“Early last year as an Obamacare repeal bill was flailing in the House, top Trump administration officials showed select House conservatives a secret road map of how they planned to gut the health law using executive authority.
The March 23 document, which had not been public until now, reveals that while the effort to scrap Obamacare often looked chaotic, top officials had actually developed an elaborate plan to undermine the law — regardless of whether Congress repealed it.
Top administration officials had always said they would eradicate the law through both legislative and executive actions, but never provided the public with anything close to the detailed blueprint shared with the members of the House Freedom Caucus, whose confidence — and votes — President Donald Trump was trying to win at the time. The blueprint, built off the executive order to minimize Obamacare’s “economic burden,” that Trump signed just hours after taking the oath of office, shows just how advanced the administration’s plans were to unwind the law — plans that would become far more important after the legislative efforts to repeal Obamacare failed…
“The primary problem here is government officials, government agencies, were taking steps that would lead to fewer people having coverage and erecting barriers to people having coverage,” he said. “In addition to that, you have kind of a closed-door, back-room slimy deal here that should trouble anyone.”
The document lists 10 executive actions the Trump administration planned to take to “improve the individual and small group markets most harmed by Obamacare.”
Those include calling for stricter verification of people who try to sign up outside of the open enrollment period; cutting the sign-up period in half; and giving states authority to determine whether insurers had to cover the full range of benefits required by Obamacare and whether their networks of doctors were sufficient.
Those policies are among seven proposals in the plan that have since been implemented. Four of the ideas and a portion of a fifth had been publicly proposed but not yet finalized when the document was shared.” (A)

“Out on the campaign trail, Trump frequently called for the repeal and replace of Obamacare, and the executive order signaled that doing away with President Obama’s sweeping health care law would be a priority from day one. While Trump has been unsuccessful in repealing the Affordable Care Act during his first year in office, the Department of Health and Human Services has managed to make significant changes.
In 2017, Health and Human Services under the Trump administration rolled back the Obamacare birth control mandate, allowing employers to exempt themselves if they have a moral or religious objection, ended cost-sharing reduction payments to insurance companies to help provide lower cost insurance for middle and low income consumers, cut advertising and outreach spending for the Affordable Care Act 90 percent, cut the sign-up period on the federal health care exchanges in half, and threw out the individual mandate—a tax penalty for those who don’t sign up for health insurance.” (B)

“Unable to roll back Obamacare’s health-care expansion legislatively, they’re now doing so administratively, through a series of technical, boring-sounding regulatory changes.
This GOP effort ramped up last week, when the Trump administration began allowing states to erect new barriers to Medicaid eligibility.
In the half-century since Medicaid was first created, eligibility has always been based almost entirely on financial circumstances such as income and assets; the program’s goal, after all, was to help less-well-off Americans obtain medical care. Last week, though, the Trump administration announced that it would start allowing states to impose other requirements on Medicaid recipients, including proof that they are working, looking for work, volunteering or in school.” (C)

“The number of people in the U.S. without health insurance increased in 2017 for the first time since Obamacare took effect, a possible sign that Obamacare’s rising premiums are putting insurance out of reach for millions of people.
The number of uninsured rose by 3.2 million from 2016 to 2017, according to the latest Gallup-Sharecare Well-Being Index.
That increase means 12.2 percent of the U.S. population was uninsured last year. In contrast, 10.9 percent was uninsured in 2016, a record low since Gallup and Sharecare started tracking the rate in 2008.
The 2017 uninsured rate is still lower than the peak uninsured rate of 18 percent in 2013, before people became able to buy government-subsidized healthcare plans through exchanges or enroll in expanded Medicaid, both provisions of Obamacare.
But it still represents a significant increase, one that hit blacks hardest. The index said the uninsured rate rose 2.3 percent for blacks, 2.2 percent for Hispanics, and 2 percent for young adults aged 18 to 25.
One factor in the rising uninsured rate could be the rising price of Obamacare plans. Though most who are enrolled through the exchanges receive a subsidy that shields them from price increases, those without subsidies and others who buy plans with Obamacare’s mandates, often off-exchange, have to pay the full price of increases.” (D)

“SINCE THE big Obamacare repeal-and-replace bills failed in the Senate, Congress and President Trump have sought to undermine the law in subtler ways. First, Republican lawmakers repealed Obamacare’s individual mandate, a key element of the law’s design. Now the Trump administration is rolling out rules that threaten to damage the structure further.
The Labor Department this month proposed looser regulations on so-called association health plans, under which small businesses, professional associations and others in similar circumstances can band together and buy insurance coverage for their groups as though they were large employers. The department argues that up to 11 million people working at small businesses or as sole proprietors lack health insurance, and that the new rules would help provide them more options.
In fact, there is a potentially large downside. The rules would also excuse association health plans from covering 10 classes of essential health benefits. Plans would probably be cheaper, but they would likely cover less than the comprehensive ones Obamacare sought to make the national standard. It is likely that some people who buy these plans will develop significant health problems and find themselves disastrously under-covered. Some may be willing to take that risk. The bigger problem is that opening a new avenue to buying shoddier insurance may harm everyone else seeking affordable, comprehensive coverage when they cannot get it from a large employer.” (E)

“Having wiped out the requirement for people to have health insurance, Republicans in Congress are taking aim at a new target: the mandate in the Affordable Care Act that employers offer coverage to employees.
And many employers are cheering the effort.
While large companies have long offered health benefits, many have chafed at the detailed requirements under the health law, including its reporting rules, which they see as onerous and expensive. Now that relief has been extended to individuals, some companies believe they should be next in line.
The individual mandate and the employer mandate are “inextricably entwined,” said James A. Klein, the president of the American Benefits Council, an influential lobby for large companies like Dow Chemical, Microsoft and BP, the oil and gas producer.
“It is inequitable to leave the employer mandate in place when its purpose — to support the individual mandate — no longer exists,” Mr. Klein said. “We are urging Congress to repeal the employer mandate.”
Opposition to the employer mandate could increase as more employers are fined for not offering coverage or for not meeting federal standards for adequate, affordable coverage. Since October, the Internal Revenue Service has notified thousands of businesses that they owe money because they failed to offer coverage in 2015, when the mandate took effect.” (F)

“The Centers for Disease Control and Prevention (CDC) says it “has not banned, prohibited, or forbidden” the use of certain words in official documentation, the agency director says in response to concerns from Senate Democrats.
Democrats had been concerned, they said last month, “that the Trump Administration is yet again prioritizing ideology over science” after reports claimed agencies within the Department of Health and Human Services (HHS) had banned employees from using words including “fetus,” “vulnerable” and “science-based.”
CDC Director Brenda Fitzgerald told Sen. Brian Schatz (D-Hawaii) in a letter released Tuesday the HHS style guide does recommend avoiding the use of “vulnerable,” “diversity,” and “entitlement.” Fitzgerald added that CDC recommends substituting the colloquial “ObamaCare” for “Affordable Care Act” or “ACA.”” (G)

“Many states are eager to reverse the damage from Obamacare in 2018, but in some cases, they will need help from Congress, leading health care experts say.
The following are six ways the states and/or the federal government could push for change or reforms in the year ahead. 1.State innovation waivers; 2. Revive Graham-Cassidy; 3. Direct primary care; 4. Medicaid work requirements; 5. Telemedicine to cut costs; 6. Regulations for new hospitals. (H)

“The increasing number of people coming to the emergency room is partly due to Obamacare, because 880,000 more people in New Jersey became insured. The largest share of that number are low-income people who now qualify for Medicaid.
That’s where Gov. Chris Christie comes in. After the Affordable Care Act passed, most Republican governors said they wouldn’t opt into the voluntary expansion of Medicaid, even though the federal government would pay for 90 percent of the extra cost.
“Medicaid is pretty well expanded in our state already because of the legacy of previous democratic governors,” Christie told Fox and Friends in July 2012. “So I don’t think there’s a lot more for us to do in New Jersey in that regard.”
But six months later, squeezed between his ambition to run for president and re-election in a majority blue state, he bucked his own party and took the money. There are now more than half a million poor people who gained access to healthcare in New Jersey.
“It was a very big move,” said Joel Cantor, director of the Rutgers Center for Health Policy. “Expanding Medicaid has been huge for this state, enfranchising hundreds of thousands of people and helping to finance our healthcare system more robustly and more stable than it had been in the past.”..
But he turned his attention to the opioid epidemic, and worked almost exclusively on it. It was a good time to be working on the problem in New Jersey, because half a million low-income people were added to the Medicare rolls, and many of those people were now able to get treatment for drug addiction. A wide spectrum of people who work on recovery say that was the game changer in New Jersey.
Christie also gets credit for expanded access to Naloxone, which can save the life of someone overdosing, and for signing the Good Samaritan law, which encourages drug users to call for help without fear of arrest when a friend is overdosing.” (I)

“More American women started getting recommended mammography screening after an “Obamacare” rule made the tests free, a new study finds.
The rule meant that Medicare and most private insurers could no longer require women to foot part of the bill — whether through copays or requiring them to pay a deductible first.
After the rule went into effect, the study found, the number of women in Medicare Advantage plans who got mammography screening rose by 5.5 percentage points: from just under 60 percent in the two years before the rule, to 65.4 percent in the two years after.
That’s the good news. The worry is what could happen if the Affordable Care Act rule is repealed, said lead researcher Dr. Amal Trivedi, an associate professor of medicine at Brown University in Providence, R.I.
“Our study suggests that if the cost-sharing provisions are repealed and health plans reinstate copayments for screening mammograms, fewer older women will receive recommended breast cancer screening,” Trivedi said. “That could harm public health.” (J)

“A new study suggests that the Medicaid expansion helped hospitals in rural areas keep their doors open. But will this be enough going forward?
The Affordable Care Act’s Medicaid expansion drove down the uninsured rate in the United States.
Now a new study suggests that the expansion boosted the financial health of many hospitals that serve a high number of the uninsured, especially in rural areas.
Researchers found that hospitals in the 32 states and District of Columbia that expanded Medicaid were more than 6 times less likely to close than hospitals in the 18 states that said no to the expansion.
Some areas were helped more than others by the Medicaid expansion.” (K)

“Democrats are shifting to offense on health care, emboldened by successes in defending the Affordable Care Act. They say their ultimate goal is a government guarantee of affordable coverage for all…
Time will tell. Here’s a sample of ideas under debate by Democrats and others on the political left:
—Medicare for All: Vermont Sen. Bernie Sanders made single-payer, government-run health care the cornerstone of his campaign for the 2016 Democratic presidential nomination. It remains the most talked-about health care idea on the left. Financing would be funneled through the tax system. Individuals wouldn’t have to worry about deductibles, copays or narrow provider networks. Although state-level attempts to enact single-payer care have foundered because of the large tax increases needed, about one-third of Sanders’ Democratic colleagues in the Senate are co-sponsoring his latest bill.
—Medicare-X: The legislation from Sens. Kaine, and Michael Bennet, D-Col., would allow individuals in communities lacking insurer competition to buy into a new public plan built on Medicare’s provider network and reimbursement rates. Medicare would be empowered to negotiate prescription drug prices. Medicare-X would be available as an option through HealthCare.gov and state health insurance markets. Enrollees could receive financial assistance for premiums and copays through the Obama health law. Eventually, Medicare-X would be offered everywhere for individuals and small businesses.
—Medicare Part E: Yale University political scientist Jacob Hacker has proposed a new public health insurance plan based on Medicare, for people who don’t have access to job-based coverage meeting certain standards. It would be financed partly with taxes on companies that don’t provide insurance. Consumers would pay income-based premiums. Hospitals and doctors would be reimbursed based on Medicare rates, generally lower than what private insurance pays. “The crucial part of this is that you have guaranteed health insurance, just like you have guaranteed Medicare or Social Security,” said Hacker. He’s working with Democrats in Congress to turn the concept into legislation.
—Medicaid Buy-In: Sen. Brian Schatz, D-Hawaii, and Rep. Ben Ray Lujan, D-N.M., have introduced legislation that would allow states to open their Medicaid programs up to people willing to pay premiums. Although Medicaid started out as insurance for the poor, it has grown to cover about 75 million people, making it the largest government health program. Most beneficiaries are now enrolled in private insurance plans designed for the Medicaid market.” (L)

