RIP to Christine McVie, the singer-songwriter responsible for some of Fleetwood Mac’s biggest hits.  

Today in health, the rise of new COVID-19 omicron subvariants BQ.1 and BQ.1.1 has led to the one remaining monoclonal antibody treatment no longer being authorized by the FDA. 

Welcome to Overnight Health Care, where we’re following the latest moves on policy and news affecting your health. For The Hill, we’re Nathaniel Weixel and Joseph Choi.

Authorization for COVID antibody treatment paused

The Food and Drug Administration (FDA) said on Wednesday that the COVID-19 monoclonal antibody treatment bebtelovimab from Eli Lilly is no longer authorized for emergency use in the U.S. as it is not expected to be effective at neutralizing the two most dominant omicron subvariants in the country right now. 

The omicron subvariants BQ.1 and BQ.1.1 collectively account for 57.3 percent of COVID-19 cases in the U.S. right now, having pushed the BA.5 omicron subvariant out as the dominant subvariant earlier this month. 

Unsuited to newer mutations: 

• “Given that a COVID-19 infection is likely to be caused by a non-susceptible SARS-CoV-2 variant, and consistent with the terms and conditions of the Letter of Authorization, bebtelovimab is not currently authorized for emergency use in any U.S. region at this time,” the FDA said in a statement. 
  
• “Lilly and the FDA agree that it is not medically appropriate, at this time, to treat high-risk patients with mild-to-moderate COVID-19 with bebtelovimab in the US,” Eli Lilly said in a statement, confirming that its monoclonal antibody treatment does not appear to neutralize the BQ.1 and BQ.1.1 subvariants. 

The agency stated that Eli Lilly and its distributors have paused distribution of bebtelovimab until further notice and the Administration for Strategic Preparedness and Response has also paused the fulfillment of any pending requests for the drug. 

Bebtelovimab was the last monoclonal antibody authorized for treating COVID-19. Other previous antibody treatments have been withdrawn from the market. 

With this treatment no longer being distributed or authorized for use, the FDA advised that health care providers choose “appropriate” treatments including the authorized antivirals Paxlovid, Veklury and Lagevrio. 

Read more here. 

CDC testing Mich., Pa. wastewater for polio

The U.S. Centers for Disease Control and Prevention is expanding its wastewater testing for polio in parts of Michigan and Pennsylvania, officials announced Wednesday.   

The CDC will begin wastewater testing in Michigan’s Oakland County and an unspecified area around Philadelphia. 

• “Wastewater testing can be an important tool to help us understand if poliovirus may be circulating in communities in certain circumstances,” said José R. Romero, director of the CDC’s national center for immunization and respiratory diseases. 
  
• “Vaccination remains the best way to prevent another case of paralytic polio, and it is critically important that people get vaccinated to protect themselves, their families and their communities against this devastating disease.”  

Polio outbreaks once caused panic in the United States, but those concerns died once a vaccine was created and widely distributed in the 1950s and 1960s.   

Concerns over the spread of polio have been renewed this year, however, after the first case of paralytic polio in nearly a decade was diagnosed in an unvaccinated man in Rockland County, N.Y., in July.  

Since then, New York health officials have detected 89 “cases of interest,” 82 of which have been linked to the infected Rockland man. The virus has been found in sewage water in New York City, Orange County, Sullivan County, Queens County and Nassau County.   

Read more here.

INDIANA AG FILES COMPLAINT AGAINST DOCTOR WHO PERFORMED ABORTION ON 10-YEAR-OLD

Indiana Attorney General Todd Rokita (R) on Wednesday said he filed a complaint with the state's medical licensing board, asking it to investigate an Indianapolis doctor who provided an abortion to a 10-year-old rape victim from Ohio. 

The complaint alleges Caitlin Bernard violated federal and Indiana law related to patient privacy and the reporting of child abuse by sharing the girl's story with the press "to further her political agenda." 

Rokita said Bernard also failed to immediately report to state authorities the abuse and rape that led to the girl’s pregnancy. 

Bernard is suing Rokita to stop his office from accessing confidential medical records it requested as part of an investigation into her medical practice. 

In a statement, Bernard's attorney called the complaint "a last-ditch effort to intimidate Dr. Bernard and other providers of abortion care." 

Read more here.

GOP GOVERNORS, SENATORS TAKE AIM AT PENTAGON VAX MANDATE 

Nearly all Republican governors and 13 GOP senators are taking aim at the Biden administration’s military COVID-19 vaccine mandate, with the two groups on Wednesday urging congressional leadership to try to alter or altogether dismantle the ruling.  

The 21 GOP governors, led by Tennessee Gov. Bill Lee, issued a joint letter to top lawmakers asking them to “take immediate action to remove and prohibit” the mandate.  

• “The Biden vaccine mandate on our military creates a national security risk that severely impacts our defense capabilities abroad and our state readiness here at home,” the governors argue, claiming that “current servicemembers are leaving our ranks, and new recruits are not signing up to join.”  
  
• The 13 Republican senators want to insert language in the annual defense authorization bill that would prohibit any service member from being removed from the ranks should they refuse the coronavirus vaccine, as well as reinstate those already discharged with back pay.  

Flashback: The Pentagon in August 2021 required COVID-19 vaccinations for all service members — including those in the National Guard and Reserve — with those who do not comply facing loss of days they accrue toward retirement, loss of pay or even dismissal from the ranks known as involuntary separation.  

The U.S. military in February began to discharge service members for refusing the vaccine, with Pentagon officials in April telling Congress about 3,400 troops had been involuntarily separated from service.  

Read more here.

Companies ask SCOTUS to nix flavored-tobacco ban

A group of tobacco companies have asked the Supreme Court to issue an injunction on California’s ban on flavored tobacco products, which was voted into law at the ballot box earlier this month. 

Companies including the R.J. Reynolds Tobacco Company, the Santa Fe Natural Tobacco Company and Modoral Brands Inc. submitted a request for an injunction to the Supreme Court arguing that sales bans in the 9th Circuit Court of Appeals, of which California is a part, have been reversed by the court on prior occasions. 

On Election Day, 62 percent of California voters chose “Yes” on the proposition to prohibit the sale of flavored tobacco products. The ban affects products with non-tobacco flavors, such as fruit, mint and vanilla. Vending machines or stores that are found to be in violation face a $250 fee. 

The ban is set to go into effect beginning on Dec. 22. 

The question: The tobacco companies are asking that the Supreme Court consider whether the Family Smoking Prevention and Tobacco Control Act, a 2009 bill that gives the secretary of Health and Human Services the power to restrict or allow the sale of tobacco products, preempts the ban issued in California. 

Possible precedent: 

• The companies cited a previous cases where the Supreme Court overturned the 9th Circuit’s findings on bans regarding the sale of meat from “downer” animals, ones that are unable to walk. Federal law requires that downer cows not be slaughtered for human consumption. 
  
• In this earlier case, the court had ruled that federal law explicitly preempted the California law, which sought to include other livestock into the downer slaughter ban. 

Read more here.

WHAT WE'RE READING

• The chase is on: Regulators are slowly cracking down on vapes aimed at teens (NPR) 
• Older adults face Medicare hurdles for substance use treatment (Roll Call) 
• Newest Alzheimer’s drugs take large but fraught step toward approval (Wall Street Journal) 
• COVID hit HIV detection in Europe, threatens eradication progress (Reuters) 

STATE BY STATE

• New Mexico sues over a dozen tobacco companies (KVIA) 
• Texas’ rural hospitals are — once again — at grave risk of closing (Texas Tribune) 
• Minnesota's medical cannabis program adds qualifying conditions: IBS and OCD (MPR News) 

That's it for today, thanks for reading. Check out The Hill's Health Care page for the latest news and coverage. See you tomorrow.

