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Centers for Disease Control

We need to understand what we did wrong

So yeah, we need this.

Two of the nation’s most influential experts on the coronavirus pandemic, both based in Texas, are calling for an independent, nonpartisan investigation of the U.S. response to the novel coronavirus.

“We must prevent this from happening again,” said Gerald Parker, who directs the pandemic and biosecurity program at Texas A&M’s Bush School of Public Service. “This is not going to be our last pandemic.”

Peter Hotez, a Houston-based vaccine researcher and frequent commentator on cable news, noted that the current virus, SARS-CoV-2, is the third coronavirus to pose a major health threat in the last 20 years. And given that outbreaks had already wreaked havoc in China and Europe, U.S. public health systems were notably slow to respond.

“What hurt Wuhan was what hurt New York City,” said Hotez, “which is that virus transmission went on for six weeks before there was any public health intervention.”

In a videotaped interview with John Sharp, chancellor of The Texas A&M University System, Parker suggested an investigation modeled on the nonpartisan 9/11 Commission.

[…]

Hotez, who also participated in the interview with Sharp, said later that he feared a congressional panel would become “a political circus.” Instead he proposed a review by the National Academies of Sciences, Engineering and Medicine.

Among the questions Hotez wants answered: How, for the whole month of February, did the U.S. miss evidence that the virus was already here? Given the crowding and high number of underlying conditions in low-income neighborhoods, what was done to prepare African-American and Hispanic communities in the early days? Why didn’t the CDC have a centralized epidemiological model, including models of cities and metropolitan areas? And how can the U.S. prepare for future epidemics?

For those who are fans of comparing government to business, this is a very standard business thing to do. Call it an after-action review, or a root cause analysis, or just a plain old audit, it really is vital to learn from experiences, good and bad, so that you can understand what happened and why it happened, and what you can do better next time. I think we can all agree that there is plenty to be learned from this saga, and we all owe it to ourselves to do that. I would hope that much is non-controversial.

But let’s be real, there’s no way to do this that won’t involve politics. You can put together the bluest of blue ribbon panels, staff it with the bona fidiest of experts, and stick entirely to a just-the-facts narrative, it’s still going to be political. That’s because the single biggest actor in this drama was Donald Trump, and his influence on the decisions made at the state and local level was entirely political. Any review that doesn’t do a thorough accounting of this isn’t worth the effort. If Republicans haven’t figured out that Trump’s mishandling of this is what’s killing them in the polls right now, I can’t help them, but I would think they’d want to help themselves. If we manage to get an all-Democratic government next year (please, please), I won’t really expect Republicans to like anything such a report would say. That’s shouldn’t be the point, or anyone’s concern. Do a thorough review, get all the facts out into the open, learn everything there is to be learned, and let the chips fall where they may.

Please wear a mask

Don’t be that person. Seriously.

Kara McIntyre remembers the day she likely contracted COVID-19 — she wasn’t wearing a face mask.

She was at Target and began to feel dizzy. Later she checked her temperature and had a fever. So she got tested for the novel coronavirus, and a few days later her results came back positive.

The 39-year-old radio deejay did not wear a face mask before she was infected in March, something she said she feels guilty about now.

“I know I came in contact with a person who tested positive for it,” McIntyre said. “I wasn’t going out much, but I put gas in my car, went to the grocery store. Knowing I went through that and may have gotten other people sick, that’s terrifying.”

As the state reopens restaurants, shopping malls, gyms and salons, whether or not to wear a mask has become a hot-button issue. To some, it’s a way to signal one has their neighbor’s health and well-being in mind. To others, it’s an inconvenience or an attack on American freedoms.

[…]

The Centers for Disease Control and Prevention recommends everyone wear a face mask in public, in addition to practicing social distancing and frequent hand washing. But the president and vice president are often photographed without them.

Face masks have become a divisive issue even in Houston, where residents are known for coming together during times of crisis like Hurricane Harvey, said Cathy Power, 51.

“What I gather is that there is a narrative out there that masks are for the weak. This is wrong — masks are worn to protect others; they are not for protecting yourself,” said Power, who lives in the East End, and suffers chronic health issues. “They reduce the risk by keeping droplets from traveling as far as they would if you were not wearing a mask. It works best if we all wear them.”

People wear masks to protect others around them as studies have shown it has little to do with our own ability to not be infected, said Dr. David Persse, Houston’s health authority.

“Take a mirror, breathe on it and see the mist that forms. If you’re ill, the mist is full of virus,” Persse said. “Do the same thing with the mask in front of you; you’ll see far less of any mist on that mirror at all. That’s how it works.”

This is the sort of assumption that drives post-reopening models that predict a large increase in COVID-19 infections. If people are literally and figuratively letting their guard down, we’re going to be right back where we were in early March before all the shutdowns. We don’t want that, right?

So that leaves two viable options. One is to continue to stay home as much as possible and be relentless about social distancing and avoiding crowds. If you’re doing that, then for the most part you don’t need to wear a mask. But when you are out in public, in places where you are interacting with or just in close contact with other people, then you really do need to wear one. Grocery shopping? Wear a mask. Getting your hair cut? Wear a mask. They do make a difference.

More to the point, if we all agree that the cost of keeping the economy on ice is very high, the key to reopening is to find ways to reduce risk while out in public. Wearing a mask is a low-cost method of risk mitigation. The more we do it, the more free we can be with our movements and interactions.

That’s really all there is to it. If we do this together, we can get that curve down to zero, which is the best-case scenario short of a vaccine. (Which an astonishingly large percentage of people say they won’t take, but that’s a rant for a different day.) Remember, lots of people have no choice about this – health care workers and people in all kids of retail and service jobs have been wearing masks all day every day for a long time now. It’s not that often that you can do a fairly small thing and make a big difference. This is one of those times. Wear your mask. Thank you.

Hollywood’s plans to come back

I’ve posted a few times about how sports leagues like MLB are making plans to return to action from coronavirus shutdowns. The larger entertainment industry, including TV and movie making, are in a similar position as the sports leagues, and they too are starting to game out how they can (safely) return to doing what they do. This story gives a good outline of where that stands.

We are still months away from cameras rolling — studios’ most optimistic projections are for July-August production restarts, and the more realistic ones are aiming to be up and running by September. California is still under a stay-at-home order, which currently expires on May 15.

There are many different issues we will cover, starting today with the resumption of location and soundstage shoots.

Getting up and running again in this brave new world is going to be very difficult to navigate. For one thing, insurers are unlikely to cover productions for COVID-19 cases when business resumes, according to multiple sources in the know. Producers all over filed multimillion-dollar claims triggered when civil authorities — governments — prevented filming from continuing and forcing production shutdowns. When the business starts up, that will now be considered an identified risk, and insurers will not cover it, sources said, just as CDC is warning of a second coronavirus wave.

What does that mean? Most likely, everyone on a film or TV production will be required to sign a rider, similar to ones they sign covering behavior codes in areas like sexual harassment, to indemnify the productions. “You acknowledge you are going into a high-density area, and while we will do our best effort to protect you, nothing is failsafe and if you contract COVID-19, we are not liable,” said a source involved drawing up these guidelines. “There is no other way we can think of to address this. If you don’t want to sign, don’t take the job.”

Conversations about how to return to production began ramping up late last week amid stabilizing levels of new COVID-19 cases and deaths in Los Angeles County, boosted by an encouraging drop in new infections over the weekend. Unfortunately, the optimism was short lived — Tuesday and Wednesday brought record spikes in deaths– but discussions continue because the business cannot begin to recover until an industry goes back to work.

So far, there are no protocols on which studios have settled, but active discussions continue, including with the film commissions in New York and Los Angeles, we hear. AMPTP and IATSE are leaning in hardest here to map lists of safety concerns and solutions, and every major studio in Hollywood has top people trying to figure out every scenario that needs to be addressed before shows can get up and running. The same conversations are taking place in other areas that touch the business, from the offices where people work and congregate, to hotspot eateries and movie theaters.

A lot of this starts with the state of California’s plan to gradually ease up on restrictions. Studios will still need to contend with any remaining local restrictions. There’s a lot in here, from catering to heavier use of green screens to avoid filming crowds to extra special handling of topline stars, and some of the items listed will likely be similar to the steps other businesses will have to take to reopen their own offices. Check it out.

Mask up

Time for the next step in virus mitigation.

Judge Lina Hidalgo

Harris County Judge Lina Hidalgo on Wednesday ordered residents to cover their faces in public, the latest effort by local governments to slow the spread of the novel coronavirus.

The new rules, which require residents 10 and older to cover their nose and mouth when outside the home, take effect Monday and last 30 days. Acceptable garments include a homemade mask, scarf, bandana or handkerchief. Medical masks or N-95 respirators are not recommended as they are most needed by first responders and health workers.

Under the order, the county’s 4.7 million residents must cover their faces at all times except when exercising, eating or drinking; the exemptions also include when individuals are alone in a separate single space, at home with roommates or family, or when wearing a mask poses a greater risk to security, mental or physical health. Violating the mask rules is punishable by a fine of up to $1,000, though Hidalgo urged police to use discretion.

Unlike previous restrictions announced by the city and county executives, Hidalgo’s mask order drew fierce, partisan rebuke, highlighting what has become a national political divide over coronavirus restrictions.

[…]

Employers at businesses deemed essential under Harris County’s stay-at-home order must provide face coverings and training to workers whose jobs require them to come into contact with colleagues or the public. Hidalgo has yet to determine whether to extend the stay-at-home rules, which expire April 30.

Hospitalization data suggests the curve of new cases is flattening here, Hidalgo said at a news conference Wednesday. The region still is susceptible to another wave of infections, she warned.

“If we get cocky, we get sloppy, we get right back to where we started, and all of the sacrifices people have been making have been in vain,” Hidalgo said while wearing a homemade mask. “Let’s not get complacent. Let’s remember that we still have work to do.”

Hidalgo said the mask rules were spurred by her team’s realization the outbreak would require a long-term health response that extends beyond the end of stay-home rules.

Houston Mayor Sylvester Turner endorsed Hidalgo’s plan. He thanked residents for their sacrifices to date and said he would announce a plan Thursday to distribute 70,000 masks to vulnerable residents.

Masks are a crucial tool to prevent a surge in cases as businesses and public spaces reopen, said Firas Zabaneh, an infectious disease expert at Houston Methodist. He said they also serve as a visual reminder to maintain social distancing.