“Wisconsin Gov. Scott Walker (R) is looking to stabilize the state’s ObamaCare marketplace after Republicans failed to repeal and replace the law last year.
“Their failure to act on this issue is yet another call for us to step up and lead,” Walker told the Wisconsin State Journal.
“I wanted to get premiums for that individual market more compatible with where the group insurance premiums are.”
Walker said he will seek federal permission to set up a reinsurance program, which provides payments to plans that cover higher-cost enrollees in an effort to lower premiums for everyone else.
Walker also said he will ask state lawmakers to codify in state law protections for people with pre-existing conditions.
The proposed reinsurance program, to start in 2019 if approved by the Trump administration, would pay 80 percent of claims between $50,000 and $250,000.
The program would cost about $200 million a year, according to the newspaper, with $150 million coming from the federal government.
Lawmakers in Congress are also working to pass legislation to shore up ObamaCare.
A fix being pushed by Sens. Lamar Alexander (R-Tenn.) and Susan Collins (R-Maine) would fund key ObamaCare insurer payments and give states billions of dollars to set up reinsurance or high-risk pools for expensive patients.”
The two senators are hoping the bills get added to an upcoming long-term spending deal.” (M)

“Sen. Susan Collins (R-Maine) said Monday that she is “optimistic” that the ObamaCare fixes she is pushing for can still pass, despite the deadline for voting on them having “slipped.”
“Our negotiations with the House are going very, very well,” Collins told reporters. “The deadline slipped but the policy is what is important.”
Senate Majority Leader Mitch McConnell (R-Ky.) in December gave a commitment to Collins to support the passage of two bills aimed at stabilizing ObamaCare markets and lowering premiums before the end of the year, in exchange for her vote for the tax reform bill.
The end of the year came and went without votes on the two bills, but Collins said Monday she is still “optimistic.”” (N)

“Rep. Pat Meehan (R-Pa.) denied allegations that he sexually harassed a young female staffer and blamed Obamacare for some of his behavior that she perceived as hostile..
Meehan denied that he retaliated against her and instead blamed any negative behavior on stress over the Republican effort to dismantle Affordable Care Act. On the day Meehan penned the letter to his aide, the House voted to partially repeal and replace the health care law.” (O)

(A) Trump’s secret plan to scrap Obamacare, by JENNIFER HABERKORN, https://www.politico.com/story/2018/01/10/trump-obamacare-secret-plan-278145
(B) HHS goal under Trump: rolling back Obamacare, by MERIDITH MCGRAW, http://abcnews.go.com/Politics/hhs-goal-trump-rolling-back-obamacare/story?id=52222200
(C) Trump is hoping you won’t notice his backdoor repeal of Obamacare,by Catherine Rampell, https://www.washingtonpost.com/opinions/trump-is-hoping-you-wont-notice-his-backdoor-repeal-of-obamacare/2018/01/15/aa33f968-fa3b-11e7-8f66-2df0b94bb98a_story.html?utm_term=.d1bdb2297f9d
(D) Number of people without health insurance rises for first time since Obamacare, by Kimberly Leonard , http://www.washingtonexaminer.com/number-of-people-without-health-insurance-rises-for-first-time-since-obamacare/article/2646021
(E) These Trump administration changes could make health-care coverage worse , https://www.washingtonpost.com/opinions/these-trump-administration-changes-could-make-health-care-coverage-worse/2018/01/15/70319d64-f267-11e7-b3bf-ab90a706e175_story.html?utm_term=.bd8f10c8d781
(F) Individual Mandate Now Gone, G.O.P. Targets the One for Employers, By ROBERT PEARJAN, https://www.nytimes.com/2018/01/14/us/politics/employer-mandate.html
(G) CDC rejects censorship reports: ‘There are absolutely no “banned” words’, by NATHANIEL WEIXEL, http://thehill.com/policy/healthcare/368105-cdc-rejects-censorship-reports-there-are-absolutely-no-banned-words
(H) 6 Actions States, Federal Government Could Take on Obamacare, Health Care in 2018, by Fred Lucas, http://dailysignal.com/2018/01/12/6-actions-states-federal-government-could-take-on-obamacare-health-care-in-2018/
(I) What Christie May Not Want to Admit: He Had Success with Obamacare, by Nancy Solomon, https://www.wnyc.org/story/what-christie-may-not-want-admit-he-had-success-obamacare/
(J) Obamacare Led to Rise in Breast Cancer Screening, by BY TOBY MURPHY, http://www.infosurhoy.com/cocoon/saii/xhtml/en_GB/health/obamacare-led-to-rise-in-breast-cancer-screening/
(K) Rural hospitals rely on Medicaid expansion to stay open, study shows, https://www.pbs.org/newshour/health/rural-hospitals-rely-on-medicaid-expansion-to-stay-open-study-shows
(L) On health care, Democrats are shifting to offense, by Ricardo Alonso-Zaldivar, http://www.norwichbulletin.com/news/20180108/on-health-care-democrats-are-shifting-to-offense
(M) Wisconsin’s Republican governor looks to shore up ObamaCare market, by JESSIE HELLMANN, http://thehill.com/policy/healthcare/370128-wisconsins-republican-governor-looks-to-shore-up-obamacare
(N) Collins ‘optimistic’ ObamaCare fixes will pass, by PETER SULLIVAN, http://thehill.com/policy/healthcare/370152-collins-optimistic-obamacare-fixes-will-pass
(O) GOP Rep. Blames Obamacare For Sexual Harassment Allegations, by Willa Frej, https://www.huffingtonpost.com/entry/pat-meehan-obamacare-sexual-harassment_us_5a6841a1e4b002283007d9bc

Hospitals and clinics would be forced to turn away millions of patients. Critical medications and care would not reach people in time. Millions of people in every state would be felled by the virus, and hundreds of thousands—including newborn babies, toddlers and older adults—would die in the weeks and months following the initial outbreak. The GDP in the United States would plummet as much as $2 billion, if not more.
Inadequate preparedness programs—and the investments required to fund and sustain them—mean that even with some of the best available healthcare there is, the United States remains woefully susceptible to a major future flu epidemic that might make this year’s widespread lethal outbreak look mild in comparison. Over the last decade, the federal government has cut upwards of 50% of its funding for the U.S. Public Health Emergency Preparedness program that it created in the aftermath of the 9/11 attack to protect against bioterror, pandemics and other public health emergencies. This has cost state and local health departments some 45,000 jobs. And the Trump administration is now calling for even more draconian budget cuts…
Why do we as a nation continue to leave ourselves vulnerable? The shockingly simple answer lies in our collective complacency. As soon as headlines about the flu are gone, hospitals are emptied of flu patients, schools are back in session and workplace absenteeism declines, we go back to business as usual. Pandemic preparedness plans are put back on the shelf. Funding for public health preparedness and flu R&D disappears into a haze of competing demands.” (A)

“With a nasty flu season underway across the country, businesses can expect to see billions of dollars in lost productivity, according to global outplacement consultancy Challenger, Gray & Christmas.
“We’re predicting about 11 million Americans will fall ill over the flu season and that’s going to cost employers over $9 billion in wages being paid to employees that are staying home sick,” Andy Challenger, the firm’s vice president, told CNBC’s “Closing Bell” on Friday.
That estimate does not take into account those workers who need to stay home to care for a sick family member…
Challenger said it’s important that workers don’t try to tough it out and go into the office and that employers discourage sick employees from coming in. Limiting meetings and expanding remote work options are two ways to help prevent the spread of the illness, he noted.
“It’s better to make sure an entire department doesn’t fall ill and cost the company a lot of money over the flu season,” Challenger said.
As for when to return to the office, Schaffner said, “After you’ve started to get better, two, three days after the onset of disease, if you’re adult you can come on back to work.”
If the worker has a fever, the CDC recommends staying home for at least 24 hours until the fever subsides.” (B)

“Keyboards, especially within a work environment, can harbour flu germs, experts say.
“At any given time the human body is emitting anywhere from one to tens of millions of microbes every hour,” Canadian microbiologist Jason Tetro says. “Normally that’s not a problem – however, if you happen to be sick then that microbial cloud starts to incorporate a number of these pathogens that you happen to be infected with.”
Those pathogens, Tetro says, land on people and surfaces and end up posing a risk.
“That poses a risk because you’re not going to get sick by picking up somebody’s skin or hair bacteria from a keyboard, but you may get sick if you happen to pick up dry droplets from someone who had the cough or flu,” he says.
And those droplets can end up on what are called “high touch surfaces.”
These are surfaces that have a higher likelihood of leading to infection, Tetro says. That likelihood essentially comes down to the number of times something is touched.
Flu germs (and cold germs for that matter) live on surfaces between two to eight hours at a time. The higher the number of high-touch surfaces you come into contact with everyday, the greater your chances of picking up those germs.
So what are some of those high touch surfaces? Water coolers, taps and water fountains. Photo copiers and printers in offices. Bathroom surfaces. Door handles. Soap dispensers that require pumping. Subway poles. Mobile devices. Keyboards. Flight check-in kiosks at airports. Shopping carts.” (C)

“It is easier to spread the influenza virus (flu) than previously thought, according to a new University of Maryland-led study released today. People commonly believe that they can catch the flu by exposure to droplets from an infected person’s coughs or sneezes or by touching contaminated surfaces. But, new information about flu transmission reveals that we may pass the flu to others just by breathing…
“We found that flu cases contaminated the air around them with infectious virus just by breathing, without coughing or sneezing,” explained Dr. Donald Milton, M.D., MPH, professor of environmental health in the University of Maryland School of Public Health and lead researcher of this study. “People with flu generate infectious aerosols (tiny droplets that stay suspended in the air for a long time) even when they are not coughing, and especially during the first days of illness. So when someone is coming down with influenza, they should go home and not remain in the workplace and infect others.”…
“The study findings suggest that keeping surfaces clean, washing our hands all the time, and avoiding people who are coughing does not provide complete protection from getting the flu,” said Sheryl Ehrman, Don Beall Dean of the Charles W. Davidson College of Engineering at San José State University. “Staying home and out of public spaces could make a difference in the spread of the influenza virus.” (D)

“Lost in the flurry of news stories is the startling and alarming report from the CDC in December that only about one-third of pregnant women are getting flu shots. A startling 64 percent of pregnant women had not been vaccinated against the flu, despite recommendations from the CDC, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists.
While 98 percent of pregnant women reported visiting a doctor or other medical professional at least once before or during pregnancy, the CDC found that only about 59 percent reported receiving a recommendation for and offer of flu vaccination from a doctor or other medical professional, while 16 percent received only a recommendation for — but no offer of — the vaccine. A whopping 26 percent received neither a recommendation for nor an offer of flu vaccination…
Pregnant women and their unborn babies are especially vulnerable to influenza and are more likely to develop serious complications from it. About one-third of cases of pneumonia are caused by respiratory viruses, the most common of which is influenza. Pneumonia and other complications increase the risk of preterm labor. Babies in utero are also at risk of complications: Pregnant women who develop the flu are more likely to give birth to children with birth defects of the brain and spine.” (E)

