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March 18, 2023

Ozempic prescriptions can be easy to get online. Its popularity for weight loss is hurting those who need it most | CNN

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CNN
—

Telehealth and social media are playing a significant role in driving demand for Ozempic, a prescription drug that treats Type 2 diabetes, experts told CNN. The current drug shortage has limited access for patients with diabetes who rely on it to control their blood sugar.

Digital health companies make medications like Ozempic easier to get by providing prescriptions online. Many advertise quick and easy — sometimes same-day — access.

“Anecdotally, it’s almost easier to get medication [via digital health companies],” said Dr. Disha Narang, endocrinologist and director of obesity medicine at Northwestern Medicine, Lake Forest Hospital. “But not always the safest.” People who put in average weights on the online intake forms were still offered the antidiabetic drug, Narang told CNN.

In part because of Ozempic’s popularity, the prescription weight loss drug market has grown significantly, according to MarketData Enterprises, an independent market research and consulting firm. The market surpassed forecasters’ expectations for 2022 and is expected to become a nearly $2 billion industry in 2023.

WeightWatchers is also tapping into the telehealth prescription drug space. Last week, the company bought telehealth subscription service Sequence, which helps connect patients to doctors who can prescribe weight loss and diabetes drugs.

“At the start of 2022, these companies weren’t marketing this stuff,” Narang said, noting advertising around Ozempic took off in 2022. “I think we really need to start questioning our ethics around this.”

There are few across-the-board requirements when it comes to digital health companies’ intake processes, Dr. Bree Holtz, an associate professor at Michigan State University studying telemedicine, told CNN. Once a patient fills out the required forms online, information gets transferred to an in-state provider who can write the prescription. Some companies require that the patient hop on a video or phone call with the provider — others don’t require either.

“It’s a little scary that you can just wake up and get these appointments in — or these pharmaceuticals — and you’re not being cared for,” said Holtz.

Telehealth has been a game changer in providing access to health care, particularly during the pandemic. And especially for people living in places where high-quality primary care is not available, direct to consumer telehealth services can help fill a gap, said Dr. Laurie Buis, associate professor in the Department of Family Medicine at the University of Michigan, whose research focuses on digital health.

When patients begin to seek selective treatment from selective providers, however, Buis says it opens the door to problems like fragmented care or abuse. Telehealth providers may not have access to a patient’s full medical history and may be less able to provide holistic care that a primary care physician otherwise could.

“I have no doubt that some of these services are doing a good job,” said Buis. “There are also services that don’t take it quite as seriously. And that’s of concern.”

The US Food and Drug Administration first announced that Ozempic was in shortage last August. Supply will likely be strained through mid-March, according to the FDA drug shortages database.

Ozempic prescriptions in the US reached an all-time high in the last week of February, with over 373,000 prescriptions filled, according to a J.P. Morgan analysis of IQVIA data shared with CNN. That’s an increase of 111%, compared with the same week in 2022.

Of these, more than half were new prescriptions, according to a CNN review of J.P. Morgan’s analysis.

With many patients relying on Ozempic for diabetes treatment, providers like Narang are scrambling to figure out what alternatives to put their patients on.

“We’re getting messages daily about patients not being able to get their own medication,” Narang said. “It’s been tough for patients and providers alike.”

Ozempic currently holds more than 40% of the US market share of glucagon-like peptide 1 (GLP-1) agonists — a class of drugs that mimic an appetite-regulating hormone — according to analysis from J.P. Morgan. These drugs work by stimulating the release of insulin, which helps lower blood sugar. They also slow the passage of food through the gut.

Ozempic has grown quickly in popularity since it was first put on the market in 2018. The drug has safely and successfully been used to help diabetics improve blood sugar levels and put diabetes into remission, Narang told CNN. Ozempic is the most potent of all the GLP-1 medications, she said.