“The public will be safer with masks on,” Zabaneh said. “As we ease the restrictions, more and more people are going to be interacting with each other.”

The Centers for Disease Control recommends wearing masks when social distancing is not possible, such as at a grocery store. Many people who have coronavirus do not show symptoms, and the disease can be spread through speaking, coughing or sneezing.

I omitted all the partisan criticism, which included a particularly whiny response from the police union president, because sniveling is pathetic and life is short. As the story notes, Laredo and Dallas and San Antonio have issued similar orders without any of the fuss; I’ll leave it to you to decide why the same thing from Judge Lina Hidalgo inspired such vitriol. The police guy went running to AG Ken Paxton to ask if she was allowed to do that, and he demurred, while reminding the cops that they do have the discretion to not issue citations.

Anyway, look. The way forward with this pandemic, certainly until we have an effective treatment regimen and eventually a vaccine, is going to include things like masks, plus continued social distancing and universal testing and a whole lot more hand sanitizer and bleach wipes. This is the new normal, whether we like it or not. It would be nice if everyone went along with this willingly, but we’ve already seen that a significant portion of the population doesn’t take any of this seriously. This is where we are.

Galveston and Montgomery Counties have not followed suit. For what it’s worth, they were behind the curve in issuing stay-at-home orders, too. With Greg Abbott’s forthcoming order to “reopen” the economy, it’s possible that Hidalgo’s order will be quite short-lived, since Abbott seems to have remembered that he doesn’t like letting local governments do things. As is so often the case lately, I have no idea what happens next. Buckle up, it’s gonna be bumpy. The Press has more.

Ridiculous Hotze lawsuit now in district court

We are all dumber by the mere existence of this.

The Texas Supreme Court has dismissed a lawsuit challenging the constitutionality of Harris County’s stay-at-home order, though the legal fight is set to continue in state district court.

The Wednesday ruling came at the request of the suit’s plaintiffs, including longtime conservative activist Steve Hotze and the pastors of three Houston-area churches.

Earlier this week, Jared Woodfill, the group’s attorney, filed a new case in Harris County that similarly claims County Judge Lina Hidalgo’s stay-at-home order violates the plaintiffs’ First Amendment rights because it allegedly continues to restrict church services even after Hidalgo revised it to align with Gov. Greg Abbott’s executive order deeming churches “essential businesses.”

The governor’s March 31 directive, akin to the stay-at-home orders issued by counties across Texas, came one day after anti-LGBTQ Republican activist Hotze and pastors Juan Bustamante, George Garcia and David Valdez filed a petition arguing that Harris County’s order violates the Constitution by ordering the closure of churches and failing to define gun shops as “essential” businesses.

The four original plaintiffs remain on the new lawsuit, and they are joined by Tom DeLay, the former House Majority Leader who represented a district in the Houston area until 2006. The plaintiffs also have challenged Montgomery County’s stay-at-home order in a different state district court.

[…]

Last Friday, Hidalgo revised her order to “permit in-person religious services that comply with the CDC’s guidelines,” according to a court filing by the county attorney’s office. The plaintiffs are continuing to challenge Hidalgo’s order in state district court, Woodfill said, in part because it imposes penalties — up to 180 days in jail and a $1,000 fine — that Abbott’s does not.

Hidalgo’s amended order says: “Per the Texas Attorney General’s guidance on this topic, if religious services cannot be conducted from home or through remote services, then religious services may be conducted in churches, congregations and houses of worship.”

Woodfill said he interprets that language to bar most churches from meeting in person, because most are capable of holding services remotely.

“Just about every church has the ability to do that,” Woodfill said. “Maybe there are some small churches that don’t. That doesn’t mean your parishioners have internet or the ability to access the service. We think that’s clearly government coming in to the church and issuing edicts and mandates that are an infringement on religious liberties.”

See here for the background. All this and Tom DeLay, too, because you can’t spell “stupid, evil, and corrupt” without Tom DeLay. Bear in mind, Hotze got what he wanted from Abbott’s executive order. It’s just that he’s special, so very special, and the rules of law and man don’t apply to him. I could sit here and spew invective at him all day, but what’s the point? He’s a sociopath, and this is what he does. If you get hurt as a result, that’s not his problem.

The Republican death wish

It would be one thing if they were just putting their own lives at risk, but that’s not how viruses work.

After Dallas County Judge Clay Jenkins became the first to announce a mandatory stay-at-home rule, conservative groups including Empower Texans began ringing alarms in opposition to Jenkins and to Republican Gov. Greg Abbott, who they say paved the way for the move.

Abbott had said he would applaud local leaders who felt they should issue stay-at-home orders for their communities.

“I’m extremely concerned about what Dallas Co just did, and Abbott’s apparent sanctioning of it,” Empower Texans president Ross Kecseg wrote on Twitter.

So far, Lt. Gov. Dan Patrick is the highest-ranking state official to echo those concerns.

“What I’m living in fear of is what is happening to this country,” Patrick said in a Fox News interview. “I don’t want the whole country to be sacrificed.”

Patrick, who turns 70 next week, went on to say he’d be willing to risk his own life and well-being to help preserve the way of life for other Americans — a statement that drew harsh rebukes on social media and inspired hashtags such as #DieForTheDow.

[…]

Critics of the stay-at-home orders are contradicting the advice of public health authorities at every level of government, from the World Health Organization to the national Centers for Disease Control and Prevention to local health officials. Epidemiologists have stressed that keeping people apart is the best way to fight back against a new virus for which there is no vaccine, and that aggressive early steps are the only way to get ahead of COVID-19.

The discord in Texas mirrors what’s going on at the national level with Republican governors showing more reluctance than Democratic ones, like Cuomo, to shutting down their states, said Timothy Callaghan, assistant professor of health policy and politics at the Texas A&M School of Public Health.

“On the one hand, they certainly want to protect the public health, but they are also afraid about hindering the freedoms of their citizens and they’re also concerned about the economic impact of having society in many ways shut down,” Callaghan said. “It’s a tricky balancing act for many politicians on the conservative side.”

Not only does that send Texans a mixed message but Callaghan said it could also reduce the effectiveness of the orders.

“If you want to see a true impact of flattening the curve throughout the state of Texas, it’s important for it to be a statewide policy,” Callaghan said. “Certainly in those areas that choose to enact some sort of shelter in place policy, you’re going to see some effect, but we don’t know if it’s going to be a smaller effect than if the entire state had chosen to do something.”

See here for the background. It’s not actually clear that they want to protect public health, since everyone who knows anything about public health and epidemiology is practically shouting from the rooftops that these shutdowns are necessary and we risk having literally millions of people die without them. Indeed, rightwing magazines are touting the virtues of deliberately spreading coronavirus, in a ridiculous and dangerous belief that it’s preferable to social distancing. I suspect there’s a certain amount of cognitive dissonance going on, since the one thing that can mitigate the economic impact of the stay-at-home orders is massive government action to put money in people’s pockets to replace the income they’d be losing, and that would seem to be the thing that Dan Patrick fears more than his own death. It’s clear that they’re taking their direction from Donald Trump, because that’s what they do these days and Trump is getting tired of the whole pandemic thing. It will be interesting to see if actual elected Republicans turn on Greg Abbott if he however reluctantly orders a statewide shutdown. In the meantime, I don’t know what there is to say other than there’s one way to get through this without a lot of people dying, and what these Republicans are agitating about is not it.

Further delay for Opening Day

Mid-May at the most optimistic, and that’s very likely too soon.

Major League Baseball pushed back opening day until mid-May at the earliest on Monday because of the new coronavirus after the federal government recommended restricting events of more than 50 people for the next eight weeks.

Baseball Commissioner Rob Manfred made the announcement following a conference call with executives of the 30 teams.

“The clubs remain committed to playing as many games as possible when the season begins,” the commissioner’s office said in a statement.

The Centers for Disease Control and Prevention recommended Sunday that gatherings of 50 people or more be canceled or postponed across the country for the next eight weeks.

“The opening of the 2020 regular season will be pushed back in accordance with that guidance,” Manfred said.

No telling at this point when games will start. The All-Star Game at Dodger Stadium in Los Angeles on July 14 could be in jeopardy.

“We’re not going to announce an alternate opening day at this point. We’re going to have to see how things develop,” Manfred told the St. Louis Post-Dispatch at Cardinals camp in Jupiter, Florida. He didn’t want to speculate about the possibility of playing in empty stadiums, saying part of that decision would depend on timing.

See here for the background. This assumes that after eight weeks we will not be under a general directive to greatly limit public gatherings, and that MLB players will be more or less ready to go as soon as that happens. I’ll take the over on this best and assume that sometime in June is a more realistic target. The NBA is currently aiming for mid-to-late June, and if that is how it works out for MLB as well, I’ll be reasonably satisfied. That could yield an MLB season of between 90 and 120 games, depending on when in June things could start and whether the end of the season could be pushed back and/or whether there might be more doubleheaders. I’m sure there will be plenty of discussions between the league and the union, as there are now about pay and service time and what have you. Three months seems like forever now, but if we’re at a point of normality again where sports have returned, I for one will be pretty damn happy. I mean, there are plenty of worse alternatives at this time.

The Houston healthcare community is preparing for COVID-19

I sure hope it’s enough.

With last week’s new certainty that the novel coronavirus is loose and being transmitted in Houston, the region’s medical providers are bracing for the current handful of known cases to blaze into an outbreak like nothing in modern memory.

“We had been saying, ‘It’s not a matter of if, it’s a matter of when,’” said Umair Shah, executive director of Harris County Public Health. “That’s not the case anymore. It’s now.”

By shutting down events and closing schools, officials aim to “flatten the curve” — to stop too many people from getting sick at the same time and overwhelming the region’s hospitals and medical providers.

Much about the highly contagious new virus remains unknown, and projections of its future behavior vary wildly.

Based on scenarios from the Centers for Disease Control and Prevention, the New York Times estimated that anywhere from 2.4 million to 21 million people in the United States could require hospitalization, “potentially crushing the nation’s medical system, which has only about 925,000 staffed hospital beds.”

For most people, the virus is expected to be mild. But up to 20 percent of cases — mostly people over 60 or with underlying medical conditions — may require hospitalization.