“The Department of Health and Human Services doesn’t have the funding it needs to prepare for a public health emergency, according to an official at the agency.
The Senate Health, Education, Labor and Pensions Committee held a hearing on Wednesday that focused on the reauthorization of the Pandemic and All Hazards Preparedness Act. At the hearing Robert Kadlec, M.D., HHS assistant secretary for preparedness and response, said that the agency is “working with half an aircraft carrier” to address the needs of 320 million people in the event of a public health emergency.
“We can’t do more things with limited resources,” he told senators.” (F)

“Confirmed cases of the flu are growing at a faster pace than the past two seasons in New Jersey, and with the worst months yet to come, it might be the nastiest year in a while.
There were 1,166 confirmed cases in the past week, as compared to 697 for the same period last season and 24 for 2015-16, according to state Department of Health data.
Why is this year’s flu season shaping up to be a serious threat? The type of flu strain spreading throughout the state — the dreaded H3N2 virus, a form of influenza A — is typically associated with more severe illness than other strains.
“What we’re seeing now is a lot of H3N2 (and) that is the predominant risk of more severe cases,” said Dr. David J. Cennimo, an epidemiologist at University Hospital in Newark and an assistant professor of medicine-pediatrics infectious disease at Rutgers Medical School.
The H3N2 virus has been particularly notable in California, overwhelming hospitals and medical professionals.
In total, there are 3,189 confirmed cases of the flu so far this year in the Garden State. The virus is now at high flu levels in all parts of the state, according to the health department.” (G)

“The flu was so bad last week in New York, it was the worst since the state started recording the data 14 years ago.
The Department of Health reported the number of lab-confirmed influenza cases last week was 6,083, an increase of more than 50 percent from the week before.
There were 1,606 people hospitalized with confirmed cases of the flu in New York last week. That was the highest weekly number of cases reported since the Department of Health began reporting the data in 2004.” (H)

“The current flu epidemic wreaking havoc across the nation was in part fanned by so many people spreading germs while traveling over the holidays, according to the U.S. Centers for Disease Control and prevention.
As 49 states are reporting widespread flu activity, “Good Morning America” spoke with a flight attendant and a doctor to get some expert tips on how to prevent the spread of flu germs while traveling on airplanes or passing through major airports.
Why this year’s flu season is so bad and what you can do about it
1. Wipe down communal surfaces such as tray tables and armrests
2. Turn on your air vent
3. Let other passengers board first
4. Choose a window seat
5. Avoid caffeine, alcohol while aboard
6. Use a nasal spray. (I)

“The Centers for Disease Control and Prevention may be able to continue its immediate response to seasonal influenza in the event the government shuts down, a senior administration official said Friday night on a call with reporters.
“CDC will specifically be continuing their ongoing influenza surveillance,” the official said. “They’ll be collecting data reported by states, hospitals, [and] others and they’ll be reporting that critical information needed for state and local health authorities.”
Those remarks stand in direct contrast to the fiscal year 2018 contingency plan posted by the Department of Health and Human Services Friday morning, which specifically lists the agency’s seasonal flu work as one of the activities that will not continue in the case of a shutdown.” (J)

Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

(A) Our Complacency About the Flu Is Killing Us, by JONATHAN D. QUICK, http://time.com/5107964/flu-2018-epidemic/
(B) Andy Challenger told CNBC the firm predicts 11 million Americans will fall ill, costing employers more than $9 billion in wages being paid to employees who are staying home sick, Michelle Fox, https://www.cnbc.com/2018/01/19/2018-flu-season-could-cost-employers-more-than-9-billion.html
(C) Don’t touch these surfaces if you want to avoid the flu, by Dani-Elle Dubé, https://jumpradio.ca/news/3973361/dont-touch-these-surfaces-if-you-want-to-avoid-the-flu/
(D) Flu may be spread just by breathing, new study shows; coughing and sneezing not required, https://sph.umd.edu/news-item/flu-may-be-spread-just-breathing-new-study-shows-coughing-and-sneezing-not-required
(E) Two-thirds of pregnant women aren’t getting the flu vaccine. That needs to change, by MARK N. SIMON, https://www.statnews.com/2018/01/18/flu-vaccine-pregnant-women/
(F) HHS’ Robert Kadlec, M.D.: Agency needs more funding to prepare for public health emergencies, by Paige Minemyer, https://www.fiercehealthcare.com/healthcare/department-health-and-human-services-public-health-emergencies-funding-senate?mkt_tok=eyJpIjoiWVdVMU5qVm1ORGd6WVdaaiIsInQiOiJYYUE2UG5FWEhNdnpIOVY4WHRHelFya2greEdhcmVheXYyNGxpSzJJT0srdFM1SThRdUNteVlzRjRUSkxPUlwvY2pCVUFJZWJZT083SUZweDgzbVpKV0E1ZWQzQk5ZN0ltYjJocmtNOEV4b3E1eWY4Z1luMFF2THVaUkQ0YlNCclUifQ%3D%3D&mrkid=654508
(G) Flu season in N.J. could be worst in recent years, new data shows, by Erin Petenko and Spencer Kent, http://www.nj.com/news/index.ssf/2018/01/flu_season_in_nj_could_be_worst_in_recent_years_ne.html#incart_river_index
(H) Flu everywhere: NY had worst week ever, by Natasha Vaughn, https://www.democratandchronicle.com/story/news/politics/albany/2018/01/22/flu-everywhere-ny-had-worst-week-ever/1054647001/
(I) Planes and the flu: 6 things to know to help you stay healthy while flying, http://abcnews.go.com/Health/planes-flu-things-stay-healthy-flying/story?id=52418032
(J) Flu response will be maintained during shutdown, officials say, contrary to previous plan, by ERIN MERSHON, https://www.statnews.com/2018/01/19/flu-response-government-shutdown/

“The last government shutdown — which lasted for 16 days in October 2013 — sheds light on just how far flung are the consequences of congressional inaction, especially for health companies and public health workers. STAT talked to former officials at the FDA, CDC, and NIH about how that shutdown affected the work they could do…
In 2013, the CDC shuttered most of its annual seasonal influenza program during the shutdown. It largely stopped tracking disease outbreaks across the country, ceasing communications with the local officials and clinicians who help the federal workers connect the dots when an outbreak might be growing. It stopped testing most incoming samples and specimens to ensure safety, and it largely stopped monitoring infections at airports around the country, according to documents and former agency staffers…” (A)

(A) How a government shutdown could affect drug safety, flu response, and more, by ERIN MERSHON and IKE SWETLITZ, https://www.statnews.com/2018/01/17/government-shutdown-cdc-fda-nih/

“In a press briefing on Friday, Dr. Dan Jernigan — director of the influenza division in the CDC’s National Center for Immunization and Respiratory Diseases — confirmed that the outbreak can legitimately be called an epidemic. “We have very specific criteria where we can say the epidemic is beginning and ending based on when flu activity goes above a certain baseline. So we’ve clearly passed that baseline back in November and we’re at the peak of it now,” he said.” (A)

Weekly US Map: Influenza Summary Update – highlight and click on
https://www.cdc.gov/flu/weekly/usmap.htm

During week 1 (December 31, 2017-January 6, 2018), influenza activity increased in the United States.
Geographic Spread of Influenza: The geographic spread of influenza in 49 states was reported as widespread; Guam and one state reported regional activity; the District of Columbia reported local activity; the U.S. Virgin Islands reported sporadic activity; and Puerto Rico did not report. (B)

“Think hospitals are under a strain now, from a slightly bad flu season? Wait until a really bad one hits.
Experts agree the U.S. is not ready for a bad epidemic, or even for some other disaster that would affect hospital supplies. And funding cuts mean even a little strain has a bigger impact than in years past…
“Each year, the healthcare system gets a thinner and thinner veneer of preparedness,” said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
“It takes less and less impact for a healthcare system to go from routine to crisis.”..
Yet, every year, school systems and hospitals get caught short. There are spot shortages of drugs that fight flu such as Tamiflu and for the past three years, there’s been a shortage of certain preparations of saline solution — a hospital staple.
This year, the saline shortage has been made even worse by Hurricane Maria’s devastation in Puerto Rico, the U.S. territory where 40 percent of the saline supply is made…
Infectious disease experts have been urging the U.S. government to do more to keep the country prepared for outbreaks of diseases such as a new strain of flu, Ebola and severe acute respiratory syndrome, or SARS…
Influenza specialists say repeatedly that the chance of a new flu pandemic is 100 percent. Flu mutates constantly, and a major new strain emerges about every 20 years. The last one was H1N1 “swine” flu in 2009, which was fairly mild, but worse epidemics are probable.
No country can be ready without having stockpiles of drugs, vaccines and equipment, plans for deploying them and someone with the authority to make fast decisions…
Last year’s budget provides just $57 million for influenza pandemic planning.
“I think it is in part a sense that until it’s a downright crisis, everybody assumes everything is OK,” Osterholm said. “ (C)

“The huge numbers of sick people are also straining hospital staff who are confronting what could become California’s worst flu season in a decade.
Hospitals across the state are sending away ambulances, flying in nurses from out of state and not letting children visit their loved ones for fear they’ll spread the flu. Others are canceling surgeries and erecting tents in their parking lots so they can triage the hordes of flu patients…
Connie Cunningham and her staff at Loma Linda University Medical Center were triaging so many flu patients after New Year’s that they assembled what looks like a giant, brown camping tent in their emergency room parking lot. Several hospitals in California are treating flu patients in so-called “surge tents” intended for major disasters.
So many people are showing up sick with the flu that Loma Linda hospital put up this giant tent to treat patients in.
On a recent weekday morning, Cunningham walked through the tent, lined with folding chairs and patient beds that are separated by sheets hung from the ceiling.
Cunningham, executive director for the hospital’s emergency services, said she’d thought they would dismantle the tent after a few days, but staff are still treating 60 more patients each day than usual, she said.
“In my career, I’ve never seen anything like this,” she said…
Many hospitals also say they’re too full to accept any more patients or ambulances.
And when paramedics are allowed to drop off patients at a hospital, the emergency room is often so crowded that there aren’t available staff members to transfer care to. So the emergency responders can’t get back on the road to answer incoming 911 calls, said Kay Fruhwirth, L.A. County’s assistant director of emergency medical services.
“If there’s not a nurse available, and/or a bed — it’s usually an ‘and’ — they’re waiting there with the patient,” she said. (D)

“Still, the fact remains that every single year there is a flu epidemic. The principle behind these perennial epidemics is “persistence through plasticity,” said Dan Jernigan, MD, MPH, the director of the CDC’s Influenza Division. To put it simply, the influenza virus is always mutating to get around the vaccine and people’s natural immunities. “These constant changes do allow for adaptation,” he said. This adaptation makes it really hard to match a virus to the flu strain that’s circulating.
So with H3N2 as the major flu strain getting people sick this season, it’s possible you’ll get sick. And if you do, it’s likely you’ll receive antiviral drugs. The CDC recommends drugs belonging to the class called neuraminidase inhibitors, which block the enzyme that the influenza virus needs to reproduce. Clinical trials have shown that neuraminidase inhibitors are effective against both influenza A and influenza B, unlike the older M2 inhibitors. This is good for flu patients because you could still come down with one of the other common flu strains.
Here’s the thing, though: There haven’t been any double-blind placebo-controlled trials of these antiviral drugs on influenza cases, says Alicia Fry, MD, MPH, the chief of the CDC Influenza Division’s Epidemiology and Prevention Branch. They do show some significant positive results, though. According to Fry, early treatment with antiviral drugs does improve outcomes — something that can be seen even without placebo trials. It reduces mortality in adults, it reduces the severity of the illness in children, and it reduces the duration of sickness. (E)

