9.58am EDT09:58

Uncertainty for US schools amid Delta variant threat

It is the first day of school in some parts of the country today, and there is uncertainty about what the school year will actually look like with the patchwork of Covid-19 rules and the spread of the delta variant.

Last week, a report by the Centers for Disease Control and Prevention (CDC) found that an unvaccinated teacher in a California elementary school infected half her students and 26 people in total in May. The teacher did not wear a mask as she read to students, even though the school required face coverings indoors and they were one of only two staff members at the school who were unvaccinated.

More than 180,000 Covid-19 cases were reported in children from 12 August to 19 August and represented about 22.4% of the weekly reported cases, according to the American Academy of Pediatrics (AAP).

As of 25 August, 11.7m children under age 18 had received the first dose of the vaccine.

There are also tensions around how rules to prevent the spread of Covid-19 will be enforced and the response from parents. When school started two weeks ago in northern California’s Amador county, a parent attacked a principal over a mask dispute.

We will have updates on that and other US news today in the blog.

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Nine members of one family were killed in a US drone strike targeting a vehicle in a residential neighborhood of Kabul, according to a relative of those killed.

Those killed included six children, the youngest being a 2-year-old girl, the brother of one of the dead told a local journalist working with CNN.  

He said the people killed were his brother Zamaray (40 years old), Naseer (30), Zameer (20), Faisal (10), Farzad (9), Armin (4), Benyamin (3), Ayat (2) and Sumaya (2). 

The brother cried as he told the journalist that they were “an ordinary family.”

“We are not ISIS or Daesh and this was a family home — where my brothers lived with their families,” he said.

CNN obtained images of the aftermath of the strike. A US official confirmed the location in Kabul’s Khaje Bughra neighborhood. US Central Command said earlier they were assessing the possibilities of civilian casualties. 

A man named Ahad, who said he was a neighbor of the family, told CNN: “All the neighbors tried to help and brought water to put out the fire and I saw that there were 5 or 6 people dead. The father of the family and another young boy and there were two children. They were dead. They were in pieces. There were [also] two wounded.”  

Ahad told CNN he had witnessed the airstrike at around 5 pm local time as he walked towards his home. He said he heard the noise of the rocket and a loud bang, and ducked for cover, before trying to help rescue his neighbors. Ahad told CNN that two other people were wounded in the attack.

The US military said in their statement that there were “Significant secondary explosions from the vehicle indicated the presence of a substantial amount of explosive material,” the spokesperson said. 

A local journalist who visited the scene soon after the airstrike told CNN that “whatever material was in the car, I don’t know. The car was in a very bad state, just a skeleton of the car was left.”  

The journalist — who is not being named for security reasons — was told by family members of the deceased that there were two cars parked at the home: One was a Corona and the other was a Camry.

The journalist said he’d been told that one of the cars contained one of the fathers and his three children getting ready to go to a family event.  

 

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A US Marine from Nebraska was among the service members killed in the bombing in Kabul, Afghanistan, Thursday. 

Cpl. Daegan Page was 23 years old, his family said in a statement provided to CNN. 

“Daegan will always be remembered for his tough outer shell and giant heart,” the family statement said. “Our hearts are broken, but we are thankful for the friends and family who are surrounding us during this time.” They said he planned to possibly become a lineman once his Marine enlistment was finished. 

Page was raised partly in Iowa and near Omaha, Nebraska, and served at Camp Pendleton in California.  

“He loved hunting and spending time outdoors with his dad, as well as being out on the water,” said the family. “He was also an animal lover with a soft spot in his heart for dogs.” 

The statement said that Page joined the US Marine Corps after graduating from Millard South High School. He was a longtime Boy Scout and “enjoyed playing hockey for Omaha Westside in the Omaha Hockey Club and was a diehard Chicago Blackhawks fan.” 

