'Dangerously' high measles cases in rural New York force governor to declare state of emergency

Measles cases have "increased dangerously" in rural New York, spurring Gov. Kathy Hochul to declare a statewide public health emergency, Joseph Goldstein reports for The New York Times. As of Oct. 3, 108 measles cases had been reported in the state, the most since 2019, and most of those cases are in the rural Finger Lakes region. In counties with the most cases, fewer than 80% of children have been vaccinated by age 2. 

Houchul's declaration will make it easier for midwives, pharmacists and other health care workers to administer measles shots. Hochul said the declaration would "strengthen our ongoing efforts to confront this disease," and that "no one should get seriously ill or die from a vaccine-preventable disease." 

Goldstein reports that the U.S. is facing a "resurgence in measles, driven by declining vaccination rates, with case counts soaring in 2026." There have been nearly 4,000 cases recorded in 2026 so far, "by far the highest in more than 30 years." He writes that South Carolina and Utah have been "especially hard hit," and that Pennsylvania has had more than 1,000 cases and five deaths from measles this year.

Measles is highly contagious, and can cause swelling in the brain that leads to blindness. Babies who are too young to be vaccinated are at high risk for the disease. Measles had been largely eradicated from the U.S. 25 years ago, but fears about the MMR vaccine causing autism have led to decreased vaccination rates, even though many scientific studies have debunked those claims. 

Quick hits: 'New' Superman is super-rural; VA restructuring; chocolate bar price bump; public pool safety; how much land does each state farm?

Superman (David Corenswet) and his dog Krypto in ‘Superman’ (Warner Bros, IMDb image via the Yonder).

Before Superman was super-anything, he was an orphan raised by farmers in Smallville, Kansas. The newest Superman is an old-fashioned, sincere and sometimes corny-sounding hero-in-the-making, who struggles to stay true to his ideals "in a world beset by 24/7 media noise, rationalized indifference, and organized meanness," writes Adam B. Giorgi for The Daily Yonder. "The boon of super strength and super speed doesn’t necessarily make it any easier to keep being good in the face of hardship, to do the right thing when the chips are down, or to be kind even when it’s not expected or rewarded."

After shedding roughly 30,000 jobs earlier this year and announcing it plans to curtail further layoffs, the Department of Veterans Affairs is still restructuring. "Senior leaders are telling employees that major changes are still coming," reports Eric Katz of Government Executive. "The VA is looking to empower medical center directors. Several employees, based on meetings and internal conversations, speculated that headquarters and possibly regional staff could be a casualty of that change."

'Inflation isn't finished with your chocolate bar.'

Chocolate maker Hershey may sell delightful sweets, but its latest announcement is a summer bummer. "Hershey is raising prices on its candy in response to continued high cocoa costs," reports Owen Tucker-Smith and Jesse Newman of The Wall Street Journal. While exact price hikes will vary, U.S. consumers can expect a roughly 20% increase on Hershey treats. "Three-quarters of Hershey’s confection portfolio should continue to cost $4 or less. . . .Demand for Hershey’s products has stayed strong. Shares of Hershey are up more than 7% this year."

With its varied seasons and climates, U.S. farmers and gardeners grow thousands of different crops each year. The amount of land dedicated to principal crops depends on the state. Discovering which states and regions farm the most land is best described in the map shared below.

Over half of Iowa is dedicated to farming. Click on map to enlarge.

The future of farming may involve less physical labor and more technology. "Imagine a farm where fleets of autonomous tractors, drones and harvesters are guided by AI that tweaks operations minute by minute based on soil and weather data," reports William Boston of The Wall Street Journal. "Farmers could swap long hours in the cab for monitoring dashboards and making high-level decisions. . . . Despite the promise of digital tools and autonomous machines, cost is a big barrier." 

Taking care while enjoying public pools can help reduce the chance of illness or skin rashes.
(Photo by Maria Korneeva, Moment, Getty Images via The Conversation CC)

Does chlorine kill all infectious "things" that end up swimming in the public pool? No. "Summer news headlines and social media posts often spotlight the 'ick-factor' of communal swimming spaces. These concerns do have some merit," writes Lisa Cuchara for The Conversation. "The good news is that chlorine, which is widely used in pools, is effective at killing many pathogens. The not-so-good news is that chlorine does not work instantly, and it doesn’t kill everything. . . .Read Cuchara's 10 tips for healthier public pool swimming here.

Opinion: The ongoing measles outbreak was 'avoidable.' Now what?

Map by Sarah Milotte, The Rural Index via The Daily Yonder

As measles cases in the U.S. top more than 1,000 diagnosed infections, medical experts Richard Hughes and Anna Larson call the ongoing outbreak "an avoidable public health failure," in their opinion for MedPage Today.

Measles was declared "eliminated" in the United States in 2000, but its status is evolving. The most recent eruption of the highly contagious disease began in rural Texas and "continues to unfold with additional deaths in Texas and New Mexico, an exposure at a major U.S. airport following an identified case in Maryland, and expanding to over half of U.S. states," Hughes and Larson write.

The newly appointed Secretary of Health and Human Services, Robert F. Kennedy Jr., has added to the confusion about the measles, mumps and rubella (MMR) vaccine by endorsing "unproven treatments for measles and emphasizing vaccination as a personal choice rather than a public good," they write. When "he finally recommended measles vaccination to address the snowballing case count, he then ordered the search for new measles treatments instead of promoting vaccination."

Searching for a new measles "cure" won't stop the continuing spread of the disease, but beefing up MMR vaccine rates could. Instead, the administration "has canceled research related to vaccine hesitancy and misinformation," Hughes and Larson add, "and announced a requirement that all new vaccine products undergo placebo-controlled clinical trials prior to licensure."