“The most optimistic assumption among government experts is that the season peaked a few weeks ago, marking the apex of what was already an early and severe outbreak. However, such an outlook requires observers to ignore that outpatient doctor visits have continued to climb (albeit more slowly) in the first week of 2018, yielding the most flu cases ever for this time of the year.
Even if the hopeful assessment by the U.S. Centers for Disease Control and Prevention bears out, there will still be another 11 weeks to 13 weeks of flu circulating across the country. “In general, we see things peaking right about now, but that means there is still a whole lot more flu to go,” Jernigan said. “In addition, there are other strains of influenza still to show up that could be a major cause of disease.”
That may already be happening. The CDC is starting to see infections caused by the H1N1 strain of the virus in states grappling with high levels of the H3N2 strain, the predominant version this season. In addition, Jernigan said yet another type of flu, caused by the influenza B viruses, is still expected to show up later in the season.
H3N2 has compounded the damage usually wrought by the annual flu outbreak. It’s known for both its severity and ability to evade the protection provided by vaccinations that are typically more effective against the other types of flu…
The CDC’s latest method to categorize the severity of a flu outbreak, which takes into account indicators including hospitalizations, outpatient visits and deaths across an entire outbreak, already places the current season in the top three. During the 2014-2015 flu season, there were more than 700,000 hospitalizations. The current outbreak is matching the beginning of that period, though it’s unclear what the remainder of the season will look like, Jernigan said. Last year’s entire season saw more than 600,000 hospitalizations.
“You didn’t have this all-at-once phenomena that we’re getting now, where hospitals are having lots of cases all at once all across the U.S.,” he said. Jernigan was forthright about the agency’s inability to accurately predict the intensity of the influenza season.
“We are always expecting there to be an unusual season,” he said. “We are rather humbled by this virus. We are always preparing for a severe season and welcome a less severe season, but it’s difficult to predict what will happen.” (F)

“A modeling program called FluSurge developed by the Centers for Disease Control and Prevention to help hospitals plan generates some pretty sobering scenarios, he noted. In a bad pandemic, hospitals might have four times more people in need of a ventilator than they have ventilators, and far too few intensive care beds for the seriously ill.
“So there would be a big mismatch between demand for care, lifesaving care, and the ability to provide it,” Inglesby said. “We would have a huge problem in this country.”
The problem with influenza relates to the way it attacks, sickening large numbers of people in a relatively short period of time.
A hospital can plan for how much cancer care it will need to deliver based on the size of the nearby population and estimates of rates of various cancers. Affected people will seek care over the course of any given year.
But with flu, most of the severe illness happens in the space of a few weeks in any one location. The pressure that puts on a health system is exacerbated by the fact that some of the people needed to care for the sick fall ill themselves.
Getting help from elsewhere — as a community will often do in the case of a major medical disaster — isn’t really an option during flu epidemics, because other places are either dealing with their own or steeling themselves for a wave that’s about to hit. In the first week of this month, the entire continental United States was reporting widespread flu activity…
But the inability to predict the intervals between flu pandemics makes it easy for officials to shift preparedness efforts into the “should do” instead of the “must do” column.
There were nearly 40 years between the 1918 and 1957 pandemics; then the 1968 pandemic hit 11 years later. And then there was a 41-year interval before 2009. There is virtually no way to tell when the next will occur.
If anyone knew for sure that the next pandemic was coming soon, then society would begin planning aggressively, Inglesby said. “But since we have uncertainty about the timing and severity of the next pandemic, we’re kind of in this relatively modest national effort to prepare hospitals, which is doing what it can with the resources available.” “ (G)

“A company making “smart thermometers” that upload body temperatures to its website claims to be tracking this year’s flu season faster and in greater geographic detail than public health authorities can.
This year’s flu season — which the Centers for Disease Control and Prevention considers “moderately severe” — has left Missouri and Iowa the “sickest states in the country,” said Inder Singh, the founder of Kinsahealth.com.
California has had its worst outbreak in five years, with nearly 1 percent of the state exhibiting flu symptoms on Jan. 2, he added. By contrast, New York, New England and the Southeast have had relatively mild seasons so far, but cases are rising and should peak in two weeks.
Mr. Singh’s data paints a different picture from that of the C.D.C., which held a news conference Friday to announce that flu activity was “widespread” across the continental United States, which is unusual. (Hawaii’s outbreak is smaller, the agency said.)…
The C.D.C. data comes from hospitals and clinics that report how many cases of “influenza-like illness” they treat. Delays can result if clinic statisticians are busy or if state health departments do not pass on the figures quickly.
Kinsa, by contrast, is able almost instantly to spot fever spikes in states — or even in cities and neighborhoods. More than 500,000 households now own its smartphone-connected oral and ear thermometers, Mr. Singh said, and the company gets about 25,000 readings each day.
(Of course, the company cannot measure hospitalizations, deaths, or which strains of flu are circulating, or consistently distinguish flu from other febrile illnesses.)
Kinsa’s technology was approved by the Food and Drug Administration in 2014 and gathered data in subsequent flu seasons; the company hopes to soon publish a study by outside experts assessing its accuracy in measuring the seasonal spread.
Those experts, Mr. Singh said, found the data to be more accurate than Google’s Flu Trends, which Google shut down three years ago after it missed the peak of the 2013-2014 season.
Google tracked internet searches for terms like “flu,” “fever” and so on, but could be misled by, for example, searches triggered by news coverage.” (H)

“One of the best defenses against the flu starts with tissue and hankerchiefs, two Northwest Indiana health professionals say.
For tissues, don’t use them twice. For hankies, don’t use them at all.
Donna E. Ricard, nurse practitioner with Franciscan Senior Health & Wellness at the Dyer Medical Pavilion, and Laura Matthys, manager at Franciscan Senior Health & Wellness, are emphatic about maintaining good hygiene to avoid spread of the virus. That means washing hands, using hand sanitizer, covering the cough and tossing tissues in the trash.
Some seniors need to break their habit of keeping tissues in their sleeves, according to Matthys. Matthys and Ricard both highly recommend everyone use a tissue once and throw it in the trash.
“And no hankies!” scolds Matthys. She’s not joking. Matthys recognizes there is a generation of men and women who still carry handkerchiefs in their purses and pockets.
Though many seniors have made it a lifelong habit to use a hanky instead of tissue, they may not realize how unsanitary it is — especially if they lend them to a friend, the health professionals said….
As the Indiana Department of Health reports widespread influenza-like illnesses, healthcare providers urge everyone to get a flu shot, be fastidious about washing their hands, covering their mouths when they cough and — as Ricard and Matthys said — remembering to throw away used tissues.” (I)

“In 2015, during an interview on the former Opie & Jim Norton radio show, Trump was asked if he gets the flu shot every year, and said no:
“I’ve never had one… Thus far I’ve never had the flu. I don’t like the idea of injecting bad stuff into [my] body, which is basically what they do…I’ve never had a flu shot, and I’ve never had the flu…I have friends that religiously get the flu shot and then they get the flu… I’ve seen a lot of reports that the last flu shot is virtually totally ineffective.”
He also said: “I’ve passed on it, but that doesn’t mean [other] people should.” “ (J)

Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

(A) Watch how the flu became an epidemic, by SUSAN STEADE, https://www.mercurynews.com/2018/01/16/watch-how-the-flu-became-an-epidemic/
(B) 2017-2018 Influenza Season Week 1 ending January 6, 2018, https://www.cdc.gov/flu/weekly/index.htm
(C) Flu stresses hospitals, shows we’re not ready for emergencies, by MAGGIE FOX, https://www.nbcnews.com/health/health-news/flu-stresses-hospitals-shows-we-re-not-ready-emergencies-n838086
(D) California hospitals face a ‘war zone’ of flu patients — and are setting up tents to treat them, by Soumya Karlamangla, http://www.latimes.com/local/lanow/la-me-ln-flu-demand-20180116-htmlstory.html
(E) A Monster of a Flu Season Has the CDC Hunkering Down on Strategies, by Peter Hess, https://www.inverse.com/article/40232-glu-tamiflu-antivirals-h3n2-cdc-recommendations
(F) Why the Deadly 2018 Flu Season Could Get Even Worse , https://www.msn.com/en-us/health/medical/why-the-deadly-2018-flu-season-could-get-even-worse/ar-AAuLvdq?li=BBmkt5R&ocid=spartandhp
(G) A severe flu season is stretching hospitals thin. That is a very bad omen, By HELEN BRANSWELL, https://www.statnews.com/2018/01/15/flu-hospital-pandemics/?utm_source=STAT+Newsletters&utm_campaign=6a8b566307-On_Call&utm_medium=email&utm_term=0_8cab1d7961-6a8b566307-150519373
(H) ‘Smart Thermometers’ Track Flu Season in Real Time, by DONALD G. McNEIL Jr. , https://www.nytimes.com/2018/01/16/health/smart-thermometers-flu.html
(I) Don’t want to get the flu? Stop using hankies, experts say, by Nancy Coltun Webster, https://www.mercurynews.com/2018/01/16/watch-how-the-flu-became-an-epidemic/
(J) Did President Donald Trump Get the Flu Shot?, by ALEXANDRA SIFFERLIN, http://time.com/5093600/president-trump-flu-shot/

“The emergency room at Good Samaritan Hospital has been so packed with patients suffering from miserable flu symptoms the past few weeks, with incoming ambulances lined up outside and hospital rooms jammed, the staff has gone to its “Code Green” nearly every day.
“It’s all hands on deck,” said Dr. David Feldman, chairman of Good Samaritan’s Emergency Department.
Hospital CEO Joe DeSchryver has picked up a broom to sweep out emergency rooms for the stream of patients. Grace Ibe, a vice president, has wheeled patients in gurneys upstairs. And CFO Jody Dial has come in at midnight to troubleshoot and bring pizza…
At hospitals around the Bay Area and across the country, those on the front lines of what is shaping up to be the worst flu season in a decade are struggling to keep up — and wondering whether it will get worse.
Doctors and nurses are working overtime and double shifts. Some have become sick themselves, causing staff shortages when they are needed most. As one doctor put it, in emergency departments where misery is often hidden behind ubiquitous blue masks, “there’s a lot of coughing, sneezing, crying and fever.”” (B)

“Because the flu is so common, we tend to minimize its importance. Consider the contrast with how the United States responded to Ebola a few years ago. We had a handful of infections, almost none of them contracted here. One person died. Yet some states considered travel bans, and others started quarantining people.
Worldwide, just over 10,000 people died in the 2014-15 West African outbreak of Ebola: a relatively new, frighteningly contagious illness that people feared could become a global pandemic. It’s not surprising that it got a lot of attention. Yet the tens of thousands who died of influenza in the United States the same year barely made the news.”
The C.D.C. estimated that in the 2015-2016 flu season, the flu shot prevented more than five million cases of the flu, about 2.5 million medical visits and more than 70,000 hospitalizations. It was also estimated that it prevented 3,000 deaths.” (C)