If everyone gets sick more or less at once, area hospitals almost certainly would not have enough rooms, critical care or ventilators. In Italy, where officials waited to control the outbreak, an extraordinary surge of cases has left the medical system on the verge of collapse.

Based on Harris County estimates, County Judge Lina Hidalgo said recently that if 30 percent of Harris County residents were to become sick at the same time and 20 percent of those people needed hospital care, medical infrastructure would be overloaded.

“We simply do not have enough hospital capacity to assume all of those people,” Hidalgo said. “We can’t afford to have a sudden spike in cases.”

Even the best case — a slowed outbreak that continues for months — is almost certain to pose significant challenges to the area’s hospitals, clinics and doctor’s offices.

[…]

The virus poses particular threats to hospital personnel, who will be working long hours under stressful conditions — and facing coronavirus-related personal problems such as a lack of child care due to school closures. In the worst scenario, seen in China, medical personnel become ill themselves, and their colleagues have to take care of them.

Testifying before Congress earlier this month, Dr. Peter Hotez, a Baylor College of Medicine vaccine researcher and infectious disease specialist, urged that special attention be paid to hospital workers.

“If health care professionals are out of work because they’re sick, or if they’re being taken care of by other health care professionals in ICUs, that’s a disaster,” he said.

And just this weekend, two ER doctors, one in New Jersey and one in Kirkland, Washington, have tested positive for coronavirus. Even with the best preventative measures, this thing is going to spread. All we can do – all that we must do – is take every action we can to try to limit how quickly it spreads. That’s our best hope.

The state responds to coronavirus

Like it or not, we need to be prepared.

Texas officials are scrambling to remain prepared for a major outbreak of a pneumonia-like disease whose global spread one expert says is now moving into “the next phase.”

From the governor’s office to hospitals to state agencies, Texas officials are intensifying efforts to plan for scenarios that could unfold now that the coronavirus is no longer relatively contained to China and surrounding countries and the number of cases is soaring in countries in Europe and the Middle East.

“I think we need to call an audible,” said Peter Hotez, an infectious disease specialist at Baylor College of Medicine and Texas Children’s Hospital. “We need to refresh the algorithms about who’s at risk and when we should suspect someone has the virus. We’re not calling it an epidemic yet, but we should start operating as if it were.”

Hotez said the disease’s spread — the number of cases in Italy and Iran, now about 900, more than doubled in two days, for instance — has made basing screening on the individual’s travel history less relevant. He also noted some recent cases have been characterized by gastrointestinal symptoms rather than respiratory symptoms.

[…]

There are 10 patients with the coronavirus in Texas, including six confirmed by the CDC and four who tested positively in Japan but whose results have not yet been confirmed by the U.S. agency. Of the 10, two came from Wuhan on a State Department-chartered flight and eight came from the Diamond Princess cruise.

There are 15 cases in the U.S. — none in Texas — that weren’t imported.

But CDC officials warned this week that it’s a matter of “when, not if” the virus arrives in the U.S. in larger numbers. The officials said people should start preparing for significant disruptions to daily life.

Noting the alarm that caused in some people who rushed out to buy water or face masks, Dr. Umair Shah, executive director of the Harris County Public Health Authority, said the remarks glossed over the timeline at which the U.S. cases are likely to significantly ramp up. He said that likely won’t be soon.

“The containment strategy in China was effective for giving everyone more time to prepare for the virus,” said Shah, noting the realistic hope was always to delay the virus’ spread, not stop it. “Governments were able to get information out and alert people to be on guard, just as they should be for the everyday flu.”

Three basic things: One, don’t panic. Two, be extra careful about what you read and especially what you share regarding coronavirus. Don’t be one of those idiots who passes along rumors and lies because you couldn’t be bothered to do a little vetting first. And three, practice good hygiene. Cough and sneeze into your elbow, wash your hands frequently, and if you do get sick, stay home. We can all do our part to make a difference.

The extraordinary danger of being pregnant and uninsured in Texas

So utterly appalling.

Right there with them

From 2012 through 2015, at least 382 pregnant women and new mothers died in Texas from causes related to pregnancy and childbirth, according to the most recent data available from the Department of State Health Services; since then, hundreds more have likely perished. While their cases reflect the problems that contribute to maternal mortality across the United States — gross medical errors, deeply entrenched racism, structural deficiencies in how care is delivered — another Texas-size factor often plays a significant role: the state’s vast, and growing, problem with health insurance access.

About one in six Texans — just over 5 million people — had no health insurance last year. That’s almost a sixth of all uninsured Americans, more than the entire population of neighboring Louisiana. After trending lower for several years, the Texas rate has been rising again — to 17.7% in 2018, or about twice the national average.

The numbers for women are even worse. Texas has the highest rate of uninsured women of reproductive age in the country; a third were without health coverage in 2018, according to a DSHS survey. In some counties, mainly along the Mexico border, that estimate approaches 40%.

Public health experts have long warned that such gaps can have profound consequences for women’s health across their lifespans and are a critical factor in why the U.S. has the highest rate of maternal deaths in the developed world. Texas’ maternal mortality numbers have been notably troubling, even as errors in key data have complicated efforts to understand what’s going on and led skeptics, including the governorto question whether there’s really a crisis.

Hardly anyone outside the policy world has taken a deep look at how these insurance gaps play out for women in the second-largest state in the U.S. — at how, in the worst-case scenarios, lack of access to medical care endangers the lives of pregnant women, new mothers and babies.

ProPublica and Vox have spent the last eight months doing just that — combing through government data and reports, medical records and research studies, and talking with scores of women, health care providers, policymakers and families of lost mothers around the state. We learned about Rosa Diaz and dozens of others, mostly women of color, by scouring medical examiner’s databases for sudden, “natural” deaths, then inspecting investigator and autopsy reports for clues about what went wrong.

The picture that emerges is of a system of staggering complexity, riddled with obstacles and cracks, that prioritizes babies over mothers, thwarts women at every turn, frustrates doctors and midwives, and incentivizes substandard care. It’s “the extreme example of a fragmented system that cares about women much more in the context of delivering a healthy baby than the mother’s health in and of itself,” said Eugene Declercq, professor of community health sciences at Boston University School of Public Health.

Most of the mothers whose cases we examined were covered by Medicaid for low-income pregnant women, a state-federal health insurance program that pays for 53% of the births in Texas, more than 200,000 a year, and 43% of all births nationwide. In Texas, the program covers OB-GYN visits, medications, testing and nonobstetric care, from endocrinologists to eye exams.

But the application process is so cumbersome that women in the state have the latest entry to prenatal care in the country, ProPublica and Vox found. It can take months to be seen by regular providers and even longer to access specialists. This poses the greatest danger for high-risk mothers-to-be — as many women on Medicaid are, having had no medical care for significant parts of their lives. Then, roughly two months after delivery, pregnancy Medicaid comes to an end, and the safety net gives way to a cliff. For many new mothers, the result is a medical, emotional and financial disaster.

More than half of all maternal deaths in the U.S. now occur following delivery, according to the Centers for Disease Control and Prevention, with as many as 24% happening six or more weeks after a woman gives birth. In Texas, the proportion of late-postpartum deaths is closer to 40%, with black women bearing the greatest risk. “To lose health care coverage really has a tremendous potential to worsen outcomes,” said Dr. Lisa Hollier, chief medical officer for obstetrics and gynecology for Texas Children’s Health Plan and chair of the state’s maternal mortality review committee.

This is a long excerpt, but there’s a lot more to the story, so please read the whole thing. There are numerous policy decisions at fault here – not expanding Medicaid, low Medicaid reimbursements, cutting off Planned Parenthood and substituting in wholly inadequate alternatives, and more – and all of them can be laid at the feet of the state’s Republican leadership. Whoever runs against Greg Abbott and Dan Patrick and Ken Paxton in 2022 should loudly and repeatedly assert that every maternal death in Texas is their fault. I keep saying this, and it keeps being true: Nothing will change until we have different, and better, government in this state. There’s no other way to do it.

Another look at scooter mayhem

From the Associated Press:

Photo: Josie Norris /San Antonio Express-News

As stand-up electric scooters have rolled into more than 100 cities worldwide, many of the people riding them are ending up in the emergency room with serious injuries. Others have been killed. There are no comprehensive statistics available but a rough count by The Associated Press of media reports turned up at least 11 electric scooter rider deaths in the U.S. since the beginning of 2018. Nine were on rented scooters and two on ones the victims owned.

With summer fast approaching, the numbers will undoubtedly grow as more riders take to the streets. Despite the risks, demand for the two-wheeled scooters continues to soar, popularized by companies like Lime and Bird. In the U.S. alone, riders took 38.5 million trips on rentable scooters in 2018, according to the National Association of City Transportation Officials.

[..]

Data on injuries or fatalities linked to scooters is hard to come by because the industry is so new. In Austin, Texas, public health officials working with the Centers for Disease Control counted 192 scooter-related injuries in three months in 2018. Nearly half were head injuries, including 15% that were traumatic brain injuries like concussions and bleeding of the brain. Less than 1% of the injured riders wore a helmet.

Bird, one of the largest scooter-sharing companies, dropped its scooters on the streets of Santa Monica, California, in September 2017 and within a few months riders were showing up at the emergency room, according to Dr. Tarak Trivedi, an emergency room physician in Los Angeles and co-author of one of the first peer-reviewed studies of scooter injuries. The following year, Trivedi and his colleagues counted 249 scooter injuries, and more than 40% were head injuries. Just 4% were wearing a helmet.

“I don’t think our roads are ready for this,” Trivedi said.

Bird and Lime both recommend that riders wear helmets, and they’ve handed out tens of thousands for free. But last year, Bird successfully fought a California proposal that would have required helmets for adults, maintaining that scooters should follow the same laws as electric bikes that don’t require adult helmets.

Bird says helmet requirements are off-putting to riders and could lead to fewer scooters on the road. Almost counterintuitively, the company argues that it’s better to have more riders than less because it forces drivers to pay attention to them.

“There’s a safety in numbers effect, where the motorists know that there’s people out on the street, so they act accordingly,” said Paul Steely White, director of safety policy and advocacy for Bird.

Getting people to wear helmets is a challenge. Riders don’t want exposure to lice or germs that could be found in shared helmets, and many make a spontaneous decision to scoot while they’re already out and about.