Behind the brand name Ozempic is the medication semaglutide. While Ozempic is used primarily to treat Type 2 diabetes, another drug by the name Wegovy — also semaglutide — is approved specifically for chronic weight management.

Although approved by the FDA in 2021, Wegovy was not readily available through most of last year, according to Narang, so people turned to Ozempic. According to the FDA drug shortages database, Wegovy was undersupplied starting at the end of last March but came back in stock earlier this year.

Social media buzz around the two drugs took off at the start of 2023. Celebrities shared their testimonies about how semaglutide helped them shed unwanted pounds. Elon Musk, for example, publicly credited Ozempic and Wegovy in part for his weight loss.

#Ozempic and #Wegovy have been “extremely popular” over the last few months on TikTok, according to company analytics.

The use of Ozempic and Wegovy for short-term weight loss has resulted in real consequences for patients who need the drugs most for diabetes treatment and chronic weight management, said Narang. For example, some insurance companies in the past have reportedly refused to cover Wegovy, one calling it a “vanity drug.”

Both drugs are intended for long-term use, not for short-term weight loss. Their appetite-regulating effects wear off quickly after you stop taking them.

“This is not meant to be a medication to take off your last five or 10 pounds to get ready for an event or something like that. It’s not for use of three or four weeks,” Narang said. “When we think about weight management, we’re thinking about the next 25 years of someone’s life.”

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March 18, 2023

Chronic pain patients struggle to get opioid prescriptions filled, even as CDC eases guidelines | CNN

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KHN
—

Jessica Layman estimates she has called more than 150 doctors in the past few years in her search for someone to prescribe opioids for her chronic pain.

“A lot of them are straight-up insulting,” said the 40-year-old, who lives in Dallas. “They say things like ‘We don’t treat drug addicts.’”

Layman has tried a host of non-opioid treatments to help with the intense daily pain caused by double scoliosis, a collapsed spinal disc, and facet joint arthritis. But she said nothing worked as well as methadone, an opioid she has taken since 2013.

The latest phone calls came late last year, after her previous doctor shuttered his pain medicine practice, she said. She hopes her current doctor won’t do the same. “If something should happen to him, there’s nowhere for me to go,” she said.

Layman is one of the millions in the U.S. living with chronic pain. Many have struggled to get opioid prescriptions written and filled since 2016 guidelines from the Centers for Disease Control and Prevention inspired laws cracking down on doctor and pharmacy practices. The CDC recently updated those recommendations to try to ease their impact, but doctors, patients, researchers, and advocates say the damage is done.

“We had a massive opioid problem that needed to be rectified,” said Antonio Ciaccia, president of 3 Axis Advisors, a consulting firm that analyzes prescription drug pricing. “But the federal crackdowns and guidelines have created collateral damage: patients left high and dry.”

Born of an effort to fight the nation’s overdose crisis, the guidance led to legal restrictions on doctors’ ability to prescribe painkillers. The recommendations left many patients grappling with the mental and physical health consequences of rapid dose tapering or abruptly stopping medication they’d been taking for years, which carries risks of withdrawal, depression, anxiety, and even suicide.

In November, the agency released new guidelines, encouraging physicians to focus on the individual needs of patients. While the guidelines still say opioids should not be the go-to option for pain, they ease recommendations about dose limits, which were widely viewed as hard rules in the CDC’s 2016 guidance. The new standards also warn doctors about risks associated with rapid dose changes after long-term use.

But some doctors worry the new recommendations will take a long time to make a meaningful change — and may be too little, too late for some patients. The reasons include a lack of coordination from other federal agencies, fear of legal consequences among providers, state policymakers hesitant to tweak laws, and widespread stigma surrounding opioid medication.

The 2016 guidelines for prescribing opioids to people with chronic pain filled a vacuum for state officials searching for solutions to the overdose crisis, said Dr. Pooja Lagisetty, an assistant professor of medicine at the University of Michigan Medical School.