What is likely to happen? "We can expect vaccination challenges to compound, immunization rates to decline, and vaccine-preventable diseases to rise," Hughes and Larson write. "A comprehensive U.S. approach to shore up our measles defenses and preserve elimination status is imperative, but unlikely."

What can be done to slow the current measles outbreak down? "Consistent application of proven public health measures -- expanded vaccine access, particularly in underserved populations, and improved disease and vaccine surveillance systems," according to Hughes and Larson. "The need to combat misinformation and instill public trust in vaccines is obvious, but bears repeating. . . . Now is not the time for complacency; it's time for action."

As measles spread in west Texas, the state's 'lackluster investment' in rural health care systems is exposed

Measles is a highly contagious disease
caused by a virus. (Adobe Stock photo)

As the number of diagnosed cases of measles continues to climb, the outbreak in rural west Texas has exposed a health care system that is unprepared to handle even a smaller-scale contagion, reports Pooja Salhotra of The Texas Tribune. "Aging infrastructure, a dearth of primary care providers and long distances between testing sites and laboratories plague much of rural Texas, where the measles outbreak has concentrated."

A few years back, rural Texas was ravaged by Covid infections. Like Covid, the recent measles outbreak is "revealing how a lack of public health resources leaves rural communities vulnerable," Salhotra explains. "What’s left are local leaders forced to scrape together the few tools they have to respond to an emergency, contending with years of lackluster investment from the state and federal level to proactively prevent emerging public health threats."

A lack of hospitals, physicians and dilapidated facilities are just some of rural Texas' health care woes. "Some 64 Texas counties don’t have a hospital, and 25 lack primary care physicians," Salhotra reports. "Swaths of Texas have scant resources for public awareness campaigns. And they lack sufficient medical staff with expertise to provide the one-on-one education needed to encourage vaccination and regular visits to the doctor."

To slow the spread of measles, "rural health care teams have cordoned off spaces to conduct measles testing," Salhotra writes. They've "used social media to blast residents with information about vaccination efficacy and schlepped throat swabs across counties to ship them to a state lab in Austin — the only public state facility that was conducting measles testing until the Texas Tech University Bioterrorism Response Laboratory, part of a national network of CDC-funded labs, began measles testing" recently.

The primary goal of public health is prevention; however, "it’s emergencies that spur the most action, particularly in rural communities," Salhotra explains. "It was only after a school-aged child died from measles that state and federal support intensified."

Currently, Texas "spends less on public health per person than the vast majority of other states, according to the State Health Access Data Assistance Center, whose analysis shows Texas spent $17 per person on public health in 2023. A decade earlier, the spend was $19," Salhotra reports. "The low levels of state funding particularly hurt rural communities that have higher rates of uninsured Texans and more senior citizens with greater health needs."

National vaccination rates may continue to slump as states relax vaccination mandates

Child vaccination rates continue to decline.
(CDC photo, Unsplash)

Sliding vaccine rates could become a national trend as several states relax vaccine requirements and reduce promotion efforts, reports Shalina Chatlani of States Newsroom. "Vaccination rates are lower than they were before the pandemic."

Even with a growing measles outbreak in Texas, many Americans continue to reject or remain uncertain about vaccination requirements. "Public health experts worry that the confirmation of vaccine skeptic Robert F. Kennedy Jr. as secretary of the U.S. Department of Health and Human Services could add fuel to such efforts, leading to the resurgence of long-tamed infectious diseases," Chatlani explains. "Kennedy has made numerous baseless or false claims about vaccines."

Before the pandemic, most Americans accepted vaccination mandates as a medical directive based on scientific expertise, but that has changed. Al Cross, director emeritus of the Institute for Rural Journalism at the University of Kentucky, explained the shift, "Public health was once about doctors and nurses, and when it became defined in the public mind as coming from politicians, trust in it eroded quickly."

Without that trust, more parents have sought vaccination exemptions for their children. Chatlani reports, "Changing attitudes have had an impact: Vaccination rates among children born in 2020 and 2021 declined by between 1.3 and 7.8 percentage points for recommended shots, compared with children born in 2018 and 2019, according to a September report by the federal Centers for Disease Control and Prevention."

The accepted reasons parents can use to avoid state vaccination requirements are also likely to increase. "Republican officials in more than a dozen states have introduced legislation to loosen vaccine rules or otherwise reduce their use," Chatlani adds. An Idaho Senate panel recently considered a bill "that would ban mRNA vaccines, including Covid-19 vaccines, for a decade. Montana and Mississippi lawmakers considered but defeated similar proposals."

Rural communities struggle to find ways to communicate with growing non-native English-speaking population

Despite the ongoing growth of non-native English-speaking populations in rural communities, people in many counties and towns have failed to find effective ways to communicate with residents still learning English. The small town of Elko, Nevada, serves as an example. The town's "Hispanic or Latino population has grown to about 26%," reports Jazmin Orozco Rodriguez of KFF Health News. "The share of people age 5 or older who speak a language other than English at home increased to 18% as of 2022, while Spanish is the language spoken in nearly 15% of households."

With Elko's number of non-native English-speaking residents, the area needs translation support to ensure all residents understand vital information. Unfortunately, "state lawmakers in Nevada left out smaller counties from a recently enacted statewide language-access law," Rodriguez writes. "Not providing language access to people who need it is not only a violation of civil rights protected by Title VI of the Civil Rights Act, but it also can create public health and safety concerns said Jake Hofstetter, a policy analyst for the Migration Policy Institute, a think tank focused on immigration policy and research."

