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Freeman doctor educates residents on COVID-19 and the lessons learned

JOPLIN, Mo. – From how the coronavirus spreads and the symptoms that come with it, to the long term impacts and the knowledge that’s brought about the evolution of treatments.

“This past 18 months has been all about this grand experiment of trying to find out what are effective treatments, and what is a waste of time.” says Dr. Rob McNab, a physician at Freeman Health System who was the director of the hospital’s COVID unit.

Healthcare professionals like Dr. McNab have learned a lot about the virus over the last 18 months. And Tuesday, he’s passing that information on to residents who participate in Freeman Advantage, a wellness program for residents 50 and older, like Marjorie Ellis.

“I have known some (people) that have passed away, and so you know that makes you very conscientious I guess you could say about the disease,” says Ellis.

“We all recognize that this is a very infectious disease. The new Delta variant is multiple times more infectious than the original. If you’re an elderly person and, or, if you have significant health problems, you’re at the very highest risk to have a really severe infection. And that, obviously, can be life threatening,” says McNab. “So in talking to the advantage group, if any of them have vaccine hesitancy we can talk about that and address it.”

Even with slews of information being available online and otherwise, McNab says it’s still important to talk about even the basics.

“Some of it’s accurate, and some of it’s inaccurate,” says McNab. “And I think that the most important thing for me is to talk to people that are.. who I would describe as vaccine hesitant. They’re not against vaccinations, but they’re cautious. And rightly so. How can you make good decisions with poor information?”

He hopes that the accurate information he gets to the group will spread as they have conversations with friends and family. Something that’s especially important as vaccinations slow, hospitalizations increase, and the delta variant of the virus spreads in the four-states.

“That’s the best way, word of mouth, to be able to get good information out to the community. Because if you are at high risk, and you’re hesitant to get that vaccine, you’re the person that I really want to find and talk to,” says McNab.

More information: https://www.cdc.gov/coronavirus/2019-ncov/index.html

Related stories: https://www.koamnewsnow.com/covid-19-delta-variant-emerging-in-kansas-and-missouri/

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‘Obamacare’ survives: Supreme Court dismisses big challenge

WASHINGTON (AP) — The Supreme Court, though increasingly conservative in makeup, rejected the latest major Republican-led effort to kill the national health care law known as “Obamacare” on Thursday, preserving insurance coverage for millions of Americans.

The justices, by a 7-2 vote, left the entire Affordable Care Act intact in ruling that Texas, other GOP-led states and two individuals had no right to bring their lawsuit in federal court. The Biden administration says 31 million people have health insurance because of the law, which also survived two earlier challenges in the Supreme Court.

The law’s major provisions include protections for people with existing health conditions, a range of no-cost preventive services, expansion of the Medicaid program that insures lower-income people and access to health insurance markets offering subsidized plans.

“The Affordable Care Act remains the law of the land,” President Joe Biden, said, celebrating the ruling. He called for building further on the law that was enacted in 2010 when he was vice president.

Also left in place is the law’s now-toothless requirement that people have health insurance or pay a penalty. Congress rendered that provision irrelevant in 2017 when it reduced the penalty to zero.

The elimination of the penalty had become the hook that Texas and other GOP-led states, as well as the Trump administration, used to attack the entire law. They argued that without the mandate, a pillar of the law when it was passed, the rest of the law should fall, too.

And with a Supreme Court that includes three appointees of former President Donald Trump, opponents of “Obamacare” hoped a majority of the justices would finally kill the law they have been fighting for more than a decade.

But the third major attack on the law at the Supreme Court ended the way the first two did, with a majority of the court rebuffing efforts to gut the law or get rid of it altogether.

Trump’s appointees — Justices Amy Coney Barrett, Neil Gorsuch and Brett Kavanaugh — split their votes. Kavanaugh and Barrett joined the majority. Gorsuch was in dissent, signing on to an opinion from Justice Samuel Alito.

