As one stalwart finance officer once told me, “Our pension funds basically sucked up all the new revenue we’d been hoping to set aside to properly fund OPEB.” Those and other priorities for spending each incremental revenue dollar continued to crowd out the opportunity to institute consistent actuarial funding for OPEB benefits; the path of least resistance for policymakers who lack foresight and a sense of fiscal responsibility has been to keep kicking the can.
So it is that between 2015 and 2019, the state and local sector had clearly sorted itself into three classes of employers: (1) those who had trimmed or modified their OPEB commitments and liabilities to sustainable levels, (2) those who had begun actuarial funding of an OPEB trust fund, and (3) those doing nothing and leaving the problem to their successors and future taxpayers.
Beginning Monday, at the order of Democratic Governor Kathy Hochul, every business in the state was required by law to have every employee and customer show proof of full COVID-19 vaccination, or make everyone inside their doors over the age of 2 wear a mask.
Violators face fines of up to $1,000. Enforcement is being left to county governments, of which an estimated one-quarter—almost all run by Republicans—have indicated they will not participate in.
The two-shot vaccination rate for New Yorkers ages 12 and older currently stands at 81 percent. Six months ago, when Hochul’s predecessor Andrew Cuomo lifted almost all statewide COVID restrictions, he did so because the Empire State had crossed the 70 percent threshold set by the Centers for Disease Control and Prevention (CDC)—not for full vaccination of everyone over age 12, mind you, but for single shots among adults.
Contra Hochul, it is far from clear that even 100 percent vaccination would have prevented a third consecutive winter surge across the northeast, which currently has the highest rates of vaccination and coronavirus cases in the United States.
Turokk Dow is one of about 87,000 young children who are diagnosed with lead poisoning in the US each year, more than three decades after the neurotoxin was banned as an ingredient in paint, gasoline and water pipes. Today, lead lingers in houses and apartments, yards and water lines, and wherever states and communities ramp up testing, it becomes clear that the nation’s lead problem is worse than we realized, experts say.
A study published in JAMA Pediatrics this fall suggested that more than half of all US children have detectable levels of lead in their blood – and that elevated blood lead levels were closely associated with race, poverty and living in older housing. Black children are particularly at risk.
“Most American children are exposed to lead, a substance that is not safe at any level,” said co-author Dr Harvey Kaufman, a senior medical director at Quest Diagnostics, which led the study. According to the CDC, “[e]ven low levels of lead in blood have been shown to negatively affect a child’s intelligence, ability to pay attention, and academic achievement.”
In California, for example, a 2020 report found that 1.4 million low-income children who were supposed to receive testing never got checked for blood poisoning. In some states, like New York, testing of all children is required, but there is often insufficient followup. A study by the New York City comptroller found that 9,000 rental buildings where children tested positive for blood poisoning were never inspected for lead, resulting in additional children being poisoned.
Author(s): Erin McCormick in Rhode Island and Eric Lutz
The Omicron variant of the coronavirus can partially evade the protection from two doses of Pfizer Inc (PFE.N) and partner BioNTech’s COVID-19 vaccine, the research head of a laboratory at the Africa Health Research Institute in South Africa said on Tuesday.
Still, the study showed that blood from people who had received two doses of the vaccine and had a prior infection were mostly able to neutralize the variant, suggesting that booster doses of the vaccine could help to fend off infection.
For context: a recent study by Pfizer, the pharma company backing the drug, found Paxlovid decreased hospitalizations and deaths from COVID by a factor of ten, with no detectable side effects. It was so good that Pfizer, “in consultation with” the FDA, stopped the trial early because it would be unethical to continue denying Paxlovid to the control group. And on November 16, Pfizer officially submitted an approval request to the FDA, which the FDA is still considering.
As many people including Zvi, Alex, and Kelsey have noted, it’s pretty weird that the FDA agrees Paxlovid is so great that it’s unethical to study it further because it would be unconscionable to design a study with a no-Paxlovid control group – but also, the FDA has not approved Paxlovid, it remains illegal, and nobody is allowed to use it.
One would hope this is because the FDA plans to approve Paxlovid immediately. But the prediction market expects it to take six weeks – during which time we expect about 50,000 more Americans to die of COVID.
Perhaps there’s not enough evidence for the FDA to be sure Paxlovid works yet? But then why did they agree to stop the trial that was gathering the evidence? Or perhaps there’s enough evidence, but it takes a long time to process it? But then how come the prediction markets are already 90% sure what decision they’ll make?
High U.S. drug prices are a financial strain for patients, employers, and state and federal governments. In the following charts, we present the findings from a number of studies on prescription drug costs and spending in the United States with other high-income countries to reveal the main culprit: high U.S. prices for brand-name drugs.
The data for this chartpack come from the following sources: the Commonwealth Fund’s 2020 International Health Policy Survey; 1980–2020 pharmaceutical spending data from the Organisation for Economic Co-operation and Development (OECD); 2020 individual-level administrative claims or registry data compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC); and IQVIA’s MIDAS database for 33 OECD member countries for 2018.