While much of rural America is white and English-speaking, its population has diversified, leaving smaller communities struggling to adapt to residents who aren't proficient in English. Rodriguez explains, "Implementing state and local language-access laws, however, is a challenge, researchers say, given standards can vary across state agencies and localities, making it difficult to ensure high-quality assistance is provided to speakers of various non-English languages."

The language-access challenges rural communities now face will continue to grow. "The number of white residents in rural parts of the nation decreased by about 2 million from 2010 to 2020, according to an analysis by the Carsey School of Public Policy at the University of New Hampshire," Rodriguez reports. "And the percentage of people who are members of a racial or ethnic minority living in rural areas increased from 20% in 2010 to 24% in 2020, with the largest share being Hispanic."

Language access services in metro and urban settings have grown; however, "Hofstetter said he doesn’t see many local policies that focus on the issue in rural areas," Rodriguez writes. "People living in rural areas may still benefit from a patchwork of resources through state agencies that provide services in their counties or local programs required to address language access because of federal funding."

Nonetheless, language barriers put non-native English speakers at a disadvantage. Rodriquez adds, "The degree to which local governments offer communications in languages other than English varies for several reasons, including enforcement of civil rights protections. That enforcement relies on civil rights complaints, which often must be filed by residents who may not know their rights related to language access."

More Americans are opting out of Covid-19 vaccinations; survey shows the choice can be based on political views

Pew Research Center graph

It has been four years since the U.S. rolled out lockdowns and mask mandates to slow the spread of Covid-19. Many Americans, both Republican and Democrat, received the country's first Covid-19 vaccine in fairly equal numbers. However, after that initial jump-off point, Covid-19 vaccines have become more partisan, and many Americans seem less concerned about the virus despite its continuing presence in the population.

"A new Pew Research Center survey finds that just 20% of Americans view the coronavirus as a major threat to the health of the U.S. population today, and only 10% are very concerned that they will get it and require hospitalization," report Alec Tyson and Giancarlo Pasquini for the Pew Research Center. "This data represents a low ebb of public concern about the virus that reached its height in the summer and fall of 2020, when as many as two-thirds of Americans viewed Covid-19 as a major threat to public health."

While it's hard to explain why so many U.S. citizens seem indifferent to the disease, vaccination numbers speak to an overall lack of public interest. "Just 28% of U.S. adults say they have received the updated Covid-19 vaccine, which the Centers for Disease Control and Prevention recommended last fall to protect against serious illness," Pew reports. "This stands in stark contrast to the spring and summer of 2021, when long lines and limited availability characterized the initial rollout of the first Covid-19 vaccines. A majority of U.S. adults (69%) had been fully vaccinated by August 2021."

Historically, political affiliation hasn't been a factor in vaccination status. A Pew survey from 2023 reported: "Robust public confidence in the value of childhood vaccines for MMR, with no decline in the large majority who say the benefits outweigh the risks compared with surveys conducted before the coronavirus outbreak." The Covid-19 vaccination does not have that kind of unilateral support, but instead vaccine choices fall along party lines. Tyson and Pasquini write, "Democrats and Democratic-leaning independents remain more likely than Republicans and GOP leaners to say they've received an updated Covid-19 vaccine (42% vs. 15%). This 27-point gap in recent vaccination is about the same as in January 2022."

The gap is even more distinctly party-affiliated among Americans 65 and older, who are ironically more at risk of dying from the disease. Pew reports, "In the current survey, 66% of Democrats ages 65 and older say they have received the updated Covid-19 vaccine, compared with 24% of Republicans ages 65 and older. This 42-point partisan gap is much wider now than at other points since the start of the outbreak."

Tyson and Pasquini add, "Still, the virus continues to circulate widely in the United States, with wastewater data suggesting that cases in the early part of 2024 were among the highest they have been since the first omicron wave in 2022."

There aren't enough rural veterinarians; new legislation sets out a plan to attract new graduates

Rural America needs more veterinarians.

(Farm Journal photo)

Forty years ago, there were plenty of country veterinarians to care for livestock and other food animals. That's no longer the case and lawmakers are working to address the issue. "New legislation has been introduced to address the critical shortage of veterinarians practicing in rural America," reports Rhonda Brooks of Farm Journal. The bipartisan legislation, the Rural Veterinary Workforce Act S.2829, was introduced this past week as a plan to address the steep decline of veterinarians practicing in rural areas. "A report commissioned by Farm Journal Foundation in 2022, noted that more than 500 counties across the U.S. have shortages of food animal veterinarians." 

The act would provide student loan tax benefits for graduates who choose  rural practice. The break helps "give more veterinarians the opportunity to practice in small, rural communities where their services are needed most," Brooks reports. "This change would reflect similar exemptions provided to medical doctors and other human health practitioners."

The lack of food animal veterinarians isn't just about farmers and animals; it can affect the public's food supply. Cornell University's Dr. Clinton Neill told Brooks, "The decline in food animal veterinarians in rural areas heightens concerns for several risks, including food safety threats, animal disease outbreaks, the potential passing of animal diseases to human populations, and decreasing rural economic growth. In essence, veterinarians protect the whole of the human and animal population, so it is critical that we have a strong pipeline of practitioners to work in rural areas."

Reasons new vet school graduates steer away from rural practice include "high levels of education debt that have outpaced potential earnings, especially in the rural U.S.," Brooks explains. "[The legislation] is encouraging more veterinarians to pursue companion animal practices and work in urban and suburban areas where incomes are often higher."