The dozens of laws that states passed limiting how providers prescribe or dispense those medications, she said, had an effect: a decline in opioid prescriptions even as overdoses continued to climb.

The first CDC guidelines “put everybody on notice,” said Dr. Bobby Mukkamala, chair of the American Medical Association’s Substance Use and Pain Care Task Force. Physicians reduced the number of opioid pills they prescribe after surgeries, he said. The 2022 revisions are “a dramatic change,” he said.

The human toll of the opioid crisis is hard to overstate. Opioid overdose deaths have risen steadily in the U.S. in the past two decades, with a spike early in the covid-19 pandemic. The CDC says illicit fentanyl has fueled a recent surge in overdose deaths.

Taking into account the perspective of chronic pain patients, the latest recommendations try to scale back some of the harms to people who had benefited from opioids but were cut off, said Dr. Jeanmarie Perrone, director of the Penn Medicine Center for Addiction Medicine and Policy.

“I hope we just continue to spread caution without spreading too much fear about never using opioids,” said Perrone, who helped craft the CDC’s latest recommendations.

Christopher Jones, director of the CDC’s National Center for Injury Prevention and Control, said the updated recommendations are not a regulatory mandate but only a tool to help doctors “make informed, person-centered decisions related to pain care.”

Multiple studies question whether opioids are the most effective way to treat chronic pain in the long term. But drug tapering is associated with deaths from overdose and suicide, with risk increasing the longer a person had been taking opioids, according to research by Dr. Stefan Kertesz, a professor of medicine at the University of Alabama-Birmingham.

He said the new CDC guidance reflects “an extraordinary amount of input” from chronic pain patients and their doctors but doubts it will have much of an impact if the FDA and the Drug Enforcement Administration don’t change how they enforce federal laws.

The FDA approves new drugs and their reformulations, but the guidance it provides for how to start or wean patients could urge clinicians to do so with caution, Kertesz said. The DEA, which investigates physicians suspected of illegally prescribing opioids, declined to comment.

The DEA’s pursuit of doctors put Danny Elliott of Warner Robins, Georgia, in a horrible predicament, said his brother, Jim.

In 1991, Danny, a pharmaceutical company rep, suffered an electric shock. He took pain medicine for the resulting brain injury for years until his doctor faced federal charges of illegally dispensing prescription opioids, Jim said.

Danny turned to doctors out of state — first in Texas and then in California. But Danny’s latest physician had his license suspended by the DEA last year, and he couldn’t find a new doctor who would prescribe those medications, Jim said.

Danny, 61, and his wife, Gretchen, 59, died by suicide in November. “I’m really frustrated and angry about pain patients being cut off,” Jim said.

Danny became an advocate against forced drug tapering before he died. Chronic pain patients who spoke with KHN pointed to his plight in calling for more access to opioid medications.

Even for people with prescriptions, it’s not always easy to get the drugs they need.

Pharmacy chains and drug wholesalers have settled lawsuits for billions of dollars over their alleged role in the opioid crisis. Some pharmacies have seen their opioid allocations limited or cut off, noted Ciaccia, with 3 Axis Advisors.

Rheba Smith, 61, of Atlanta, said that in December her pharmacy stopped filling her prescriptions for Percocet and MS Contin. She had taken those opioid medications for years to manage chronic pain after her iliac nerve was mistakenly cut during surgery, she said.

Smith said she visited nearly two dozen pharmacies in early January but could not find one that would fill her prescriptions. She finally found a local mail-order pharmacy that filled a one-month supply of Percocet. But now that drug and MS Contin are not available, the pharmacy told her.

“It has been a horrible three months. I have been in terrible pain,” Smith said.

Many patients fear a future of constant pain. Layman thinks about the lengths she’d go to in order to get medication.

“Would you be willing to buy drugs off the street? Would you be willing to go to an addiction clinic and try to get pain treatment there? What are you willing to do to stay alive?” she said. “That is what it comes down to.”

