AACN Creates Toolkit to Help Navigate Those Holiday Vaccination Discussions

AACN Creates Toolkit to Help Navigate Those Holiday Vaccination Discussions

The American Association of Critical-Care Nurses (AACN) has created a guide to help those who have been vaccinated to engage in constructive conversations with family members and friends who are hesitant about the vaccine. The toolkit is part of AACN’s Hear Us Out campaign to report nurses’ reality from the front lines of the COVID-19 pandemic and urge those who are unvaccinated to reconsider.

“COVID-19 is still here. The majority of patients with COVID we’re seeing in ICUs haven’t been vaccinated, and their journey often ends with a nurse holding their hand as they die,” said Beth Wathen, AACN president and a clinical practice specialist in Denver. “Nurses need allies to end this pandemic, and productive conversations about the vaccine among family, friends and those who trust each other can open minds.”

The toolkit includes tips to help individuals prepare for potentially challenging conversations and talk with those who hesitate to get vaccinated. It provides resources to continue the conversation, including tip sheets, links to trusted information sources, short videos of nurses sharing profound experiences of taking care of unvaccinated patients with COVID-19 and more to help keep talking with people about the importance of getting vaccinated.

“This toolkit offers straightforward tips to keep sensitive conversations from becoming confrontational,” said Stephanie Burdick, a community health strategist in Salt Lake City. “It fills a critical gap in community health education as the public prepares to celebrate the upcoming holidays with friends and loved ones.”

A recent AACN survey of more than 6,500 acute and critical care nurses found that 76% of respondents say that people who have yet to be vaccinated threaten nurses’ physical and mental well-being. It also found that 92% of nurses surveyed said they believe the pandemic has depleted nurses at their hospitals and, as a result, their careers will be shorter than they intended.

“We know that people in communities with low vaccination rates are at greater risk for becoming seriously ill with COVID-19 and dying from what is now largely a preventable disease,” said Amanda Bettencourt, AACN president-elect and an assistant professor in Philadelphia. “The pandemic has brought the nursing profession into crisis, and the public is a critical part of the solution. The fastest way out of this is by more people getting vaccinated.”

To learn more about how AACN is helping Americans have informed and constructive conversations about the decision to be vaccinated, visit hearusout.com.

Texas Providers See Increased Interest in Birth Control Since Near-Total Abortion Ban

Texas Providers See Increased Interest in Birth Control Since Near-Total Abortion Ban

In September, when Texas’ near-total abortion ban took effect, Planned Parenthood clinics in the Lone Star State started offering every patient who walked in information on Senate Bill 8, as well as emergency contraception, condoms and two pregnancy tests. The plan is to distribute 22,000 “empowerment kits” this year.

“We felt it was very important for patients to have as many tools on hand to help them meet this really onerous law,” said Elizabeth Cardwell, lead clinician at Planned Parenthood of Greater Texas, which has 24 clinics across the northern and central regions of the state and provides care to tens of thousands of people annually.Originally published in Kaiser Health News.

Most of their patients — who tend to be uninsured and have annual household incomes of less than $25,000 — had not known about SB 8 the first several weeks after implementation, said Cardwell. But once they learned about it, patients seemed to rush to get on birth control, she said.

SB 8 allows private citizens, in Texas or elsewhere, to sue anyone who performs an abortion in the state or who “aided or abetted” someone getting an abortion once fetal cardiac activity is detected. This is generally around six weeks, before most people know they’re pregnant. It’s had a chilling effect in Texas, where access to abortion was already limited.

Medical staffs are doubling down on educating patients about birth control. They recognize the strategy isn’t foolproof but are desperate to prevent unintended pregnancies, nearly half of which nationwide end in abortion.

“It’s more important now than it ever has been,” said Cardwell. “I’ve been in abortion care 30-plus years, and my go-to line was ‘You’ve got plenty of time. You don’t have to feel rushed. Talk with your partner. Talk with your family,’” she said. “Now we don’t have that luxury.”