You can add this to the Austin study, which is now beginning to paint a consistent picture. Here’s the problem as I see it: Scooters on sidewalks are a danger to pedestrians, while scooters on roads are a danger to themselves, with worse potential consequences. They’re all right on bike paths and bike trails, as long as those are not used by pedestrians, but there aren’t enough of them to support the scooter business model. I don’t know how they’re supposed to fit into an urban street system. There’s something to be said for the “safety in numbers” effect – the same is known to be true for bicycles – but how many scooters will there need to be to get to that effect, and how long might that take? I just hope that we can figure out some better strategies to minimize the damage until we get there.

(That definitely means making helmets mandatory. I mean, come on.)

Austin’s scooter study

Be careful riding these things, and for crying out loud wear a helmet.

A first-of-its-kind study on injuries related to dockless electric scooters found that most incidents were preventable, and now Austin city officials are hoping to use their findings to inform future policy.

The city’s health and transportation departments collaborated with the Centers for Disease Control and Prevention to review 271 reports of possible scooter related injuries filed from Sept. 5 to Nov. 30, 2018. The study, however, only confirmed 190 cases involved scooter riders, one involved a pedestrian and one involved a cyclist. The rest were determined to be hurt while riding a gas-powered scooter, moped or device that uses three wheels, or didn’t involve a device at all, said Jeff Taylor, an Austin Public Health epidemiologist.

“If anything, this study also helped prove out that, that we need to be more precise in our language when we’re recording data that a scooter is not just a scooter. We mean something very specific,” Austin Transportation Department Director Robert Spillar said Thursday.

The CDC said the study found “a high proportion of e-scooter related injuries involved potentially preventable risk factors, such as lack of helmet use or motor vehicle interaction.” City officials also said almost half the head injuries documented could have been prevented.

The study drew data from Austin-Travis County EMS incident reports and information from nine area hospitals, as well as from interviews with some who were injured. Taylor said it was important to interview the injured so the data could be more specific.

Among the findings:

• 20 people for every 100,000 scooter trips taken were injured, and most were first-time riders.

• 48% were between 18 and 29 years old. Researchers recommend targeting educational materials to that age group going forward.

• 39% of injuries happened between the hours of 6 p.m. and 6 a.m.

• 29% told researchers they had been drinking before they rode.

• Only one person of the 190 riders hurt was wearing a helmet.

• More than half of the riders were injured in the street and a third were hurt while riding on the sidewalk.

• More than a third said speed contributed to them crashing.

Having more accurate data about the scooters and how they’re affecting Austin residents could help inform policy discussions in the future, said Dr. Christopher Ziebell, emergency department medical director for Dell Seton Medical Center. The hospital does not have a uniform way to record the number and type of scooter injuries coming into the emergency room, he said.

[…]

During a period comparable to the one the CDC studied — four months in 2018, between May 7 and Sept. 6 — the Texas Department of Transportation found that in Austin 1,945 people were injured in a vehicle and eight were killed; 105 were injured on motorcycles and five were killed; 60 were hurt using bicycles. Scooter injuries during that time tallied 28, according to the city of Austin.

Lessening the number of injuries related to scooters could start with messaging and education, Ziebell said. Patients have told him they thought hopping on a scooter would be a quick, fun thing, but they end up hitting a pebble and crashing.

“I still hear patients who come in and say, ‘I had no idea,’ ” he said. His patients range in age from their 20s to 70s.

See here for the background. I don’t know why there’s such a wide disparity between the CDC and TxDOT studies in terms of the number of scooter-related injuries over similar time spans. My guess is that only a fraction of scooter injuries in the latter period were reported to TxDOT. Be that as it may, while the scooters caused their share of (I daresay mostly preventable) mayhem, they’re a drop in the bucket next to motor vehicles. Let’s do what we can to make scooters safer, but let’s not lose sight of the bigger picture. Mother Jones has more.

Measles, schmeasles

Eh, no biggie.

With U.S. measles cases this year reaching historic levels since being practically eradicated nearly 20 years ago, a host of bills targeting vaccination policies in Texas don’t appear to be gaining traction in the Legislature.

The U.S. Centers for Disease Control and Prevention has confirmed 704 cases of the measles in 22 states so far this year, the most of any year since 1994. Fifteen of those cases have been in Texas, the Texas Department of State Health Services said.

Considering the scope of the crisis, Rekha Lakshmanan, policy director for the Immunization Partnership, a group devoted to eradicating vaccine-preventable diseases, said lawmakers this session are missing an important opportunity to pass what she called “common-sense immunization laws,” among them bills aimed at increasing data transparency.

Notable among those measures are Senate Bill 329, filed by Sen. Kel Seliger, R-Amarillo, which would require the Department of State Health Services to publish the immunization opt-out rates for individual public schools. Currently, the health department is only required to post this information for districts as a whole and private schools. Another, House Bill 1966 by Rep. Gene Wu, D-Houston, would empower child care facilities to list their immunization opt-out rates for parents who are interested.

Vaccine advocates say making this data available would help parents choose the best place to send their children, particularly if the children have compromised immune systems and can’t be vaccinated.

“If you cannot vaccinate your child, then you need to place them in a child care facility with children who are vaccinated, I think, for the obvious reason that you know those children would not spread it to your child if there is a contagion that goes through the population,” Wu said of his legislation.

Opponents say the information does not reflect the overall health of a facility and could lead to kids being discriminated against for not being vaccinated, even though names would not be published.

Lawmakers heard testimony on both bills in committee hearings last week but did not vote on either. Next week is the deadline for the House to advance bills. The Senate has until May 22.

See here, here, and here for some background. This story was from the weekend, so please note that the House deadline for voting out bills is tonight at midnight. After that, it’s Senate bills or attaching amendments if your bill died in committee. The anti-vaxxers complaints do not move me. I see this as a matter of giving parents the information they need to make good choices. If that means that preschools and child care facilities are less inclined to take kids whose parents chose not to vaccinate them because it’s bad for their business, well, that should tell you something.

Also, too:

Amid a record-breaking national outbreak of measles, the number of Texans who exempt their children from vaccination for non-medical reasons took another big leap this past school year.

The number increased 14 percent in 2018-2019, continuing a 15-year-long trend that public health officials worry is leaving communities vulnerable to the resurgence of preventable diseases such as measles, which has been confirmed this year in 23 states, including Texas. The number of measles cases this year is the largest since 1994.

“Seeing non-medical exemptions increase again on a double-digit scale should create outrage for everyone,” Allison Winnike, president and CEO of the Houston-based Immunization Partnership, said in a statement. “It’s time for Texans to take action.”

Porfirio Villarreal, public information officer for the Houston health department, added that it’s “disappointing to see yet another rise in the number of parents opting out of life-saving vaccines, mostly due to the vast amount of misinformation on the internet and social media channels.”

The number of exemptions are still small, 64,176, but they represent a roughly 2,000 percent increase since 2003, when the state began allowing parents to decline immunization requirements for reasons of conscience. There were about 3,000 in 2003-2004, and a little under 57,000 in 2017-2018.

[…]

Texas is one of 17 states that allow waivers of school vaccine requirements based on parents’ conscience or personal beliefs. Only three states — California, Mississippi and West Virginia — don’t grant exemptions on religious grants. All 50 states allow exemptions for medical conditions, such as a compromised immune system.

Of course, tightening up the rules for exemptions is not on the table at all. The report that produced this data breaks it down by school district but – as we know – not by individual school. I don’t even know what else to say.

Another scooter casualty study

To be done in Austin.

As many as 14,000 dockless electric scooters are on the streets of Austin, whose 326 square miles are home to almost 1 million people. That likely makes Austin one of the cities with the highest scooter-to-citizen ratio in the nation — though the electric vehicles are also rapidly multiplying on the streets and sidewalks of Atlanta, San Diego, Nashville and Washington. At least 1,200 more are poised to appear in Austin whenever already-licensed operators deploy them. Ten companies have licenses to operate now.

Austin city leaders, worried about injuries for both users and pedestrians, asked the Centers for Disease Control and Prevention to investigate scooter-related crashes and injuries. The first-ever CDC scooter study will also look at how accidents could be prevented.

“We’re totally paranoid,” said Forrest Preece, a retired advertising executive who lives in a downtown condo and leads a largely pedestrian life.

“I’m 72 and my wife is 70. It would be easy to knock us over,” he said. “My wife actually went online and found a little mirror to attach to her wrist to look behind her so she’s not constantly turning around. We go single file so she can see that mirror and see what’s behind us.”

These scooters are everywhere — speeding by or strewn on sidewalks — and are likely to overwhelm the city this spring as Austin readies for an onslaught of scooter-riding visitors during the annual SXSW Conference & Festivals, running March 8-17. Last year’s SXSW drew 432,500 people.

The scooter study was launched in December when three CDC epidemiologists spent two weeks in Austin reviewing incidents and scooter-related injuries during a 60-day period from September to November. They began contacting the 258 individuals identified through EMS calls or who visited emergency rooms with a scooter-related injury. Findings from this study will likely be released in March and could have far-reaching effects as cities across the country grapple with reports of injuries from these e-scooters.

“We don’t know if there’s something unique about Austin or the population there that may be different from other parts of the United States or globally,” said Eric Pevzner, chief of the Atlanta-based CDC Epidemic Intelligence Service, which is conducting the probe. “The rate of scooter injuries in Austin may be consistent with what’s being noticed in other places, or it may be much higher.”

[…]

The CDC Austin study will calculate injuries per number of scooters ridden and per mile traveled. As researchers speak with those hurt, they’ll ask about road conditions, street types, weather, helmet use and behaviors, including alcohol use while riding.

While the study continues, Austin’s transportation department announced a “pause” in issuing new licenses to dockless mobility operators to assess the level of demand for those currently licensed and to ensure safety. The city is also reviewing its current rules and expects to revise the scooter rider ordinance this spring.

This story references the earlier study that was done in California, whose methodology was slightly different. The city of Austin just witnessed its first fatality involving a scooter, which would make it the third nationally. I look forward to seeing the results, and even more the recommendations for how cities should try to make these things safer to operate.

Typhus in Texas

One more thing to worry about, in case you needed it.

Strickland spent four days in a hospital receiving treatment and needed about a year to fully recover from the potentially fatal disease transmitted by fleas believed nowadays to be carried most abundantly by opossums and other backyard mammals that spread them to cats and dogs.