The Food and Drug Administration (FDA) said on Wednesday that the COVID-19 monoclonal antibody treatment bebtelovimab from Eli Lilly is no longer authorized for emergency use in the U.S. as it is not expected to be effective at neutralizing the two most dominant omicron subvariants in the country right now.

The omicron subvariants BQ.1 and BQ.1.1 collectively account for 57.3 percent of COVID-19 cases in the U.S. right now, having pushed the BA.5 omicron subvariant out as the dominant subvariant earlier this month.

"Given that a COVID-19 infection is likely to be caused by a non-susceptible SARS-CoV-2 variant, and consistent with the terms and conditions of the Letter of Authorization, bebtelovimab is not currently authorized for emergency use in any U.S. region at this time," the FDA said in a statement.

The agency stated that Eli Lilly and its distributors have paused distribution of bebtelovimab until further notice and the Administration for Strategic Preparedness and Response has also paused the fulfillment of any pending requests for the drug.

For the moment, the FDA is recommending that remaining supplies of bebtelovimab be retained in case a variant that is susceptible to the drug becomes more prevalent in the U.S. in the future.

"Lilly and the FDA agree that it is not medically appropriate, at this time, to treat high-risk patients with mild-to-moderate COVID-19 with bebtelovimab in the US," Eli Lilly said in a statement, confirming that its monoclonal antibody treatment does not appear to neutralize the BQ.1 and BQ.1.1 subvariants.

"Lilly continually monitors the global COVID-19 environment, assessing the neutralization activity of potential antibody therapies against a wide array of existing and emerging mutations and variants," said the company. "Lilly will continue to search and evaluate monoclonal antibodies to identify potential candidates for clinical development against new variants."

Monoclonal antibodies function by mimicking natural antibodies produced by the immune system, limiting how much a virus can replicate inside a person's body. Before vaccines and treatments were available, monoclonal antibodies were one of the only treatments available for COVID-19 infections.

In 2020, former President Trump was given a round of monoclonal antibodies when he was hospitalized with COVID-19, later calling the treatment a "miracle."

With this treatment no longer being distributed or authorized for use, the FDA advised that healthcare providers choose "appropriate" treatments including the authorized antivirals Paxlovid, Veklury and Lagevrio.

The agency also recommended the use of convalescent plasma — taken from the blood of people who have recovered from COVID-19 infections — for patients who have compromised immune systems.

The U.S. Centers for Disease Control and Prevention is expanding its wastewater testing for polio in parts of Michigan and Pennsylvania, officials announced Wednesday.  

Polio outbreaks once caused panic in the United States but those concerns died once a vaccine was created and widely distributed in the 1950s and 1960s.  

Concerns over the spread of polio have been renewed this year, however, after the first case of paralytic polio in nearly a decade was diagnosed in an unvaccinated man in Rockland County, N.Y., in July.  

Since then, New York health officials have detected 89 “cases of interest,” 82 of which have been linked to the infected Rockland man. The virus has been found in sewage water in New York City, Orange County, Sullivan County, Queens County and Nassau County.  

The CDC will begin wastewater testing in Michigan’s Oakland County and an unspecified area around Philadelphia, according to The Washington Post.  

“Wastewater testing can be an important tool to help us understand if poliovirus may be circulating in communities in certain circumstances,” said Dr. José R. Romero, director of the CDC’s national center for immunization and respiratory diseases. “Vaccination remains the best way to prevent another case of paralytic polio, and it is critically important that people get vaccinated to protect themselves, their families and their communities against this devastating disease.” 

Polio can be found among communities with low vaccination rates and the virus can quickly spread. One out of every four people who contract the virus will eventually show flu-like symptoms such as a sore through, fever, nausea, headache and exhaustion.  

But most people who contract the virus will show no symptoms, according to the CDC.  

A smaller percentage of people will develop serious complications after contracting the virus.

There are two types of poliovirus vaccines. The first is a shot that can be administered in the leg or the arm that has an inactivated spread of the virus which has been in the United States since 2000. 

The second in the oral vaccine which contains a weakened strain of the virus administered via a few small drops in the mouth. The oral vaccine is common outside of the U.S. but in communities with low vaccination rates, this method may allow the poliovirus to mutate leading to the spread of vaccine-derived poliovirus.  

Indiana Attorney General Todd Rokita (R) on Wednesday said he filed a complaint with the state's medical licensing board, asking it to investigate an Indianapolis doctor who provided an abortion to a 10-year-old rape victim from Ohio.

The complaint alleges Caitlin Bernard violated federal and Indiana law related to patient privacy and the reporting of child abuse by sharing the girl's story with the press "to further her political agenda."

Rokita said Bernard also failed to immediately report to state authorities the abuse and rape that led to the girl’s pregnancy.

"Dr. Bernard violated the law, her patient’s trust, and the standards for the medical profession when she disclosed her patient’s abuse, medical issues, and medical treatment to a reporter at an abortion rights rally to further her political agenda," Rokita's office said in a statement. 

Rokita's office did not say what kind of penalty it was seeking, saying "it is up to the Medical Licensing Board to determine whether there are consequences."

Bernard said she performed the abortion in June, days after the Supreme Court's decision to overturn Roe v. Wade. The girl traveled from Ohio and was referred to Bernard because abortions were illegal under Ohio's newly enacted trigger law.

When Bernard’s actions gained national attention, some news outlets and Republican politicians— including Ohio's Attorney General— falsely suggested Bernard fabricated the story and that the girl did not exist. 

Once it was confirmed, Rokita publicly said on platforms such as Fox News that he intended to investigate whether Bernard had filed the proper notices for abortions under Indiana state law.

Shortly after Rokita made his public remarks about Bernard, her employer, Indiana University Health, released a statement saying it had found no evidence Bernard failed to comply with privacy laws.

Records obtained by various media outlets showed that Bernard filedan  appropriate report with the Indiana Department of Health within the required three-day window.

Bernard is suing Rokita to stop his office from accessing confidential medical records it requested as part of an investigation into her medical practice.

In a statement, Bernard's attorney called the complaint "a last-ditch effort to intimidate Dr. Bernard and other providers of abortion care."

"Though I am disappointed he has put my client in this position, we are not surprised given Mr. Rokita's consistent efforts to use his office to seek to punish those with whom he disagrees at the expense of Indiana taxpayers," said Kathleen DeLaney of DeLaney & DeLaney LLC.

A group of tobacco companies have asked the Supreme Court to issue an injunction on California's ban on flavored tobacco products, which was voted into law at the ballot box earlier this month.

Companies including the R.J. Reynolds Tobacco Company, the Santa Fe Natural Tobacco Company and Modoral Brands Inc. submitted a request for an injunction to the Supreme Court arguing that sales bans in the 9th Circuit Court of Appeals, of which California is a part, have been reversed by the court on prior occasions.

On Election Day, 62 percent of California voters chose "Yes" on the proposition to prohibit the sale of flavored tobacco products. The ban affects products with non-tobacco flavors, such as fruit, mint and vanilla. Vending machines or stores that are found to be in violation face a $250 fee.

The ban is set to go into effect beginning on Dec. 22.

The tobacco companies are asking that the Supreme Court consider whether the Family Smoking Prevention and Tobacco Control Act, a 2009 bill that gives the secretary of Health and Human Services the power to restrict or allow the sale of tobacco products, preempts the ban issued in California.

The 9th Circuit Court of Appeals has already rejected a request for emergency injunction by the same parties, finding that while the Tobacco Control Act gives the Food and Drug Administration the authority to regulate tobacco products, it does not entirely take away local and state authority over regulation of the drug.

The companies stated that they will "suffer irreparable harm because they will be unable to sell their products in one of the Nation’s largest markets," if this ban is allowed to stand.

They cited a previous cases where the Supreme Court overturned the 9th Circuit's findings on bans regarding the sale of meat from "downer" animals, ones that are unable to walk. Federal law requires that downer cows not be slaughtered for human consumption.

In this earlier case, the court had ruled that federal law explicitly preempted the California law, which sought to include other livestock into the downer slaughter ban.