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Everyone is to blame for the catastrophe in Afghanistan, except the people who started it. Yes, Joe Biden screwed up by rushing out so chaotically. Yes, Boris Johnson and Dominic Raab failed to make adequate and timely provisions for the evacuation of vulnerable people. But there is a frantic determination in the media to ensure that none of the blame is attached to those who began this open-ended war without realistic aims or an exit plan, then waged it with little concern for the lives and rights of the Afghan people: the then US president, George W Bush, the British prime minister Tony Blair and their entourages.

Indeed, Blair’s self-exoneration and transfer of blame to Biden last weekend was front-page news, while those who opposed his disastrous war 20 years ago remain cancelled across most of the media. Why? Because to acknowledge the mistakes of the men who prosecuted this war would be to expose the media’s role in facilitating it.

Any fair reckoning of what went wrong in Afghanistan, Iraq and the other nations swept up in the “war on terror” should include the disastrous performance of the media. Cheerleading for the war in Afghanistan was almost universal, and dissent was treated as intolerable. After the Northern Alliance stormed into Kabul, torturing and castrating its prisoners, raping women and children, the Telegraph urged us to “just rejoice, rejoice”, while the Sun ran a two-page editorial entitled “Shame of the traitors: wrong, wrong, wrong … the fools who said Allies faced disaster”. In the Guardian, Christopher Hitchens, a convert to US hegemony and war, marked the solemnity of the occasion with the words: “Well, ha ha ha, and yah, boo. It was … obvious that defeat was impossible. The Taliban will soon be history.”

The few journalists and public figures who dissented were added to the Telegraph’s daily list of “Osama bin Laden’s useful idiots”, accused of being “anti-American” and “pro-terrorism”, mocked, vilified and de-platformed almost everywhere. In the Independent, David Aaronovitch claimed that if you opposed the ongoing war, you were “indulging yourself in a cosmic whinge”.

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Biden has decided, in consultation with his national security team, to stick with the August 31 deadline for withdrawing troops from Afghanistan, according to a senior administration official.

Biden made the decision mindful of the security risks in remaining the country longer, the official said, and he has asked for contingency plans in case he determines at a later date the US needs to remain in the country for longer. …

Biden’s aides expected him to discuss the airlift, and potentially explain his decision to leave at the end of the month, on a morning video conference with the heads of the world’s leading democracies.

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Photo from providence.org

Press release from Providence St. Joseph Health:

Four Providence hospitals in Northern California (formerly Providence St. Joseph Health) were recognized by US News & World Report as High Performing for their performance in treating a variety of commonly occurring conditions and medical procedures.

 

“At Providence, we are committed to providing the highest quality of care to our patients,” said Roberta Luskin-Hawk, M.D, Chief Executive for Providence in Humboldt County. “Our caregivers in Humboldt are pleased to be recognized once again for their unwavering commitment to providing personalized, compassionate care and the best outcomes for our patients.”

U.S. News generates these hospital rankings by evaluating data on nearly 5,000 hospitals with the goal of helping patients decide where to receive care. The publication focuses on a variety of specialties, procedures, and conditions and only a small minority of hospitals achieved the “high performing” distinction in these areas.

Providence St. Joseph Hospital in Eureka and Providence Redwood Memorial Hospital in Fortuna were recognized as “high-performing” for the following procedures and/or conditions treated:

Providence St. Joseph Hospital 

• Colon cancer surgery
• Heart failure
• Heart attack
• Kidney failure
• Chronic Obstructive Pulmonary Disease (COPD)
• Pneumonia

Providence Redwood Memorial Hospital

Other Providence hospitals recognized by US News & World Report in Northern California were Providence Queen of the Valley Medical Center (Napa County) and Providence Santa Rosa Memorial Hospital (Sonoma County).

Click here learn more about the US News & World Report 2020-2021 “Best Hospital” rankings.

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The State Department on Wednesday sent a notice to the thousands of locally employed staff at the Kabul embassy telling them that they can come to the airport for evacuation flights, according to the message reviewed by CNN.