Between 2003 and 2013, typhus increased tenfold in Texas and spread from nine counties to 41, according to Baylor College of Medicine researchers

The numbers have increased since then.

Harris County, which reported no cases before 2007, had 32 cases in 2016, double the previous years’ numbers.

Researchers do not know why the numbers are increasing.

In any case, the infection is severe enough that 60 percent of people who contracted the infection during the 10-year period had to be hospitalized. Four died, one in Houston.

“We can now add typhus to the growing list of tropical infections striking Texas,” said Dr. Peter Hotez, founding dean of the National School of Tropical Medicine at Baylor and Texas Children’s Hospital, “Chagas, dengue fever, Zika, chikungunya and now typhus – tropical diseases have become the new normal in south and southeast Texas.”

[…]

It was Strickland’s bout with the disease, in 2009, that first got the attention of Dr. Kristy Murray, a Baylor associate professor of infectious disease who had taught about typhus in the Valley but had not heard of it in modern-day urban centers, despite a focus on the tropical diseases that have emerged in Texas in recent times.

In the ensuing years, Murray heard enough anecdotal evidence of an increase in cases from local doctors that she decided to look at state data, combing through case histories to document the numbers and spot trends.

Murray was struck by the results, published recently in the journal Emerging Infectious Diseases, which showed 222 cases in Texas in 2013, many in Houston, Austin and San Antonio. That was up from just 30 reported cases in 2003, all in the southern part of the state, in counties such as Hidalgo and Nueces where the disease has remained an issue over the decades.

Unlike many tropical diseases, which predominate in poor areas, the new cases of typhus were just as likely to be reported in more affluent areas, such as Bellaire and West University.

The highest rate of attack was in kids, 5 to 19 years old.

In 2016, according to the most recent state data, the number of Texas cases had risen to 364.

The study in question is here. Typhus, it should be noted, is not the same as typhoid fever, of Typhoid Mary fame. The study in question was published a couple of months ago, and there were a few stories on the same topic at the time. Country musician Bruce Robison had to cancel a few shows recently after he came down with typhus. It can be spread by fleas, so make sure your pets are getting treated. Common symptoms include fever, headache, and a rash, so be aware and take care.

We’re going to be fighting about vaccinations for a while

I wish it weren’t so, but it is.

Texas is one of 18 states that allow non-medical exemptions to the vaccines required for school attendance. California had a similar law allowing non-medical exemptions, until last year when it enacted a law that has one of the strictest requirements in the country after a 2014 outbreak of measles traced to the Disneyland theme park infected more than 100 people around the country.

Many of the parents opting out of the immunizations, which are widely recommended by doctors, say they fear a link between the vaccines and health problems such as autism. But studies that they cite have been widely debunked by public health officials.

“Year after year we’ve seen a steady increase in the number of students with a conscientious exemption from vaccination in Texas,” said Christine Mann, a spokeswoman for the Texas Department of State Health Services. “But overall, the numbers are small.”

Even though statewide levels of vaccinations remain high, at over 98 percent, what concerns public health officials are the growing clusters of geographic areas with high rates of unvaccinated children. Texas went from just 2,314 “conscientious exemptions” in 2003 to 44,716 this year, according to the Texas Department of State Health Services.

Some parents are pressing state officials to let them know how many of their children’s peers are unvaccinated. Jinny Suh, who has a 4-year-old son, is helping spearhead a petition drive asking legislators to change state law so that the number of school exemptions is public. Currently, exemption rates are available for individual private and charter schools, but only district-wide for public schools.

State Rep. César Blanco, a Democrat from El Paso, introduced a bill during the last legislative session that would have required schools to notify parents about vaccination rates at the school level, but the bill was stalled in committee.

“As a parent, there are lots of things that people get very passionate about,” Suh said, “but for some reason, in my experience, vaccinations remains an almost taboo topic besides a few passionate people.”

Yes, the anti-vaxxers are a minority, but they are a vocal and organized minority, which is a recipe for political success. Unfortunately, the end result of that political success is a growing public health problem, which is compounded by a lack of leadership in our state government. Honestly, what we need here is for an organized pushback against the anti-vaxxers, a pro-vaccine Moms Demand Action kind of thing. The main difference here isn’t that there is an anti-vaccination legislative faction that needs to be countered. I doubt there are that many legislators who are truly anti-vaccination, though there are a decent number who are in favor of “conscience” objections to some extent. It’s more that there isn’t a vocal and active pro-vaccination legislative force that can advance the cause and/or defend against attempts to weaken vaccination requirements. People who want to see more kids get vaccinated and fewer kids get exempted from vaccinations need to elect a few of their own. Until that happens, we’re going to see more stories like this one.

Still asking for Zika help

From the inbox:

Mayor Sylvester Turner

Mayor Sylvester Turner

Following reports of the first local mosquito-borne Zika infections in the U.S., Mayor Sylvester Turner is once again calling on the state of Texas and federal government to provide financial assistance to help fight it.

“There are already 14 confirmed cases of Zika virus being transmitted locally in Florida,” said Mayor Turner. “I believe it is just a matter of time before Texas is in a similar situation. Cities are the front line of defense in this battle, and we could use some financial assistance from the state and federal governments. It makes no sense to wait until there is an outbreak here.”

Since February, the City of Houston Solid Waste Department has been conducting weekend sweeps of illegal dump sites that can serve as mosquito breeding grounds. To date, 3,433 tons of debris and 29,130 tires have been hauled away at an annual cost of $3.6 million. With some additional state or federal funding, the City could purchase new equipment to increase collection frequency beyond the weekends, develop and distribute educational materials informing residents of proper and free disposal options and establish three additional heavy trash drop-off locations.

Last week, the Houston Health Department was awarded $1.5 million by the Centers for Disease Control to use for surveillance, testing and prevention. The City is already in discussion with Harris County on the best way to maximize the use of these dollars.

Houston has documented 12 travel-associated cases of Zika virus infection since the start of the outbreak in Latin America earlier this year. Harris County has confirmed another 12 cases – 11 are travel related and one is an infant with microcephaly born to a mother who contracted the virus while traveling outside the United State. There are a total of 80 confirmed Zika cases in Texas. At this time, there is no evidence the virus has infected mosquito populations in the state.

In addition to the neighborhood trash sweeps, the City has public service announcements at the airports, on public transit, in city water bills and on local TV. The health department is going door-to-door to distribute insect repellent in underserved neighborhoods, and the City’s regional public health laboratory is supporting local hospitals and clinics with Zika infection testing.

Residents are encouraged to follow the three Ds of mosquito defense: drain, dress, DEET! Drain standing water on your property and keep hedges trimmed. Wear long pants and long sleeves, keep windows and screens repaired and use air conditioning. When outside, spray exposed skin with mosquito repellant containing DEET, reapply as necessary and use netting to protect babies in strollers or car seats.

This is not the first time Mayor Turner has asked for this help. I doubt the Republican-controlled Congress is any more interested in taking action now than it was then, but it can’t hurt to ask. Better to keep expectations low, though.

Another story on how Texas’ uninsured rate has fallen under Obamacare

Same book, next chapter.

It's constitutional - deal with it

It’s constitutional – deal with it

A study released Tuesday shows that the rate of Texans without insurance has dropped to its lowest point since the late 1990s because of the Affordable Care Act, Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation reported.

Prior to the implementation of the ACA in September 2013, the uninsured rate in Texas was about 26 percent – more than one in four. By this March, that rate had dropped to about 18 percent, the study said.

Researchers found declines in every age group, ethnic and racial demographic, and across income levels. Texans between the ages of 50 and 64 showed the steepest decline, dropping to 10 percent from 21 percent during that time period.

Those with low to modest incomes of $16,000 and $47,000 also showed big gains in coverage. Their rate of uninsured is now about 13 percent compared to 23 percent in 2013.

“For more than a decade prior to the ACA, the uninsured rate remained above 20 percent and was rising. It’s now clear that it’s moving in the opposite direction and the ACA deserves the credit,” Elena Marks, president and CEO of Episcopal Health Foundation, said in a statement Tuesday.

Despite progress, Texas continues to lead the nation in the number and rate of the uninsured.

In fact, the new study shines a light on a gaping hole in coverage across the state. Nearly half, or 46 percent, of Texans earning less than $16,000 per year remain uninsured, the report shows.

A copy of the report is here, and a compendium of Baker Institute research on the topic of health insurance under the ACA in Texas is here. Another recent study, by the U.S. Centers for Disease Control and Prevention, had Texas’ rate of uninsured residents below 17%, somewhat lower than what this one has. That may reflect a slight difference in methodology or definitions, it’s hard to say. The trend is clear, and so is the fact that by any measure, Texas is still the worst at getting its residents covered. Even among states that did not expand Medicaid, Texas’ uninsured rate is higher than average, as you can see on that first link. And yes, you can make less than $16K a year but not qualify for Medicaid in this state. Basically, unless you’re a child or you’re disabled, you’re SOL as far as that goes. But don’t worry, you can always go to the emergency room and get some service at a much higher cost to a much smaller tax base. That’s how Greg Abbott and Dan Patrick want it to be. Forbes has more.

The latest good news/bad news on Texas uninsured numbers

Good news: Texas’ percentage of uninsured residents continues to drop. Bad news: It’s still higher than what the national average was in 2010, the year before the Affordable Care Act was passed.

It's constitutional - deal with it

It’s constitutional – deal with it

The percentage of Texans without insurance has dropped dramatically since the launch of the Affordable Care Act, the U.S. Centers for Disease Control and Prevention reported Tuesday. In 2015, the uninsured rate fell to 16.8 percent.

While the state continues to lead the nation in the rate of people who are not covered, advocates for the health care law who have watched its implementation say the headway is undeniable. Prior to the law’s passage in 2010, the Texas rate of uninsured hovered around 25 percent, or one in four.

“This is indeed significant progress,” said Elena Marks, president and CEO of Episcopal health Foundation in Houston. She is co-author of a separate series of ACA tracking reports issued through Rice University’s Baker Institute for Public Policy.

Nationally, the rate of uninsured fell to a historic low of 9.1 percent last year, the National Health Interview Survey released Tuesday found. That translates to about 7.4 million people gaining coverage last year on top of the 8.8 million who signed up in 2014. It is the first time the uninsured rate has slid into the single digits.