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March 17, 2023

US maternal death rate rose sharply in 2021, CDC data shows, and experts worry the problem is getting worse | CNN

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CNN
—

As women continue to die due to pregnancy or childbirth each year in the United States, new federal data shows that the nation’s maternal death rate rose significantly yet again in 2021, with the rates among Black women more than twice as high as those of White women.

Experts said the United States’ ongoing maternal mortality crisis was compounded by Covid-19, which led to a “dramatic” increase in deaths.

The number of women who died of maternal causes in the United States rose to 1,205 in 2021, according to a report from the National Center for Health Statistics, released Thursday by the US Centers for Disease Control and Prevention. That’s a sharp increase from years earlier: 658 in 2018, 754 in 2019 and 861 in 2020.

That means the US maternal death rate for 2021 – the year for which the most recent data is available – was 32.9 deaths per 100,000 live births, compared with rates of 20.1 in 2019 and 23.8 in 2020.

The new report also notes significant racial disparities in the nation’s maternal death rate. In 2021, the rate for Black women was 69.9 deaths per 100,000 live births, which is 2.6 times the rate for White women, at 26.6 per 100,000.

The data showed that rates increased with the mother’s age. In 2021, the maternal death rate was 20.4 deaths per 100,000 live births for women under 25 and 31.3 for those 25 to 39, but it was 138.5 for those 40 and older. That means the rate for women 40 and older was 6.8 times higher than the rate for women under age 25, according to the report.

The maternal death rate in the United States has been steadily climbing over the past three decades, and these increases continued through the Covid-19 pandemic.

Questions remain about how the pandemic may have affected maternal mortality in the United States, according to Dr. Elizabeth Cherot, chief medical and health officer for the infant and maternal health nonprofit March of Dimes, who was not involved in the new report.

“What happened in 2020 and 2021 compared with 2019 is Covid,” Cherot said. “This is sort of my reflection on this time period, Covid-19 and pregnancy. Women were at increased risk for morbidity and mortality from Covid. And that actually has been well-proven in some studies, showing increased risks of death, but also being ventilated in the intensive care unit, preeclampsia and blood clots, all of those things increasing a risk of morbidity and mortality.”

The American College of Obstetricians and Gynecologists previously expressed “great concern” that the pandemic would worsen the US maternal mortality crisis, ACOG President Dr. Iffath Abbasi Hoskins said in a statement Thursday.

“Provisional data released in late 2022 in a U.S. Government Accountability Office report indicated that maternal death rates in 2021 had spiked—in large part due to COVID-19. Still, confirmation of a roughly 40% increase in preventable deaths compared to a year prior is stunning new,” Hoskins said.

“The new data from the NCHS also show a nearly 60% percent increase in maternal mortality rates in 2021 from 2019, just before the start of the pandemic. The COVID-19 pandemic had a dramatic and tragic effect on maternal death rates, but we cannot let that fact obscure that there was—and still is—already a maternal mortality crisis to compound.”

Health officials stress that people who are pregnant should get vaccinated against Covid-19 and that doing so offers protection for both the mother and the baby.

During the early days of the pandemic, in 2020, there was limited information about the vaccine’s risks and benefits during pregnancy, prompting some women to hold off on getting vaccinated. But now, there is mounting evidence of the importance of getting vaccinated for protection against serious illness and the risks of Covid-19 during pregnancy.

The Covid-19 pandemic also may have exacerbated existing racial disparities in the maternal death rate among Black women compared with White women, said Dr. Chasity Jennings-Nuñez, a California-based site director with Ob Hospitalist Group and chair of the perinatal/gynecology department at Adventist Health-Glendale, who was not involved in the new report.

“In terms of maternal mortality, it continues to highlight those structural and systemic problems that we saw so clearly during the Covid-19 pandemic,” Jennings-Nuñez said.