Justice Stephen Breyer wrote for the court that the states and people who filed a federal lawsuit “have failed to show that they have standing to attack as unconstitutional the Act’s minimum essential coverage provision.”

In dissent, Alito wrote, “Today’s decision is the third installment in our epic Affordable Care Act trilogy, and it follows the same pattern as installments one and two. In all three episodes, with the Affordable Care Act facing a serious threat, the Court has pulled off an improbable rescue.” Alito was a dissenter in the two earlier cases in 2012 and 2015, as well.

Like Alito, Justice Clarence Thomas was in dissent in the two earlier cases, but he joined Thursday’s majority, writing, “Although this Court has erred twice before in cases involving the Affordable Care Act, it does not err today.”

Because it dismissed the case for the plaintiff’s lack of legal standing — the ability to sue — the court didn’t actually rule on whether the individual mandate is unconstitutional now that there is no penalty for forgoing insurance. Lower courts had struck down the mandate, in rulings that were wiped away by the Supreme Court decision.

With the latest ruling, the Supreme Court reaffirmed that “the Affordable Care Act is here to stay,” former President Barack Obama said, adding his support to Biden’s call to expand the law.

Texas Attorney General Ken Paxton pledged to continue the fight against “Obamacare,” which he called a “massive government takeover of health care.”

But it’s not clear what Republicans can do, said Larry Levitt, an executive vice president for the nonprofit Kaiser Family Foundation, which studies health care.

“Democrats are in charge and they have made reinvigorating and building on the ACA a key priority,” Levitt said. “Republicans don’t seem to have much enthusiasm for continuing to try to overturn the law.”

Republicans have pressed their argument to invalidate the whole law even though congressional efforts to rip out the entire law “root and branch,” in Senate GOP leader Mitch McConnell’s words, have failed. The closest they came was in July 2017 when Arizona Sen. John McCain, who died the following year, delivered a dramatic thumbs-down vote to a repeal effort by fellow Republicans.

Chief Justice John Roberts said during arguments in November that it seemed the law’s foes were asking the court to do work best left to the political branches of government.

The court’s decision preserves benefits that have become part of the fabric of the nation’s health care system.

Polls show that the law has grown in popularity as it has endured the heaviest assault. In December 2016, just before Obama left office and Trump swept in calling the ACA a “disaster,” 46% of Americans had an unfavorable view of the law, while 43% approved, according to the Kaiser Family Foundation tracking poll. Those ratings flipped, and by February of this year 54% had a favorable view, while disapproval had fallen to 39% in the same ongoing poll.

The health law is now undergoing an expansion under Biden, who sees it as the foundation for moving the U.S. to coverage for all. His giant COVID-19 relief bill significantly increased subsidies for private health plans offered through the ACA’s insurance markets, while also dangling higher federal payments before the dozen states that have declined the law’s Medicaid expansion. About 1.2 million people have signed up with HealthCare.gov since Biden reopened enrollment amid high levels of COVID cases earlier this year.

Most of the people with insurance because of the law have it through Medicaid expansion or the health insurance markets that offer subsidized private plans. But its most popular benefit is protection for people with preexisting medical conditions. They cannot be turned down for coverage on account of health problems, or charged a higher premium. While those covered under employer plans already had such protections, “Obamacare” guaranteed them for people buying individual policies.

Another hugely popular benefit allows young adults to remain on their parents’ health insurance until they turn 26. Before the law, going without medical coverage was akin to a rite of passage for people in their 20s getting a start in the world.

Because of the ACA, most privately insured women receive birth control free of charge. It’s considered a preventive benefit covered at no additional cost to the patient. So are routine screenings for cancer and other conditions.

For Medicare recipients, “Obamacare” also improved preventive care, and more importantly, closed a prescription drug coverage gap of several thousand dollars that was known as the “doughnut hole.”

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Associated Press writer Ricardo Alonso-Zaldivar contributed to this report.

