Hospitals struggle with staff shortages as federal Covid funds run out

“Hospitals across the country are grappling with widespread staffing shortages, complicating preparations for a potential Covid-19 surge as the BA.5 subvariant drives up cases, hospital admissions and deaths.

Long-standing problems, worker burnout and staff turnover have grown worse as Covid-19 waves have hit health care workers again and again — and as more employees fall sick with Covid-19 themselves.”

How the pandemic screwed up our antibiotics

“if we’re not very careful now, humanity may backslide into a world where our antibiotics become useless — and the common infections they used to treat cut our lives short.

The Covid-19 pandemic has made that danger worse. According to a new report from the Centers for Disease Control and Prevention (CDC), during the first year of the pandemic, the problem of drug resistance only intensified.

Drug resistance is what happens when we overuse antibiotics in the treatment of humans, animals, or crops. When a new antibiotic is introduced, it can have great, lifesaving results — for a while. But then the bacteria adapt. Gradually, the antibiotic becomes less effective, and we’re left with diseases we’re less able to treat.

Even before Covid-19, experts had been warning that we’re approaching a post-antibiotic era — a time when our antibiotics would become largely useless against health problems ranging from tuberculosis to STIs to urinary tract infections. They noted that routine hospital procedures like C-sections and joint replacements could become more dangerous, too, as the risk associated with infection — especially infections acquired in hospitals — increases.

Some professionals, especially in hospitals, had heeded the experts’ warnings, and we’d seen some progress as a result. Take staph infections, for example. A 2019 CDC report noted that rates of methicillin-resistant Staphylococcus aureus (MRSA) had dropped. And overall, deaths caused by drug resistance had decreased by 18 percent since 2013.

But the Covid-19 pandemic has reversed years of hard-won progress. Drug-resistant hospital-related deaths and infections from seven pathogens grew 15 percent from 2019 to 2020, including a 13 percent increase for MRSA infections, which can be deadly.

One reason for that is that hospitals overprescribed antibiotics, according to the CDC. From March through October 2020, almost 80 percent of Covid-19 patients who were hospitalized were given antibiotics. As a viral illness, Covid-19 isn’t affected by antibiotics, but doctors may have been keen to prescribe them to cure or protect against secondary infections, especially given that hospital stays for Covid-19 can be long and intensive.

“This setback can and must be temporary,” Michael Craig, the director of the CDC’s Antibiotic Resistance Coordination and Strategy Unit, said in a statement. “The best way to avert a pandemic caused by an antimicrobial-resistant pathogen is to identify gaps and invest in prevention to keep our nation safe.”

Obviously, the last thing we want is for the Covid-19 pandemic to pave the way for a new pandemic caused by some drug-resistant pathogen.”

“The good news is that we can absolutely address the problem of drug resistance. In its new report, the CDC calls for doubling down on strategies we know work, like preventing hospital-acquired infections in the first place and training medical professionals on when it is and isn’t appropriate to dole out antibiotics.”

Dobbs Opened Up an Attack on Doctors

“The whole sorry affair should remind us of one key reason why Roe was decided in the first place: to protect doctors.

It is a sad fact that some doctors will avoid providing essential medical care if the treatment in question is politically controversial. These doctors understandably fear that an overzealous prosecutor might use a vague law against them, just as Indiana’s attorney general threatened to do here.

Doctors who deal in certain types of pharmaceuticals run the same risks. In fact, just three days after Dobbs, the Supreme Court actually enhanced the legal protections for doctors who prescribe opioids. In an ironic twist, the Court did so while effectively reviving a pre-Roe case that protected the medical privacy rights of abortion providers.”

“The Dobbs decision obliterated those medical privacy protections by a narrow 5–4 vote. Yet by a 6–3 vote just three days later, the Supreme Court embraced the logic of Roe’s most important predecessor (Vuitch) when it strengthened the medical privacy rights of doctors who prescribe opioids (Ruan).