Patients, too, seem to feel a sense of urgency. During September, according to data from Planned Parenthood of Greater Texas, medical staff provided patients with some form of birth control — for example, pill packs, Depo-Provera shots or IUD implant insertions — in more than 3,750 visits, 5% more than in September 2020.

Dr. Jennifer Liedtke, a family physician in West Texas, said she and her nurse practitioners explain SB 8 to every patient who comes to their private practice and saw a 20% increase in requests for long-acting reversible contraceptive methods, known as LARCs, in September.

LARCs, a category that includes intrauterine devices and hormonal implants, have become increasingly appealing because they are 99% effective at preventing pregnancy and last several years. They are also simpler than the pill, which needs to be taken daily, or the vaginal ring, which needs to be changed monthly.

Still, LARCs are not everyone’s preferred method. For example, inserting an IUD can be painful.

A doctor’s office is one of the few opportunities for reliable birth control education. Texas law doesn’t require schools to teach sex education, and if they do, educators must stress abstinence as the preferred birth control method. Some doctors opt to explain abortion access in the state when naming birth control options.

Liedtke is used to having to explain new laws passed by the Texas legislature. “It happens all the time,” she said. But the controversy surrounding SB 8 confuses patients all the more as the law works its way through the court system with differing rulings, one of which briefly blocked the measure. The U.S. Supreme Court heard related arguments Nov. 1.

“People just don’t understand,” said Liedtke. “It was tied up for 48 hours, so they are like, ‘It’s not a law anymore?’ Well, no, technically it is.”

Not all providers are able to talk freely about abortion access. In 2019, the Trump administration barred providers that participate in the federally funded family planning program, Title X, from mentioning abortion care to patients, even if patients themselves raise questions. In early October, the Biden administration reversed that rule. The change will kick in this month. Planned Parenthood can discuss SB 8 in Texas because Texas affiliates do not receive Title X dollars.

Dr. Lindsey Vasquez of Legacy Community Health, the largest federally qualified health center in Texas and a recipient of Title X dollars, said she and other staff members have not discussed abortion or SB 8 because they also must juggle a variety of other priorities. Legacy’s patients are underserved, she said. A majority live at or below the federal poverty level.

Nearly two years into the covid-19 pandemic, “we’re literally maximizing those visits,” Vasquez said. Their jobs go beyond offering reproductive care. “We’re making sure they have food resources, that they have their housing stable,” she said. “We really are trying to make sure that all of their needs are met because we know for these types of populations — patients that we serve — this may be our only moment that we get to meet them.”

Specialized family planning clinics that receive Title X dollars do have proactive conversations about contraceptive methods, according to Every Body Texas, the Title X grantee for the state.

Discussions of long-acting reversible contraception must be handled with sensitivity because these forms of birth control have a questionable history among certain populations, primarily lower-income patients. In the 1990s, lawmakers in several states, including Texas, introduced bills to offer cash assistance recipients financial incentives to get an implant or mandate insertion for people on government benefits, a move seen as reproductive coercion.

“It’s important for a client to get on the contraceptive method of their choice,” said Mimi Garcia, communications director for Every Body Texas. “Some people will just say, ‘Let’s get everyone on IUDs’ or ‘Let’s get everybody on hormonal implants’ because those are the most effective methods. … That’s not something that’s going to work for [every] individual. … Either they don’t agree with it philosophically or they don’t like how it makes their body feel.”

It’s a nuanced subject for providers to broach, so some suggest starting the conversation by asking the patient about their future.

“The best question to ask is ‘When do you want to have another baby?’” said Liedtke. And then if they say, ‘Oh, gosh, I’m not even sure I want to have more kids’ or ‘Five or six years from now,’ then we start talking LARCs. … But if it’s like, ‘Man, I really want to start trying in a year,’ then I don’t talk to them about putting one of those in.”

The Biden administration expected more demand for birth control in Texas, so Health and Human Services Secretary Xavier Becerra announced in mid-September that Every Body Texas would receive additional Title X funding, as would local providers experiencing an influx of clients as a result of SB 8.