“So in terms of issues of racial health inequities, of structural racism and bias, of access to health care, all of those factors that we know have played a role in terms of maternal mortality in the past continue to play a role in maternal mortality,” she said. “Until we begin to address those issues, even without a pandemic, we’re going to continue to see numbers go in the wrong direction.”

Some policies have been introduced to tackle the United States’ maternal health crisis, including the Black Maternal “Momnibus” Act of 2021, a sweeping bipartisan package of bills that aim to provide pre- and post-natal support for Black mothers, including extending eligibility for certain benefits postpartum.

As part of the Momnibus, President Biden signed the bipartisan Protecting Moms Who Served Act in 2021, and other provisions have passed in the House.

In the United States, about 6.9 million women have little or no access to maternal health care, according to March of Dimes, which has been advocating in support of the Momnibus.

The US has the highest maternal death rate of any developed nation, according to the Commonwealth Fund and the latest data from the World Health Organization. While maternal death rates have been either stable or rising across the United States, they are declining in most countries.

“A high rate of cesarean sections, inadequate prenatal care, and elevated rates of chronic illnesses like obesity, diabetes, and heart disease may be factors contributing to the high U.S. maternal mortality rate. Many maternal deaths result from missed or delayed opportunities for treatment,” researchers from the Commonwealth Fund wrote in a report last year.

The ongoing rise in maternal deaths in the United States is “disappointing,” said Dr. Elizabeth Langen, a high-risk maternal-fetal medicine physician at the University of Michigan Health Von Voigtlander Women’s Hospital. She was not involved in the latest report but cares for people who have had serious complications during pregnancy or childbirth.

“Those of us who work in the maternity care space have known that this is a problem in our country for quite a long time. And each time the new statistics come out, we’re hopeful that some of the efforts that have been going on are going to shift the direction of this trend. It’s really disappointing to see that the trend is not going in the right direction but, at some level, is going in the worst direction and at a little bit of a faster rate,” Langen said.

“In the health care system, we need to accept ultimate responsibility for the women who die in our care,” she added. “But as a nation, we also need to accept some responsibility. We need to think about: How do we provide appropriate maternity care for people? How do we let people have time off of work to see their midwife or physician so that they get the care that they need? How do all of us make it possible to live a healthy life while you’re pregnant so that you have the opportunity to have the best possible outcome?”

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March 16, 2023

How to reduce PFAS in your drinking water, according to experts | CNN

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CNN
—

In the next three years, drinking water in the United States may be a bit safer from potentially toxic chemicals that have been detected in the blood of 98% of Americans.

Perfluoroalkyl and polyfluoroalkyl substances or PFAS are a family of thousands of man-made chemicals that do not break down easily in the environment. A number of PFAS have been linked to serious health problems, including cancer, fertility issues, high cholesterol, hormone disruption, liver damage, obesity and thyroid disease.

The US Environmental Protection Agency proposed on Tuesday stringent new limits on levels of six PFAS chemicals in public water systems. Under the proposed rule, public systems that provide water to at least 15 service connections or 25 people will have three years to implement testing procedures, begin notifying the public about PFAS levels, and reduce levels if above the new standard, the EPA said.

Two of the most well-studied and potentially toxic chemicals, PFOA and PFOS, cannot exceed 4 parts per trillion in drinking water, compared with a previous health advisory of 70 parts per trillion, the EPA said.

Another four chemicals — PFNA, PFHxS, PFBS and GenX — will be subject to a hazard index calculation to determine whether the levels of these PFAS pose a potential risk. The calculation is “a tool the EPA uses to address the cumulative risks from all four of those chemicals,” said Melanie Benesh, vice president of government affairs for the Environmental Working Group, a consumer organization that monitors exposure to PFAS and other chemicals.

“The EPA action is a really important and historic step forward,” Benesh said. “While the proposed regulations only address a few PFAS, they are important marker chemicals. I think requiring water systems to test and treat for these six will actually do a lot to address other PFAS that are in the water as well.”

