Dr. Peter Hotez: Anti-science rhetoric is threatening lives worldwide (azcentral.com)
EPA announces $30M grant for PFAS treatment in Tucson (azcentral.com)
US Surgeon General Vivek Murthy talks mental health with ASU students (azcentral.com)
Arizona mobile health teams bring medication, services to patients (azcentral.com)
Guest Blog via AzPHA Member Allan Williams, MPH, PhD
CDC data as of 11/09/23 indicated that nearly 1.2 million COVID deaths (underlying or contributing cause) have occurred in the U.S since the start of the pandemic. In Arizona, 33,788 COVID deaths have occurred according to the COVID dashboard at ADHS as of 10/04/23.
Many COVID deaths could have been prevented had more individuals and public officials followed recommended public health prevention guidelines or had officials not been prevented by legislators from implementing preventative measures or even providing accurate information on vaccines, treatments, and other measures.
As previously noted in the 08/27/23 AZPHA Policy Update, COVID deaths do not reflect the full impact of the pandemic on mortality.
Many other causes of death have also been elevated during the pandemic due in part to delayed or denied access to healthcare, unemployment, and many other factors.
For example, a comparison of just the 15 leading causes of death during 2018-2019 to those causes during 2020-2021 showed significantly increased rates of death for nine of the 15 causes in the U.S .and 8 of the 15 causes in Arizona, including heart disease, accidents, strokes, diabetes, liver disease, hypertension, Parkinson’s disease, and homicides. Other causes such as firearm deaths and opioid overdose deaths also increased.
As has been widely reported, the increased pandemic-related deaths have had a dramatic effect on life expectancy (which assumes current mortality rates were to continue though life). In 2020, life expectancy at birth declined by 1.8 years in the US and by 2.5 years in Arizona compared to 2019. In 2021, life expectancy declined by 2.4 years in the US and 2.8 years in Arizona compared to 2019.
The CDC has tracked overall excess deaths (Table 1) for the U.S. and for each state by week, month, and year. For each time period (week, month, or year) the observed deaths from all causes are compared to the estimated expected number of total deaths had the pandemic not occurred.
Those estimates are based on weekly death data during 2017-2019. It’s important to note that estimates of expected deaths (and the percent excess) are much more accurate for time periods closer to the 2017-2019 comparison period. Thus, the estimated excess would be most accurate for 2020 and least accurate for 2022.
In previous Policy Updates we compared the percent of excess deaths among the states for specific pandemic years. In 2020, the 29% excess of total deaths in Arizona was the highest among the states. In 2021, Arizona tied with Alaska with a 38% excess based on still provisional data.
Final 2021 data, however, indicated that Alaska had a 39% excess, barely exceeding Arizona’s 38% excess. In 2022, provisional data indicate Alaska again narrowly exceeded Arizona with a 27% excess vs a 25% excess for Arizona.
For an overall perspective, CDC data was used to aggregate total observed deaths and expected deaths during 2020-2022 to calculate the overall percent of excess deaths for each state.
As shown in the map above, Arizona led all states with an overall 31% excess deaths in 2020-22. Alaska and New Mexico followed with 27%. Vermont, Hawaii, and Massachusetts had the smallest excesses at 10%.
Based on the CDC estimates of excess deaths, Arizona experienced an excess of 55,000 deaths (including COVID) during 2020-2022.
However, using a slightly different approach for estimating the “expected” number of deaths based on extrapolation of the linear increase in total deaths during 2015-2019 (R² = 0.975, p = 0.002) and on slightly newer provisional data for 2022 yields a higher number of expected deaths and therefore a lower number of excess deaths, approximately 41,000. Wherever the true value lies, both estimates represent a tragic and largely avoidable mortality toll among Arizona residents.
The portion of the excess due to COVID varied widely by state, ranging from 45% to 100+%. For Arizona, COVID represented 53% of excess deaths, while for the U.S. COVID accounted for 68% of the excess.
CDC found 10 strategies by scanning scientific literature to examine interventions that have been successfully implemented in at least one jurisdiction and have proven effective at reducing overdose deaths as well as the risk factors that contribute to overdose.6 These strategies include the following:
Our 2024 AZPHA Conference will be focusing on public health responses to the continuing opioid epidemic with a focus on how to effectively use resources from the various opioid settlements to fund evidence-based interventions like those found by CDC above.
CDC found 10 strategies by scanning scientific literature to examine interventions that have been successfully implemented in at least one jurisdiction and have proven effective at reducing overdose deaths as well as the risk factors that contribute to overdose.6 These strategies include the following:
Our 2024 AZPHA Conference will be focusing on public health responses to the continuing opioid epidemic with a focus on how to effectively use resources from the various opioid settlements to fund evidence-based interventions like those found by CDC above.
CMS granted the temporary extension of the State’s existing COVID-19 Appendix K authority to allow the State and CMS to continue negotiations over the demonstration amendment application submitted on September 27, 2023 that proposes to allow AHCCCS to continue the program permanently. The COVID-19 Appendix K authority will now expire March 29, 2024 or once the proposal is approved, whichever may come first.