But providers said improved access to contraception will not blunt the law’s effects. It will not protect patients who want to get pregnant but ultimately decide on abortion because they receive a diagnosis of a serious complication, their relationship status changes, or they lose financial or social support, said Dr. Elissa Serapio, an OB-GYN in the Rio Grande Valley and a fellow with Physicians for Reproductive Health.

“It’s the very best that we can do,” said Cardwell, of Planned Parenthood of Greater Texas. “There’s no 100% effective method of birth control.”

New Covid Study: Kids, Adults Equally Vulnerable to Infection

New Covid Study: Kids, Adults Equally Vulnerable to Infection

New research addresses the misconception that children are less susceptible to infection with the new coronavirus. According to a recent report in JAMA Pediatrics , children and adults have similar risks of becoming infected with SARS-CoV-2, but a much larger proportion of infected children do not show symptoms of COVID-19. When one household member is infected, there is a 52% chance they will transmit it to at least one other person with whom they live.

The findings are based on the Coronavirus Household Evaluation and Respiratory Testing (C-HEaRT) study led by the Centers for Disease Control and Prevention (CDC) in collaboration with investigators at University of Utah Health, Columbia University, Marshfield Virology Laboratory, and Abt Associates.

“Often, it seemed like children weren’t sick because they didn’t have any symptoms,” says Christina Porucznik, Ph.D., professor of public health at U of U Health, who led investigation of 189 families in Utah. “But some were actually infected, and they could still spread COVID-19.”

Early in the pandemic, reports indicated that children accounted for the minority of COVID-19 cases. However, the observation was not able to distinguish between two scenarios. One was that children were less susceptible to infection. Another was that reported case rates in children were artificially low because they did not show symptoms, and therefore were not tested.

To better understand infection dynamics, the C-HEaRT study followed 310 households with one or more children aged 0 to 17 years in Utah and New York City. More than 1,236 study participants submitted samples for weekly molecular testing (PCR) for SARS-CoV-2 infections and completed weekly questionnaires about symptoms. On average, each person was observed for 17 weeks, and the report included a total of 21,465 person-weeks of surveillance time. The results were from September 2020 through April 2021, before the Delta variant emerged in the U.S.

The study showed that:

  • Children and adults 18 years and older had similar rates of infection.
  • Children in different age groups (birth to 4 years; 5 to 11 years; 12 to 17 years) also had similar rates of infection. Infection rates in each group were between 4.4 to 6.3/1,000 person-weeks.
  • About half of the cases in children were symptomatic, compared with 88% of adult cases.
  • In households with one or more infected individuals, the overall average household infection risk was 52%.
  • The mean household infection risk was 40% in Utah and 80% in New York City.

More research will need to be done to investigate whether differences in housing density, the timing of emergence of the Delta variant, or other factors contributed to differences in household transmission rates in Utah and New York. Additionally, infection rates and household infection risk may be higher in the general population since study participants could be more likely to carry out COVID-19 prevention behaviors.

This study’s results highlight that many infections in children go undetected, underscoring the need for surveillance testing and for children to continue public health safety measures to protect the people around them, Porucznik says. “We know that until kids can be vaccinated, it’s still important for them to wear masks when they’re in groups and to keep them apart,” she says. “And most of all, when they are sick, keep them home.”

So Far, Over 140k Children Have Lost Primary or Secondary Caregivers to Covid-19

So Far, Over 140k Children Have Lost Primary or Secondary Caregivers to Covid-19

One U.S. child loses a parent or caregiver for every four COVID-19 deaths, a new modeling study published today in Pediatrics reveals.  The findings illustrate orphanhood as a hidden and ongoing secondary tragedy caused by the COVID-19 pandemic and emphasizes that identifying and caring for these children throughout their development is a necessary and urgent part of the pandemic response – both for as long as the pandemic continues, as well as in the post-pandemic era.