Despite the overwhelming vote in support of the ban, the tobacco companies claimed in their request that public interest "strongly" favored the injunction. They also claimed that this ban would push consumers to the "illicit market" for the banned products.

While the companies cite the Tobacco Control Act, the bill also includes a provision that prohibits the sale of tobacco products with additives, natural or artificial, or that characterizes the flavor of the tobacco smoke, apart from menthol or tobacco.

The bill explicitly states that it does not "prohibit federal agencies, states, political subdivisions, or Indian tribes from enacting additional or more stringent measures," though other measures like tobacco product standards, premarket review and misbranding still fall under federal authority.

🎭 Looks like we’ll be stuck with the Phantom for just a bit longer. A boost in ticket sales has pushed back the end of “The Phantom of the Opera” on Broadway by two months. 

Today in health, Twitter will no longer be enforcing its COVID-19 misinformation policy as part of Elon Musk’s aims of rolling back content moderation on the platform. 

Welcome to Overnight Health Care, where we’re following the latest moves on policy and news affecting your health. For The Hill, we’re Nathaniel Weixel and Joseph Choi. Someone forward you this newsletter?

Twitter won't enforce COVID misinformation policy

Twitter is no longer enforcing its policy about COVID-19 misinformation as part of changes made under new CEO Elon Musk.  

Twitter did not formally announce the change, but a note was added to the top of the page about the policy to say that the rule was being rolled back. 

“Effective November 23, 2022, Twitter is no longer enforcing the COVID-19 misleading information policy,” the note stated. 

• The platform suspended more than 11,000 accounts for violating the policy between January 2020 and September 2022, according to data published by Twitter. 
  
• The cessation of the policy’s enforcement is part of changes Musk has made since closing his $44 billion acquisition of Twitter at the end of October. He has pledged to create a “free speech” platform, detailing a vision for having less content moderation measures in place in a way that critics have warned will lead to more hate speech and misinformation on the site. 

Civil rights and other advocacy groups have been putting pressure on Musk to change course and bring back content moderation measures through a campaign urging advertisers to pull their ads from Twitter. 

Imran Ahmed, CEO of the the Center for Countering Digital Hate, called the rollback of the COVID-19 misinformation policy an “irresponsible decision” that puts lives at risk and “opens the floodgates to those who spread deadly lies.” 

Read more here. 

Flu season intensifies with 6M infected in US: CDC

Flu season is intensifying in the U.S. with more than 6 million cases confirmed so far, the Centers for Disease Control and Prevention (CDC) reported on Monday. 

The federal health agency said in a weekly update it has already recorded more than 53,000 hospitalizations and 2,900 deaths from the flu this season, as of the week ending Nov. 19. 

Twelve children have died from the flu so far, the CDC said, and the cumulative hospitalization rate is the highest it’s been at this point in the flu season since
2010-2011. 

Flu season typically starts in October and ends around May, with a peak in December or January. It began six weeks early this year, causing a spike in hospitalization rates. 

• Influenza A is the dominant virus, making up close to 100 percent of all confirmed flu cases, according to the CDC. 
  
• Of the confirmed cases of Influenza A, 78 percent are the H3N2 strain and
  22 percent are the H1N1 strain. 

As of the week ending Nov. 19, the states most affected by the flu so far this season include California, Texas, New Mexico, Colorado, Washington, Virginia and New Jersey, which are among those the CDC lists with a very high activity level. 

The influenza surge comes as cases of RSV are starting to recede, meaning hospitals — which were overwhelmed with pediatric rSV patients — can’t catch a break.  

Read more here. 

NYC TO INVOLUNTARILY HOSPITALIZE MORE MENTALLY ILL PEOPLE

New York City Mayor Eric Adams (D) revealed a new plan Tuesday to remove people with severe, untreated mental illness from city streets and subways.  

Under the plan, New York City agencies would be able to forcibly hospitalize people who appear to be mentally ill even if they do not pose a threat to others around them.   

In a Tuesday press conference, Adams directed city agencies like the New York Police Department, the New York City Fire Department, and emergency responders to bring the mentally ill to hospitals for extended emergency care. 

“The common misunderstanding persists that we cannot provide involuntary assistance unless the person is violent, suicidal, or presenting a risk of imminent harm,” Adams said. 

“This myth must be put to rest. Going forward we will make every effort to assist those who are suffering from mental illness and whose illness is endangering them by preventing them from meeting their basic human needs.”  

Read more here. 

YOUNG PEOPLE MADE UP GREATER PROPORTION OF 2021 COVID DEATHS

The proportion of young people who died from COVID-19 in 2021 surpassed that of 2020, marking a shift in the pandemic’s mortality dynamics. 

That’s according to new research from investigators at Brigham and Women’s Hospital in Boston. Results also showed the median age of COVID-19 death decreased from 78 years in 2020 to 69 years in 2021. 

“A shift in COVID-19 mortality to relatively younger people in the second pandemic year contributed to markedly increased premature mortality from this increasingly preventable death,” said study co-author Mark Czeisler, a medical student at Harvard Medical School, in a release.  

“Understanding the factors that contribute to this age shift is critical as we continue developing our knowledge of the COVID-19 pandemic.” 

Older adults tended to have higher vaccination rates than their younger counterparts, and these vulnerable individuals tended to adhere more strictly to nonpharmaceutical interventions in 2021, researchers wrote. 

Read more here.

Medical company, Google partner on cancer screenings

Medical technology company iCAD Inc. announced on Monday it has signed a commercialization agreement with Google Health to utilize its artificial intelligence technology for the improvement of breast cancer screenings. 

In a statement, iCAD said Google will be licensing its AI tech for “breast cancer and personalized risk assessment.” This marks the first instance in which Google has entered into a commercial partnership to use its AI imaging technology for clinical practice. 

Google said in its own statement that its mammography AI technology will be incorporated into iCAD’s products. According to both companies, the ultimate goal of this partnership is to improve breast cancer detection and assessment of short-term personal cancer risk. 

• “Joining forces with Google marks a historic milestone for our Company, as leveraging Google’s world-class AI and Cloud technology elevates the caliber of our market-leading breast AI technologies and may also accelerate adoption and expand access on a global scale,” said Stacey Stevens, iCAD’s president and CEO. 
  
• iCAD already uses AI technology in its breast cancer screenings. Steven said the inclusion of Google’s AI will allow her company to “improve the performance of our algorithms for both 2D and 3D mammography.” 

In 2020, a study was published that found Google’s AI outperformed radiologists in both the U.K. and the U.S. when it came to accurately detecting breast cancers, reducing the rates of false-positives and false-negatives. 

Read more here.

WHAT WE'RE READING

• One step closer to a universal flu vaccine? (The New York Times) 
• Former Merck CEO: Democracy and the drug industry are both in danger (Stat) 
• RSV cases may have peaked in the US but the flu is surging (Bloomberg)

STATE BY STATE

• Rural Colorado tries to fill health worker gaps with apprenticeships (Kaiser Health News) 
• Bill would keep unelected Texas health officials from mandating student vaccines (CBS News) 
• Hospitals had to put charity care rules on their websites months ago. Some didn’t do it (Los Angeles Times) 
• Massachusetts residents can earn $75 by getting a COVID shot at these locations (MassLive.com) 

That's it for today, thanks for reading. Check out The Hill's Health Care page for the latest news and coverage. See you tomorrow.

Medical technology iCAD Inc. announced on Monday it has signed a commercialization agreement with Google Health to utilize its artificial intelligence technology for the improvement of breast cancer screenings.

In a statement, iCAD said Google will be licensing its AI tech for "breast cancer and personalized risk assessment." This marks the first instance in which Google has entered into a commercial partnership to use its AI imaging technology for clinical practice.

Google said in its own statement that its mammography AI technology will be incorporated into iCAD's products. According to both companies, the ultimate goal of this partnership is to improve breast cancer detection and assessment of short-term personal cancer risk.