In 2010, the national rate of uninsured was 16 percent.

“The historically low rate of uninsured in America reflects people’s desires for health coverage. Americans like having access to health care,” said Ken Janda, president and CEO of Community Health Choice, a nonprofit managed-care organization serving Harris and 19 other Texas counties.

[…]

The CDC study shows that last year adults in states that expanded Medicaid were less likely to be uninsured. In those states, the percentage of un-insured decreased to 9.8 in 2015 from 18.4 percent two years earlier. By contrast, the uninsured rate in states like Texas that chose not to expand the program decreased to 17.5 percent last year from 22.7 percent in 2013.

Raise your hand if you’re surprised that the states that have refused to expand Medicaid had the highest rates of uninsured residents pre-Obamacare. I’ve pretty much run out of things to say with these news stories, so fill in your own snarky/heartfelt/cynical comment as appropriate.

Why are some people more likely to smoke than others?

From the CDC:

American adults who are uninsured or on Medicaid smoke at rates more than double those for adults with private health insurance or Medicare, according to a study published by the Centers for Disease Control and Prevention in today’s Morbidity and Mortality Weekly Report (MMWR).

Data from the 2014 National Health Interview Survey (NHIS) show that 27.9 percent of uninsured adults and 29.1 percent of Medicaid recipients currently smoke. By contrast, 12.9 percent of adults with private insurance and 12.5 percent of those on Medicare currently smoke.

“Smoking kills half a million Americans each year and costs more than $300 billion,” said CDC Director Tom Frieden, M.D., M.P.H. “This report shows real progress helping American smokers quit and that more progress is possible.”

The study reported that the prevalence of cigarette smoking among U.S. adults declined from 20.9 percent to 16.8 percent from 2005 to 2014, including a full percentage-point decline between 2013 and 2014 alone. The considerable drop in the overall adult smoking rate over time shows marked progress toward achieving the Healthy People 2020 goal of reducing the cigarette smoking rate to 12 percent or lower. Another major finding was that the average number of cigarettes smoked per day among daily smokers declined from 16.7 in 2005 to 13.8 in 2014 — driven by declines in the proportion of daily smokers who smoked 20 or more cigarettes per day.

At-risk populations

The study found other differences in smoking rates consistent with previous studies. In 2014, prevalence of cigarette smoking was higher among these groups:

  • Males (18.8 percent vs. 14.8 percent for females)
  • Adults ages 25-44 years (20.0 percent)
  • Multiracial (27.9 percent) or American Indian/Alaska Natives (29.2 percent)
  • People with a General Education Development certificate (43.0 percent)
  • People who live below the federal poverty level (26.3 percent)
  • People who live in the Midwest (20.7 percent)
  • People who have a disability/limitation (21.9 percent)
  • People who are lesbian, gay, or bisexual (23.9 percent)

“These findings underscore the importance of ensuring that proven strategies to prevent and reduce tobacco use reach the entire population, particularly vulnerable groups,”said Brian King, Ph.D., deputy director for research translation, CDC Office on Smoking and Health. Comprehensive smoke-free laws, higher prices for tobacco products, high-impact mass media campaigns, and barrier-free access to quitting help are all important. They work to reduce the enormous health and financial burden of tobacco use and secondhand smoke exposure among Americans.”

Changes in the U.S. health-care system continue to offer opportunities to improve the use of clinical preventive services among adults. The Patient Protection and Affordable Care Act of 2010 is increasing the number of Americans with health insurance and is expected to improve tobacco cessation coverage.

Currently, neither private insurers nor state Medicaid programs consistently provide comprehensive coverage of evidence-based cessation treatments. In 2015, although all 50 state Medicaid programs covered some tobacco cessation treatments for some Medicaid enrollees, only nine states covered individual and group counseling and all seven FDA-approved cessation medications for all Medicaid enrollees. Cessation coverage is used most when smokers and health-care providers know which cessation treatments are covered.

I find this fascinating. I’m old enough to remember when smoking was ubiquitous – I’ve experienced the smoking section of airplanes and restaurants – but nowadays not only do I hardly know any smokers, most of the people I know are militantly anti-smoking. The combination of government action and peer pressure has basically made my life, and the lives of most people I know, a non-smoking zone. Which, from my perspective, is awesome. But that yields a big question: Why is it that this effort has been so much more successful among some parts of society than others? What is it that we’ve been doing wrong, or doing inadequately? There’s a huge societal cost to smoking, so figuring this out would be a big deal. I hope the next study focuses on that question.

Fighting pertussis

Sure hope these folks can make a lot of progress in their work.

Of the more than 30,000 children hospitalized with pertussis in the United States each year, 10 to 20 will die. Worldwide, pertussis infects more than 16 million and causes nearly 200,000 deaths a year.

“We need to come up with some therapeutic options,” [Dr. Mary Healy, a pediatric infectious disease specialist with Texas Children’s Hospital and Baylor College of Medicine] said. “We have very little to offer.”

That soon could change. Last month, a research team led by scientists from the University of Texas at Austin reported progress developing antibodies that could be used to combat pertussis infections in those too young to be vaccinated.

The work was led by Jessica Maynard, an associate professor of chemical engineering at UT, who previously had worked on an Ebola treatment

Pertussis is a bacterial infection that colonizes the lungs and secretes about 20 disease-causing compounds and toxins.

“We can’t really agree on which of them are the most important,” Maynard said. “But we think it’s the pertussis toxin, because it’s directly responsible for the increase in your white blood cell count.”

Those cells flood into the blood and can clog the lungs and other organs. Antibiotics can help clear the bacteria, but they do not affect the toxins that are doing all the damage. Researchers previously tried pulling various antibodies from vaccinated people and using those to treat infants, with little success.

Maynard’s team decided to focus on two antibodies that would bind tightly to the pertussis toxin and deactivate it. They cloned the antibodies to deliver them to infants in massive amounts.

“We’re really trying to go after the symptoms,” Maynard said.

In laboratory tests, the antibodies protected mice from being infected with pertussis, much like a vaccine. The researchers also tested the antibodies as a treatment in baboons that were sick with pertussis. The antibodies did not clear the bacteria, but they lowered white blood cell counts, speeding recovery.

[…]

Widespread vaccination still is the key strategy in the United States for protecting infants.

The current vaccine is effective but imperfect. Immunity tends to wane after three years. And since the disease is less severe in older children and adults, siblings or parents of infants could be infected and not know it. They unknowingly can pass on the infection to vulnerable babies.

Public health experts advocate a strategy called cocooning, in which adults and adolescents who will be in contact with a baby get vaccinated at least two weeks earlier.

“Probably the most important thing you can do is vaccinate a pregnant woman in the third trimester of pregnancy,” Healy said. “The theory then is they won’t get pertussis and give it to the baby.”

You know how I feel about vaccinations. It’s more than a little scary to realize that I could have been a carrier and passed it on to one of my kids before they were old enough to be immunized. And while pertussis may be less severe in adults than in kids, it can still be really, really awful. So please, make sure your vaccinations are up to date. And send some happy thoughts to Dr. Maynard and her team.

State cuts off funds to Planned Parenthood for HIV testing

Seriously?

Right there with them

Right there with them

Amid an ongoing battle over Planned Parenthood’s participation in the state Medicaid program, Texas health officials are cutting off funding to a Planned Parenthood affiliate for an HIV prevention program.

In a notice received by Planned Parenthood Gulf Coast late Monday, an official with the Department of State Health Services informed the Houston-based provider that it would not renew its contract for HIV prevention services.

The long-standing grant, which funds HIV testing and prevention services, was set to expire on Dec. 31, according to the notice which was obtained by the Texas Tribune.

“There will be no further renewals of this contract,” a DSHS official wrote in the notice to Planned Parenthood.

The contract is federally funded through the Centers for Disease Control and Prevention but managed by the state. A spokeswoman for the CDC said she was unaware of the state’s notice and did not immediately provide comment.

By ending Planned Parenthood’s contract, the state is cutting off almost $600,000 in annual funding, which the health care provider used for HIV testing and counseling, condom distribution and referral consultations.

Incredible. At least with the cutoff of Women’s Health Program funds, the state made some arrangements for alternate options. It was half-assed and still caused a huge unnecessary upheaval for thousands of women, but there was at least a token gesture towards maintaining the service. That doesn’t appear to be the case here, or at least the flunkies at the HHSC had no comment at the time the story was published. Unless PPGC decides to continue this on its own dime, this service just goes away. Because why would Greg Abbott care about people who might have HIV? And remember, the root of all this is a pack of lies that the state is hoping you’ll all forget.

The Chron story on this is here. I don’t know if this action can be wrapped into the ongoing litigation over the state cutting off Medicaid funds for Planned Parenthood, but regardless perhaps some political pressure can be applied.

Texas Democrats in Congress sent a letter to the Centers for Medicaid and Medicare Services this month asking that they “explore all options available at the federal level” to stop the State of Texas from blocking Planned Parenthood from receiving Medicaid funding for health services.

[…]

“Members of the delegation understand that there is a precedent for intervention, and several options available for the federal government to bring Texas into compliance with federal law,” said Congressman Marc Veasey, D-Fort Worth. “In the past, CMS has decreased or removed federal funding from Texas, which we do not want to happen again as doing so would decrease access to care instead of expanding it.”

Click over to see the letter, which was signed by ten members of the Texas Congressional delegation. The Observer and the Press have more.

Take the mosquito threat seriously

If mosquitoes weren’t one of the Biblical plagues visited on Egypt, they should have been.

You’ve probably heard of the potentially deadly West Nile virus, but this summer, people in the Houston area could begin to be at more risk of contracting two other mosquito-borne viruses.

Chikungunya made headlines last year after Texas’ first cases were reported in the Austin and Houston areas. In both cases, the patients had recently visited the Caribbean, where the virus is more common. The disease causes fevers and severe joint pain. So far, there have been no known transmissions of the virus here, but experts are braced for the possibility this summer. The virus is not usually fatal, but it often causes excruciating joint pain.

Dengue, however, can be deadly, and it is a major cause of illness and death in the tropics and subtropics, according to the Centers for Disease Control and Prevention. Symptoms include severe headache, eye pain, joint pain, muscle or bone pain, rash, mild bleeding (such as from the nose or gums or easy bruising), and low white cell count.