From April 1, 2020 through June 30, 2021, data suggest that more than 140,000 children under age 18 in the United States lost a parent, custodial grandparent, or grandparent caregiver who provided the child’s home and basic needs, including love, security, and daily care. Overall, the study shows that approximately 1 out of 500 children in the United States has experienced COVID-19-associated orphanhood or death of a grandparent caregiver. There were racial, ethnic, and geographic disparities in COVID-19-associated death of caregivers: children of racial and ethnic minorities accounted for 65% of those who lost a primary caregiver due to the pandemic.

Children’s lives are permanently changed by the loss of a mother, father, or grandparent who provided their homes, basic needs, and care. Loss of a parent is among the adverse childhood experiences (ACEs) linked to mental health problems; shorter schooling; lower self-esteem; sexual risk behaviors; and increased risk of substance abuse, suicide, violence, sexual abuse, and exploitation.

“Children facing orphanhood as a result of COVID is a hidden, global pandemic that has sadly not spared the United States,” said Susan Hillis, CDC researcher and lead author of the study. “All of us – especially our children – will feel the serious immediate and long-term impact of this problem for generations to come. Addressing the loss that these children have experienced – and continue to experience – must be one of our top priorities, and it must be woven into all aspects of our emergency response, both now and in the post-pandemic future.”

The study was a collaboration between the Centers for Disease Control and Prevention (CDC), Imperial College London, Harvard University, Oxford University, and the University of Cape Town, South Africa. Published in the Oct. 7 issue of the journal Pediatrics, it was jointly led by CDC’s COVID Response and Imperial College London, and partly funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), as well as Imperial College London.

“The magnitude of young people affected is a sobering reminder of the devastating impact of the past 18 months,” said Dr Alexandra Blenkinsop, co-lead researcher, Imperial College London. “These findings really highlight those children who have been left most vulnerable by the pandemic, and where additional resources should be directed.”

The analysis used mortality, fertility, and census data to estimate COVID-19-associated orphanhood (death of one or both parents) and deaths of custodial and co-residing grandparents between April 1, 2020, and June 30, 2021, for the U.S. broadly, and for every state. “COVID-19-associated deaths” refers to the combination of deaths caused directly by COVID-19 and those caused indirectly by associated causes, such as lockdowns, restrictions on gatherings and movement, decreased access or quality of health care and of treatment for chronic diseases. The data were also separated and analyzed by race and ethnicity, including White, Black, Asian, and American Indian/Alaska Native populations, and Hispanic and non-Hispanic populations.

The study authors estimate that 120,630 children in the U.S. lost a primary caregiver, (a parent or grandparent responsible for providing housing, basic needs and care) due to COVID-19-associated death.  In addition, 22,007 children experienced the death of a secondary caregiver (grandparents providing housing but not most basic needs). Overall, 142,637 children are estimated to have experienced the death of at least one parent, or a custodial or other co-residing grandparent caregiver.

“The death of a parental figure is an enormous loss that can reshape a child’s life. We must work to ensure that all children have access to evidence-based prevention interventions that can help them navigate this trauma, to support their future mental health and wellbeing,” said NIDA Director Nora D. Volkow, MD. “At the same time, we must address the many underlying inequities and health disparities that put people of color at greater risk of getting COVID-19 and dying from COVID-19, which puts children of color at a greater risk of losing a parent or caregiver and related adverse effects on their development.”

Racial and ethnic disparities in COVID-related caregiver loss

There were significant racial and ethnic disparities in caregiver deaths due to COVID-19. White people represent 61% of the total U.S. population and people of racial and ethnic minorities represent 39%  of the total population. Yet, study results indicate that non-Hispanic White children account for 35% of those who lost a primary caregiver (51,381 children), while children of racial and ethnic minorities account for 65% of those who lost a primary caregiver (91,256 children).