Legislation sponsors: Debbie Stabenow (D), John Boozman (R), Susan Collins (R), Mike Crapo (R), Kirsten Gillibrand (D), Cindy Hyde-Smith (R), Angus King (I), Amy Klobuchar (D), Jerry Moran (R), Lisa Murkowski (R), Patty Murray (D), James Risch (R), Tina Smith (D)

What's going on with the latest Covid-19 vaccines? Here are answers to frequently asked questions.

Updated Covid-19 vaccines from Pfizer/BioNTech and Moderna have rolled out to pharmacies. The Food and Drug Administration approved the mRNA vaccines for everyone 6 months and older. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted 13-1 to recommend that everyone 6 months and older should get the shots, and the CDC endorsed that recommendation.

Lori Robertson and Catalina Jaramillo of FactCheck.org, a service of the Annenberg Public Policy Center at the University of Pennsylvania. Robertson and Jaramillo compiled a list of common questions and answers about the vaccines, and here's a condensed version of their report:

How are these updated shots different from the last one? All of the Pfizer/BioNTech and Moderna Covid-19 vaccines — the originals, the bivalent boosters and the latest updates — use the same mRNA technology to trigger an immune response to the spike protein of SARS-CoV-2, the virus that causes Covid-19. The spike protein is what the virus uses to enter cells.

The difference between the versions of the vaccines is in what type of spike protein they prompt the body to make. The mRNA in the 2023-2024 vaccines instructs cells to make the spike protein of omicron variant XBB.1.5. The variant became a concern at the end of last year, when the CDC projected it made up 40.5% of new CCovid-19 cases in the U.S., a figure that rose to nearly 90% by early March.

Who is eligible to get an updated vaccine? Everyone 6 months of age and older is eligible for these vaccines.The FDA said those age 5 and older can get a single dose of either mRNA vaccine if at least two months have passed since the prior Covid-19 vaccine dose. Unvaccinated people can also get a single dose. Children ages 6 months through 4 years who previously were vaccinated are eligible to get one or two doses, depending on which vaccines they have received and when. Children in this age group who haven’t been vaccinated against Covid-19 can get three doses of the latest Pfizer vaccine or two doses of Moderna’s. . . . Those who are immunocompromised can also receive additional doses.

What evidence supports the use of the updated vaccines? The FDA said it approved and authorized the latest formulas of the vaccines based on its evaluation of manufacturing data and data showing the immune response to these vaccines against prevalent variants is similar to that of previous versions of the vaccines against prior variants.. . . . The FDA is using a similar approach to the annual influenza vaccines, which are tweaked each year to combat the influenza strains expected for that season. Flu vaccines are approved each year without clinical studies because the changes, compared with prior vaccines, are small and because it wouldn’t be possible to test the vaccines each year in people before the flu season.

How effective are they? We don’t have vaccine effectiveness data for the updated vaccines specifically, but data on similar, previous vaccines show they were quite effective at preventing severe disease. And the research. . . .by Moderna and Pfizer/BioNTech shows the updated version increases neutralizing antibodies against the new and emerging variants.

How safe are they? Moderna’s clinical trial for the latest vaccine showed that the percentage of participants reporting mild side effects, such as pain, swelling, headache, fatigue and muscle aches, was similar to or, in many cases, lower than the reporting rates for the prior Covid-19 vaccines. But, the safety evaluation of this formula is based on hundreds of millions of doses of Covid-19 vaccines administered over the past few years.

Are the shots still free, and where can I get one? The vaccines are no longer provided by the federal government for free, but private insurance companies, Medicare and Medicaid, and some CDC programs will cover them.

For more detailed explanations and questions, read the full article here. 

When Americans no longer trust each other, the problem can be deadly. It hits rural areas the hardest, study shows

An unhealthy mistrust has spread across the U.S.
(ProMarket photo, University of Chicago)

Not being able to trust our neighbors or our country's leaders not only feels rotten, it can lead to physical illnesses. "People died in the pandemic because they didn't trust the government or their neighbors to do the right thing," reports Frank Morris of KCUR in Kansas City. "And it's not getting better. Today, distrust is making people sicker, especially where health care is fragile across giant swaths of rural America. . . . Tom Bollyky, director of the global health program at the Council on Foreign Relations, said while the worst of the pandemic has passed (for now), the United States' deadly epidemic of mistrust is raging unchecked."

Bollyky was the lead author of a large study published in The Lancet this year, "taking a fine-grain look at Covid death and infection rates across the United States and the many factors that contributed to the differences," Morris writes. Bollyky told him: "This pandemic has been less about the microbe spreading around and more about the people to which it's spreading. It's about us, and how we feel about each other, and how we hang together as a community."

Morris reports, "Covid death rates varied wildly between states. The government tracked these rates as deaths per million people. New Hampshire lost 218 residents per million to Covid during the research period. New Hampshire has the highest rate of interpersonal trust in the U.S., as measured by long-running surveys testing trust between individuals. . . . Covid-19 was almost twice as deadly in Missouri as it was in New Hampshire. Almost a dozen other states fared even worse, partly due to distrust."

The pandemic years didn't just erode interpersonal trust, it decreased Americans' faith in vaccines overall. Brock Slabach, chief operations officer at the National Rural Health Association, told Morris, "And then, to add insult to injury, we have lower rates, for example, of childhood immunization that directly comes out of the pandemic and mistrust in vaccines generally. And so we're going to see childhood diseases that we thought we'd eradicated returning."