“Influenza activity is widespread in all states except Hawaii (and the District of Columbia), according to the weekly flu report released Friday by the US Centers for Disease Control and Prevention.
“Flu is everywhere in the US right now,” said Dr. Dan Jernigan, director of the CDC’s influenza branch. “This is the first year we’ve had the entire continental US at the same level (of flu activity) at the same time.” It has been an early flu season that seems to be peaking now, he said, with a 5.8% increase in laboratory-confirmed cases this week over last.
There were 11,718 new laboratory-confirmed cases during the week ending January 6, bringing the season total to 60,161. These numbers do not include all people who have had the flu, as many do not see a doctor when sick.
Seven additional pediatric deaths were reported during the week ending January 6, bringing the total for the season to 20…
Different states, different responses
Alabama Gov. Kay Ivey declared a state public health emergency because of the flu on Thursday.
Scott Harris, acting state health officer at the Alabama Department of Public Health, said the influenza outbreak includes high activity throughout the state but particularly in metropolitan areas. This “crush” means some hospitals are operating over capacity, leaving some patients sitting in ERs. The public health emergency order helps health care professionals manage resources more efficiently and provides leeway so alternative care can be provided when personnel are unable to offer standard care…
Texas, which laboratory-confirmed 5,585 cases of the flu as of that date, is seeing activity levels “at the highest level — widespread — for a few weeks,” said Lara M. Anton, a press officer for the Department of State Health Services….
“There are reports of hospitals throughout the state that have needed to divert non-emergency ambulances for periods of time because of overcrowding in their ER,” Anton said. With most hospitals coming off “divert status” within the same day, the state’s hospital system has been managing the increased number of patients. The department continues to monitor the situation closely and “will step in with support when it is requested,” she said.
Texas is encouraging “anyone with symptoms to stay home and to see their health care provider, as antiviral medications may shorten the duration of their illness..” (D)

“Big-city hospitals in Texas have been overwhelmed this week by an influx of flu patients, and state health officials say influenza activity is widespread across the state.
At Parkland Memorial Hospital in Dallas, waiting rooms turned into exam areas as a medical tent was built in order to deal with the surge of patients. A Houston doctor said local hospital beds were at capacity, telling flu sufferers they might be better off staying at home. Austin’s emergency rooms have also seen an influx of flu patients.
But high emergency room volumes and filled hospital beds are “not uncommon” for this point during flu season, which runs from October to May, said Lara Anton of the Texas Department of State Health Services.
“We definitely know it’s widespread,” Anton said this week. “We have been at widespread for the past three weeks.” But she added that it’s too early in the season to know whether this year’s flu impact is extraordinary.
On Monday alone, Parkland’s emergency department had seen 930 patients — double what the hospital typically sees for people with flu symptoms by this time of year, Dr. Joseph Chang, associate chief medical officer for Parkland, told CBS11.” (E)

“A shortage of the plastic bags used to deliver fluids and medicine to sick and dehydrated patients is spurring area hospitals to find alternative delivery methods in the midst of a nasty flu season.
Hospitals in Michigan and nationwide have resorted to jury-rigging solutions and even reverting to labor-intensive methods rarely used since the advent of the IV bags that have become indispensable in modern medicine. Those alternatives have increased the workload for pharmacists and nurses, and are forcing some hospitals to beef up staffing to keep pace with the need.
The problem comes in the wake of Hurricane Maria, which devastated operations in Puerto Rico at the major manufacturing plants for the bags.
Hardest hit have been the small-volume IV bags of 100 milliliters or less that are used to infuse antibiotics, cancer medicines and other critical drugs. Prior to the shortage, the five-hospital Beaumont Health system reportedly went through about 50,000 per month. Beaumont gets its small IV bags from Baxter, the nation’s largest supplier of the mini-bags, whose manufacturing facilities in Puerto Rico were idled by the storm. Their operations are expected to be back to full production by the end of January, but experts say it will take time to replenish supplies…
The shortage has been exacerbated by the flu outbreak, which has spiked emergency room visits and hospital admissions across the country. Beaumont Health announced Friday it was imposing visitation restrictions at its hospitals due to high volumes of patients with upper respiratory infections, predominantly the flu.”..
“Some days we’re able to get saline solution, other days we can get dextrose,” he said. “We have to work very closely with our nursing staff and providers to make sure whatever changes we’re making are safe for the patients.”
Some of the alternatives implemented include using portable pumps instead to administer some medicines. Supportive medicines, like those for nausea or to calm anxiety, are given orally when possible. And nurses can hand-push medications into IV lines at the bedside as another alternative.
Communication among staff is critical to ensure patient safety, Smith emphasized. Karmanos uses its internal online communications system, tip-sheets and other methods to keep all staff informed of up-to-the-minute changes.
“Everybody has to be on the same page on what we’re doing,” Smith said. “The nurse at the bedside (needs to know) exactly what you’re doing.” (F)

“According to the numbers, this year’s flu season is in fact worse than usual. It got started early, and it’s been more severe. Twenty kids have died of the flu since October. And in the week ending January 6, 22.7 out of every 100,000 hospitalizations in the U.S. were for flu—twice the number of the previous week.
“Flu is everywhere in the U.S. right now,” Dan Jernigan, director of the Center for Disease Control and Prevention’s influenza branch, said during a Friday press briefing. “This is the first year we’ve had the entire continental U.S. be the same same color”—referring to a map of state-by-state estimate of flu activity. That color is brown, meaning the flu is “widespread” everywhere in the U.S. except for Hawaii and the District of Columbia.
Several factors have come together make this year’s flu worse for patients who get sick and for hospitals trying to treat them.
First, the virus. Fears of a bad flu season first began in the early fall, after public health officials noticed a worse-than-average flu season in the southern hemisphere. The dominant circulating strain this year is H3N2, which hits humans harder than other strains. Scientists don’t really know why, but flu seasons where H3N2 have dominated in the past have tended to be worse. STAT reporter Helen Branswell called it the “problem child of seasonal flu.”
H3N2 (red) makes up the majority of lab-confirmed cases of flu this season. (CDC)
Second, the vaccine. This year’s vaccine was only 10 percent effective against the problematic H3N2 strain in Australia…
In recent years, researchers have tried to stop relying on chicken eggs. This flu season, for the first time, the H3N2 component of one type of vaccine, Flucelvax, was made in dog cells rather than chicken eggs. However, Flucelvax is more expensive and less widely available; most people who got the vaccine this year likely got the ones grown in chicken eggs. Researchers also are pursuing a universal flu vaccine that works against all strains.” (G)

“If you experience flu-like symptoms, you should first call or visit your primary care provider, who can quickly assess your health needs. By taking this step, you can avoid potentially long wait times at your nearby emergency department.
Your physician can also determine whether you need additional care because of the severity of symptoms or other risk factors, such as age (under 2 or over 65), pregnancy, a compromised immune system, or a chronic disease such as diabetes, heart disease or neurological disorders.
Each year, millions of children get sick with the flu and thousands are hospitalized. Some kids are at higher risk of serious complications: those younger than five, and any child who has a chronic medical condition such as asthma, diabetes, or disorders of the brain or nervous system. However, even healthy children can develop complications.
The best way to protect children is a yearly, injectable flu vaccine. It is not too late to get a shot. The vaccine protects your child against flu illnesses, which can reduce visits to the doctor and missed school days, and can prevent hospitalizations.
Symptoms of the flu typically begin one to four days after exposure to the virus and, in children, last one to two weeks. In addition to the typical fever, cough, aches and fatigue, children are more likely than adults to suffer vomiting and diarrhea – which can lead to dehydration.
Call the pediatrician if your child develops a fever; starts breathing rapidly or has trouble breathing; is not drinking enough; is less responsive than normal; or has the flu, gets better, and then relapses with fever or cough.” (H)

“The C.D.C. recommends people who are hospitalized or at high risk for complications of the flu, such as older patients, pregnant women and those who are otherwise immunocompromised, take the antiviral drug oseltamivir, sold under the brand name Tamiflu, because observational data indicate it might reduce the likelihood of death.
Other researchers, including those at the Cochrane Collaboration, disagree, saying that there’s not enough evidence to support taking oseltamivir or its chemical cousin zanamivir (brand name Relenza). They question the wisdom of spending billions stockpiling them as many countries, including the United States, began doing during the swine flu scare in the mid 2000s. Indeed, the World Health Organization last year downgraded oseltamivir from its list of essential medicines. It may or may not help, depending on which study you look at.
For healthy people who get the flu, most researchers agree the data indicates oseltamivir taken within 48 hours of onset can reduce the duration by about two-thirds of a day. But at around $154 for a course of the medication, that may not be worth it, given that the side effects include nausea and vomiting.
“We wish we had better drugs that could wipe out flu,” said Angela Campbell, a medical officer with the C.D.C.’s Influenza Division. But she said oseltamivir is “what we have right now” and in outpatient situations “it’s really the clinician’s decision with the patient based on a number of factors,” including cost and effectiveness, whether it should be prescribed or not.
The C.D.C. also still recommends getting this season’s flu shot, despite its questionable prophylactic value, because it might reduce the severity of the flu should you contract it. In previous years, against strains other than H3N2, flu shots have had reported effectiveness of about 40 percent to 60 percent. (I)

“If ever there was a case where familiarity bred contempt, and that contempt represented grave danger, it is the flu. Our casual references to “cold and flu” epitomize that perilous mindset. We seemingly think of the flu, likely due to its predictably annual impositions and its long familiarity, as a nuisance on par with the common cold. In my years of patient care, this mentality has been confirmed by the frequent, popular conflation of the two conditions; patients who merely have colds routinely self-diagnose the flu…
There is a case to make, and one that has been made, that we are more vulnerable now than in 1918. The global population of humans is vastly greater; the global population of domestic animals is greater; the co-habitation of the two in much of Asia persists; and global travel means that an outbreak anywhere can be everywhere else far more expeditiously now than a century ago. That is all legitimate cause for serious concern.
There are, however, reasons to think we may be less prone to catastrophe than our early 20th century forebears. They experienced a flu pandemic during a grueling world war. While current posturing about nuclear arms and buttons on desks is far from comforting, we may hope to avoid a recurrence of that dire confluence.
There is much less abject global poverty now than in 1918. We have antiviral drugs that are at least often and partially effective against flu. The world’s population is better nourished. And, of course, we have monumental advances in medical care overall that allow for far more effective management of flu complications, such as pneumonia.
That’s all reassuring. But it is by no means a case for complacency. Nor does any resource we have defend against the pernicious corrosion of Internet conspiracy theories and anti-vaccination sentiment run amok. No, vaccines are not perfectly, unfailingly safe, and they are certainly not perfectively effective. But they need be neither to be monumentally safer than and preferable to the diseases they help prevent. That is true of influenza, as it is true of polio, and was true of smallpox. I favor natural approaches to health and medicine when they are known to work, but there is no alternative ever shown to do what vaccines do; arguments to the contrary simply abandon epidemiology for ideology…
That we were catastrophically unprepared to be “flu’d” in 1918 was a surprise for which we may blame the virus. If we are so “flu’d” again, however, then we will need to hold ourselves accountable, and suffer the shame of tragic complacency along with the inevitable cost in lives. We are forewarned; whether or not we choose to be forearmed is up to us.” (J)

“You’ve no doubt heard the saying “feed a cold; starve a fever.” However, the healing power of nourishment and energy through foods is vital when you’re battling an intestinal virus or common cold in order to boost your immunity and give your body the energy it needs to fight off whatever illness is ailing you, particularly if you’re dealing with flu symptoms for several days or weeks.
Here are eight foods that are gentle on your body yet will help you overcome the flu…
Chicken Soup. There’s obviously some truth to the “Chicken Soup for the Soul” phenomenon. Not only is a steaming hot bowl of chicken soup comforting at time when you’re not feeling you’re best—each bowl contains vitamins, nourishment, minerals, and hydration benefits that you can’t get from starving a cold.
According to research from Mount Sinai, in Miami, Florida, chicken soup has the ability to improve air flow and flush out mucus in the nasal passages thanks to the copious amount of hot, steamy liquid within. A 1998 research report entitled “Coping With Allergies and Asthma” also found that a bowl of chicken soup actually contains anti-inflammatory properties that boost the tiny hairs-like follicles (known as cilia) in your nasal passages, which filter and stop the transportation of viruses, fungus, and bacteria from entering the body and causing nasty infections.” (K)

Hospital Pandemic Influenza Planning Checklist (L)
Planning for pandemic influenza is critical for ensuring a sustainable healthcare response. The Centers for Disease Control and Prevention (CDC), with input from other Federal partners, have developed this checklist to help hospitals assess and improve their preparedness for responding to pandemic influenza. Because of differences among hospitals (e.g., characteristics of the patient population, size of the hospital/community, scope of services), each hospital will need to adapt this checklist to meet its unique needs and circumstances.1 This checklist should be used as one of several tools for evaluating current plans or in developing a comprehensive pandemic influenza plan.

Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

(A) CDC quietly postpones nuclear war prep briefing to focus on the flu epidemic instead, by Ilene MacDonald, https://www.fiercehealthcare.com/healthcare/cdc-quietly-postpones-nuclear-war-prep-briefing-to-focus-flu-epidemic-instead?mkt_tok=eyJpIjoiT0RjMk56UXpZMlUwT0RnMCIsInQiOiJOSG9PSVk1XC9IZ0JuR3N3eEFwbElmSXlWZkQ0aHprVVFTbTNkVjBIVmNKUGpKcXROZDV3cTdZXC90TDFqVCt2RFBUeUFodDhsS3QwMER2bktyWmNCUU5hdno5ZndKVjdBUXBoU1l2bUhXcitjN2M1S09mbE9aWmc2d3ZaOGRYOGVoIn0%3D&mrkid=654508
(B) Flu deaths rise, patients pack Bay Area emergency rooms: ‘All hands on deck,’ doctor, by Julia Prodis Sulek, https://www.mercurynews.com/2018/01/14/flu-deaths-rise-patients-pack-bay-area-emergency-rooms-all-hands-on-deck-doctor-says/
(C) Still Not Convinced You Need a Flu Shot? First, It’s Not All About You, by Aaron E. Carroll, https://www.nytimes.com/2018/01/15/upshot/flu-shot-deaths-herd-immunity.html?_r=0
(D) Flu stomps the nation, overwhelming ERs and leaving 20 children dead, by Susan Scutti, http://www.cnn.com/2018/01/12/health/flu-surveillance-cdc/index.html
(E) Flu patients leave Texas hospitals strapped, by SYDNEY GREENE, https://www.texastribune.org/2018/01/11/flu-levels-rise-texas-officials-advise-public-be-aware/
(F) Detroit area hospitals’ IV bags drying up in flu season, by Karen Bouffard, http://www.detroitnews.com/story/life/wellness/2018/01/12/detroit-area-hospitals-iv-bags/109411668/
(G) The Perfect Storm Behind This Year’s Nasty Flu Season, by SARAH ZHANG, https://www.theatlantic.com/health/archive/2018/01/the-perfect-storm-behind-this-years-nasty-flu-season/550469/
(H) 2018 Flu Treatment, Prevention and How to Care for Others with the flu, https://www.lifespan.org/centers-services/primary-care-services/2018-flu-treatment-prevention-and-how-care-others
(I) In the Flu Battle, Hydration and Elevation May Be Your Best Weapons, by KATE MURPHY, https://www.nytimes.com/2018/01/12/well/live/flu-h3n2-virus-care-remedy.html
(J) Flu Us Twice?, by David L. Katz, https://www.huffingtonpost.com/entry/flu-us-twice_us_5a58b6f5e4b0d3efcf695772
(K) 8 Foods to Eat When Fighting the Flu, by Emily Lockhart, http://www.activebeat.co/diet-nutrition/8-foods-to-eat-when-fighting-the-flu/
(L) https://www.cdc.gov/flu/pandemic-resources/pdf/hospitalchecklist.pdf

President Donald Trump in October promised to “liberate” Americans from the “scourge of addiction,” officially declaring a 90-day public health emergency that would urgently mobilize the federal government to tackle the opioid epidemic.
That declaration runs out on Jan. 23, and beyond drawing more attention to the crisis, virtually nothing of consequence has been done…
A senior White House official disputed the assessment of inaction, saying the emergency declaration has allowed the president to use “his bully pulpit to draw further attention to this emergency that he inherited.” The official added that the declaration has enabled federal agencies to “really change their focus and prioritize the crisis,” and that getting an effective media campaign underway “takes time.”…
In West Virginia, which has the highest drug overdose death rate in the country, Public Health Commissioner Rahul Gupta hasn’t seen any significant change under Trump’s emergency order. “His thoughts and prayers have helped,” Gupta said. “But additional funding and resources would be more helpful.”..
State health officials and policy experts say billions of dollars in new funding are needed to make a dent in the crisis. The Public Health Emergency Fund, which HHS could tap under the Trump declaration, has a balance of just $57,000, and the administration hasn’t proposed replenishing it. Rather than asking for new money, the administration can move funds around in existing agency budgets — but that just means taking money away from other health programs….
The White House official said the administration is “actively in discussion with Congress” about funding for the crisis.” (A)

Congress approved bipartisan legislation in 2016 that authorized $1 billion over two years for opioid crisis response grants to states, which was signed into law by Obama. The first $500 million was doled out last year. The rest is being held up in a larger fight over a bill to fund the government, but it is eventually expected to be appropriated and distributed to states. And other money that Trump has touted comes from the CDC and the Substance Abuse and Mental Health Services Administration — agencies whose budgets were kept mostly flat under the 2017 spending bill and would have been cut in Trump’s budget proposal for 2018…
The administration has emphasized a law-and-order approach, cracking down on drug offenses and trying to cut the flow of illegal drugs into the country. Attorney General Jeff Sessions recently challenged states that have voted to legalize marijuana.
Trump’s health department has routinely touted its “five-point” strategy to combat the opioid crisis: prevention, treatment and recovery; expanding access to the overdose reversal drug naloxone; improving data about the scope of the crisis; and supporting research on pain and how it is managed.
Nevertheless, Eric Hargan, the acting HHS secretary, said in November that the president was leaving it to Congress to decide whether more money should be appropriated. Democrats argued hypocrisy. (B)

“A majority of the public considers addiction to prescription pain medication a major problem nationally (53%) but does not deem it a national emergency (28%) (Politico–HSPH, 2017). Substantially fewer people see it as an emergency (16%) or a major problem (38%) in their own community (PBS–Marist, 2017). In a list of national health problems, abuse of prescription painkillers ranks fifth in the proportion of the public that considers it an extremely serious disease or health condition facing the country (28%; KFF, April 2016). Concern about prescription-drug abuse as a public health problem has grown over time. Nearly 4 in 10 people (38%) currently believe it’s an extremely serious public health problem, double the proportion (19%) who believed so in 2013 (Pew, 2013 and 2017). More than 6 in 10 (63%) believe that the problem of addiction to prescription pain medications has increased in the past year, 26% think it has stayed about the same, and only 2% believe it has decreased (PBS–Marist, 2017)….
An important finding from our review is that at a time when public- and private-sector leaders are seeking a substantial increase in government funding for opioid-addiction treatment programs and legislation requiring insurers to offer coverage for these treatments, polls show a large share of the public uncertain about the long-term effectiveness of treatment. Over the next few years, this impression could affect family referrals to treatment programs, as well as public support for them and for a government requirement that insurance cover their cost. There is a clear need for the medical and scientific communities to educate the public about the issues surrounding the potential effectiveness of treatment.” (C)

“Pharmaceutical manufacturers such as Purdue Pharma, Endo International plc (ENDP – Get Report) , Teva Pharmaceutical Industries Ltd. (TEVA – Get Report) , Johnson & Johnson Inc. (JNJ – Get Report) and Allergan plc. (AGN – Get Report) as well as distributors Cardinal Health Inc. (CAH – Get Report) , McKesson Corp. (MCK – Get Report) and AmerisourceBergen Corp. (ABC – Get Report) have all been challenged by various parties to take action in the opioid epidemic…
Ohio is ground zero, where ten people die every day from opioids leaving behind families and friends and creating holes in cities and towns in the Buckeye state that don’t heal easily. And there is a cost beyond the human. Children moved from addicted parents to foster care cost $45 million a year. Indeed, half the kids in foster care come from parents addicted to opioids. Counseling and medication costs $216 million a year. Treating kids who are born drug dependent adds another $130 million. Ohio estimates that work lost because of the opioid crisis, fatal overdoses, and medical expenses costs $4 billion a year. From 2011 to 2015 3.8 billion doses of opioid meds were prescribed in Ohio. The state only has 11.6 million residents. In 2016, it lost 4,050 of those residents to overdoses of opioids, heroin and fentanyl, a dangerous synthetic opioid, according to Ohio’s own data…
While the pharmaceutical companies may not be beating a path to Columbus to talk to DeWine, that doesn’t mean they aren’t responding. A spokesman for Janssen said in an email “We believe the allegations in the lawsuit against our company are both legally and factually unfounded. Responsibly used opioid-based pain medicines give doctors and patients important choices to help manage the debilitating effects of chronic pain. Janssen has acted in the best interests of patients and physicians with regard to opioid pain medicines, which are FDA-approved and carry FDA-mandated warnings about possible risks on every product label.”…
McKesson, the San Francisco-based drug distributor, has spent its share of time in the harsh glare of the media spotlight. Investigative stalwart 60 Minutes and the Washington Post teamed up on a December report that showed the infighting between the Drug Enforcement Agency and the Justice Department over how best to go after McKesson regarding allegations that the company had been careless in its distribution and sale of opioids. While the DEA felt it had a criminal case against the company and more than enough evidence of wrongdoing for federal prosecutors, the case never saw the inside of a courtroom. Prosecutors maintained the case didn’t merit criminal charges and wasn’t strong enough. At one point the DOJ allegedly suggested the DEA become friendlier with the pharmaceutical industry.
Instead the DOJ huddled with a team of lawyers defending McKesson, negotiating a settlement that included a $150 million fine and a suspension of four of McKesson’s drug warehouses and increased staffing as well as McKesson hiring an independent monitor.” (D)

“A federal judge on Tuesday set a goal of doing something about the nation’s opioid epidemic this year, while noting the drug crisis is “100 percent man-made.”
Judge Dan Polster urged participants on all sides of lawsuits against drugmakers and distributors to work toward a common goal of reducing overdose deaths. He said the issue has come to courts because “other branches of government have punted” it.
The judge is overseeing more than 180 lawsuits against drug companies brought by local communities across the country, including those in California, Illinois, Kentucky, Ohio and West Virginia. Municipalities include San Joaquin County in California; Portsmouth, Ohio; and Huntington, West Virginia.
Polster said the goal must be reining in the amount of painkillers available.
“What we’ve got to do is dramatically reduce the number of pills that are out there, and make sure that the pills that are out there are being used properly,” Polster said during a hearing in his Cleveland courtroom. “Because we all know that a whole lot of them have gone walking, with devastating results.”
The judge said he believes everyone from drugmakers to doctors to individuals bear some responsibility for the crisis and haven’t done enough to stop it…
Polster likened the epidemic to the 1918 flu which killed hundreds of thousands of Americans, while pointing out a key difference.
“This is 100 percent man-made,” Polster said. “I’m pretty ashamed that this has occurred while I’ve been around.” (E)