The letter from CMS, and more information and documents, are posted on the Parents as Paid Caregivers web page.
Centers for Medicare & Medicaid Services (CMS) will begin displaying the ‘Birthing-Friendly’ designation icon on CMS’s Care Compare online tool.
CMS created the new designation to find hospitals and health systems that take part in a statewide or national perinatal quality improvement collaborative program and that implement evidence-based care to improve maternal health. The public can use the Care Compare tool — along with a complementary interactive map to find a hospital or health system with the ‘Birthing-Friendly’ designation in their area.
HHS Proposes Minimum Staffing Standards to Enhance Safety and Quality in Nursing Homes
Last week CMS issued a proposed rule that seeks to set up comprehensive staffing requirements for nursing homes including national minimum nurse staffing standards.
Under CMS’s proposal, nursing homes taking part in Medicare and Medicaid would have to meet specific nurse staffing levels that promote safe, high-quality care for residents.
CMS also proposes to require states to collect and report on compensation for workers as a percentage of Medicaid payments for those working in nursing homes and intermediate care facilities
CMS estimates approximately three quarters (75%) of nursing homes would have to strengthen staffing in their facilities.
Federal Register :: Federal Register Documents Currently on Public Inspection
Wednesday, November 15 | 4:00pm – 5:00pm MST
Translational research is critical to ensuring that our work actually improves public health. But this type of work often requires skillsets in more than one field, work that does not fit neatly into a traditional job category, and relationships.
Moreover, laws and employer policies limit permissible political activities, government systems are confusing, and the adversarial nature of politics is downright intimidating.
During this free webinar presenters will highlight the skills, activities, and methods necessary to transform evidence or abstract ideas into sound policies.
Learning Objectives:
Special Olympics Arizona is looking for a full-time Research Coordinator to coordinate the first phase of a longitudinal evaluation that examines the impact of Special Olympics participation on physical, mental, and socio-emotional health.
Over the last several years, Special Olympics has expanded their mission to include a host of programming that includes mental and social-emotional health. The funding for the position is secure. Learn much more about the position and how to apply: Longituidnal Evaluation Research Coordinator
States (including Arizona) have vaccination requirements for school attendance. States report data to CDC on the number of children in kindergarten who are exempt from their state’s vaccine requirements. That data provides the best proxy we have for actual childhood immunization rates. CDC just released their latest analysis on national immunization rates (as measured by exemptions) this week… and it’s not a pretty picture for Arizona. Nationally, 2-dose MMR coverage was 93.1% while it is only 89.9% in Arizona. In fact, Arizona has among the lowest childhood vaccination rates in the U.S.
There are many reasons why vaccination rates can be poor. Part of it can be attributed to parental vaccine hesitancy and even politics (these days). Some are related to policy decisions. For example, states that only allow medical exemptions to school attendance requirements (no ‘personal exemptions’) have higher vaccination rates than those that allow for personal exemptions (like Arizona).
But much of it can be attributed to how easy or difficult it is for parents to vaccinate their kids. The more difficult/inconvenient it is to get your child vaccinated the more likely it is that they’ll remain unvaccinated.
Sadly. it’s has been getting harder and harder for parents to get their kids vaccinated in Arizona because so many doctor’s offices dropped out of the Vaccines for Children program.
The Vaccines for Children Program exists to make it convenient for families to get their kids vaccinated and to make sure kids whose parents don’t have health insurance can still get their kids vaccinated. Funding for VFC comes via the CDC, who buys vaccines at a discount and distributes them to states. States distribute them to physicians’ offices & clinics that take part in the VFC program. ADHS manages the VFC program in our state.
So how good of a job has Arizona been doing implementing the VFC program? Not very good. Arizona lost 50% of its VFC providers during the Ducey administration – going from 1,200 to 600… reducing access to vaccine and lowering childhood vaccination rates.
Arizona now only has 6 VFC providers per 10,000 Medicaid eligible kids, while the national average is 24 providers per 10,000 Medicaid kids… meaning Arizona only has 25% of the number of VFC providers per Medicaid enrolled kid compared with the national average.
Providers who left VFC over the last few years say they quit because of the administrative hassles imposed on them by the state over the last 8 years (ADHS not AHCCCS). At the top of the list of grievances is ADHS’ punitive practice of financially punishing providers who have vaccine wastage rates over 5% making participation financially difficult (see this letter to AZAAP members regarding ADHS’ policy).
While it’ll be very difficult to bring back providers who’ve left the VFC program, there are immediate interventions that ADHS should take to stop the exodus more providers from the VFC program like immediately suspending vaccine restitution penalties for wastage rates over 5% pending the development of a new ADHS Restitution Policy and making sure remaining VFC providers know about the suspension of their punitive restitution penalties.
There will be many other recommendations coming out shortly in a report from the Arizona Partnership for Immunizations, but immediately suspending ADHS’ punishments is needed right now to stop even more providers from fleeing the coop.