This contradictory and confusing state of affairs is bad both for medicine and for the law, and it ought to be fixed as soon as possible. Whenever a poorly drafted statute is open to abuse by an overreaching prosecutor, the Supreme Court has the option of using the void-for-vagueness doctrine to strike down the offending law. The Court could also require that all abortion regulations conform to the doctor-friendly rules spelled out in Ruan and Vuitch. Particularly egregious laws, meanwhile, can be invalided by the courts for lacking a rational basis.

The Constitution provides firm procedural safeguards whenever the government interferes with life, liberty, property, or privacy. The Supreme Court needs to ensure that doctors still enjoy those safeguards’ benefits.”

Can pharmacists refuse to fill prescriptions for drugs that can be used in abortions?

“Methotrexate is a fairly common drug that treats a wide range of medical conditions. I take it to help control an autoimmune disorder. So do about 60 percent of rheumatoid arthritis patients. It is used to treat some cancers, such as non-Hodgkin lymphoma. It also has at least one other important medical use.

The drug is the most common pharmaceutical treatment for ectopic pregnancies, a life-threatening medical condition where a fertilized egg implants somewhere other than the uterus — typically a fallopian tube. If allowed to develop, this egg can eventually cause a rupture and massive internal bleeding. Methotrexate prevents embryonic cell growth, eventually terminating an ectopic pregnancy.

And so many patients who take methotrexate say they have become the latest victims of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization — the decision overruling Roe v. Wade.

It’s unclear how widespread this phenomenon is, though the problem is serious enough that the Arthritis Foundation put out a statement warning that “arthritis patients who rely on methotrexate are reporting difficulty accessing it,” and that “at least one state — Texas — allows pharmacists to refuse to fill prescriptions for misoprostol and methotrexate, which together can be used for medical abortions.”

In some cases, pharmacists are reportedly reluctant to fill methotrexate prescriptions in states where abortion is illegal, and doctors are similarly reluctant to prescribe it. In other cases, pharmacists may refuse to fill valid methotrexate prescriptions because they personally object to abortion, even in states where the procedure remains legal.”

What Puts Someone at Risk of Catching Monkeypox?

“As monkeypox spreads across the United States, it may be giving people flashbacks to the days of wiping down counters and groceries to get rid of the coronavirus. But for most people, the risk of getting monkeypox remains low. Almost all cases in the current outbreak — 98% — have been in adult men who have sex with men.

So how is the virus spreading? Studies of previous outbreaks suggest that the monkeypox virus is transmitted in three main ways: through direct contact with an infected person’s rash, by touching contaminated objects and fabrics or by respiratory droplets produced when an infected person coughs or sneezes. There is also evidence that a pregnant woman can spread the virus to her fetus through the placenta.

Scientists are still trying to understand if the virus can spread through semen, vaginal fluids, urine or feces and if people can be contagious before they develop visible symptoms.”

“The activities that put a person at highest risk of catching the virus involve close, intimate contact with another infected individual. This includes the kind of skin-to-skin contact that occurs during sex as well as when cuddling, hugging, massaging or kissing another person. Condoms probably add a layer of protection during sex, but they are unlikely to prevent contact with lesions on an infected person’s groin, thighs, buttocks or on other parts of their body.

Roommates and family members in the same house are also at significantly higher risk of getting monkeypox compared to any other individuals a patient may come into close contact with, said Dr. Bernard Camins, the medical director for infection prevention at the Mount Sinai Health System.

Household contacts can catch monkeypox through contaminated clothes, towels and bedding. Shared utensils that may carry an infected person’s saliva should also be considered high risk, said Saskia Popescu, an infectious disease epidemiologist at George Mason University.”