For people who are concerned about PFAS exposure, three years or so is a long time. What can consumers do now to limit the levels of PFAS in their drinking water?

First, look up levels of PFAS in your local public water system, suggested David Andrews, a senior scientist at the Environmental Working Group. The advocacy nonprofit has created a national tap water database searchable by zip code that lists PFAS and other concerning chemicals, as well as a national map that illustrates where PFAS has been detected in the US.

However, not all water utilities currently test for pollutants, and many rural residents rely on wells for water. Anyone who wants to personally test their water can purchase a test online or from a certified lab, Andrews said.

“The most important thing is to ensure the testing method can detect down to at least four parts per trillion or lower of PFAS,” he said. “There are a large number of labs across the country certified to test to that level, so there are a lot of options available.”

If levels are concerning, consumers can purchase a water filter for their tap. NSF, formerly the National Sanitation Foundation, has a list of recommended filters.

“The water filters that are most effective for PFAS are reverse osmosis filters, which are more expensive, about in the $200 range,” Andrews said. Reverse osmosis filters can remove a wide range of contaminants, including dissolved solids, by forcing water through various filters.

“Granular activated carbon filters are more common and less expensive but not quite as effective or consistent for PFAS,” he said, “although they too can remove a large number of other contaminants.”

Reverse osmosis systems use both carbon-based filters and reverse osmosis membranes, Andrews explained. Water passes through the carbon filter before entering the membrane.

“The important part is that you have to keep changing those filters,” he said. “If you don’t change that filter, and it becomes saturated, the levels of PFAS in the filtered water can actually be above the levels in the tap water.”

Carbon filters are typically replaced every six months, “while the reverse osmosis filter is replaced on a five-year time frame,” he added. “The cost is relatively comparable over their lifetime.”

Another positive: Many of the filters that work for PFAS also filter other contaminants in water, Andrews said.

Drinking water is not the only way PFAS enters the bloodstream. Thousands of varieties of PFAS are used in many of the products we purchase, including nonstick cookware, infection-resistant surgical gowns and drapes, mobile phones, semiconductors, commercial aircraft, and low-emissions vehicles.

The chemicals are also used to make carpeting, clothing, furniture, and food packaging resistant to stains, water and grease damage. Once treated, the report said, textiles emit PFAS over the course of their lifetimes, escaping into the air and groundwater in homes and communities.

Made from a chain of linked carbon and fluorine atoms that do not readily degrade in the environment, PFAS are known as “forever chemicals.” Due to their long half life in the human body, it can take some PFAS years to completely leave the body, according to a 2022 report by the prestigious National Academies of Sciences, Engineering, and Medicine.

“Some of these chemicals have half-lives in the range of five years,” National Academies committee member Jane Hoppin, an environmental epidemiologist and director of the Center for Human Health and the Environment at North Carolina State University in Raleigh, told CNN previously.

“Let’s say you have 10 nanograms of PFAS in your body right now. Even with no additional exposure, five years from now you would still have 5 nanograms.

“Five years later, you would have 2.5 and then five years after that, you’d have one 1.25 nanograms,” she continued. “It would be about 25 years before all the PFAS leave your body.”

The 2022 National Academies report set “nanogram” levels of concern and encouraged clinicians to conduct blood tests on patients who are worried about exposure or who are at high risk. (A nanogram is equivalent to one-billionth of a gram.)

People in “vulnerable life stages” — such as during fetal development in pregnancy, early childhood and old age — are at high risk, the report said. So are firefighters, workers in fluorochemical manufacturing plants, and those who live near commercial airports, military bases, landfills, incinerators, wastewater treatment plants and farms where contaminated sewage sludge is used.