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Philips recalls ventilators and CPAP machines over cancer concerns

(CBS) – Philips recalls breathing devices and ventilators due to foam that might degrade and become toxic. It could possibly cause cancer, the Dutch medical equipment maker said on Monday.

The recall involves specific Philips Bi-Level Positive Airway Pressure (Bi-Level PAP), Continuous Positive Airway Pressure (CPAP) and mechanical ventilator devices to address potential health risks related to polyester-based polyurethane sound abatement foam that is in the machines, Philips said in a news release. Scroll down to see a full list of recalled devices, or, click here.

Foam used to soften the sound made by the machines can deteriorate and project tiny particles and gases that can irritate airways, cause headaches and possibly be toxic or carry cancer risks, according to the company.

No deaths have been reported in connection with the recalled devices.

“We deeply regret any concern and inconvenience that patients using the affected devices will experience because of the proactive measures we are announcing today to ensure patient safety,” CEO Frans van Houten stated.

Philips has produced millions of devices using the foam, with a low complaint rate of 0.03% last year, the company reported.

The company, one of the largest manufacturers of sleep apnea machines and ventilators, reported in quarterly earnings in late April that it had identified a quality issue with some sleep apnea and respiratory products, stating it was looking into the matter.

Sleep and respiratory care recall update – Philips

Sleep and respiratory care update Philips

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Worker shortage causes long waits for child psychiatric care

TOPEKA, Kan. (AP) — Psychiatric facilities have enough beds to treat children in Kansas in need of intensive mental health care, but a worker shortage means that about 100 of those spots remain empty.

Kansas News Service reports that in recent years, children have often waited months for openings in specialized facilities that offer long-term psychiatric care. In mid-2018, the average wait was nearly 200 days.

The wait time fell in 2019 and 2020, and as of last month, the average wait was 44 days. Yet 146 children remain in line for their turn, even though 104 beds are open.

Residential care centers are struggling to fill jobs that are physically and emotionally taxing, yet sometimes pay less than $15 an hour.

KidsTLC in Olathe is urging the state to help with incentives that could range from college tuition waivers and signing bonuses to subsidies for health insurance or child care.

KidsTLC bought land in March 2020 to add another 50 beds for children, and that work was finished in December, nearly doubling KidsTLC’s residential capacity. Forty-five of the new beds remain empty.

“We had space, we were licensed, and were feeling just exceptional about that and being able to make a significant dent in that waitlist,” CEO Erin Dugan said. “And then it became really hard to hire staff.”

Nonprofit facilities offer more than 400 beds for long-term psychiatric youth care in Kansas. Many of those slots were added within the past 18 months as the administration of Gov. Laura Kelly worked to license more beds and reduce wait times.

Andrew Brown, the state’s commissioner of behavioral health services, said the state would like to get to a point where the average wait time is a week or less.

KidsTLC has almost 300 workers but wants about 425. It has not struggled to hire and retain therapists and other salaried specialists. But hourly staff trained to work on site around the clock are a different matter.

Dugan said her organization offers starting pay of $14 an hour. It is now considering raising that to $16 an hour, but doing so would require significant fundraising by KidsTLC, which gets paid for its patients by Medicaid. Medicaid rates are widely considered low compared to private health insurance.

“How does KidsTLC find a couple million dollars?” Dugan asked. “It’s not sitting around.”

Meanwhile, the state has called on one of its Medicaid contractors to reduce wait times.

KanCare, the state’s Medicaid system, is privatized and run by three companies: Aetna Better Health of Kansas, Sunflower or UnitedHealthcare.

Those companies review and approve applications for residential treatment, but the state’s tracking of wait times that began in 2019 found that children with Aetna waited significantly longer than the others. The state found that Aetna appeared to have problems promptly gathering paperwork such as parental releases to get children in line for care.

“We hope that we will see improvements,” Brown said.