During and continuing after the pandemic, patient-doctor trust plummeted, and that distrust could make the next pandemic worse. Slabach told Morris: "Through the pandemic, we've added this issue of mistrust in the very professionals that for centuries we've valued as an important source of information for health and healthcare. . . . If we have another health crisis, this will come right back because we've not addressed some of the underlying issues. And so we're still going to be facing higher rates of disease, higher spread of death because of this misinformation and the lack of trust that we have in those areas of our system that know what to do in response."

Loneliness has increased across the U.S.; it shortens life expectancy, but there are solutions

Loneliness can lead to premature death.
(Photo by Andre Frueh, Unsplash)

Loneliness is a feeling as old as time, but it can lead to poor brain health and shorter life expectancy. According to America's top public health official, Surgeon General Vivek H. Murthy, loneliness is "as harmful as smoking 15 cigarettes a day and more lethal than consuming six alcoholic drinks a day," opinion columnist Nicholas Kristof writes for The New York Times as part of a series titled "How America Heals," aimed at finding ways to fix this problem.

Chronic loneliness cuts deeper than sadness; researchers have linked it to strokes, heart disease, dementia, inflammation and suicide. Kristof writes, "It's also more dangerous than physical inactivity, obesity and air pollution, Murthy says. . . . It breaks the heart literally as well as figuratively." The physical and societal problems that result from loneliness are so harmful Murthy issued a rare advisory in May with a framework to rebuild social connection and community in the United States.

Research also shows Americans have been growing lonelier. A majority of adults (58%) report experiencing loneliness, according to a Morning Consult survey commissioned by The Cigna Group, a health insurance company. Why did loneliness increase? Kristof says the trends toward larger homes and longer working hours have left less time to share meals, and he notes studies that show social media has led to people being more lonely. Pets and talking robots have been suggested as solutions, he writes, but "It seems that there's something to be said for friends who are living, breathing human beings."

Kristof writes that there are ways to build connections that bind us together, including some approaches taken in the United Kingdom, which he says "is the pioneer of these efforts, having established the post of minister for loneliness in 2018. Britain oversees public-private partnerships that collectively knit millions of people together with programs like nature walks, songwriting workshops and community litter pickups.

"That's because if the researchers are correct, social isolation probably kills far more people in the West each year than terrorists and murderers, and it costs the public enormous sums in unnecessary health costs," Kristof writes. "Countermeasures can make a huge difference: One review of 148 studies concluded that social connections increase the odds of an individual's surviving over roughly the next seven years by about 50 percent."

Surgeon General Murthy offered a strategy to address loneliness that begins with building infrastructure that enables social connection: physical infrastructure such as parks and libraries, and social infrastructure to weave together volunteers or enthusiasts with similar interests. Britain can serve as a model for this, Kristof writes. He cites a town that has trained more than 1,100 volunteers to be "community connectors" who engage people and encourage them to join events or participate in programs. "Solutions to loneliness are like that — little nudges to encourage us to mingle the way we evolved."

Alabama agrees to provide sewage-disposal systems to a county, in first-of-its-kind settlement agreement with feds

Sewage overflow in Lowndes County (Photo: Dennis Pillion, AL.com)

Do all Americans have a right to sanitation even if they cannot afford the systems needed to do the job? "The federal government now seems to be answering yes to that question, using a civil-rights investigation to press Alabama to solve long-standing sewage infrastructure problems in remote and lightly populated areas," reports Dennis Pillion of AL.com.

The Justice Department alleged that the Alabama Department of Public Health "engaged in a consistent pattern of inaction and/or neglect concerning the health risks associated with raw sewage" in Lowndes County, a rural, majority-Black county of about 10,000 people. Now Alabama "is the first state to reach an interim settlement agreement with federal authorities on environmental-justice grounds," agreeing to provide the county with adequate sewage treatment. The Environmental Protection Agency defines environmental justice as "the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income, with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies."

Lowndes County
(Wikipedia map)

Widespread poverty is one reason Lowndes County has been unable to resolve its sanitation challenges. The second obstacle is its very dense Black Belt soil, which "makes many septic systems inoperable," Pillions notes. "Addressing the wastewater needs of each residence in Lowndes County will likely require treatment systems of all different shapes, sizes and technologies [and many millions of dollars, but just how much is still a huge question. . . . Much of the cost will come from federal funds. The agreement stipulates that ADPH should seek funding from the American Rescue Plan Act and other federal grants to conduct its analysis and create an action plan to solve these sewage issues. ADPH will collaborate with the Centers for Disease Control and other federal agencies throughout the project."

Connecticut joins N.J. in requiring climate-change education

A student climate change summit at Joshua Tree National Park,
Calif. (Joshua Tree National Park photo/Flickr via Stateline)

Climate-change education is emerging as a critical factor in addressing the problem, and many U.S. schools are developing or implementing curriculum. In June of 2020, "New Jersey became the first state to incorporate climate-change lessons into its education standards for kindergarten through 12th grade. Connecticut will be the second state to do so, starting next month," reports Alex Brown of Stateline. "Several other states are considering similar measures, while some have provided funding for climate learning opportunities. Most states have adopted standards that include climate change, but education experts say the subject is taught spottily and is usually limited to science classes. Some educators say there's growing recognition that climate change demands a more comprehensive approach."

In New Jersey, "The state has created lesson plans and professional development for teachers and is offering millions of dollars in grants to support hands-on learning," Brown reports. "The state established those resources in partnership with groups such as Sustainable Jersey, a nonprofit network that certifies municipalities and schools on sustainability standards. . . . Those tools, said Randall Solomon, Sustainable Jersey's executive director, were just as important as the standards themselves."