“Joining forces with Google marks a historic milestone for our Company, as leveraging Google’s world-class AI and Cloud technology elevates the caliber of our market-leading breast AI technologies and may also accelerate adoption and expand access on a global scale,” said Stacey Stevens, iCAD's president and CEO.

iCAD already uses AI technology in its breast cancer screenings. Steven said the inclusion of Google's AI will allow her copmany to "improve the performance of our algorithms for both 2D and 3D mammography."

Greg Corrado, head of Health AI at Google, called the partnership an "inflection point."

"After several years of investment and intentional research and testing, we’re now ready to partner with iCAD to take the next steps toward integrating this technology into a real-world clinical setting and work together to make a difference in the lives of millions of people undergoing breast cancer screening," Corrado said.

In 2020, a study was published that found Google's AI outperformed radiologists in both the U.K. and the U.S. when it came to accurately detecting breast cancers, reducing the rates of false-positives and false-negatives.

Flu season is intensifying in the U.S. with more than six million cases confirmed so far, the Centers for Disease Control and Prevention (CDC) reported on Monday.

The federal health agency said in a weekly update it has already recorded more than 53,000 hospitalizations and 29,000 deaths from the flu this season, as of the week ending Nov. 19.

Twelve children have died from the flu so far, the CDC said, and the cumulative hospitalization rate is the highest it's been at this point in the flue season since the 2010-2011 one.

The CDC recommends that everyone aged 6 months and older get vaccinated against the flu annually.

Flu season typically starts in October and ends around May, with a peak in December or January. It began six weeks early this year, causing a spike in hospitalization rates.

The season is ramping up even as the U.S. continues to combat the COVID-19 pandemic and a new surge of respiratory syncytial virus (RSV), a critical illness for youth that has put a strain on children's hospitals.

With the "triple threat" of viruses impacting children's health care across the nation, some pediatric groups are calling on the Biden administration to declare a national emergency to free up additional resources.

As of the week ending Nov. 19, the states most affected by the flu so far this season include California, Texas, New Mexico, Colorado, Washington, Virginia and New Jersey, which are among those the CDC lists with a very high activity level.

Influenza A is the dominant virus, making up close to 100 percent of all confirmed flu cases, according to the CDC.

Of the confirmed cases of Influenza A, 78 percent are the H3N2 strain and 22 percent are the H1N1 strain.

The chief of the International Monetary Fund (IMF) called for a “recalibration” of China’s strict “zero-COVID” policy on Tuesday following rare protests in the country against the rules that put pressure on Chinese officials to ease them. 

Kristalina Georgieva, the managing director of the IMF, told The Associated Press in an interview that China needs to change its policy because of the impact it is having on people and the economy. 

China has pursued a strategy of trying to reduce the number of cases active in the country to as close to zero as possible, ordering as many as millions of civilians to go into lockdown to prevent the virus’ spread. 

But tens of thousands of cases are still happening in China, and the number of new infections hit record levels in recent days. 

Most of the Chinese population has never been exposed to the virus because of the policy, so they have not built up an immunity. Lower vaccination rates among elderly individuals are also allowing the virus to spread more easily and cause more deaths as more contagious variants develop. 

Protests have broken out in China against the country’s COVID-19 policies, in part fueled by a deadly fire at an apartment in the northwestern city of Urumqi last week. Chinese protesters have argued that the country’s lockdowns slowed firefighters’ response to the fire and cost lives. 

Some protesters called on Chinese President Xi Jinping to step down. 

China has announced small changes to its policies related to the virus, only requiring buildings or neighborhoods to be isolated instead of entire cities. But it has not shown indications of any broad overhauls of its “zero COVID” policy. 

“We see the importance of moving away from massive lockdowns, being very targeted in restrictions,” Georgieva said. “So that targeting allows to contain the spread of COVID without significant economic costs.” 

She said China should focus on vaccinating the most “vulnerable” people.

Believe it: Merriam-Webster's 2022 word of the year is “Gaslighting.” 

Today in health, we look as the White House’s booster push falls flat against widespread pandemic fatigue even as another coronavirus surge looms. 

Welcome to Overnight Health Care, where we’re following the latest moves on policy and news affecting your health. For The Hill, we’re Nathaniel Weixel and Joseph Choi. Someone forward you this newsletter? 

White House battles pandemic fatigue in vax push 

Public health officials have repeatedly warned that the U.S. will likely face another wave of COVID-19 infections as the weather gets colder and people travel and gather for the holidays.   

But it doesn’t seem to be convincing a checked-out public to get vaccinated. 

New COVID-19 booster shot uptake remained low heading into the Thanksgiving holiday, frustrating Biden administration officials who previously called for the public to get booster shots in time for Halloween.  

The government has purchased 171 million doses of the updated vaccine. But federal data shows that just 11 percent of the population older than age 5 has received a dose, including just under 30 percent of people 65 and older. 

• Anthony Fauci, in likely his final White House briefing before he leaves government, implored people to get vaccinated and not get complacent about COVID-19. 
  
• “My message, and maybe the final message I give you, please, for your own safety, for that of your family, get your updated COVID-19 shot as soon as you’re eligible to protect yourself, your family and your community,” Fauci said. 

New COVID-19 cases and hospitalizations are down from the most recent summer surge, even as the virus continues to circulate and deaths have plateaued at about 2,200 people every week. 

Updated data show the greatest danger is still to people who are not vaccinated. But there is also a significant concern for vulnerable people who are not up to date with their vaccines. Even though they may have received the original vaccine, they need an updated shot to be protected from severe disease and possible death from newer variants.  

“Here’s what we know: If folks get their updated vaccines, and they get treated, if they have a breakthrough infection, we can prevent essentially every COVID death in America,” White House COVID-19 response coordinator Ashish Jha said.  

Read more here. 

WHO to phase out ‘monkeypox,’ rename it ‘mpox’ 

The World Health Organization (WHO) on Monday said it is renaming “monkeypox” as “mpox” amid concerns that the name may be considered racist and might not accurately describe the origin of the virus. 

The two terms will be used simultaneously for one year while “monkeypox” is phased out, WHO said in a statement. The agency over the summer said it would consider suggestions for a name change.  

• “When the outbreak of monkeypox expanded earlier this year, racist and stigmatizing language online, in other settings and in some communities was observed and reported to WHO,” the agency said. 
  
• “In several meetings, public and private, a number of individuals and countries raised concerns and asked WHO to propose a way forward to change the name,” WHO said. 

An uncommon move: Assigning names to existing diseases is rare, but it is the responsibility of WHO under the International Classification of Diseases (ICD). Usually, the ICD updating process takes up to several years, but the WHO said the process was accelerated in this case. 

LGBTQ activists, scientists and public health experts have been calling for the name change since the U.S. outbreak began earlier this year. They argue the name plays into racist stereotypes about Africa and hampers the global response. 

Read more here. 

FAUCI: ‘KEEP THE POLITICS OUT OF’ INVESTIGATING COVID ORIGINS 

Anthony Fauci, the chief medical adviser to President Biden, said on Sunday that the U.S. is in a “much better” place in the pandemic compared to a year ago but stressed it is not completely over. 

“I don’t like reading in the newspapers or getting my report from the COVID team: today we lost 400 people, today we lost 350 people,” Fauci said during an appearance on CBS’s “Face the Nation.” “So it’s much, much better than it was, but it is not at a level low enough where we should feel we’re done with it completely, because we’re not.” 

On Sunday, moderator Margaret Brennan noted that Fauci a year ago indicated on the show that he would feel comfortable retiring once COVID-19 is in the rearview mirror and doesn’t dominate the mental framework of society. 

Fauci plans to step down from his government roles next month, including his post at the National Institute of Allergy and Infectious Diseases, which Fauci has led for
38 years. 

• Fauci responded by noting that the current case and death rates are dramatically lower than one year ago, when the omicron variant began to surge. 
  