Local transmissions of these two viruses could start in part because Houston is a major air travel hub, said Dr. Scott Weaver, director of the University of Texas Medical Branch at Galveston’s Institute for Human Infections and Immunity. “We have imported cases all the time. We have the right mosquito to initiate the transmission cycle.”

That mosquito is the Aedes aegypti, one of the most common of the dozens of types of mosquitoes in the Houston area.

Chikungunya just arrived in the Americas in the last year and half and has been spreading north through Mexico, where the virus has not been before, Weaver said. So it could cross the border.

[…]

The Aedes aegypti bites in the daytime, while the type the carries West Nile virus, Culex, strikes in the evening. So bug repellent should be worn anytime, not just at dawn and dusk, when the Culex mosquitoes are most active.

Aedes aegypti also tends to enter people’s houses, where public spraying efforts can’t reach them.

“You can’t just stay inside and assume you’ll be protected,” Weaver said.

He advises checking your property every few days to empty or remove debris, flower pots, or anything else that may hold standing water.

Remember, it’s gonna be a bad year for us, skeeter-wise. Take every reasonable step you can to minimize the threat.

How to deal with anti-vaxxers

It’s a big problem.

Certain that they are right, struggling to find ways to get their message across, public health officials are exasperated by their inability to convince more U.S. parents to vaccinate their children.

“I think we’re all kind of frustrated,” said Stephen Morse, a Columbia University infectious disease expert. “As scientists, we’re probably the least equipped to know how to do this.”

They say they are contending with a small minority of parents who are misinformed — or merely obstinate — about the risks of inoculations. The parents say they have done their own research and they believe the risks are greater than health authorities acknowledge; they are merely making their own medical choices, they say.

Most parents do bring their children for shots, and national vaccination rates for kindergarteners remain comfortably above 90 percent. Experts aren’t even sure the ranks of families who don’t vaccinate are growing to any significant degree.

But in some states, the number of parents seeking exemptions from school attendance vaccination requirements has been inching up. In some communities, large proportions of household skip or delay shots. The rise has come despite unsettling outbreaks of some vaccine-preventable diseases that had nearly disappeared from the United States.

“Part of the reason everyone is so concerned about this is because they don’t know whether things will get worse,” said Dr. Walter Orenstein of Emory University, considered one of the nation’s leading experts on vaccines.

[…]

Experts see the cooperation of physicians as a key to prodding families to get old and new vaccines. They believe too many family physicians and pediatricians have been lax. Some doctors perhaps see themselves as too busy to spend time debating the value of vaccines with resistant families. Some have complained about the cost and hassle of stocking the shots. A smaller contingent may have their own questions about vaccine, and indulge families that want to postpone or skip shots.

ACIP has been looking at the problem. So has another national panel — the National Vaccine Advisory Committee, chaired by Orenstein — which two years ago convened a Vaccine Confidence Working Group to study the issue. In a draft set of recommendations presented this month, the group said there’s not enough good information on where clusters of unvaccinated people are, to what extent they are growing, and why they exist.

The workgroup is recommending more study, and better training of physicians so that they will work harder to present childhood vaccination as the sensible way to go.

Another strategy is to simply make more parents vaccinate, through a concerted effort to eliminate philosophical exemptions to vaccinations or to make the exemption application process more demanding. Several experts interviewed believed reducing exemptions is the most practical approach, in a country where individual freedoms are sometimes celebrated at the expense of the communal good.

I’m on record as being in favor of severely limiting personal exemptions for vaccinations, and taking a punitive approach as needed to compel the obstinate holdouts to comply. If you want to call this a matter of freedom, I say it’s my freedom to live a healthy life that’s at stake. Be that as it may, it would be much better if people were more willing to comply on their own. Ruth Graham, writing in Slate, makes an important point about this.

“There is a history of paternalism in medicine,” said Jordynn Jack, an associate professor of English at the University of North Carolina at Chapel Hill whose 2014 book Autism and Gender explores how ideas about gender have affected debates about autism, including the vaccine controversy. “The language that’s used by the scientific community to communicate that vaccines are safe sometimes falls into that paternalistic model. ‘I’m telling you what’s right, and I’m telling you as a scientific authority,’ ” Jack said. “For some people that’s persuasive, but for others it’s not.” In her book, Jack dissects how contemporary mothers often think of themselves as “warriors” on behalf of their sick children, fighting first for a diagnosis and then for treatment. If procuring basic care for a sick child feels like a battle, then why trust the enemy’s propaganda?

Concern about not being taken seriously by medical professionals causes other problems for women as well. Surely by now we have learned that a successful outreach program depends on being able to speak to people in a way they will relate to. Seems to me that’s a good place to begin here as well. Of course, as this AusChron post points out, people have to be willing to listen, and to understand what they’re being told, too.

Please get a flu shot

It’s always a good idea, even if it’s more effective in some years than in others.

The flu vaccine may not be very effective this winter, according to U.S. health officials who worry this may lead to more serious illnesses and deaths.

Flu season has begun to ramp up, and officials say the vaccine does not protect well against the dominant strain seen most commonly so far this year. That strain tends to cause more deaths and hospitalizations, especially in the elderly.

Only 48 percent of the 85 samples of H3N2 influenza viruses that have been tested since Oct. 1 are closely related to the strain that was picked for the vaccine distributed in North America, according to the agency.

“Though we cannot predict what will happen the rest of this flu season, it’s possible we may have a season that’s more severe than most,” said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, at a news conference Thursday.

CDC officials think the vaccine should provide some protection and still are urging people to get vaccinated. But it probably won’t be as good as if the vaccine strain was a match.

Flu vaccine effectiveness tends to vary from year to year. Last winter, flu vaccine was 50 to 55 percent effective overall, which experts consider relatively good.

[…]

Current flu vaccines are built to protect against three or four different kinds of flu virus, depending on the product. The ingredients are selected very early in the year, based on predictions of what strains will circulate the following winter.

The ingredients always include a Type A H3N2 flu virus. The most severe flu seasons tend to be dominated by some version of that kind of flu bug. The three most deadly flu seasons of the last 10 years – in the winters of 2003-2004, 2007-2008, and 2012-2013 – were H3N2 seasons.

In March, after the H3N2 vaccine strain was vaccine production was underway, health officials noted the appearance of a new and different strain of H3N2. “This is not something that’s been around before,” Frieden said.

But health officials weren’t sure if the new strain would become a significant problem in the United States this winter until recently, they said. Lab specimens from patients have shown that the most commonly seen flu bug so far is the new strain of H3N2. Specifically, about 48 percent of the H3N2 samples seen so far were well matched to what’s in the vaccine, but 52 percent were not, the CDC said.

Not perfect, but your odds are still a lot better with the vaccine than without. As the story notes, in an average year about 24,000 Americans die from the flu. I’ll have to check my math on this, but I’m pretty sure that’s more than the number of Americans that die from Ebola. (Which we still need to fight against as well, but Congressional Republicans have lost interest in Ebola since it’s not generating scary cable news stories any more.) So don’t fall for the hysteria. Please put the odds in your favor and get a flu shot, OK? Thanks.

Two data points on e-cigarettes

The World Health Organization wants them to be regulated more strongly.

Governments should ban the use of electronic cigarettes indoors and in public places and outlaw tactics to lure young users, the World Health Organization said in a report released on Tuesday. It also raised concerns about the role of big tobacco companies in the fast-growing market.

Considering the numerous uncertainties surrounding e-cigarettes, which have been on the market for less than a decade, the United Nations organization said it was appropriate to prohibit their use indoors “until exhaled vapour is proven to be not harmful to bystanders.”

It also called for regulation to ensure the products contain a standard dose of nicotine, as the drug content now varies widely between manufacturers. And to stop children from picking up the habit, it said that e-cigarette sales to minors should be banned and that fruity, candy-type flavorings should be prohibited.

[…]

Electronic nicotine delivery systems “are the subject of a public health dispute among bona fide tobacco-control advocates that has become more divisive as their use has increased,” the report notes. Some experts embrace them as a means of reducing the harm associated with traditional cigarettes while others view them as a threat to the progress that has been made in “denormalizing” the use of tobacco.

Proponents of e-cigarettes argue that they are safer than tobacco, because they do not contain the carcinogens found in tar and other tobacco components. Anecdotal evidence suggests e-cigarettes may hold promise as smoking cessation aids, too. But the World Health Organization report noted that there is scant evidence for their effectiveness in helping smokers give up the habit; the only randomized trial to date to have compared e-cigarettes with nicotine patches “showed similar, although low, efficacy for quitting smoking.”

The organization said e-cigarette advertisers should be prohibited from making any health claims, including on the product’s purported value as a smoking cessation aid, “until manufacturers provide convincing supporting scientific evidence and obtain regulatory approval.”

The report is here. I’ve been following this stuff because while some municipalities are treating e-cigarettes like traditional tobacco products, others like Houston have made no move to amend their existing anti-smoking ordinances. Some jails in Texas are allowing the use of e-cigarettes on the less-harmful-than-tobacco theory, while others aren’t. It’s a coming public debate, and as things stand right now there’s a lack of information about their effects. A lot of entities are waiting to hear more from organizations like the WHO and the Surgeon General.

Also in the news: adolescents who use e-cigarettes are much more likely to try tobacco, according to the CDC.

The morass of conflicting information about e-cigarettes and tobacco use grew deeper Monday, when the Centers for Disease Control and Prevention released a new study showing that adolescents who vape say they are much more likely to smoke conventional cigarettes.

The results show that 43.9 percent of sixth- through 12th-graders who had used e-cigarettes said they intended to light up conventional cigarettes over the next year, compared with 21.5 percent of youth who had never used the electronic nicotine delivery systems.

Overall, more than 263,000 adolescents who had never smoked before used e-cigarettes in 2013, up from 79,000 in 2011, the CDC reported in a study in the journal Nicotine and Tobacco Research. The data come from the agency’s National Youth Tobacco Surveys for 2011-2013.

The study also showed that 21.9 percent of the youth who had never smoked traditional cigarettes intended to give them a try in the next year — almost exactly the same proportion as the 21.5 percent who had never tried an e-cigarette — and that, overall, the percentage of youths who reported an intention to smoke declined “significantly” in the 2013 survey.