When looking at both primary and secondary caregivers, the study found that findings varied greatly by race/ethnicity: 1 of every 168 American Indian/Alaska Native children, 1 of every 310 Black children, 1 of every 412 Hispanic children, 1 of every 612 Asian children, and 1 of every 753 White children experienced orphanhood or death of caregivers. Compared to white children, American Indian/Alaska Native children were 4.5 times more likely to lose a parent or grandparent caregiver, Black children were 2.4 times more likely, and Hispanic children were nearly 2 times (1.8) more likely.

Overall, the states with large populations – California, Texas, and New York – had the highest number of children facing COVID-19 associated death of primary caregivers. However, when analyzed by geography and race/ethnicity, the authors were able to map how these deaths and disparities varied at the state level.

In southern states along the U.S.-Mexico border, including New Mexico, Texas, and California , between 49% and 67% of children who lost a primary caregiver were of Hispanic ethnicity. In the southeast, across Alabama, Louisiana, and Mississippi, between 45% to 57% of children who lost a primary caregiver were Black. And American Indian/Alaska Native children who lost a primary caregiver were more frequently represented in South Dakota (55%), New Mexico (39%), Montana (38%), Oklahoma (23%), and Arizona (18%).

The current study follows closely in line with a similar study published in The Lancet in July 2021, which found more than 1.5 million children around the world lost a primary or secondary caregiver during the first 14 months of the COVID-19 pandemic.  In both the global and US studies, researchers used the UNICEF definition of orphanhood, as including the death of one or both parents6. The definition includes children losing one parent, because they have increased risks of mental health problems, abuse, unstable housing, and household poverty. For children raised by single parents, the COVID-19-associated death of that parent may represent loss of the person primarily responsible for providing love, security, and daily care.

“We often think of the impact of COVID-19 in terms of the number of lives claimed by the disease, but as this study shows, it is critical to also address the broader impact – both in terms of those who have died, and those who have been left behind,” said study co-author Charles A. Nelson III, PhD. who studies the effects of adversity on brain and behavioral development at Boston Children’s Hospital. “We must ensure children who have lost a parent or caregiver have access to the support services they need, and that this additional impact of the COVID-19 pandemic is comprehensively addressed in both our rapid response and our overall public health response.”

There are evidence-based responses that can improve outcomes for children who experience the COVID-associated death of their caregivers:

  • Maintaining children in their families is a priority. This means families bereaved by the pandemic must be supported, and those needing kinship or foster care must rapidly receive services.
  • Child resilience can be bolstered via programs and policies that promote stable, nurturing relationships and address childhood adversity. Key strategies include:
    • Strengthening economic supports to families.
    • Quality childcare and educational support.
    • Evidence-based programs to improve parenting skills and family relationships.
  • All strategies must be age specific for children and must be sensitive to racial disparities and structural inequalities. They must reach the children who need them most.

In the closing words of the paper, “Effective action to reduce health disparities and protect children from direct and secondary harms from COVID-19 is a public health and moral imperative.”

U.S. Department of Health and Human Services(link is external)

CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

CDC Studies Show More COVID-19 Cases in Areas Without School Masking Policies

CDC Studies Show More COVID-19 Cases in Areas Without School Masking Policies

Today, CDC released three studies in the Morbidity and Mortality Weekly Report (MMWR) that highlight the importance of using layered prevention strategies including universal masking to stop the spread and minimize disruptions to school operations for safe in-person education. These studies found that school districts without a universal masking policy in place were more likely to have COVID-19 outbreaks. Nationwide, counties without masking requirements saw the number of pediatric COVID-19 cases increase nearly twice as quickly during this same period.

One report from Arizona revealed that schools in two of the state’s most populous counties were 3.5 times more likely to have COVID-19 outbreaks if they did not have a mask requirement at the start of school compared with schools that required universal masking on day one. Universal masking is an important component in the recommended layered prevention strategy for schools, and this study continues to demonstrate that facemasks when used as part of the larger strategy can reduce spread of COVID-19 and prevent outbreaks in schools.