The PFAS-REACH (Research, Education, and Action for Community Health) project, funded by the National Institute of Environmental Health Sciences, gives the following advice on how to avoid PFAS at home and in products:

Stay away from stain-resistant carpets and upholstery, and don’t use waterproofing sprays.
Look for the ingredient polytetrafluoroethylene, or PTFE, or other “fluoro” ingredients on product labels.
Avoid nonstick cookware. Instead use cast-iron, stainless steel, glass or enamel products.
Boycott takeout containers and other food packaging. Instead cook at home and eat more fresh foods.
Don’t eat microwave popcorn or greasy foods wrapped in paper.
Choose uncoated nylon or silk dental floss or one that is coated in natural wax.

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March 12, 2023

What is the painful condition called shingles? | CNN

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CNN
—

Sen. Dianne Feinstein, the 89-year-old California Democrat, recently announced she is out of the hospital and recovering at home from shingles, a painful viral inflammation in the skin’s nerves that causes a blistering rash lasting for two to four weeks. Feinstein was diagnosed in February and hospitalized in San Francisco last week.

Shingles, also called herpes zoster, is caused by the varicella-zoster virus — which is the same virus responsible for chickenpox. Varicella zoster is also responsible for a rare condition called Ramsay Hunt syndrome that caused pop star Justin Bieber’s face to become partially paralyzed in June 2022.

“As you can see, this eye is not blinking. I can’t smile on this side of my face. This nostril will not move,” Bieber said at the time in answer to fans who wondered why he had canceled performances.

Painful skin is one of first signs of shingles, and for some people, the pain is intense. It can create a burning sensation, or the skin can tingle or be sensitive to touch, according to the Mayo Clinic. Shingles can occur at other places on the body, such as the face and scalp, but the most common presentation is on the torso on one side of the body.

A red rash will begin to develop at the site of the pain within a few days. The rash often begins as a small, painful patch, which then spreads like “a stripe of blisters that wraps around either the left or right side of the torso,” the Mayo Clinic said.

In rare cases, the rash may become more widespread and look similar to a chickenpox rash, typically in people with weakened immune systems, according to the US Centers of Disease Control and Prevention.

In addition to pain, some people may develop chills, fatigue, fever, headache, upset stomach and sensitivity to light. See a doctor if you are over 50, have a weakened immune system, the rash is widespread and painful, or the pain and rash occur near an eye.

“If left untreated, this infection may lead to permanent eye damage,” according to the Mayo Clinic.

The varicella-zoster virus is highly contagious when in the blister stage, spreading through direct contact with the fluid from blisters and via viral particles in the air.

However, you cannot get shingles from someone who has shingles. If you aren’t vaccinated for chickenpox or haven’t previously had it and are infected by that person, you will develop chickenpox, which then puts you at risk for shingles later in life, the CDC said.

If you have shingles, you can prevent the spread of the virus by covering the rash and not touching or scratching the raised vesicles that form the rash, the CDC stated. Wash your hands often.

“People with shingles cannot spread the virus before their rash blisters appear or after the rash crusts,” the CDC said.

If the rash is covered, the risk of transmission “is low,” the CDC said. “People with chickenpox are more likely to spread (the virus) than people with shingles.”

If you think you have shingles, call a doctor as soon as you can, the CDC recommended. If caught early, there are antiviral medications, including acyclovir, valacyclovir and famciclovir, that can shorten the length and severity of the illness.

“These medicines are most effective if you start taking them as soon as possible after the rash appears,” the CDC said.

Doctors may also suggest over-the-counter or prescription pain medication for the burning and pain, while calamine lotion, wet compresses and oatmeal baths may ease itching.

For older adults, the population most likely to develop shingles, the best treatment is prevention. The US Food and Drug Administration approved a two-dose vaccine called Shingrix in 2017 for people 50 and older.

“Shingrix is also recommended for adults 19 years and older who have weakened immune systems because of disease or therapy,” the CDC said.