• “That is much, much better than we were a year ago,” Fauci said on CBS. “But if you look at it in a vacuum, it’s still not a great place to be.” 

Read more here. 

LIFE INSURERS PAY RECORD DEATH BENEFITS IN 2021 

New data released by the American Council of Life Insurers (ACLI) shows companies paid $100 billion to the beneficiaries of policyholders who died last year.   

That number is the highest amount life insurance companies have paid out to policyholder beneficiaries in a single year, according to a release from the ACLI.   

• While the ACLI data does not show policyholder cause of death, Vice President and Chief Economist at ACLI Andrew Melnyk said COVID-19 is most likely a driving force behind the spike in payouts for the second year in a row.   
  
• And that spike is driven by two reasons: the disease’s presence resulting in more Americans purchasing life insurance and the sheer number of people who have died as a result of being infected with the virus. 

Preexisting trend: Life insurance payments have gone up since 2019, according to ACLI data. The number of life insurance policies bought last year was about
6 percent higher than in 2020 with about 46 million policies purchased in 2021.  

Read more here. 

Battle against RSV in schools recalls COVID-19 fight 

Schools are preparing for another winter marked by mass sickness, as the respiratory syncytial virus (RSV) continues to spike among children, prompting precautions that mirror those seen during COVID-19.  

Facilities with younger children such as day cares and pre-K programs face a potential “tripledemic” of RSV, COVID-19 and the flu this season. Day cares and classrooms are known to be vectors of transmission for pathogens like RSV, a virus for which there is currently no vaccine. 

• A big part of keeping children safe is clear communication between the educators and parents, said Shannon Robinson, health and nutrition manager at the childcare nonprofit Bright Beginnings in Washington, D.C. 
  
• “It’s just a matter of continuing to educate our parents and allow them to ask questions that they may have, because a lot of the information is new to parents where they don’t quite understand what exactly is happening,” Robinson said. 

Enforcing boundaries: “I do know that most childcare providers are really reinforcing to the parents that they are not going to accept a child that has any symptoms into their program, which is hard to do. Parents need to go to work, but that’s the number one line of defense,” Cindy Lehnhoff, director of the National Child Care Association, told The Hill.  

Major U.S. school districts told The Hill that while they are not mandating mitigation methods, they are encouraging parents, teachers and students to return to the practices that became commonplace during the worst parts of the COVID-19 pandemic. 

Hand washing, sanitizing toys, keeping children home when they are sick — and clear communication between parents and educators — are all seen as crucial to keep children safe this winter.  

Read more here. 

WHAT WE'RE READING

• Experimental flu shot aims to target 20 influenza viruses in a single vaccine (USA Today) 
• WHO’s departing chief scientist regrets errors in debate over whether SARS-CoV-2 spreads through air (Science) 
• Covid deaths skew older, reviving questions about ‘acceptable loss’ (Washington Post) 

STATE BY STATE

• Oklahoma voters could decide on abortion access under proposed ballot initiative (KOSU) 
• Los Angeles County health officials issue cold weather alert (Los Angeles Times) 
• New program addresses shortage of rural Tennessee doctors (The Tennessean) 

THE HILL OP-ED

Stop hospital consolidations to lower health care prices for all Americans 

That's it for today, thanks for reading. Check out The Hill's Health Care page for the latest news and coverage. See you tomorrow.

The World Health Organization on Monday said it is renaming "monkeypox" as mpox amid concerns that the name may be considered racist and might not accurately describe the origin of the virus.

Mpox will be used simultaneously for one year while “monkeypox” is phased out, WHO said in a statement. The agency over the summer said it would consider suggestions for a name change. 

"When the outbreak of monkeypox expanded earlier this year, racist and stigmatizing language online, in other settings and in some communities was observed and reported to WHO," the agency said.

"In several meetings, public and private, a number of individuals and countries raised concerns and asked WHO to propose a way forward to change the name," WHO said.

Assigning names to existing diseases is rare, but it is the responsibility of WHO under the International Classification of Diseases (ICD). Usually, the ICD updating process can take up to several years, but the WHO said the process was accelerated in this case.

LGBTQ activists, scientists and public health experts have been calling for the name change since the U.S. outbreak began earlier this year.  They argue the name plays into racist stereotypes about Africa, and hampers the global response.

Cases are more often found in Central and Western African countries, leading many western nations to pay little attention to it, but a monkeypox outbreak earlier this year in Europe and the United States pushed the disease to the forefront.

The U.S. outbreak began spreading rapidly across the country in May, catching administration health officials by surprise, resulting in a scramble to bring infections under control. 

A group of scientists wrote a joint statement to the WHO in June urging for the monkeypox to be renamed, calling the name “discriminatory and stigmatizing.”

Human monkeypox was given its name in 1970, after the virus that causes the disease was discovered in captive monkeys in 1958. 

In a statement, Health and Human Services Secretary Xavier Becerrra applauded the decision and said federal public health agencies will adopt the mpox name "in correspondence with the medical community and American public from this point forward."

“We welcome the change by the World Health Organization. We must do all we can to break down barriers to public health, and reducing stigma associated with disease is one critical step in our work to end mpox,” Becerra said.

The BBC said Sunday that one of its reporters was arrested and beaten by Chinese authorities while covering protests in Shanghai over COVID-19 restrictions.

China is seeing rare outpourings of public frustration in recent days in response to strict COVID lockdowns meant to curb the spread of the virus.

In a statement on Sunday, the BBC said journalist Ed Lawrence was kicked and handcuffed for hours after being arrested while covering demonstrations in the country's economic hub.

Video circulated online showing Lawrence being arrested and detained by a group of Chinese authorities. In another video, he appears to tell colleagues to "call the consulate" while being pulled away by police.

“It is very worrying that one of our journalists was attacked in this way whilst carrying out his duties,” an BBC spokesperson said in a statement. “We have had no official explanation or apology from the Chinese authorities, beyond a claim by the officials who later released him that they had arrested him for his own good in case he caught Covid from the crowd."

The BBC said it is “extremely concerned” about Lawrence’s treatment in the country. 

China’s “zero COVID” strategy has led to a series of lockdowns all around the country, as cases soar to record levels in some places.

During an appearance on ABC’s “This Week” on Sunday, White House coronavirus response coordinator Ashish Jha told anchor Martha Raddatz that China’s strategy toward COVID-19 is not realistic. 

“Obviously, that is not our strategy,” Jha said. “We don’t think that’s realistic, certainly not realistic for the American people. Our strategy has been build up immunity in the population by getting people vaccinated. That’s how you managed an incredibly contagious variant like omicron.”

White House coronavirus response coordinator Ashish Jha on Sunday indicated China’s “zero COVID” strategy is not realistic.

During an appearance on ABC’s “This Week,” anchor Martha Raddatz asked Jha about demonstrations in cities across China over the weekend protesting the strategy, which seeks to isolate and eliminate every COVID-19 case, leading to lockdowns for millions of residents in recent months.

“Obviously, that is not our strategy,” Jha said. “We don’t think that’s realistic, certainly not realistic for the American people. Our strategy has been build up immunity in the population by getting people vaccinated. That’s how you managed an incredibly contagious variant like omicron.”

COVID-19 cases in China have hit record levels in recent days as most of the population remains unexposed to the virus, creating new restrictions in many areas of the country as places like the U.S. move away from coronavirus mandates.

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A deadly apartment fire last week in the northwestern city of Urumqi has caused resentment to swell further, with some citizens now taking to the streets in a rare show of defiance, suggesting the lockdown measures delayed firefighters’ response to the tragedy and led to more deaths. 

“I think it’s going to be very, very difficult for China to be able to contain this through their zero COVID strategy,” Jha said on ABC. “I would recommend that they pursue the strategy of making sure everybody gets vaccinated, particularly their elderly. That I think is the path out of this virus. Lockdown and zero COVID is going to be very difficult to sustain.”