The high vaccination rate stands in contrast to Puerto Rico’s initial vulnerability to the coronavirus. Four years after Hurricane Maria destroyed the electricity grid, power outages still occur regularly. Many municipalities face a shortage of health care facilities and workers.
The U.S. territory responded with some of the strictest pandemic measures in the country, including nonessential-business closures, stay-at-home orders and mask mandates.
Its successes aside, Feliú-Mójer noted that COVID-19 has still killed over 3,200 people in Puerto Rico. And she remains concerned about vaccine equity — particularly in rural communities or among older adults who can’t get out of their homes or don’t know how to make an appointment. She says the high overall vaccination rate can hide gaps in coverage.
“You have to look beyond that big number,” she said in a separate interview with NPR. “But then you look at certain municipalities like Loíza, a town in coastal northern Puerto Rico that’s predominantly Black and [a] very poor municipality. Their vaccination rate is about 55%. And so when you look at some of the social determinants that impact communities like Loíza, then they’re not doing as well.”
Author(s): PATRICK JARENWATTANANON, AYEN BIOR, SARAH HANDEL
We examine whether a country’s management of the COVID-19 pandemic relate to the downward biasing of the number of reported deaths from COVID-19. Using deviations from historical averages of the total number of monthly deaths within a country, we find that the probability of underreporting of COVID-related deaths for countries with the most stringent policies was 58.6%, compared to a 28.2% for countries with the least stringent policies. Countries with the lowest ex ante healthcare capacity in terms of number of available beds underreport deaths by 52.5% on average, compared to 23.1% for countries with the greatest capacity.
In the new world, inoculation had a very rough reception. When John Dalgleish and Archibald Campbell began inoculating individuals in Norfolk, Virginia, an angry mob burned down Campbell’s house. Similar incidents occurred in Salem and Marblehead, Mass. In Charleston, S.C., an inoculation control law of 1738 imposed a fine of £500 on anyone providing or receiving inoculation within two miles of the city. A similar law was passed in New York City in 1747.
The measures in New England were so draconian that Benjamin Waterhouse noted the paradox: “New England, the most democratical region on the face of the earth voluntarily submitted to more restrictions and abridgements of liberty, to secure themselves against that terrific scourge, than any absolute monarch could have enforced.” (This, strangely prescient, anticipates the current debate about liberty versus public health). It was in the middle colonies — Maryland, Pennsylvania, New Jersey — that inoculation was most tolerated in the second half of the 18th century. That’s why Jefferson made the long journey to Philadelphia to be inoculated in 1766.
Jefferson first became aware of the discovery of a true smallpox vaccine from the newspapers he read in Philadelphia and the new capitol in Washington, D.C. Then, on Dec. 1, 1800, just after Jefferson’s election to the presidency, Benjamin Waterhouse sent him his pamphlet on the vaccine with a lovely cover letter saying that he regarded Jefferson as “one of our most distinguished patriots and philosophers.” Jefferson responded immediately, thanking Waterhouse for the publication and declaring, with his usual grace, that “every friend of humanity must look with pleasure on this discovery, by which one evil the [more] is withdrawn from the condition of man: and contemplating the possibility that future improvements & discoveries, may still more & more lessen the catalogue of evils. in this line of proceeding you deserve well of your [country?] and I pray you to accept my portion of the tribute due you.”
Trends in vaccinations and cases by age group, at the US national level. Data is stratified by at least one dose and fully vaccinated. Data also represents all vaccine partners including jurisdictional partner clinics, retail pharmacies, long-term care facilities, dialysis centers, Federal Emergency Management Agency and Health Resources and Services Administration partner sites, and federal entity facilities.
In the midst of a “third wave” of the U.S. COVID-19 pandemic driven largely by the highly contagious Delta variant, more than seven in ten U.S. adults (72%) now report that they have received at least one dose of a COVID-19 vaccine, up from 67% in July. An additional 2% say they plan to get the vaccine as soon as possible. The share who say they want to “wait and see” how the vaccine works for others before getting it themselves dropped to 7% in September. Four percent of adults this month say they will get vaccinated only if required for work, school, or other activities and 12% say they will “definitely not” get the vaccine.
The largest increases in self-reported COVID-19 vaccination rates between July and September were among younger adults (up 11 percentage points among 18-29 year-olds) and Hispanic adults (up 12 percentage points). The largest remaining gap in vaccination rates is by partisanship, with 90% of Democrats saying they have gotten at least one dose compared to 68% of independents and 58% of Republicans. In addition, large differences in self-reported vaccination rates remain between older and younger adults, between those with and without college degrees, and between those with higher and lower incomes, while rural adults continue to lag behind those living in urban and suburban areas. Non-elderly adults without health insurance also continue to report one of the lowest COVID-19 vaccination rates of any group (54%).
Author(s): Liz Hamel Follow @lizhamel on Twitter , Lunna Lopes , Grace Sparks Follow @gracesparks on Twitter , Ashley Kirzinger Follow @AshleyKirzinger on Twitter , Audrey Kearney Follow @audrey__kearney on Twitter , Mellisha Stokes , and Mollyann Brodie Follow @Mollybrodie on Twitter