Some of the Afghans who made it into the airport were bloody and mentally distraught, having lost most of their belongings along the way, according to multiple sources familiar with the matter.

But some decided they didn’t even want to pursue the perilous journey even though they desperately want to get out of the country, multiple sources told CNN. Others who did take the dangerous risk had to turn back after facing an untenable situation.

“I decided I would rather the Taliban shoot me in the head to being stuck in that situation,” said one Afghan who worked at the embassy for years in describing his journey to CNN. 

He went to the airport with his family, including small children, at 4 a.m. local time only to get caught in a horde of thousands of people on the outskirts of the airport which left him fearing for his life. He watched as his 2-year-old son grew dehydrated and men tried to inappropriately touch his wife. The gates remained closed for too long. 

“We had to go home,” the Afghan said, describing people with guns and knives in the mass of people. “I will not go back. The Americans left me in a very bad situation. They know it. They put our family’s lives in risk.”

The US military is in communication with the local Taliban commander on the ground in Kabul, and they are discussing “making sure that those at-risk Afghans, Special Immigrant Visa applicants and additional Afghan citizens that we want to move through are able to move through,” Pentagon press secretary John Kirby said Thursday during an on-camera briefing.

Kirby noted the reports of some hostile Taliban actions towards Afghans on the way to the airport, but by and large US officials are saying that the Taliban are largely keeping their commitment to ensure safe passage and pointing to the evidence: the Afghans and Americans who have been able to get to the airport. 

President Biden said yesterday that the US is looking at evacuating between 50,000 and 65,000 Afghans in total, a figure that includes the Afghan visa and refugee applicants plus their families.

Biden did not commit to keeping the US troop presence at the Kabul airport until that number of Afghans are evacuated but he did say that the US troop presence would stay in place until all Americans who want to get out of the country are out.

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Last year, Becker’s spoke to the top 10 hospitals named to U.S. News and World Report’s 2020-21 Best Hospitals Honor Roll to look at what they are doing to address health disparities. A year later, Becker’s checked in with those systems to look at how their health equity initiatives have evolved, what has been the most successful and if there are any results to report from those initiatives.

Mayo Clinic

In 2020, Rochester, Minn.-based Mayo Clinic announced an investment of $100 million over 10 years to combat health disparities.

This was a “big, bold move” for health system leaders, who have spent time over the last year identifying strategic priorities related to the investment, said John Knudsen, MD, medical director for Mayo Clinic’s Office of Health Equity and Inclusion.

Dr. Knudsen said Mayo has specifically considered how it will allocate this money across the organization from a multisite perspective, as well as how it will distribute the funds within research and education.

One part of the investment is developing an advanced diversity, equity and inclusion platform to identify and track progress in addressing disparities. It is intended to use both qualitative and quantitative metrics.

“This was one thing we thought was important, sort of a high-level dashboard, analytic platform to look at all aspects [of diversity, equity and inclusion],” said Dr. Knudsen. “And, obviously, it’s not just something that’s a single page. It’s intended to say, ‘What are we doing with workforce? What about research?’ All of these things would have a place or a home in this platform.”

Through pilot projects, he said Mayo has also identified and is now targeting health disparities in diabetes between white and Black patient populations and between the non-Hispanic or Latino and the Hispanic or Latino patient populations. Additionally, it is targeting similar health disparities in colon cancer screenings.

“A whole series of tactics will be deployed in the coming month to dig down and understand not only what’s causing the disparities but what we can do to address them. We’re looking at success as eliminating those,” Dr. Knudsen said.

Mayo is not only focusing on patients, but also the workforce. For instance, part of the $100 million investment to combat health disparities has gone toward a pilot education and training program using virtual reality technology. Dr. Knudsen said the idea behind the program is to enhance the nursing team’s empathic understanding of people’s lived experiences and to create more realistic role-playing to better navigate difficult interactions with patients, patients’ families or co-workers.