The protests were met with violence from police in places like Shanghai, who sought to break up demonstrators as some demonstrators chanted “Xi Jinping! Step down! CCP! Step down!” while standing on a road named for the city where the fire occurred.

Hours later, crowds returned to the same street on Sunday, shouting “We don’t want PCR tests, we want freedom!”

But Xi, who recently began his third term as China’s leader and increasingly surrounded himself with loyalists, so far has shown no sign of stopping the “zero COVID” strategy as the country approaches the three-year anniversary of discovering its first case in Wuhan, China.

Anthony Fauci, the chief medical adviser to President Biden, said on Sunday that the U.S. is in a “much better” place in the pandemic compared to a year ago but stressed it is not completely over.

“I don't like reading in the newspapers or getting my report from the COVID team: today we lost 400 people, today we lost 350 people,” Fauci said during an appearance on CBS’s “Face the Nation.” “So it's much, much better than it was, but it is not at a level low enough where we should feel we're done with it completely, because we're not.”

Fauci plans to step down from his government roles next month, including his post at the National Institute of Allergy and Infectious Diseases, which Fauci has led for 38 years.

On Sunday, moderator Margaret Brennan noted that Fauci a year ago indicated on the show that he would feel comfortable retiring once COVID-19 is in the rearview mirror and doesn’t dominate the mental framework of society.

Fauci responded by noting that the current case and death rates are dramatically lower than one year ago, when the omicron variant began to surge.

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“That is much, much better than we were a year ago,” Fauci said on CBS. “But if you look at it in a vacuum, it's still not a great place to be.”

The White House last week launched a new push for people to receive their COVID-19 booster shots as officials struggle to increase uptake.

About 12 percent of people aged 5 and older have received a dose of the updated vaccines that target recent variants, according to federal data.

“I think it’s a combination of an expansion and an amplification of the anti-science, anti-vax,” Fauci said of the low uptake. “There is something I've never seen in my 54 years in medicine at the [National Institutes of Health], is that the acceptance or not of a life-saving intervention is steered very heavily by your political ideology.”

Anthony Fauci, President Biden’s outgoing chief medical adviser, on Sunday urged officials to “keep the politics out of” investigating the origins of COVID-19 in China.

Speaking with moderator Margaret Brennan on CBS’s “Face the Nation,” Fauci said he is keeping an open mind, but he reiterated that the evidence is “quite strong” that the virus occurred naturally.

“They're very suspicious of anybody trying to accuse them,” Fauci said of the Chinese government. “We need to have an open dialogue with their scientists and our scientists, keep the politics out of it.”

Republicans have indicated they plan to investigate the origins of the pandemic upon taking the House majority in January as well as Fauci himself, suggesting COVID-19 instead originated from a laboratory.

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“All of my colleagues, keep an absolutely open mind,” Fauci said on CBS. “We've got to investigate every possibility because this is too important not to do that. That's not incompatible with saying the scientific evidence still weighs much more strongly that this is a natural occurrence. You must keep your mind open that it's something other than that.”

But Fauci pushed back on the notion that the Chinese Communist Party covered up the pandemic’s origins. 

“Not necessarily the scientists that we know and we have dealt with and collaborated with productively for decades, but the whole establishment — a political and other establishment in China, even when there's nothing at all to hide — they act secretive, which absolutely triggers an appropriate suspicion,” Fauci said.

He went on to criticize former President Trump’s accusatory comments against China during the early months of the pandemic, although Fauci acknowledged a need for more data.

“What happens is that if you look at the anti-China approach, that clearly the Trump administration had right from the very beginning, and the accusatory nature, the Chinese are going to flinch back and say, ‘Oh, I'm sorry, we're not going to talk to you about it,’ which is not correct. They should be,” Fauci told Brennan.

Schools are preparing for another winter marked by mass sickness, as the respiratory syncytial virus (RSV) continues to spike among children, prompting precautions that mirror those seen during COVID-19. 

Facilities with younger children such as day cares and pre-K programs face a potential “tripledemic” of RSV, COVID-19 and the flu this season.

For the majority of adults and older children, RSV causes cold and flu-like symptoms that resolve themselves in about a week. However, younger children, particularly infants and toddlers who have not been exposed to the virus, are at a high risk of developing severe illness.

Day cares and classrooms are known to be vectors of transmission for pathogens like RSV, a virus for which there is currently no vaccine.

However, educators are well practiced in the necessary precautions for combating RSV, which are similar to those taken during the height of the pandemic.

A big part of keeping children safe is clear communication between the educators and parents, said Shannon Robinson, health and nutrition manager at the child care non-profit Bright Beginnings in Washington, D.C.

“It's just a matter of continuing to educate our parents and allow them to ask questions that they may have, because a lot of the information is new to parents where they don't quite understand what exactly is happening,” Robinson said. 

Bright Beginnings runs a weekly flier in their newsletter to parents about COVID-19 and RSV precautions, providing information on what symptoms to look out for, what precautions are advisable and when to take their children to the doctor. 

“The constant communication with early prevention is key to combat where we are right now trying to get the cases down with RSV,” Robinson said, noting they have had five to six confirmed cases this year compared to 20 to 30 cases last year. 

It is possible the children’s immune systems are better this year since “last year there were also a lot of children’s first time in a school setting,” she added. 

Along with communicating symptoms, child care facilities also need to have strict standards about when children should stay home. 

“I do know that most child care providers are really reinforcing to the parents that they are not going to accept a child that has any symptoms into their program, which is hard to do. Parents need to go to work, but that's the number one line of defense,” Cindy Lehnhoff, director of the National Child Care Association, told The Hill. 

Along with boundaries for the child care providers, Lehnhoff emphasized that parents should be “very, very mindful” of the facility where they take their children, asking the providers questions about hand washing policies, sanitizing regimens and what the eating setup is like. 

Major U.S. school districts told The Hill that while they are not mandating mitigation methods, they are encouraging parents, teachers and students to return to the practices that became commonplace during the worst parts of the COVID-19 pandemic.

Hand washing, sanitizing toys, keeping children home when they are sick — and clear communication between parents and educators — are all seen as crucial to keep children safe this winter. 

The Los Angeles Unified School District (LAUSD) acknowledged in a November news release it was experiencing “extremely high respiratory infections among children.”

“Unfortunately, there has been a tremendous impact on our hospital emergency rooms,” the district, one of the largest in the country, said in a statement.

Children’s hospitals across the country are facing shortages in both beds and staffing amidst this current respiratory viral season. Many have resorted to using emergency room beds as their departments fill up.

Taking a cue from the Los Angeles County Department of Public Health, the school district encouraged parents to remind their children of proper hygiene etiquette, to consider masking while indoors and to get vaccinated against both the flu and COVID-19.

The only treatment available for RSV is monoclonal antibodies, which is typically reserved for extremely high-risk cases as a proactive measure.

Both Miami-Dade County Public Schools and Chicago Public Schools have made similar recommendations this season while stopping short of issuing outright mandates.

Even in non-traditional educational settings for students, precautions are being taken against RSV.

Erica Phillips is the executive director for the National Association for Family Child Care, an organization focused on family child care programs that encompass small groups of children in a home-based setting. 

She said family child care educators are taking the same steps traditional schools and day cares take. And despite the anxiety and concern surrounding the circulating viruses, Phillips expressed confidence child care providers are up to the challenge. 

“Family child care educators have become masters of this over the last almost three years after the onset of the COVID-19 pandemic,” she said. 

As lawmakers were being elected and constituents were voting on key ballot measures this month, one Ohio city council passed a measure with the potential to make an enormous financial impact on its community: buying out and relieving the medical debt of its residents.

The Toledo City Council voted 7-5 in early November to use $800,000 of funds from the American Rescue Plan to buy out medical debt for qualifying residents. 