Part of climate-change education's purpose is to help students understand what climate change is and that everyone can do many things about it. Breck Foster, an Oregon teacher, told Brown, "Kids understand the gloom and doom, and there's a lot of fatalism in their comments, but they don't have a lot of the facts." Many educators note that focused curriculum can empower students with those facts and inform their role. Center for Green Schools director Anisa Heming told Brown, "Kids tend to disengage if they don't have a sense that there are solutions, that they have some power in the situation, and the adults around them are acting. We have to arm them with the solutions, and then we have to act ourselves so they can see that those solutions are serious."

Climate-change education has skeptics. "In Texas, the state Board of Education directed schools earlier this year to provide textbooks that portray 'positive' aspects of fossil fuels and suggest rising temperatures are caused by natural cycles, Scientific American reported. . . . Twenty states follow Next Generation Science Standards developed by a consortium of states and education groups, which do address climate change, most often in science classes. Another 24 states have enacted similar standards of their own. But the six outlier states include Florida and Texas, with massive amounts of students. . . Leaders in New Jersey say their first school year under the new requirements has been a success, though some teachers aren't yet totally comfortable. They hope the state's standards, along with the resources it's drafted to help schools adapt, can provide a template for others." 

Researchers develop scoring system to identify long Covid; ongoing study at 85 sites needs more rural participants

Epigram.org.uk

Researchers have developed a method to determine whether someone is suffering from long Covid-19, defined as "post-acute sequelae Covid." (Sequelae are conditions resulting from earlier disease or injury.) And they're looking for more rural participants.

"This symptom-based PASC definition represents a first step for identifying PASC cases and serves as a launching point for further investigations," the reserachers report in the Journal of the American Medical Association. "Future analyses must consider the relationships among age, sex, race and ethnicity, social determinants of health, vaccination status after index date, co-morbidities, and pregnancy status during infection."

"Researchers identified symptoms that are the most distinctive to long Covid, including: fatigue, especially after exercise; brain fog; dizziness; gastrointestinal symptoms; heart palpitations; issues with sexual desire or capacity; loss of smell or taste; thirst; chronic cough; chest pain; and abnormal movements," reports Karen Weintraub of USA Today. "Each self-reported symptom is given a score and someone with a score of 12 or more 'is a person who very likely has long Covid,' said Dr. Leora Horwitz, who helped lead the research from the New York University Grossman School of Medicine. "It doesn't mean these symptoms are the most common, or the most severe, or the most burdensome, or the most important to people. It just means that these are the ones that help us identify people who have long-term consequences."

The researchers studied 9,764 adults at 85 hospitals, health centers, and community organizations in 33 states. "More than 20% of people who've had Covid score high enough six months after their infection to meet this working definition of long COVID, although one-third of them no longer meet the criteria at nine months," Weinraub reports.

The National Institutes of Health funded the research, which is continuing. "The study is still looking for participants who are Hispanic or who live in rural areas," Weintraub notes.

Questions and answers about the end of the national public-health emergency for Covid-19: There are many changes

By Kate Yandell
SciCheck, a service of FactCheck

May 11 marked the end of the federal public health emergency for Covid-19, bringing changes to health care and public benefits. These differences include changes in the cost of Covid-19 tests and treatments and the potential loss of access to free Covid-19 vaccines for people who are uninsured.

The biggest change originally tied to the emergency designation has already gone into effect. The public-health emergency allowed states to keep millions of people on Medicaid regardless of eligibility in exchange for extra federal aid. But this continuous enrollment requirement ended March 31, and states are asking Medicaid members to reconfirm their eligibility.

The emergency began in January 2020 and was renewed every 90 days after that by the secretary of the Department of Health and Human Services. Following pressure to end the emergency with the introduction of the Pandemic is Over Act in January, the Biden administration announced on Jan. 30 that it would let the emergency declaration expire May 11.

The end of the public-health emergency is not the definitive end of pandemic-related policies. Some, including some changes to telehealth coverage and expanded access to free vaccines, are still in effect.

A declaration allowing the Food and Drug Administration to grant and maintain emergency-use authorizations for measures to combat COVID-19 has no stated end date. This means that authorized treatments and vaccines, such as Paxlovid and the bivalent Moderna and Pfizer/BioNTech vaccines, can remain in use.

How will this affect Covid-19 testing?

Costs of Covid-19 testing for individuals will rise, which the Kaiser Family Foundation called the “widest ​​ranging impact” directly resulting from the end of the public health emergency.

People on Medicaid will still be able to get free at-home or health care provider-ordered tests through September 2024, before potentially facing costs. However, the requirement that insurers cover eight at-home Covid-19 tests per month ended for most other people on May 11. Private insurers and Medicare Advantage plans could decide to keep offering this coverage, while traditional Medicare will no longer offer free at-home tests.

Tests ordered by health care providers will also get more expensive for individuals. As of May 11, private insurers and Medicare Advantage plans will be able to charge patients for these tests and related visits, following the normal rules of their health care plan. People on traditional Medicare will still be able to get provider-ordered tests for free, but they may pay for visits associated with the tests.

Depending on funding and supplies, other government programs offering free tests will continue, including a Centers for Disease Control and Prevention program designed for uninsured and other disadvantaged people. AHHS says says that the mail-order at-home test program will continue through the end of May.

How will it impact Covid-19 vaccines and treatments?

The end of the public-health emergency will not immediately change the availability and costs of Covid-19 vaccines or oral antiviral treatments. This is because the emergency constituted just one of multiple layers of laws and policies that make vaccines and some treatments free.