He said Mayo also used a technology platform last year to collect stories from employees who experienced or witnessed racism, bias or discrimination at work. Now, human resources and leadership are using the stories to inform policy and other workplace initiatives.

In August, Mayo launched the second phase of that platform allowing for sharing and learning for experiences of allyship among employees.

“There’s a real yearning and interest in our workforce to do what they can to address some of these issues we know some of our workers are experiencing and facing,” explained Dr. Knudsen. “So allyship has become something a lot of people have been looking for opportunities to get behind. This has been another way to get the workforce behind some of these efforts to not only recruit and retain a more diverse workforce but also to improve the work environment.”

With research and community engagement, he said Mayo has worked hard to build strong relationships with community partners to get information out there from trusted sources but also create bidirectional communication frameworks, so the organization hears from communities about issues they’re facing or information they’re missing.

“In an organization with so many competing priorities and many activities going on, we’re always looking at what’s being supported by top leaders. That $100 million was an important message to all of us that this is something Mayo Clinic really cares about. It has reawakened and really activated a lot of people in the organization to begin to think of ways of how they or their practice or their domain could advance some of these goals around equity, inclusion and diversity,” Dr. Knudsen said.

Massachusetts General Hospital

In November, Boston-based Mass General Brigham launched United Against Racism to address structural racism.

The comprehensive, systemwide plan “invests in leadership teams and leverages a multimillion-dollar commitment with goals, timelines, accountability and metrics of success,” said Joseph Betancourt, MD, senior vice president of equity and community health at Massachusetts General Hospital, part of Mass General Brigham.

“The plan focuses on diversity of leadership and governance, training, and creating an anti-racist culture; equity in patient care via data collection, performance measurement, digital access, clinical interventions and the removal of race from clinical guidelines; and a broad new strategy on community health focused on addressing the social determinants of health, the deployment of community health workers, a mobile health initiative, advocacy and anchor investments,” he said.

Massachusetts General Hospital has also launched its Structural Equity 10-Point Plan to support, complement and build on United Against Racism at the hospital. 

Dr. Betancourt said the initiatives involve all four pillars of the hospital’s mission — care, training, research and community health, and will significantly affect the organization’s people, culture and care. 

“While we are early in our implementation, we are making steady progress and are already seeing gains and achievements, with many more expected in the short and long-term,” he said.

UCSF Health 

At San Francisco-based UCSF Health, the health system has expanded its work on health equity since 2020, said Joshua Adler, MD, executive vice president and chief clinical officer. It deployed a comprehensive system for collecting race, ethnicity, sexual orientation and gender identity data from its patients. This has allowed the system to identify and address disparities in a number of important measures of health and health outcomes. 

Over the past year, UCSF focused on hypertension control, in which its Black patients were not achieving the same level of blood pressure control as its patients overall. The health system engaged with its patients to determine who best to help them to achieve control, including directed outreach to patients to provide visits (video or in person) to evaluate blood pressure control; use of medications; any challenges they faced, provision of home blood pressure measuring devices; input from pharmacists on medication choices, side effects and mitigation efforts; and a focus on non-medication-based interventions that can lower blood pressure. 

This also included straightforward approaches by nurse managers to standardize workflows during video visits, to make sure that clinicians captured blood pressure during those visits and outreach to patients to make sure they attended their scheduled physician visits. “By June 2021, the disparity had been completely eliminated in our primary care population,” Dr. Adler said.    

In another intervention, the system found that its Latino patients have a lower rate of completed advance care directives. With interventions that included improved language concordant documents, use of interpreters and timing the discussions so that family members could participate, UCSF was able to eliminate this disparity as well.   

Since UCSF’s data infrastructure was in place, it was able to recognize an emerging disparity in real time. Patients with limited English proficiency were using video visits at a lower rate than patients overall. This was particularly relevant during the early months of the pandemic when video visits were the preferred method of care. The health system implemented an on-demand interpreter program for video visits recently and hope that this intervention will help patients utilize this technology when desired.