The Board of County Commissioners for Lucas County, for which Toledo is the county seat, also agreed to match this pledge, raising the funds to $1.6 million.

This measure was spearheaded by Toledo City Councilwoman Michele Grim (D), a longtime public health advocate who was recently elected to the Ohio House of Representatives. Around $240 million worth of debt is expected to be erased.

“An estimated 41 percent of Americans have some kind of medical debt and it's the No. 1 reason for bankruptcy,” Grim said. 

“And Toledo has been hard hit by the pandemic. It's also been hard hit by inflation, also rising housing prices and rising rents. Our poverty rate is higher than the national average … and our wages are stagnant.”

Under the measure, Toledo and Lucas County will enter into contract with RIP Medical Debt, a nonprofit founded in 2014 with the aim of buying out and abolishing medical debt. The organization will work with hospitals in the area to buy out patients' debt using the funds put forward by the city and county.

Grim was inspired to pursue the measure after seeing a similar one passed in Cooke County, Illinois, which also partnered with RIP Medical Debt. Toledo's local government will be the second the organization has partnered with.

Since its inception, the organization says it has eliminated more than $7 billion worth of debt for more than 4 million people.

“The reason why we're able to do that is because there is a for-profit debt market that exists that we sort of take advantage of,” Allison Sesso, president and CEO of RIP Medical Debt, said.

Sesso’s organization operates a proprietary method that it refers to as a “debt engine.” It buys out existing debt from participating hospitals for pennies on the dollar and analyzes the debt files to determine who is eligible for debt relief.

Patients are eligible if their income is 400 percent of the national poverty level or if they have medical debt which totals more than 5 percent of their annual income.

According to Sesso, about 80 to 90 percent of the patients the organization sees in the debt files qualify for its debt relief.

Individuals cannot apply to RIP Medical Debt for relief. Eligible patients are unaware that they are being considered and simply receive a letter in the mail informing them that their debt has been bought out and will never be collected.

Among her constituents, Grim said about 41,000 are estimated to be eligible for debt relief.

“Medical debt is a uniquely American problem,” Grim said. “And I really can't think of another better way to use our American Rescue dollars than to aid in the economic recovery of our constituents.”

The Consumer Financial Protection Bureau (CFPB) stated in a report released earlier this year that medical debt is the most common collection type on credit reports. Though this does not necessarily mean that medical debt is the most common in collections, it is disproportionately represented in credit reports when compared to other common forms of debt.

“As of 2021, 58 percent of all third-party debt collection tradelines were for medical debt, making medical debt the most common debt collection tradeline on credit records. The next most common collections tradeline was telecommunications debt, at only 15 percent of tradelines,” the agency said in the report.

According to the CFPB, the amount of U.S. medical debt currently in collections ranges from $81 billion to $140 billion. The exact amount is difficult to ascertain, as not all medical debt collections are made available to consumer reporting companies.

As the agency noted, collection tactics for such debt have long been criticized for being aggressive and convoluted, with some patients facing legal action from hospitals or others being erroneously contacted by collection agencies despite not actually having any outstanding fees.

Since the Toledo City Council voted to pass the measure, both Grim and Sesso say they have been contacted by lawmakers around the country interested in possibly doing the same thing for their own constituents.

Sesso said RIP Medical Debt is actively speaking to a handful of other local governments, though her organization likely won’t move forward with all of them. According to Sesso, partnerships are partly dependent on medical providers actually being interested in having a conversation about buying out patients’ medical debt.

As Grim heads to the Ohio state legislature, she says she would like to introduce a similar measure at the state level, though she acknowledges that what was passed in Toledo is only a small step toward addressing a much larger issue.

“As a local legislator or even as a state legislator, I can't fix our broken health care system. It's a national problem,” Grim said. “This is just the first step. This is something small and simple that we can do to help aid in economic recovery of Toledoans and Lucas County residents. And, you know, Washington, D.C., doesn't have a plan to eliminate medical debt, but Toledo, Ohio, does.”

The White House is resisting calls from pediatric health groups to declare a national emergency due to the early surge in respiratory illness in children. 

As seasonal flu, respiratory syncytial virus (RSV), coronavirus and other respiratory viruses swarm the country, the American Academy of Pediatrics and the Children's Hospital Association argue an emergency declaration, which would grant providers additional funding and more flexibility from regulations, is the best and fastest way to help the overburdened health system.

In a letter sent to President Biden and Health and Human Services Secretary Xavier Becerra last week, the two organizations said the "unprecedented levels" of RSV and rising flu infections warrant a dual declaration of a national emergency along with a public health emergency. 

“We need emergency funding support and flexibilities along the same lines of what was provided to respond to COVID surges,” the organizations wrote.  

But the Department of Health and Human Services (HHS) indicated a national emergency isn't needed at this time. 

"We have offered jurisdictions support confronting the impact of RSV and influenza and stand ready to provide assistance to communities who are in need of help on a case-by-case basis," an HHS spokeswoman said.  

"We encourage people to follow everyday preventive actions, including avoiding close contact with people who are sick, staying home when sick, covering coughs and sneezes, and staying up to date on their flu and COVID-19 vaccines to prevent the spread of infectious diseases. National public health emergencies are determined based on nationwide data, science trends, and the insight of public health experts," she added.

In a call with reporters earlier this month, administration health officials said the federal government is working with state and local partners to ease capacity issues at hospitals as respiratory illnesses surge. 

When the demand on a jurisdiction exceeds its capabilities and available resources, the federal government could step in and help with staffing and supplies, said Dawn O’Connell, the assistant secretary for preparedness and response.

Supplies like ventilators and personal protective equipment are available through the Strategic National Stockpile, O'Connell said, but no state has requested that level of support yet.

The offers of support — and calls for more — come as hospitals are at capacity, beds are scarce and staffing shortages are pushing the workforce to the breaking point. In some cases, even if hospitals have beds available, there aren't enough doctors, nurses or respiratory therapists to staff them.

According to Centers for Disease Control and Prevention data, the hospitalization rate in all kids for the week of Nov. 12 peaked at 17.5 out of every 100,000, a rate that was twice as high as any other season on record.

Capacity constraints at children’s hospitals and pediatric offices are resulting in more children being cared for in community and adult hospitals, which may have limited or no capacity to care for children.  

Amy Knight, president of the Children's Hospital Association, said an emergency declaration makes it easier for hospitals to add pediatric beds in places that aren't typically used for inpatients, like a treatment room or a playroom.

"From a regulatory standpoint, that is not an okay thing. When you have a public health emergency you are allowed to ... make those kinds of decisions," Knight said. "It ultimately creates a lot of avenues for children's hospitals to do the right thing for patients regardless of the typical regulatory bureaucratic constraints."

Oregon last week became the first state to declare an emergency in response to the RSV surge. 

With only two hospitals in the state with a pediatric ICU, Gov. Kate Brown (D) said the order will give hospitals additional flexibility to staff beds for children and allow them to draw on a pool of medical volunteer nurses and doctors and take other steps to provide care to pediatric patients.

The U.S. has been under a public health emergency for COVID-19 since 2020, and it's been renewed every 90 days. Other emergencies in recent years include the opioid epidemic, monkeypox, Zika and the H1N1 swine flu.

Public health experts said the U.S. has been judicious about declaring emergencies outside of specific instances like natural disasters, but the ongoing COVID-19 emergency has brought more attention to the process.

"COVID has led to more awareness of this possibility and potentially more desire to try to use it on the part of advocacy groups and others," said Jen Kates, a vice president at the Kaiser Family Foundation. 

"And I think that speaks to the fact that you know, it's very hard to get attention to public health crises, and resources are limited. The letter from pediatric groups is really a call to alarm that there's a public health emergency that they feel they're facing, and there's just not enough resources," Kates said.

Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, said the waivers and flexibilities that occur during a public health emergency should become the status quo. 

"I think that's the issue. Not so much that they're asking for this, but why do they have to keep asking for this?" Adalja said.