Even Exceptions To Abortion Bans Pit A Mother’s Life Against Doctors’ Fears

“With the end of Roe v. Wade’s abortion protections, there are now millions of Americans who won’t be able to get an abortion if they want one. Some, like Houshmand, will be people who are seeking abortion because of the way a pregnancy is affecting their health. In theory, this shouldn’t be a problem, thanks to exceptions for the life of the mother that are common, even in the strictest abortion bans. But the medical professionals, legal experts and researchers we spoke to said those exceptions are usually vague, creating an environment where patients have to meet some unspoken and arbitrary criteria to get treatment.”

We Don’t Need a White House Monkeypox ‘Coordinator.’ We Just Need the Vaccines.

“We’re up to about 3,600 known cases of monkeypox in the United States, according to the Centers for Disease Control and Prevention (CDC). That’s more than double the number of cases from just two weeks ago.

As the federal government struggles to distribute vaccines where they’re needed, The Washington Post reports that the White House is thinking of declaring a public health emergency and naming a “White House coordinator” to oversee the response.

The public response should be: Please don’t. Please just get the vaccines to local public health agencies and let them deal with it. Because right now, that’s about half the problem that’s causing monkeypox to spread.

Red tape from the Food and Drug Administration (FDA) and the CDC left more than a million monkeypox vaccine doses stuck in storage in Denmark, and then another roll of red tape made it incredibly difficult for doctors to prescribe an alternative monkeypox treatment because it’s still in clinical trials.

As a result, local health agencies have had to carefully portion out vaccines to the highest-risk citizens—and they’re still running out. In Los Angeles, the county Public Health Department will only administer to people who are infected, people who have had high-risk contact (typically sex) with somebody who is infected, and then gay or bisexual men or trans people who fit in one of the [certain] categories”

“Fortunately, monkeypox’s spread has still remained pretty limited even as it has grown. The percentage of growth seems huge because we’re dealing with a fairly low baseline. And though monkeypox is not technically a sexually transmitted disease—it is spread through contact with the rashes and lesions created by the virus as well as through saliva—this particular version of monkeypox has been pretty resistant so far to being spread through methods other than sexual contact.”

Health systems want government help fighting off the hackers

“Cyberattacks on health systems are on a steady rise, and their costs are mushrooming. Experts said there are a variety of reasons for the increase, including that criminals are getting more advanced and more aspects of health care are online.

When a cyberattack struck Sky Lakes Medical Center, a community hospital in southern Oregon, in late October 2020, its computers were down for three weeks. The most mundane tasks became arduous. Nurses had to check on critical patients every 15 minutes in case their vital signs changed. Doctors scribbled down their orders and the swelling mounds of paper took over whole rooms. In three weeks, the hospital ran through 60,000 sheets of paper.

Sky Lakes had to rebuild or replace 2,500 computers and clean its network to get back online. Even after it hired extra staff, it took six months to input all the paper records into the system. In total, John Gaede, Sky Lakes director of information services, says his organization spent $10 million — a big expense for a nonprofit with roughly $4.4 million in annual operating income (the organization did not pay a ransom).

For hospitals with limited budgets, there are questions about how well they can protect themselves. The attack on Sky Lakes was part of a wave of attacks in 2020 and 2021 connected to a criminal group in Eastern Europe.

“Our budgets typically have a margin of maybe 3 percent a year,” Gaede said, “but we’re supposed to compete with nation-state actors?”

Health data is lucrative on the black market, making hospitals a popular target. Plus, if a health system has ransomware insurance, criminals may think they’re guaranteed a payout. Ransomware ties up hospital records in encrypted files until a fee is paid.

“Back when ransoms were $50,000, it was cheaper to pay them than to deal with a lawsuit that would have cost far more,” says Omid Rahmani, associate director at Fitch Ratings, a credit rating agency, adding that ransoms now cost millions. “The landscape’s changed and because of that the cyber insurance side has changed — and that’s really connected to the rise of ransomware.”

In its annual cost of a data breach report, IBM writes the global average cost of an attack on a health system rose from about $7 million to over $9 million in 2021. But remediating these violations in the U.S. can be far more expensive.”