Currently, Covid-19 vaccines and oral antiviral drugs, such as Paxlovid, are sourced from the federal government’s own supply. These doses must be offered at no cost regardless of whether there is a public-health emergency.

However, the government supply of vaccines is only expected to last through the summer or early fall, depending on demand. It is also possible that a new version of the Covid-19 vaccine will come out, and these will be provided commercially rather than through government purchases.

Even after the federal vaccine doses run out, most people with insurance will still get recommended Covid-19 vaccines for free. Some laws requiring free vaccines for Medicaid and Medicare recipients were enacted during the pandemic, while requirements for no-cost coverage of any recommended vaccines from in-network providers were already in place for people with private insurance.

“It’s really the uninsured who will be the most challenged because there’s no permanent guarantee,” said Jennifer Kates, senior vice president and director of global health and HIV policy at the KFF.

To fill this gap, the Biden administration has proposed a Vaccines for Adults program, similar to the Vaccines for Children program, which provides free vaccines to children whose families couldn’t otherwise afford them. Congress has not been willing to enact this program, however.

On April 18, the administration announced the Bridge Access Program, which will temporarily provide vaccines and treatments to the uninsured. This depends in part on the government purchasing vaccines and treatments, but also on pharmaceutical companies being willing to provide them for free. “It’s not permanent and it’s unclear how far it will go,” Kates said.

The federal supply of Paxlovid will be depleted by early fall, Kates said, and some people with private insurance or Medicare will face cost sharing, just like with other drugs. As with Covid-19 tests, people on Medicaid will continue to have access to free Covid-19 drugs through September 2024.

Vaccine mandates and other changes

The Biden administration has announced it will lift most federal vaccine mandates. These mandates are winding down around the same time as the public health emergency but were ended by a separate action.

Mandates for health-care workers at facilities that treat patients on Medicare and Medicaid will end soon, with more details to come. The administration also announced an end to vaccine requirements for Head Start and federal workers, although these mandates had already been blocked by courts.

Some other policies and changes allowed during the public-health emergency will remain. For instance, many telehealth-related changes for people on Medicaid and Medicare have been made permanent or extended through the end of 2024, Kates said. Changes to rules about limits on take-home doses of methadone and access to controlled substances via telehealth will also be extended, with the intention to eventually make some permanent.

Many changes will not be immediately obvious to the public, although they could have an indirect impact. Just to name a couple examples, hospitals will no longer receive extra money from Medicare for treating hospitalized COVID-19 patients and a number of waivers are ending, such as relaxed rules on what types of care different providers can give.

Loneliness poses a public health threat for all people; rural residents are considered to be and "additional at-risk group"

By Melissa Patrick

Kentucky Health News

The physical and societal harms that come from loneliness are so bad that America's top public-health official has issued a rare advisory with a framework to rebuild social connection and community in the U.S. 

"Loneliness is more than just a bad feeling," Surgeon General Vivek H. Murthy writes in an opinion piece for The New York Times. "When people are socially disconnected, their risk of anxiety and depression increases. So does their risk of heart disease (29%), dementia (50%), and stroke (32%). The increased risk of premature death associated with social disconnection is comparable to smoking daily — and may be even greater than the risk associated with obesity."

Social disconnection was worsened by the pandemic. 

“What Covid did is really pour fuel on a fire that was already burning,” Murthy told Fenit Nirappil of The Washington Post. “I want the entire country to understand how profound a public-health threat loneliness and isolation pose.”

Murthy's opening letter in the public-health advisory, titled Our Epidemic of Loneliness and Isolation, adds, "The mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day . . .  And the harmful consequences of a society that lacks social connection can be felt in our schools, workplaces, and civic organizations, where performance, productivity, and engagement are diminished." 

To further this point, the advisory says, "Data across 148 studies, with an average of 7.5 years of follow-up, suggest that social connection increases the odds of survival by 50%." 

In the Times, Murthy tells the story of his own experience with loneliness after his first term as surgeon general and how, with the help of others, he found his way out of it. Research shows he was not alone in this feeling, he reports: "About one out of every two Americans is experiencing measurable levels of loneliness. . . . Its invisibility is part of what makes it so insidious." 

Murthy goes on to say that loneliness and isolation have led us to a place where we "are less invested in one another, we are more susceptible to polarization and less able to pull together to face the challenges that we cannot solve alone." And this, he says, "has fueled other problems that are killing us and threaten to rip our country apart." 

For all of these reasons, Murthy writes, "rebuilding social connection must be a top public-health priority in our nation." To do this, he offers three key suggestions in the op-ed, which are outlined in greater depth in the 68-page advisory. 

First, Murthy says we must strengthen our social infrastructure, such as school-based programs that teach children about building healthy relationships and workplace design that fosters social connection.

Second, we must figure out how to create space in our lives without our electronic devices so that we can be more present with each other, with a commitment to promote conversation that amplifies understanding. 

Third, we need to take steps to rebuild our connections to each other, reaching out to people we care about, talking to our neighbors, checking in with co-workers who may be having a hard time, and seeking opportunities to serve.

Murthy has long advocated treating loneliness as a public-health issue wrote a 2020 book, Together: The Healing Power of Human Connection in a Sometimes Lonely World.

Research cited in the advisory shows that nationally, social connection decreased between 2003 and 2020 as time alone increased: Isolation increased by 24 hours per month and social engagement with friends dropped 20 hours per month.

Research also shows that loneliness and isolation are most prevalent in people with poor physical or mental health, disabilities, struggling financially or living alone, says the advisory. It adds that younger and older populations struggle the most. 

"For example, while the highest rates of social isolation are found among older adults, young adults are almost twice as likely to report feeling lonely than those over 65," it says. 