Aetna said it took swift action after the state pointed out the problem.

“We immediately took steps to review our process, identify causes for delays, and implement the changes necessary to minimize interruptions in care for our members,” a company statement said. “As a result of our internal review we have modified our processes to eliminate avoidable delays.”

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US officials extend expiration dates on J&J vaccine doses

WASHINGTON (AP) — Johnson & Johnson said Thursday that U.S. regulators extended the expiration date on millions of doses of its COVID-19 vaccine by an extra six weeks.

The company said a Food and Drug Administration review concluded the shots remain safe and effective up to 4 1/2 months. The announcement comes after state officials warned that many unused doses in storage would expire before the end of the month.

Expiration dates for vaccines are determined based on data the manufacturer submits to regulators proving how long the shots stay at the right strength. FDA originally authorized J&J’s vaccine for use for up to 3 months after manufacture when stored at normal refrigeration levels. But J&J said the FDA extended the period to to 4 1/2 months, based on data from ongoing studies assessing the vaccine’s stability.

The FDA has been reviewing expiration dates on the three authorized vaccines as companies have continued to test samples of batches in the months since the shots first rolled out.

The extension will help maintain vaccine supplies even as the rate of new injections continues to slip. The country averaged about 800,000 new injections per day last week. That’s down from a high of nearly 2 million per day two months ago. Government officials have turned to a growing number of incentives to encourages shots — from paid time off to $1 million lottery prizes.

As vaccinations have slowed it’s become clear the U.S. is unlikely to meet President Joe Biden’s goal target to have 70% of American adults partially vaccinated by July 4. Roughly 64% of Americans older than 18 have had at least one dose, according to the Centers for Disease Control and Prevention.

J&J’s vaccine was highly anticipated because of its one-and-done formulation and easy-to-ship refrigeration requirements. The shot was expected to play a key role in vaccination campaigns in rural areas and low-income countries with limited health care infrastructure.

But rival drugmakers Pfizer and Moderna have already supplied more than enough doses to meet U.S. demand, with more than 129 million Americans fully vaccinated with the companies’ two-dose shots. By comparison just 11 million Americans have been vaccinated with the J&J shot.

The U.S. is set to announce plans to donate 500 million Pfizer vaccine doses for global use over the next year, on top of 80 million doses already pledged by the end of the month.

Uptake of J&J’s vaccine in the U.S. has also been hurt by contamination problems at a Baltimore factory that helps manufacture the shots. The facility was shuttered after an FDA inspection uncovered multiple problems in April and none of the vaccines made there have been distributed.

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AP Health Writer Linda A. Johnson contributed to this story

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

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FDA approves much-debated Alzheimer’s drug panned by experts

WASHINGTON (AP) — Government health officials on Monday approved the first new drug for Alzheimer’s disease in nearly 20 years, disregarding warnings from independent advisers that the much-debated treatment hasn’t been shown to help slow the brain-destroying disease.

The Food and Drug Administration said it granted approval to the drug from Biogen based on results that seemed “reasonably likely” to benefit Alzheimer’s patients. (You can find additional information on the drug here.)

It’s the only drug that U.S. regulators have said can likely treat the underlying disease, rather than manage symptoms like anxiety and insomnia.

The decision, which could impact millions of older Americans and their families, is certain to spark disagreements among physicians, medical researchers and patient groups. It also has far-reaching implications for the standards used to evaluate experimental therapies, including those that show only incremental benefits.

The new drug, which Biogen developed with Japan’s Eisai Co., did not reverse mental decline, only slowing it in one study. The medication, aducanumab, will be marketed as Aduhelm and is to be given as an infusion every four weeks.

Dr. Caleb Alexander, an FDA adviser who recommended against the drug’s approval, said he was “surprised and disappointed” by the decision.

“The FDA gets the respect that it does because it has regulatory standards that are based on firm evidence. In this case, I think they gave the product a pass,” said Alexander, a researcher at Johns Hopkins University.

