just over a month ago.

But in regions of the country making up most of the West and Midwest, the proportion of Delta variant cases is estimated to be twice that, at above 50% of cases, according to a CDC estimate. Those regions include Iowa, Kansas, Missouri, Nebraska, Colorado, Montana, North Dakota, South Dakota, Utah and Wyoming.

All of these states have less than 50% of their total population fully vaccinated, with the exception of Colorado, which recently surpassed the halfway mark.

Dr. Ashish Jha, dean of Brown University’s School of Public Health, told the New York Times that he would be more careful if he were in some of those states that had low vaccination rates, despite being fully vaccinated.

“I would not be excited about going indoors without wearing a mask — even though I’m vaccinated,” he told the Times.

Jha, like many in public health, has used the impending threat of the Delta variant to push the fastest solution: vaccines for everyone who is eligible.

“Vaccines are a way out and I continue to be concerned at how many people are holding off on getting vaccinated when it is so much safer to be vaccinated now than not,” he said on CNN.

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In Wisconsin, 95% of COVID-19 deaths since March were among unvaccinated

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(MILWAUKEE) — In Wisconsin, 95% of COVID-19 deaths since March were among locals who were unvaccinated or not fully vaccinated, state health officials said.

The state recorded 21 COVID-19 deaths that were “breakthrough cases,” meaning patients who caught coronavirus 14 days or more after completing the vaccine series, out of 433 total deaths from March 1 to June 24. Such cases accounted for just 5% of deaths in that time frame, Wisconsin’s Department of Health shared with ABC News.

Data shows the chance of catching COVID-19 after getting vaccinated is very low.

Wisconsin reported 1,572 confirmed and probable “breakthrough cases,” which amounted to 1% of total COVID-19 cases from Jan. 1 through June 24. The number of “breakthrough cases” is also a small fraction of the more than 2.9 million fully vaccinated people in the state.

“As you know, the science is clear; vaccines work in the real world. They save lives. And if you are fully vaccinated, you are protected. All three vaccines have been tested and proven to be safe and effective,” Wisconsin Department of Health Services spokesperson Elizabeth Goodsitt told ABC News. “The vaccine not only works to fight off disease, but it reduces the risks for hospitalizations and deaths, and symptoms tend to be milder if someone does get sick after receiving the vaccine than if they didn’t get one at all.”

Doctors in Wisconsin say the state’s data matches what they’re seeing unfolding in hospitals.

“The vast majority of people who we are seeing in our hospitals, and who are dying of COVID-related complications are unvaccinated, unfortunately,” Dr. Joyce Sanchez of Froedtert Hospital and the Medical College of Wisconsin told local ABC affiliate WISN.

As of Wednesday, half of Wisconsinites have received at least one dose of the COVID-19 vaccine and 46.9% have completed the vaccine series, according to state data.

The state’s latest data reports a seven-day average of 73 new confirmed COVID-19 cases a day and a seven-day average test positivity rate of 0.9%.

Overall in the pandemic, Wisconsin has recorded more than 612,700 cases and over 7,000 confirmed deaths and more than 800 probable deaths.

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