“The epidemic of drug overdose deaths is a national disaster. It claimed more than 64,000 lives in 2016, many of them by opioid overdoses. That’s far more than the number of deaths from HIV/AIDS in the peak year of 1995…
About half of opioid overdose deaths occur among men and women ages 25 to 44; it’s reasonable to assume that many are parents. Imagine the impact on a child when a parent overdoses at home or in a grocery store. Statistics can’t tally the trauma felt by a seven-year-old who calls 911 to get help for an unconscious parent, or the responsibility undertaken by a twelve-year-old to feed and diaper a toddler sibling, or the impact of school absences and poor grades on a formerly successful high school student.
Parental overdoses have an immediate impact on children. There’s also a cumulative impact as these children become adults and are themselves at risk from the same influences that drove their parents to drugs, overdoses, and early deaths.
Who are these children and adolescents? Newborns whose mothers are addicted to opioids. These babies may undergo withdrawal themselves and need special treatment. Children of all ages at risk for accidental ingestion or inhalation of toxic substances. Children living with an addicted parent, dealing with constant uncertainty and fear. Children who have taken over the role of family caregiver for younger siblings or for their addicted parents. Children who are removed from their homes and placed in foster or kinship care. Some of these children have unmet mental health care needs. Very young children exposed to toxic levels of stress that impair brain development.
No one knows how many of these vulnerable children there are in the U.S. because no one is counting. As a point of comparison, an advisory group to the British government estimated that there are between 250,000 and 350,000 children of drug abusers in the U.K. — about one for every drug user. The title of its report, Hidden Harm, applies equally well to American children. They remain hidden in families with addiction until a crisis erupts and law enforcement or child welfare agencies get involved.” (F)

“Policymakers mistakenly focus on doctors treating their patients in pain. By intruding on the patient-doctor relationship they impede physician judgment and increase patient suffering. But another unintended consequence is that, by reducing the amount of prescription opioids that can be diverted to the illicit market, they have driven nonmedical users to heroin and fentanyl, which are cheaper and easier to obtain on the street than prescription opioids, and much more dangerous.
Data from the Centers for Disease Control and Prevention show that from 2006 to 2010 the opioid prescription rate tracked closely with the opioid overdose rate, at roughly 1 overdose for every 13,000 prescriptions. Then, after 2010, when the prescription rate dropped and it became more difficult to divert opioids for nonmedical use, the overdose rate began to climb as nonmedical users switched over to heroin and fentanyl. There is a dramatic negative correlation between prescription rate to overdose rate of -0.99 since 2010.
The overdose rate is not a product of doctors and patients abusing prescription opioids. It is a product of nonmedical users accessing the illicit market.
The problem will not get better—it will probably only get worse—as long as we continue to call this an “opioid crisis.” The title is too nonspecific. This is a crisis caused by drug prohibition—an unintended consequence of nonmedical drug users accessing the black market in drugs. Policymakers should stop harassing doctors and their patients and shift the focus to reforming overall drug policy. A good place to start would be to implement harm reduction measures, such as safe syringe programs, making Medication Assisted Treatments like methadone and suboxone more readily available, and making the opioid antidote naloxone available over-the-counter, so it can be easier for opioid users to obtain. Even better would be a sober reassessment of America’s longest war, the “War on Drugs.”
Renaming the problem a “heroin and fentanyl crisis” might be a way to trigger a refocus.” (G)

“Attorney General Jeff Sessions’ reversal of an Obama-era policy that let legalized marijuana proliferate in many states across the U.S. may affect states that have medical marijuana and recreational pot use laws. It’s too early, though, to tell just how significant the impact will be.
On Thursday, Sessions rescinded a decision made in 2013 that adopted a policy of non-interference with marijuana-friendly state laws, the New York Times reported…
“Federal law normally trumps state law, so a violation of a federal criminal statute could result in significant penalties including imprisonment, even if the act is lawful under state law,”…With Sessions’ decision, people selling or using marijuana for medical purposes could be prosecuted. “As a result, it would pose a chilling effect on the use of marijuana for needed medical purposes, even if prescribed by a doctor in accordance with state law,”.
While medical marijuana can’t be legally prescribed, possessed, or sold under federal law, its use to treat some medical conditions is legal under many state laws, according to the American Cancer Society. Currently, 29 states have medical marijuana laws. The Sessions decision could put the kibosh on many of those “compassionate use” laws, though.
“It could exclude one of the key ways that physicians can help their patients and reduce suffering. It might also result in greater use of less effective and more addictive medications such as opioids,” Gostin says.
Currently, the U.S. is experiencing an opioid epidemic. Since 1999, the number of overdose deaths involving opioids quadrupled, and prescription opioids are a driving factor in the increase, according to the U.S. Centers for Disease Control and Prevention…
Under the Sessions policy reversal, a cancer patient currently using a marijuana-based drug to ease pain or nausea may have that right taken away.” (H)

“The opioid epidemic is now a full-blown national crisis, yet the federal government continues to dawdle. President Donald Trump declared opioid addiction a public health emergency, and he talks a tough game. But he has not taken forceful action. If he will not lead, Congress must — and now, before the crisis grows even worse…
This is a solvable problem, and through philanthropy we can make some progress. But real success requires much bolder leadership — and a far greater sense of urgency — from both elected officials and industry leaders…
We must stop doctors from over-prescribing opioids, especially when non-addictive pain medications (such as ibuprofen or acetaminophen) would be just as effective. More aggressive action is needed.
The Food and Drug Administration should allow only doctors who complete specialized education in pain management to prescribe opioids for more than a few days, a move FDA Commissioner Scott Gottlieb is considering. ..
Insurers and pharmacy benefit managers must better oversee opioid prescriptions. CVS Caremark has moved to limit coverage for opioid prescriptions. Others should follow its lead. These companies exist to help people lead better, healthier lives, and they should not be complicit actors in an addiction and overdose epidemic…
We must hold pharmaceutical companies accountable for the supply of prescription opioids.,,
We must start treating those with addiction disorders when they come in contact with emergency rooms, hospitals and clinics. …
We must stop stigmatizing the medications that have been proven to help people recover…
The federal government should incentivize cities and states to offer treatment to inmates, as New York City and a handful of other localities do…
We must develop better data. Existing statistics on misuse and overdose are out of date and often inaccurate….
We must do more to block the importation of heroin — and of fentanyl, much of which originates in China….” (I)

“What can health care providers do to address these problems?..
Researchers called persistent prescription opioid use “one of the most common complications after elective surgery.”
This is not to say that patients should be left writhing in pain in their hospital beds: We need to start using a multi-disciplinary and multi-modal approach to pain management. Surgeons need to engage in early education with their patients about post-operative pain management and the risks of medications, as well as setting realistic expectations about what post-surgery pain will be like.
Additionally, health care providers need to identify those most vulnerable to opioid addiction, including those with mental health issues or pre-existing substance abuse, and establish more sensitive processes that ensure they experience as little pain as possible without relying on potentially dangerous opioids.
We also need to rely more heavily on other medications in our arsenal, such as acetaminophen, non-steroidal anti-inflammatories, muscles relaxants and nerve agents. And health care providers need to be innovative and creative and find different ways to implement pain medication delivery, using methods like steroid injections and epidural catheters.
Providers must also work harder to encourage those who do develop addictions to enlist in rehabilitation, and they should involve more frequently other specialists in crafting and carrying out treatment plans, especially pain management doctors and psychologists.
Most importantly, all providers need to look in the mirror and ask themselves if we are being good stewards of prescribing practices, or if we are part of the problem we see in the news.” (J)

“The USC-Brookings Schaffer Initiative for Health Policy’s Jason N. Doctor and Michael Menchine also say that emergency rooms are playing a significant role in the opioid crisis. First, emergency room visits are a notable source of the over-prescription of opioids—often with deadly consequences. Narcotic overdose is the eighth leading cause of death within one week of an emergency room visit.
Additionally, emergency rooms are often on the frontlines of treating those harmed by the epidemic. Currently, there are over 300,000 estimated annual emergency department visits for opioid overdose.
To address the crisis, Doctor and Menchine explain Congress and the Trump administration will have to focus on reducing population exposure to opioids, creating demand for safe and effective treatments, and the effective use of emergency departments. They recommend that the current administration and Congress fund additional resources to emergency rooms, including:
The development of opioid dependence screening tools for the emergency department;
Training to emergency department staff on how to address potentially opioid dependent individuals in an ethically neutral manner;
The expansion of referral sources for outpatient addiction specialty clinics (particularly for uninsured patients or those with Medicaid insurance);
Reduced administrative barriers to becoming a Buprenorphine prescriber; and
The development of a financial reimbursement model for prescription opioid screening or treatment in emergency room settings.” (K)

“Doctors at some of the country’s largest hospital chains admit they went overboard with opioids to make people as pain-free as possible.
Now the doctors shoulder part of the blame for the country’s opioid crisis. In an effort to be part of the cure, they’ve begun to issue an uncomfortable warning to patients: You’re going to feel some pain…
Opioid addiction is a reality that has been completely disconnected from where it often starts — in a hospital….
So the nation’s largest private hospital chain is rolling out a new protocol prior to surgery. It includes a conversation Schlosser basically never had when he was practicing medicine.
“We will treat the pain, but you should expect that you’re going to have some pain. And you should also understand that taking a narcotic so that you have no pain really puts you at risk of becoming addicted to that narcotic,” Schlosser tells patients.
Besides issuing the uncomfortable warning, sparing use of opioids also takes more work on the hospital’s part — trying nerve blocks and finding the most effective blend of non-narcotics. Then after surgery, the nursing staff has to stick to it. If someone can get up and walk and cough without doubling over, maybe they don’t need potentially addictive drugs, or at least not high doses of them.” (L)

Five Big Ideas to Confront the Opioid Crisis
1. Stop overprescribing
2. Treat opioid addiction as the public health crisis that it is
3. Stop the deaths
4. Guarantee Access to Treatment
5. Invest in data and knowledge” (M)

“In New York City, opioid addiction treatment is sharply segregated by income, according to addiction experts and an analysis of demographic data provided by the city health department. More affluent patients can avoid the methadone clinic entirely, receiving a new treatment directly from a doctor’s office. Many poorer Hispanic and black individuals struggling with drug addiction must rely on these highly regulated clinics, which they must visit daily to receive their plastic cup of methadone…
This is what opioid addiction recovery is like for more than 30,000 patients enrolled in New York City’s approximately 70 methadone-based treatment programs, which provide medication-assisted treatment, counseling and other social services. Hundreds of thousands of patients across the country are enrolled in similar programs, which often receive government funding and are covered by Medicaid in New York.
For more than 40 years, methadone was the most effective method for people addicted to heroin to keep their cravings in check. But in 2002, the Food and Drug Administration approved another medication to treat opioid addiction: buprenorphine, sold most widely in a compound called Suboxone. Both methadone and buprenorphine are extremely effective in keeping recovering users from relapsing, according to medical research, but Suboxone is engineered to reduce the possibility of abuse and overdose. Crucially, the medication can be prescribed in doctors’ offices and then taken at home.
Many hoped that buprenorphine could mean an end to the daily hurdles to receiving treatment for tens of thousands of patients: no additional commute, no security check, no waiting, no line for the plastic cup.
But today in the city, that is primarily true only for middle-class or upper-middle-class patients seeking help with their addiction.” (N)

“In May 2016, Taylor Weyeneth was an undergraduate at St. John’s University in New York, a legal studies student and fraternity member who organized a golf tournament and other events to raise money for veterans and their families.
Less than a year later, at 23, Weyeneth, was a political appointee and rising star at the Office of National Drug Control Policy, the White House office responsible for coordinating the federal government’s multibillion dollar anti-drug initiatives and supporting President Donald Trump’s efforts to curb the opioid epidemic. Weyeneth would soon become deputy chief of staff.
Weyeneth’s brief biography offers few clues that he would so quickly assume a leading role in the drug policy office, a job recently occupied by a lawyer and a veteran government official. His only professional experience after college and before becoming an appointee was working on Trump’s presidential campaign.
Weyeneth’s ascent from a low-level post to deputy chief of staff is due in large part to staff turnover and vacancies. The story of his appointment and remarkable rise provides insight into the Trump administration’s political appointments and the troubled state of the drug policy office.” (O)