The advisory provides a national strategy to advance social connection that involves six pillars and the report goes on to lay out a detailed plan for how to support them. They include: strengthening social infrastructure in local communities; enacting pro-connection public policies; mobilizing the health sector; reforming digital environments; deepening our knowledge; and building a culture of connection. 

Graphic from Our Epidemic of Loneliness and Isolation public health advisory 

The report says, "We can choose, in short, to take the core values that make us strong—love, kindness, respect, service, and commitment to one another—and reflect them in the world we build for ourselves and our children. This strategy shows us how to create the connected lives and the connected world we need."

Murthy talked to Christina Caron of the Times about how to build meaningful social connections in an increasingly lonely world. He offered five tips: 

• Reconnect with people: "To get started, take 15 minutes each day to contact a friend or a relative. Put a reminder in your calendar, if needed, so that it remains a priority. Your relationships cannot thrive unless they are nurtured," she writes
• Minimize distractions: For a more satisfying quality time, put the devices down and give your full attention.“Focus on the conversation,” Murthy told Caron. “Listening is as important as what we say.”
• When people call, pick up the phone: Even if you are busy, he said. Pick it up, make a time to talk later, and do it. "That 10 seconds feels so much better than going back and forth on text," he said. 
• Serve others: Studies show that volunteering can ease feelings of loneliness and broaden our social networks, she writes. “When we help other people we establish an experience or a connection with them — but we also remind ourselves of the value that we bring to the world,” he told her. 
• Get help: Murthy said to tell someone if you are struggling with loneliness, whether that be a relative, a friend, a counselor or a health care provider. And, if you are having thoughts of harming yourself, call the 988 crisis hotline.

Experts look back at the pandemic and see a state-local public-health system that wasn't equipped to deal with it

By Krista Mahr and Daniel Payne
Politico Pulse

As the Covid-19 public health emergency enters its final weeks, Washington is still gripped by debate over how the pandemic started and what the Trump and Biden administrations got wrong. But one thing most can agree on: This won’t be the last time we face off with a deadly pathogen, and we’d better be ready. That’s the premise of a new report released by the Covid Crisis Group, headed by Philip Zelikow, former executive director of the 9/11 Commission.

The group of 34 experts was assembled in 2021 to lay the groundwork for a future Covid commission that never came to be. So they released their findings Tuesday, offering a series of lessons about what went wrong — and occasionally right — in America’s pandemic response. A few highlights:

When 19th century infrastructure met a 21st century virus: America's public-health infrastructure was built on a 19th century design, researchers wrote, focused on the state and local response to outbreaks. The Centers for Disease Control and Prevention, founded as a research center early in the 20th century, was neither conceived nor updated to manage a national health emergency. The modern health-care system evolved separately and with more resources from the nation’s public-health infrastructure, and both public health and the health-care system were detached from the bio-pharma complex, which ultimately made the drugs that saved Americans’ lives.

Policy failure created the pandemic partisan divide, not the other way around: Red and blue states had surprisingly similar approaches to lockdowns and reopenings early in the pandemic, upending the narrative that there were distinct “red” and “blue” pandemic responses. Instead, researchers said, it was a series of federal policy failures that created the toxic political environment that has come to define many people’s feelings about Covid and the government’s response.

Health security is national security: The report hails Operation Warp Speed as a major success in the pandemic response, partly due to researchers already being familiar with coronaviruses and the mRNA vaccine platform already being so advanced. The program helped invest, manufacture and distribute vaccines, and its leadership was granted unusual autonomy by the Trump administration, researchers wrote.

Two ways to look at how your state handled the pandemic: raw data, and data adjusted for state age and health status

How did your state handle the pandemic? These maps from The Lancet, a British medical journal, tell the story. The unadjusted rates on the left are from simple data: How many coronavirus infections and how many Covid-19 deaths were there, per 100,000 residents? The standardized rates take into account age and "comorbidities," other medical conditions that may lead to infection or death.

To illustrate the standardization, take a look at Kentucky, a state with relatively poor health status. Its infection and death rates were worse than the national average, but when adjusted for age and the high level of comorbidities in the population, both rates were better than the national average.

The maps accompany an article credited to a long list of researchers, led by Thomas Bollyky of the Council on Foreign Relations and Emma Castro of the Institute for Health Metrics and Evaluation at the University of Washington. They write, "States' struggles in the Covid-19 pandemic were not inevitable. The nearly four-fold differences that existed across states in Covid-19 death rates, even when standardized for factors such as age and comorbidities, suggest that lower death rates were achievable. The states with the lowest standardised Covid-19 death rates—Hawaii, New Hampshire, Maine, Vermont, and Maryland—are not confined to a single geographical region, nor did they all have governors from the same political party. The same is true for the states and territories with the highest standardized death rates—Arizona; Washington, D.C.; New Mexico; Mississippi; and Colorado."

But politics did play a role, the researchers wrote: "Declining economic conditions among lower-income Americans without a university degree have also weakened bonds of interpersonal trust—civic organisations, family bonds, and unions. Our results suggest interpersonal trust (i.e., trust in others) has played an outsized role in the Covid-19 pandemic, as it has in other epidemics where scientific uncertainties are great and public confidence is easily undermined. Having greater interpersonal trust motivates individuals to protect others in the community and reduces their fear of being misled and exploited by their peers. States with a higher percentage of people who voted for the 2020 Republican presidential candidate are associated with lower interpersonal trust in our study results. Trust has long been partisan in the USA, with citizens reporting less trust in government when the president comes from a different party than their own."