Another report found that during the two weeks following the start of school, the average change in pediatric COVID-19 case rates was lower among counties with school mask requirements (16.32 per 100,000/day) compared with counties without school mask requirements (34.85 cases per 100,000/day). This highlights the impact that universal masking policies can have on the communities that surround these school districts, as the impact of the policies can reduce the burden on the health care systems that support these school districts.

A third report studied COVID-19-related school closures and found that despite an estimated 1,801 school closures so far this school year, 96% of public schools have been able to remain open for full in-person learning. The continued focus on providing students with a safe environment for in-person learning is one of the main priorities for CDC’s guidance, and can be best achieved by following a layered prevention strategy.

These studies continue to demonstrate the importance and effectiveness of CDC’s Guidance for COVID-19 Prevention in K-12 Schools to help districts ensure safer in-person learning and stop the spread of COVID-19. Promoting vaccination of eligible persons, mask wearing, and screening testing are all proven methods to continue to work towards the end of the COVID-19 pandemic.

Wayne State Study: SARS-CoV-2 Increases Risk of Preeclampsia

Wayne State Study: SARS-CoV-2 Increases Risk of Preeclampsia

A newly published study found that women who contract COVID-19 during pregnancy are at significantly higher risk of developing pre-eclampsia, the leading cause of maternal and infant death worldwide.

In “SARS-COV-2 infection during pregnancy and risk of preeclampsia: a systematic review and meta-analysis” published in the American Journal of Obstetrics and Gynecology, researchers said their systematic review shows that women with SARS-CoV-2 infection during pregnancy had 62% higher odds of developing preeclampsia than those without the infection during pregnancy.

“This association was remarkably consistent across all predefined subgroups. Moreover, SARS-CoV-2 infection during pregnancy was associated with a significant increase in the odds of preeclampsia with severe features, eclampsia and HELLP syndrome,” said Roberto Romero, M.D., DMedSci, chief of the Perinatology Research Branch and professor of Molecular Obstetrics and Genetics at the Wayne State University School of Medicine.

Dr. Romero and Agustin Conde-Agudelo, M.D., M.P.H., Ph.D., adjunct professor of Obstetrics and Gynecology, published their findings after reviewing 28 previous studies that included 790,954 pregnant women, including 15,524 diagnosed with COVID-19 infection.

“Both asymptomatic and symptomatic infection significantly increased the risk of preeclampsia,” Dr. Romero said. “Nevertheless, the odds of developing preeclampsia were higher among patients with symptomatic illness than among those with asymptomatic illness.”

Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy. Preeclampsia warning signs, in addition to elevated blood pressure, can include headaches, swelling in the face and hands, blurred vision, chest pain and shortness of breath. While the condition can manifest within a few hours, some women report few or no symptoms.

The condition is responsible for 76,000 maternal deaths and more than 500,000 infant deaths every year, according to estimates from the Preeclampsia Foundation. It can affect the liver, kidney and brain. Some mothers develop seizures (eclampsia) and suffer intracranial hemorrhage, the main cause of death in those who develop the disorder. Some women develop blindness. The babies of preeclamptic mothers are affected by the condition and may develop intrauterine growth restriction or die in utero.

The earlier the disease starts in pregnancy, the worse the outcome can be for the baby and mother. Women with preeclampsia often do not feel the effects until the condition is severe and becomes life-threatening. Effects on the mother include cardiac problems, possible brain hemorrhage, acute renal failure, blood clotting problems and possible blindness. If left undetected, the condition can progress to eclampsia and the mother may begin convulsing. For the fetus, preeclampsia has been connected to a reduction in placental blood flow, resulting in physical and mental disability, the slowing of fetal development, and in severe cases, infants may be stillborn.

HELLP syndrome is a form of severe preeclampsia that includes hemolysis (the rupturing of red blood cells), elevated liver enzymes and a low platelet count.

While further research is needed to determine the physical mechanisms between COVID-19 infection and preeclampsia, the authors said health care professionals should be aware of the association and closely monitor pregnant women who are infected for early detection of preeclampsia.