NYU Langone Health

New York City-based NYU Langone Health launched the Institute of Excellence in Health Equity in 2020. The goal of the institute is to make sure patient outcomes are comparable, regardless of whether a patient is in Brooklyn or Manhattan, said Fritz Francois, MD, chief medical officer and patient safety officer at NYU Langone Health.

The fuel behind NYU Langone’s strategy is its key pillars such as research, clinical care and education. Community engagement, by far, has been the most successful initiative. By going into communities, the health system can get a pulse on what is going on with social determinants of health. For example, to address food insecurities, the health system uses food pantries to support the community’s needs. Community engagement is the most successful initiative because it also allows the health system to engage with communities about COVID-19 vaccine hesitancy. 

The health system is going to start focusing on how it develops the next generation of physicians to address health equity. It is looking at opportunities to embed this type of training in medical school, residency and beyond. 

NYU Langone measures the results of its initiatives by comparing mortality rates between Manhattan and Brooklyn residents. What they have seen is that patients from both locations have been having similar outcomes. The system also compares rates of hospital-acquired conditions, where there are also no differences between populations.

The institute was successful in securing funding from the National Institutes of Health to look at efforts related to hypertension. It’s an example of where the center will position itself in the future. It’s not just clinical work or just education, Dr. Francois said. It is also asking questions that can be answered with research and applying collective funding to it, he said.

Johns Hopkins Medicine

Baltimore-based Johns Hopkins Medicine’s health equity initiatives have continued to evolve during the COVID-19 pandemic. Last year, the health system discussed using a mobile COVID-19 testing site in the parking lot of one of the hardest-hit Baltimore ZIP codes with a large number of Latino residents, said Sherita Golden, MD, vice president and chief diversity officer at Johns Hopkins Medicine and professor of medicine at the Johns Hopkins University School of Medicine. Since Feb. 26, more than 4,180 individuals have been vaccinated in 40 clinics held at this location.

Johns Hopkins partnered with public health agencies in Washington, D.C., and Maryland to deliver vaccines to community members unable to access mass vaccination and clinical sites because of transportation barriers, disabilities impairing mobility, limited computer usage, lack of healthcare access and lack of broadband. Approximately 90 percent of residents vaccinated through these efforts have been Black. 

During February and March, more than 2,000 people were vaccinated in senior housing communities in Washington, D.C. — a collaboration between Johns Hopkins Medicine, the D.C. Department of Health and the D.C. Housing Authority. The initiative was expanded to Baltimore in collaboration with the Baltimore City Health Department. Since this initiative launched in late February, more than 4,000 people have been vaccinated in senior housing, places of worship and other community-based sites. Johns Hopkins also operates a mobile van to facilitate pop-up vaccine sites throughout Baltimore to reach those having difficulty accessing vaccines.

Johns Hopkins’ Office of Diversity, Inclusion and Health Equity partnered with local and community organizations to host virtual Facebook Live town halls. Each of these events reached thousands of community members across Maryland and Washington, D.C. It is key to address community concerns and restore trust, particularly in the Black and Latino communities, Dr. Golden said.

Johns Hopkins continues to monitor the demographics of those vaccinated through its mobile community efforts. It is also monitoring the reach of its education collaborations with diverse media outlets and collecting viewership statistics after each event. Johns Hopkins Medicine’s patient demographic data is missing less than 10 percent of entries. This will enable the system to look at vaccination rates among patients by race and ethnicity to guide its future efforts, Dr. Golden said.

NewYork-Presbyterian

In October 2020, New York City-based NewYork-Presbyterian launched the Dalio Center for Health Justice, dedicated to understanding and improving health equity, addressing health justice, and driving action that results in measurable improvements in health outcomes for its patients, employees and communities it serves. Because 80 percent of health outcomes are driven by social, behavioral and environmental factors, the Dalio Center focuses on supporting community initiatives, understanding and championing economic empowerment, social engagement, workforce development, neighborhood revitalization, and education, said Julia Iyasere, MD, executive director of the center.