 "This threshold to call an emergency declaration, I think it really speaks to the fact that our health care system, our public health system, isn't able to adequately respond fast enough to an infectious disease emergency on its own."

It was a mixed day for abortion rights advocates. We'll look at the details. Plus: Why the COVID-19 pandemic saw a significant drop-off in worldwide measles vaccinations for children.

Welcome to Overnight Health Care, where we’re following the latest moves on policy and news affecting your health. For The Hill, we’re Nathaniel Weixel and Joseph Choi. Someone forward you this newsletter? 

Programming note: We're taking a break starting tomorrow. Overnight Health will be back in your inboxes on Monday. Happy Thanksgiving!

Georgia's highest court OKs six-week abortion ban

Georgia’s state Supreme Court on Wednesday reinstated the state’s ban on abortions after roughly six weeks of pregnancy. 

The court granted the state’s emergency petition, and pauses a lower court ruling from last week where a judge called the ban “unconstitutional.” 

Reproductive rights groups had argued the state’s abortion ban violates the state’s constitution.  

They won a decision from the Superior Court of Fulton County, where Judge Robert McBurney ruled earlier this month that the ban was invalid. 

According to the ACLU, patients who had scheduled abortion appointments last week are being turned away. 

• Georgia’s Living Infants Fairness and Equality (LIFE) Act, passed in 2019, would ban abortions in the state after a fetal heartbeat is detected, usually around six weeks of pregnancy.  
  
• After the U.S. Supreme Court overturned Roe v. Wade in June, a complex patchwork of state laws emerged with conservative states, particularly in the South and Midwest, moving swiftly to impose new abortion restrictions and even near-total bans.  

Many people do not yet know they are pregnant at six weeks, which is the earliest that fetal cardiac electrical activity can be detected. The electrical activity is not the same as a heartbeat, though the legislation is often called a “heartbeat law.”  

Read more here.

Kansas court allows telemedicine for abortion pills 

A Kansas state court blocked a 2011 law that prohibited doctors from providing medication abortion via telemedicine. 

Shawnee County District Court Judge Teresa Watson granted a temporary injunction barring the enforcement of a state law that requires physicians to administer abortion-inducing drugs while they are in the room with the patient. 

Still, the Kansas Supreme Court may ultimately weigh in before telemedicine abortions are allowed to resume. 

• Since the Supreme Court’s decision overturning Roe v. Wade in June, women have increasingly turned to abortion pills if they need to terminate a pregnancy. It has been found to be extremely safe. 
  
• There are two pills needed for a medication abortion, which is approved by the Food and Drug Administration for the first 10 weeks of pregnancy.  

Mifepristone, a drug that blocks hormones necessary for pregnancy, was approved in 2000. It is then followed by misoprostol. 

The FDA temporarily lifted a requirement that mifepristone be dispensed in-person at a clinic or hospital because of the COVID-19 pandemic, and the Biden administration made the change permanent in December, paving the way for doctors to prescribe the drug digitally and then mail the pills to patients. 

In 2020, medication abortion accounted for 54 percent of all pregnancy terminations in the U.S.  

But 18 states have laws that prohibit the use of telemedicine for medication abortion.

BACTERIAL INFECTIONS LINKED TO 1 IN 8 DEATHS IN 2019

In a study published Monday in The Lancet, a massive group of collaborators report the first global estimates of mortality rates from bacterial pathogens.  

The study found that in 2019, 7.7 million deaths around the world were associated with bacterial infection. That estimate made up 13.6 percent, or about 1 in 8, of all global deaths that year.  

This analysis highlights the importance of understanding how many deaths can be attributed to bacterial infection, and the related issue of antimicrobial resistance, which has been steadily on the rise in recent decades.  

Taking a global view puts into perspective how many more deaths could occur if the antibiotics currently in use become less effective.  

The team used 343 million individual records and pathogen isolates to estimate deaths and type of infection responsible. 

Read more here. 

MENTAL HEALTH PROVIDER SHORTAGES CAN INCREASE YOUTH SUICIDE RATES: STUDY

Increased suicide rates among youths between ages 5 and 19 have coincided with growing shortages of mental health care providers at the county level, according to the results of a new study.  

Findings were published in JAMA Pediatrics and reflect data from 2015 and 2016.  

However, national data show more than 157 million Americans currently live in an area with a shortage of mental health care professionals.  

A total of 5,034 youth died by suicide within the study window, the majority of whom were male and white.  

Before adjusting for confounding factors, researchers found counties with provider shortages had a 41 percent higher youth suicide rate, at 5.09 deaths per 100,000 youths, compared with 3.62 deaths per 100,000 in areas without shortages.

Of the 3,133 counties included in the study, more than two-thirds had shortages of mental health care providers. These counties were more likely to have more uninsured children, lower educational attainment, higher unemployment and poverty, and were more often rural.  

Read more here. 

Missed measles vax put up to 40M children at risk

Worldwide measles vaccinations in children declined significantly during the COVID-19 pandemic, making the disease an “imminent threat” worldwide, according to a joint report released Wednesday from the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC). 

In 2021, a record high of nearly 40 million children missed a measles vaccine dose: nearly 25 million children missed their first dose, an 11 percent increase from 2020. An additional 14.7 million children missed their second dose, the report found, the lowest levels of vaccination since 2008. 

Delays increase the risk of measles outbreaks, and the agencies said now is the time for public health officials to accelerate vaccination efforts and strengthen surveillance. 

• Measles is extremely contagious, but is almost entirely preventable through vaccination. A country needs at least a 95 percent vaccination rate in order to achieve herd immunity and eliminate the virus.  
  
• But the world is well under that, as only 81 percent of children have received their first measles-containing vaccine dose, and only 71 percent of children have received their second vaccine dose. 

“For a disease like measles that’s so highly infectious, that really leaves us with an enormous number of unvaccinated children and just very high levels of risk for outbreaks and for the disease to cross borders. … Measles anywhere is a threat everywhere,” said Cynthia Hatcher, one of the report’s authors who oversees CDC’s African measles elimination work. 

Read more here.

WHAT WE'RE READING

• Trickle of covid relief funds helps fill gaps in rural kids’ mental health services (Kaiser Health News) 
• One-third of U.S. labs have stopped using race-based equations to diagnose kidney disease (Stat) 
• Adderall and amoxicillin shortages raise questions about transparency and accountability in Big Pharma (NBC) 

STATE BY STATE

• A work-from-home culture takes root in California (Sacramento Bee) 
• With term drawing to close, Baker reappointed chief medical examiner, his administration’s highest-paid employee (Boston Globe) 
• Oklahoma State Health Department mum on nonexistence of a Pandemic Center, problems at health lab (KRMG) 

That's it for today, thanks for reading. Check out The Hill's Health Care page for the latest news and coverage. See you next week.

Georgia’s state Supreme Court on Wednesday reinstated the state’s ban on abortions after roughly six weeks of pregnancy after a lower state court had overturned the ban and called it “unconstitutional.” 

The Supreme Court's decision puts the lower court ruling on hold as the state appeals the decision against the law.

Reproductive rights groups had argued the state's abortion ban violates the state’s constitution. They won a decision from the Superior Court of Fulton County, where Superior Court Judge Robert McBurney ruled earlier this month that the ban was invalid.

McBurney cited the fact that the ban was signed into law three years prior to the Supreme Court’s decision to eventually overturn Roe v. Wade, the constitutional right to have an abortion. 

The state’s attorney general office also asked the state’s Supreme Court for an order to put the decision on hold while their appeal of McBurney's was pending.

Georgia’s Living Infants Fairness and Equality (LIFE) Act, passed in 2019, would ban abortions in the state after a fetal heartbeat is detected, usually around six weeks of pregnancy. 

Georgia is one of the few GOP-led states to implement or enact abortion bans and restrictions after Roe was overturned by the nation’s highest court earlier this year.

The Associated Press contributed to this report.