We all know that smoking is terrible for you, but we don’t yet know how much, or even if, e-cigarettes are “better” than tobacco. If there is a correlation between vaping and smoking among teenagers, that’s a pretty strong piece of evidence that they’re not any better.

Pertussis

Not good.

State health officials warn that Texas is on track to see the highest number of whooping cough cases it has registered in 50 years if occurrences of the disease continue at the current rate.

As of this week, Texas has reported 1,670 cases of pertussis, better known as whooping cough, to the Centers for Disease Control and Prevention. The Texas Department of State Health Services stresses that the disease is serious, especially in young children.

Two whooping cough deaths have been reported this year in the state – children too young to be vaccinated, according to the department’s website. Thirteen percent of the whooping cough cases have required hospitalizations, with almost all of them involving infants younger than 1 year old.

Babies are especially vulnerable to the infection because they don’t have full protection against it until they’re 6 months old, when they receive the last of three shots.

Dr. Robert Lapus, pediatric emergency services director at Children’s Memorial Hermann Hospital, said two infants suffering from whooping cough recently were admitted to the hospital. Both were younger than 6 months.

[…]

The disease was common, with hundreds of thousands of cases reported annually, until the 1940s when the vaccine was introduced. For about 25 years, fewer than 5,000 cases were reported annually in the United States. The numbers started to climb again in the 1990s.

The Centers for Disease Control reports there were 159 whooping cough deaths in the United States from 2004 to 2011. Almost all the deaths – 141 of the 159 – were babies younger than 3 months old.

More than 41,000 cases were reported across the country in 2012, with 18 deaths. In Texas, there were 2,218 cases, with 159 in Harris County, 32 in Montgomery County, 12 in Fort Bend County and 10 in Galveston County.

As the story notes, low vaccination rates and higher infection rates are a national problem. As that CDC link suggests, the Affordable Care Act ought to help, since more people will be able to get primary care, which of course includes vaccinations. The bottom line is that we all need to be aware of these things. The vaccinations we got as kids don’t last forever. It’s a good idea to check and see what shots you may need now.

Wash hands or wear gloves?

There’s an interesting debate going on in Oregon about the best way to ensure food safety in restaurants and other eateries.

Oregon restaurant owners and chefs recently earned a small victory, delaying by several months a new state rule that could make dining out more expensive, create waste and, despite its good intentions, do little to protect public health.

The rule, initially set to take effect [last] Sunday, would require cooks to wear gloves or otherwise avoid touching food with their bare hands. But restaurant owners argued the requirement won’t prove safer than the state’s current rigorous hand-washing practices — and the science seems to back them up.

“The idea that using rubber gloves is going to stop people from getting sick is ludicrous,” said Andy Ricker, chef and owner of Pok Pok restaurants in Portland and New York. His New York locations already comply with that state’s no bare-hand-contact rule.

“For it to be safe, every time you touch something, you’d have to take your gloves off, wash your hands, and put on new gloves.” Ricker said.

At least a half-dozen recent studies have concluded the same: Counterintuitively, wearing gloves does little to prevent the spread of bacteria compared with effective hand washing.

Wearing gloves has been found to reduce the number of times people wash their hands, while warm, moist conditions create a hothouse for bacteria to grow. A 2005 report from the University of Oklahoma Health Sciences Center that analyzed grilled tortillas found more staph, coliform and other harmful bacteria on the samples prepared by workers wearing gloves.

“Gloves lead to a bulletproof-vest feeling,” said Bryan Steelman, owner of the Mexican eatery Por Que No? and among the restaurateurs leading the charge against the new rule. “Cooks think, ‘I have a glove on. I don’t need to wash my hands.'”

“Effective” hand-washing being the key, of course. I have to admit, this isn’t something I’d thought much about, but it’s a big deal. The annual cost of food poisoning is $77 billion, with one in six Americans affected, and 3,000 deaths. It’s also largely preventable, and doing a better job of it would no doubt help keep health care costs under control. There’s more to it than hand-washing or glove-wearing, of course, but this is the low-hanging fruit. As the story notes, both methods are effective as long as they are implemented properly. Anyway, I thought this was worth highlighting. Read the whole thing and see what you think.

The teen birth rate in Texas

The good news is that it’s declining. The bad news is that as with so many other things, Texas ranks among the lowest in the country.

Birth rate for women aged 15–19, by state: United States, 2010

Despite a slight improvement from 2009, Texas still had one of the nation’s highest teen birth rates in 2010, data released Tuesday show.

Texas took a baby step in the newest report, moving from having the nation’s third highest birth rate for teens between the ages of 15 and 19 in 2009 to the fourth highest in 2010, according to the U.S. Centers for Disease Control and Prevention.

Teen birth rates have been falling nationally and are now at an historic low going back to 1946, according to the CDC.

Texas has made dramatic strides in two decades, when its birth rates for teens 15 to 19 fell from 78.4 per 1,000 in 1991 to 52.2 in 2010, according to the CDC data. That’s a drop of 33 percent. But teen birth rates for the nation as a whole have been falling faster, from 61.8 per 1,000 in 1991 to 34.3 per 1,000 in 2010, a 44 percent decline.

“This is good news, but it’s not as good as it could be,” said David Wiley, a health education professor at Texas State University and founder of the Texas Campaign to Prevent Teen Pregnancy. “This isn’t anything to throw a party over.”

Chris Van Deusen, a spokesman for the Texas Department of State Health Services, said teen birth rates and teen pregnancies in the state “have been on a fairly steady decline.”

He provided data on teen pregnancies for girls ages 13-17 and said the state does not have quick access to the birth data used by the CDC.

“While the teen pregnancy rate has been declining, there is still room for improvement,” Van Deusen wrote in an email, “and we’re going to continue working toward that.”

You can see the CDC report here. I’m not sure what specifically Mr. Van Deusen has in mind for that, but it probably doesn’t matter. Via Sarah Kliff, who has some charts to illustrate the CDC’s data, we get the following:

In a new working paper, Kearney and Levine looked at international differences in birth rates, as well as variations among American states. There are widespread differences in rates: New Hampshire’s stands at 16.4 births per 1,000 teens, while Mississippi’s is 64.4. The researchers found a state’s level of economic inequality to be a significant influence in the birth rates. All other things being equal, “teens in the highest-inequality states are roughly 5 percentage points more likely to give birth as teens in the lowest-inequality states,” Kearney and Levine wrote. This was true even when the researchers controlled for the individual teenager’s economic status.

“We conclude that women with low socioeconomic status have more teen, nonmarital births when they live in higher-inequality locations, all else equal,” they said. “Our estimates suggest that income inequality can explain a sizable share of the geographic variation observed in the teen childbearing rate, on the order of 10 to 50 percent…To the extent that greater levels of inequality are associated with a heightened sense of economic despair and marginalization, our empirical findings support this claim.”

That economic inequality can produce high teen birth rates would align with what we know about disparities in wealth here and abroad. The World Bank has consistently found a greater level of economic inequality in the United States than in Europe.

Some other factors may also be behind the discrepancy. American teens tend to have intercourse at lower rates than some of their international counterparts, yet they are also less likely to use contraceptives. About one-third of American teens terminate their pregnancies, which is an abortion rate similar to that of Germany (31.3 percent) but slightly lower than other countries, such as the United Kingdom (38.8 percent).

I predict with great confidence that the state of Texas will do nothing to address this. Indeed, the budget cuts of 2011 did about as much as humanly possible to exacerbate it, in the short term as well as in the long term. If and when the subject of teen pregnancy comes up in the next legislative session, I predict this won’t even be part of the conversation. So don’t be surprised when not much has changed when the next batch of data gets released.

Food deserts in Houston

If you listened to the interview I did with CM Stephen Costello, you would have heard him talk about “food deserts” in Houston, which is a problem to which he has turned his attention. This Chron story goes into some detail about that.

[Costello] wants Houston’s city government to lure supermarkets to neighborhoods with few places to buy produce. He is talking about tax breaks, sales tax rebates, utility subsidies, even using public dollars to buy the land for a private business.

“When you look at bringing in a grocery store into an under-served area, you improve the health of the community and you improve the quality of life of the neighborhood,” said the At-Large Position 1 city councilman.

During budget deliberations last month, Costello tried unsuccessfully to insert an amendment that would have given priority to projects that bring healthy food to under-served areas as the city decides which developers deserve subsidies and incentives. The city, he argued, should take action to eliminate “food deserts” — areas where healthy and affordable food is difficult to come by.

The Food Trust, a Philadelphia-based nonprofit dedicated to making healthy food available to everyone, issued a report last year that found Houston to have a shortage of supermarkets and said that the shortage is most acute in low-income neighborhoods.

The Food Trust says the federal Centers for Disease Control and Prevention has noted more obesity, diabetes and other diet-related health problems in neighborhoods that have no supermarkets.

You can find the Food Trust report on Houston here. It should be noted that the problems associated with these neighborhoods that lack supermarkets are more complicated than that, but that is a big part of it, and it’s something local government can do to ameliorate.

The city is planning a supermarket summit this fall, according to Laura Spanjian, Houston’s sustainability director. Costello is seeking grocers interested in opening up shop in Sunnyside, the Antoine Drive area and the East End. He also is searching for foundations that fund public health initiatives. He is researching economic development tools the city could use to encourage supermarkets to locate in the neighborhoods.

Spanjian praised Costello’s efforts, which complement such city initiatives as community gardens and farmers markets in under-served neighborhoods. Spanjian said a local nonprofit has submitted a proposal for grant funding for a fleet of produce mobiles that would cruise the city like ice cream trucks. The city also is trying to pair convenience store owners with produce vendors to get more fruits and vegetables onto limited shelf space.

All of these ideas sound pretty good to me. Some may work better than others, but you won’t know until you try.

I hate you! Please help me!

I hate you!

[Governor Rick] Perry will moderate a forum Monday on President Barack Obama’s first 100 days.

Expect more talk about out-of-control Washington spending, says spokesman Mark Miner, with much time spent listening to people at the Dallas-area stop on a tour by three conservative radio talk-show hosts.

Please help me!

Gov. Rick Perry has asked for 37,430 courses of anti-viral medicine from the Centers for Disease Control and Prevention because of the swine flu outbreak.

Damn that meddling, intrusive, too-expensive federal government! Always there when you really need them!