In collaboration with New York City-based Weill Cornell Medicine and New York City-based Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian recently announced a health equity research grant program to support innovative research that will directly advance efforts to reduce health inequities and disparities. A grants committee with tripartite membership will evaluate and oversee the awards, with preference to funding research that provides solutions and takes action.

The system is also developing educational and outreach programs about health disparities for its staff and communities. In collaboration with the Division of Community and Population Health and the Office of Government and Community Affairs, the trio hosted a series of interactive vaccine education presentations to staff, patients and the community, engaging with about 15,000 people to date. They also hosted an annual health equity symposium to bring together leading healthcare professionals, researchers and advocates in the field.

The system is working with its medical school partners and hospital operations team to develop and expand several institutional projects to bolster its clinical programs that focus on improving access to and quality of healthcare, such as the Black Transplant Health Initiative. The goal is to address both new and historic barriers to care through enhanced engagement with the Black community — listening, building awareness, providing education, increasing access and advancing transformational transplant care.

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The evidence, compiled by federal scientists over the past several months, showed a decline in the initial round of protection against Covid-19 infection that’s coincided with a resurgence in cases driven by the more contagious Delta variant. The data looked at vaccine effectiveness in individuals across age groups, with varying medical conditions and who received the shot at different times. It was presented to White House Covid-19 task force officials at a meeting Sunday.

‘This is what moved the needle,’ one senior administration official said, describing the CDC data and the decision to urge boosters.

That data — which is set to be made public later this week — brought a swift end to a debate over when to administer boosters that has raged within the administration for months, and spurred the buildout of a plan for distributing the additional shots in a matter of weeks.

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There’s a wide range of opinions among Afghanistan war veterans about the US withdrawal, said Tom Porter, an Afghanistan veteran and the executive vice president for government relations at Iraq and Afghanistan Veterans of America (IAVA). Stressing he doesn’t speak for everyone, Porter said some veterans feel the withdrawal was overdue while others believe the United States should have stayed to prevent any violence.

“But the vast majority of veterans I’m hearing from have great concern for the veterans that have sacrificed so much and the families that are Gold Star families that lost their sons and their husbands and their fathers and mothers and other family members over the last 20 years,” Porter said.

“They are wondering, was their loved ones’ service worth it?”

The images coming out of Afghanistan are quickly building a narrative, he said, that is going to shape veterans’ views about the past 20 years.

“That’s going to color the way veterans and service members think about the end of their service, the result of their service,” Porter said. “Everybody in the community’s going to be looking to see, how is history going to remember what we did over there?”

Gerald Keen, who served in Afghanistan, told CNN’s Pamela Brown he knew this time would come. But he disagrees with the way the withdrawal has unfolded, believing American soldiers should not be sent back to do a job he feels should have been done prior to the closure of Bagram Airfield.

US Defense Secretary Lloyd Austin approved the deployment of 1,000 more US troops to Afghanistan, a defense official told CNN on Sunday, for a total of 6,000 US troops expected to be in country.

“Now we’ve got to send soldiers back in harm’s way to help evacuate the embassies and these interpreters who fought side by side with us every day,” Keen said.

Much of veterans’ anxiety is tied to the effort of getting out those who helped the United States at risk to their families’ lives, said Jeremy Butler, IAVA’s chief executive.

The US State Department has said there are some 20,000 Afghans who have applied for a Special Immigrant Visa (SIV) to be able to come to the United States. As of Friday, 1,200 Afghans and their families had been evacuated to America as part of the administration’s “Operation Allies Refuge,” and administration officials said they would accelerate efforts to get the applicants and their families out of Afghanistan and to the United States or a third country.

Even with the accelerated pace of SIV relocation, there are tens of thousands of other Afghans who worked alongside the United States who either are stuck in the pipeline or do not qualify for the program and will need to pursue other ways out, such as the administration’s new Afghan refugee designation.

Read the full story here.

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