The FDA’s top drug regulator acknowledged in a statement that “residual uncertainties” surround the drug, but said Aduhelm’s ability to reduce harmful clumps of plaque in the brain “is expected” to help slow dementia.

Under terms of the so-called accelerated approval, the FDA is requiring the drugmaker to conduct a follow-up study to confirm benefits for patients. If the study fails to show effectiveness, the FDA could pull the drug from the market, though the agency rarely does so.

Biogen did not immediately disclose the price, though analysts have estimated the drug could cost between $30,000 and $50,000 for a year’s worth of treatment.

A preliminary analysis by one group found that the drug would need to be priced $2,500 to $8,300 per year to be a good value based on the “small overall health gains” suggested by company studies. The non-profit Institute for Clinical and Economic Review added that “any price is too high” if the drug’s benefit isn’t confirmed in follow-up studies.

Nearly 6 million people in the U.S. and many more worldwide have Alzheimer’s, which gradually attacks areas of the brain needed for memory, reasoning, communication and basic daily tasks. In the final stages of the disease, those afflicted lose the ability to swallow. The global burden of the disease, the most common cause of dementia, is only expected to grow as millions more baby boomers progress further into their 60s and 70s.

Aducanumab (pronounced “add-yoo-CAN-yoo-mab”) helps clear a protein linked to Alzheimer’s, called beta-amyloid, from the brain. Other experimental drugs have done that before but they made no difference in patients’ ability to think, care for themselves or live independently.

The pharmaceutical industry’s drug pipeline has been littered for years with failed Alzheimer’s treatments, representing billions in research costs. The FDA’s greenlight is likely to revive investments in similar therapies previously shelved by drugmakers.

The new medicine is made from living cells that will have to be given via infusion at a doctor’s office or hospital.

Researchers don’t fully understand what causes Alzheimer’s but there’s broad agreement that the brain plaque targeted by aducanumab is just one factor. Growing evidence suggests family history, education and chronic conditions like diabetes and heart disease may all play a role.

“This is just one piece of the puzzle and I think all these other options need to be explored and amplified,” said Dr. Ronald Petersen, a Mayo Clinic dementia specialist who has consulted for Biogen and other drugmakers.

Patients taking aducanumab saw their thinking skills decline 22% more slowly than patients taking a sham treatment.

But that meant a difference of just 0.39 on an 18-point score of cognitive and functional ability. And it’s unclear how such metrics translate into practical benefits, like greater independence or ability to recall important details.

The FDA’s review of the drug has become a flashpoint in longstanding debates over standards used to evaluate therapies for hard-to-treat conditions. On one side, groups representing Alzheimer’s patients and their families say any new therapy — even one of small benefit — warrants approval. But many experts have warned that greenlighting the drug could set a dangerous precedent, opening the door to treatments of questionable benefit.

The approval came despite a scathing assessment in November by the FDA’s outside panel of neurological experts. The group voted “no” to a series of questions on whether reanalyzed data from a single study submitted by Biogen showed that the drug was effective.

Cambridge, Massachusetts-Biogen halted two studies of the drug in 2019 after disappointing results suggested aducanumab would not meet its goal of slowing mental and functional decline in Alzheimer’s patients.

Several months later, the company reversed course, announcing that a new analysis of one of the studies showed the drug was effective at higher doses and that the FDA had advised that it warranted review. Company scientists said the drug’s initial failure was due to some patients not receiving high enough doses to slow the disease.

But the changes to dosing and the company’s after-the-fact analysis made the results hard to interpret, raising the skepticism of many experts, including those on the FDA panel.

The FDA isn’t required to follow the advice of its outside panelists and has previously disregarded their input when making similarly high-profile drug decisions.

About 600 U.S. medical specialists took part in Biogen’s studies of the drug and many more are expected to begin offering it. Many practical questions remain unanswered: How long do patients benefit? How do physicians determine when to discontinue the drug? Does the drug have any benefit in patients with more advanced dementia?