(A) Trump declared an opioids emergency. Then nothing changed, by BRIANNA EHLEY, https://www.politico.com/story/2018/01/11/opioids-epidemic-trump-addiction-emergency-order-335848
(B) How can we solve the opioid crisis?, by Sarah Karlin-Smith, https://www.politico.com/video/2017/11/02/how-can-we-solve-the-opioid-crisis-064251
(C) The Public and the Opioid-Abuse Epidemic, by Robert J. Blendon, and John M. Benson, http://www.nejm.org/doi/full/10.1056/NEJMp1714529#t=article
(D) America’s Opioid Crisis Looks a Lot Like Big Tobacco Spats of Yesteryear, by Bill Meagher, https://www.thestreet.com/story/14397159/1/how-opioid-crisis-of-today-resembles-big-tobacco-lawsuits-battles.html
(E) Judge urges action on ‘100 percent manmade’ opioid crisis, by ANDREW WELSH-HUGGINS, http://abcnews.go.com/Health/wireStory/judge-urges-action-100-percent-manmade-opioid-crisis-52235186
(F) The statistics don’t capture the opioid epidemic’s impact on children, by CAROL LEVINE, https://www.statnews.com/2018/01/02/opioid-epidemic-impact-children/?utm_source=STAT+Newsletters&utm_campaign=073963a01b-First_Opinion&utm_medium=email&utm_term=0_8cab1d7961-073963a01b-150519373
(G) Stop Calling it an Opioid Crisis—It’s a Heroin and Fentanyl Crisis, by JEFFREY A. SINGER SHARE, https://www.cato.org/blog/stop-calling-it-opioid-crisis-its-heroin-fentanyl-crisis
(H) Could Jeff Sessions’ Marijuana Ruling Make the Opioid Crisis Even Worse?, by MARY BROPHY MARCUS, https://www.menshealth.com/health/jeff-sessions-marijuana-policy-opioid-crisis
(I) A Seven-Step Plan for Ending the Opioid Crisis, by Michael R. Bloomberg, https://www.bloomberg.com/view/articles/2018-01-10/a-seven-step-plan-for-ending-the-opioid-crisis
(J) Dr. Jacquelyn Corley To fix the opioid crisis, doctors like me may have to let patients be in pain, https://www.nbcnews.com/think/opinion/fix-opioid-crisis-doctors-me-may-have-let-patients-be-ncna836141
(K) The far-reaching effects of the US opioid crisis, by Brennan Hoban, https://www.brookings.edu/blog/brookings-now/2017/10/25/the-far-reaching-effects-of-the-us-opioid-crisis/
(L) Hospitals Brace Patients For Pain To Reduce Risk Of Opioid Addiction, by BLAKE FARMER, https://www.npr.org/sections/health-shots/2018/01/09/576584541/hospitals-brace-patients-for-pain-to-reduce-risk-of-opioid-addiction
(M) CONFRONTING OUR NATION’S OPIOID CRISIS, https://assets.aspeninstitute.org/content/uploads/2018/01/AHSG-Final-Report-2017_compressed-2.pdf
(N) Opioid Addiction Knows No Color, but Its Treatment Does, by JOSE A. DEL REAL, https://www.nytimes.com/2018/01/12/nyregion/opioid-addiction-knows-no-color-but-its-treatment-does.
(O) Trump’s response to opioid epidemic includes 24-year-old helping lead drug policy office, by Robert O’Harrow Jr., http://www.chicagotribune.com/news/nationworld/politics/ct-trump-drug-policy-office-20180113-story.html

“This winter’s flu season is turning into a “moderately severe” one that might get worse because of an imperfect vaccine and steady cold weather, flu experts and public health officials said this week…
About 80 percent of cases are of the H3N2 strain, which caused many hospitalizations and deaths this year in Australia, where winter comes in July and August.
“H3N2 is a bad virus,” Dr. Jernigan said. “We hate H3N2.”
Compared to H1N1, the other seasonal Type A strain, and to B strains that usually arrive late in the season, H3N2 tends to kill more of the very young and very old, he said…
The H3N2 component of Australia’s flu shot was reported to be only 10 percent effective at preventing infection and is the same as in North American shots. But both Dr. Jernigan and Dr. Fauci said they expected to see roughly 30 percent effectiveness when data is collected at season’s end, in part because more healthy people get their shots.
The vaccine mismatch was not caused by a genetic shift in the circulating flu, as happens in some years, but by changes in the “seed virus” used in the vaccine; as it grew in eggs, it picked up mutations foreign to human flu.” (A)

“The flu season is straining resources at hospitals nationwide with the Centers for Disease Control and Prevention reporting the flu is widespread in 46 states. Some hospitals are setting up emergency tents to handle the high volume of patients while others are dealing with a shortage of IV bags after Hurricane Maria cut power to manufacturing plants in Puerto Rico.
IV bags hold the medicines and fluids administered by IV and now nurses and doctors are being forced to find other ways to care for their patients, reports CBS News’ Michelle Miller.
In the intensive care unit at Massachusetts General Hospital, nurse Hannah Owens-Pike uses Gatorade to combat dehydration. It now takes her four times as long to administer treatment that would normally be delivered intravenously. Hospital staffers are forced to conserve supplies. (B)

Here is what you should know about this flu season:
1. It’s shaping up to be one of the worst in recent years
2. This season’s flu vaccine is likely to be less effective than in previous years
3. You should get the flu shot anyway
4. Basic precautions may spare you and your family from days in bed
5. Don’t mistake flu symptoms for those of a common cold (C)

“You’re going to be really annoyed, if after spending 12 hours waiting in the ER, we just say “you have the flu, go home.” But that’s all we’ll be able to say to you. Because we cannot cure the flu. It is a virus. We can try to make you feel better. But lots of the things we do for the flu, you can do at home. Flu care mostly consists of supportive measures like fluids and rest and over-the-counter medications.
Ibuprofen (like Motrin) usually makes people feel better than Tylenol. “Prescription strength” ibuprofen is 800 mg (four over-the-counter 200 mg tablets) taken every eight hours, and that’s the best thing to take, unless you have an ulcer. Take with food or milk or an antacid.
If you cannot hold anything down, we can give you IV fluids and anti-nausea medicine.
You may have heard of Tamiflu, the flu medicine. Tamiflu reduces symptoms by an average of one to one and a half days and can have side effects. It is also ineffective after 24 to 48 hours of symptom onset. We will give it to you if we think you really need it, but if we don’t give it, trust us that it’s because it’s not going to help you.
Do not request a Z-Pack. Antibiotics do not help a virus and risk giving you antibiotic-associated diarrhea, and you don’t want that…
There are other ways to get help beyond an unsatisfying trip to the emergency department. Here are our best suggestions:
Call your primary care doctor. Often your primary care doctor can offer advice over the phone or get you in her office. Give your doctor a chance to take care of you!
Urgent care centers: Wait times are considerably less at urgent care centers than emergency departments, and they’re usually able to estimate times over the phone. Many can administer all the treatments described above, even the IV fluids and X-rays.
Telemedicine: Consider finding out if your insurance pays for telemedicine services. This is a perfect use of telemedicine, and you won’t be exposing anyone else to the flu.” (D)

““What should you do if you have the flu?
Often the only response required for treating the flu is rest and staying hydrated, according to the CDC, since most people who get the flu do not need medical care or medication. Infected individuals should not go to the emergency room unless they have very severe symptoms, including being unable to eat, having trouble breathing, and severe vomiting.
Alas, Antibiotics are only helpful for treating bacterial infections, but influenza is caused by a virus.
People who are at high risk for complications — young children, people 65 and older, pregnant women and people with certain medical conditions — may consider taking an antiviral treatment to shorten the length of the illness. If you are in that group, contact your health care provider, the CDC suggests.
Should you go to work if you feel up to it?
Another important measure to take if you have the flu is staying home. More than one-quarter of American workers admit to going to work when they are sick, largely because of their work load, according to a survey released Tuesday by the public health nonprofit organization NSF International.
Being a martyr at work is highly discouraged by the CDC. “Stay away from others as much as possible to keep from infecting them,” the CDC said. “If you must leave home, for example to get medical care, wear a face mask if you have one, or cover coughs and sneezes with a tissue.” (E)

“At the Palomar Medical Center near San Diego, the new year ushered in a brutal flu season.
“The day came when we had extended waits in the emergency department up to eight or nine hours for a patient to be seen,” said Michelle Gunnett, emergency room nursing director. “We need to figure out other space to see patients.”
That space ended up being a triage tent set up right outside the ER.” (F)

“We are not prepared. Our current vaccines are based on 1940s research. Deploying them against a severe global pandemic would be equivalent to trying to stop an advancing battle tank with a single rifle. Limited global manufacturing capacity combined with the five to six months it takes to make these vaccines mean many people would never even have a chance to be vaccinated. Little is being done to aggressively change this unacceptable situation. We will have worldwide flu pandemics. Only their severity is unknown.
The only real solution is a universal vaccine that effectively attacks all influenza A strains, with reliable protection lasting for years, like other modern vaccines. Although the National Institutes of Health has publicly declared developing a vaccine a priority, it has only about $32 million this year specifically for such research. The Biomedical Advanced Research and Development Authority, the other federal agency responsible for developing and making available new vaccines for emergency response, has in fiscal year 2017 only a single project for $43 million supporting game-changing influenza vaccines….
The next few weeks will highlight how ill prepared we are for even “ordinary” flu. A worldwide influenza pandemic is literally the worst-case scenario in public health — yet far from an unthinkable occurrence. Unless we make changes, the question is not if but when it will come.” (G)

“In 2009, former President Barack Obama released a photo getting his H1N1 (swine flu) vaccine. President Gerald Ford got his swine flu vaccine back in 1976 on television. Plenty of governors and senators also release photos of their influenza vaccinations. In 2010, Obama officially declared Dec. 5-11 as National Influenza Vaccination Week. “I encourage Americans to get vaccinated this week if they have not yet done so, and to urge their families, friends, and co workers to do the same,” he wrote.” (H)

“Did President Donald Trump Get the Flu Shot? Some public health experts are hopeful that he will—and that he’ll talk about it” (I)

Note: This blog shares general information about understanding and navigating the health care system. For specific medical advice about your own problems, issues and options talk to your personal physician.

(A) Already ‘Moderately Severe,’ Flu Season in U.S. Could Get Worse, by DONALD G. McNEIL Jr., https://www.nytimes.com/2018/01/08/health/flu-season-cdc.html
(B) Hospitals struggle to battle peak flu season amid widespread IV bag shortage, https://www.cbsnews.com/pictures/notable-deaths-in-2017/
(C) What You Need To Know About This Year’s Flu Season, by BARBARA FEDER OSTROV, https://www.npr.org/sections/health-shots/2018/01/09/576772534/facing-down-flu-5-things-to-know-now
(D) What to Do if You Have the Flu, by Dara Kass and Brian Thomas Fletcher, http://www.slate.com/articles/health_and_science/medical_examiner/2018/01/how_to_handle_the_flu.html
(E) The flu costs Americans $10.4 billion in medical expenses and another $7 billion in lost productivity, by Kari Paul, https://www.marketwatch.com/topics/journalists/kari-paul
(F) Hospitals grapple with brutal flu season that could get even worse, by JONATHAN LAPOOK, https://www.cbsnews.com/news/hospitals-grapple-with-brutal-flu-season-that-could-get-even-worse/
(G) We’re Not Ready for a Flu Pandemic, MICHAEL T. OSTERHOLM and MARK OLSHAKERJAN, https://www.nytimes.com/2018/01/08/opinion/flu-pandemic-universal-vaccine.html?_r=0
(H) Did President Donald Trump Get the Flu Shot?, by Alexandra Sifferlin, http://time.com/5093600/president-trump-flu-shot/
(I) Did President Donald Trump Get the Flu Shot?, http://global.breaking.quwa.org/news/did-president-donald-trump-get-the-flu-shot