With FDA approval, aducanumab is certain to be covered by virtually all insurers, including Medicare, the government plan for seniors that covers more than 60 million people.

Both the FDA and Medicare are barred from considering cost when reviewing a new drug or treatment.

Even qualifying for the drug could be expensive. It’s only been tested in people with mild dementia from Alzheimer’s or a less severe condition called mild cognitive impairment. To verify a diagnosis could require brain scans that cost $5,000 or more. Insurers including Medicare don’t cover the scans because their benefits are unclear, but that could change if the scans become a gateway to treatment.

Additional scans will be needed to monitor potential side effects. The drug carries a warning about temporary brain swelling that can sometimes cause headaches, confusion and dizziness. Other side effects included allergic reactions, diarrhea and disorientation.

For patients in Biogen’s studies, the decision means they can continue taking a drug that many believe has helped.

Kevin Bonham was diagnosed with early onset Alzheimer’s in 2016 after having difficulties with memory, reading and driving. The 63-year-old from Bear Creek Village, Pennsylvania, credits the drug with helping him keep his job as a mapmaker for another three years.

“Very quickly over a period of months it was like the fog was lifted from the top of my head,” said Bonham, who is now on disability and relies on his wife, Kim, to help care for him and his teenage daughter.

Like other trial participants, Bonham had to stop taking aducanumab in March 2019 after Biogen halted its trials. He resumed infusions nearly a year ago as part of the company’s ongoing research.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

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Joplin opens COVID vaccine clinics in multiple loactions

JOPLIN, Mo. – The Joplin Health Department is setting up COVID-19 vaccine clinics at various locations across the community. The clinics will offer both first and second dose Moderna vaccines.

These clinics are open to all who are 18-years-old and over, regardless of city or state residency. No appointment is necessary. Citizens should bring a photo identification, and if they are seeking a second dose, they also need to bring their vaccination card. There is no cost associated with these vaccines.

 

Date                            Time                           Location                                 Type of Vaccine                     

Friday, June 4            9 AM – 1 PM            Senior Center                        Moderna vaccine   

                                                                        2616 S. Picher Avenue

         

Wed, June 9               9 – 11:30 AM             Joplin Health Dept.              Moderna vaccine             

                                    1:30 – 4 PM               321 East 4th Street

 

Sat, June 12               11 AM – 3 PM           Joplin Public Library           Moderna vaccine  

                                                                        1901 East 20th Street

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Oklahoma high court strikes down governor’s Medicaid plan

OKLAHOMA CITY (AP) – The Oklahoma Supreme Court has ruled Gov. Kevin Stitt’s plan to privatize much of the state’s Medicaid program is unconstitutional.

The court determined in a 6-3 ruling Tuesday that the Oklahoma Health Care Authority did not have the legislative approval to move forward with the plan. The Republican governor has pushed the plan to outsource management of the state’s Medicaid system to for-profit insurance companies. He maintains that approach will maximize health care quality while cutting costs. But a group of medical organizations filed suit in February seeking to stop the plan.

Plaintiffs included the Oklahoma State Medical Association and the Oklahoma Dental Association.

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Camp Quality Ozarks gives kids with cancer a summer camp experience

JOPLIN, Mo. – An organization is giving area kids with cancer a chance to have a summer camp experience at home.

Camp Quality Ozarks is hosting a virtual “Camp-In” with several activities for kids and their families. Normally the camp would be in-person but because of COVID-19 it has gone digital.

Yesterday the organization hosted a camp kickoff, which was in person.

“It’s a lot harder to a week-long virtual camp, but man in the end it’s definitely worth it,” said Executive Director Kirstin Patterson. “Getting to be together for these two hours tonight, we definitely had to take a lot of COVID precautions. But we got that under wraps, and we were so excited to get these two hours together.”

The camp runs all of next week.