Shingrix, which is not based on a live virus, is more than 90% effective in encouraging the aging immune system to recognize and be ready to fight the virus, according to its manufacturer, GlaxoSmithKline.

Anyone who has had a severe allergic reaction to a dose of Shingrix or is allergic to any of the components of the vaccine should avoid it, the CDC said.

“People who currently have shingles, and women who are pregnant or breastfeeding, should wait to get Shingrix,” the CDC said.

Another vaccine called Zostavax, which the FDA approved for people over 50 in 2006, is 51% effective in preventing shingles, according to the CDC. Zostavax is based on a live virus, the same approach used for the chickenpox vaccine recommended in childhood. It has not been sold in the United States since November 2020.

If you have never had chickenpox, you can’t get shingles. However, once you’ve had chickenpox, the virus remains inactive in the spine’s sensory neurons, possibly erupting years later as shingles.

Two doses of a chickenpox vaccine for children, teens and adults, introduced in 1995, is 100% effective at preventing a severe case of chickenpox, according to the CDC. Immunity lasts 10 to 20 years, the CDC noted.

In the small number of people who still get chickenpox after vaccination, the illness is typically milder, with few or no blisters.

The CDC recommends the vaccine be given to children in two doses, the first between 12 and 15 months and a second one between 4 and 6 years. Anyone 13 years old and older who has no evidence of immunity can get two doses four to eight weeks apart, the CDC said.

Some people should not get the vaccine, including pregnant women, people with certain blood disorders or those on prolonged immunosuppressive therapy, and those with a moderate or severe illness, among others.

About 1 in 10 people will develop a painful and possibly debilitating condition called postherpetic neuralgia, or long-term nerve pain. All other signs of the rash can be gone, but the area is extremely painful to touch. Less often, itching or numbness can occur.

The condition rarely affects people under 40, the CDC said. Older adults are most likely to have more severe pain that lasts longer than a younger person with shingles. For some, the nerve pain can be devastating.

“Five years later, I still take prescription medication for pain,” said a 63-year-old harpist who shared his story on the CDC website. “My shingles rash quickly developed into open, oozing sores that in only a few days required me to be hospitalized.

“I could not eat, sleep, or perform even the most minor tasks. It was totally debilitating. The pain still limits my activity levels to this day,” said the musician, who has been unable to continue playing the harp due to pain.

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March 10, 2023

Up to 20,000 people who attended a religious gathering may have been exposed to measles. What should they do next? | CNN

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CNN
—

Up to 20,000 people who attended a religious gathering at a college in Wilmore, Kentucky, in February could have been exposed to a person later diagnosed with measles.

On Friday, the US Centers for Disease Control and Prevention issued an alert to clinicians and public health officials about the confirmed case of measles in an individual present at the gathering who had not been vaccinated against the disease.

“If you attended the Asbury University gathering on February 17 or 18 and you are unvaccinated or not fully vaccinated against measles, you should quarantine for 21 days after your last exposure and monitor yourself for symptoms of measles so that you do not spread measles to others,” according to the CDC advisory.

The CDC also recommended that people who are unvaccinated receive the measles, mumps, and rubella (MMR) vaccine.

Reading this news, people may have questions about measles, including its symptoms, infection outcomes and who is most at risk. They may also want to know what makes measles so contagious, what has been the cause of recent outbreaks and how effective the MMR vaccine is.

To help answer these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. Previously, she served as Baltimore’s health commissioner, where her duties included overseeing the city’s immunization and infectious disease investigations.

CNN: What is measles, and what are the symptoms?

Dr. Leana Wen: Measles is an extremely contagious illness that’s caused by the measles virus. Despite many public health advances, including the development of the MMR vaccine, it remains a major cause of death among children globally.

The measles virus is transmitted via droplets from the nose, mouth or throat of infected individuals. If someone is infected and coughs or sneezes, droplets can land on you and infect you. These droplets can land on surfaces, and if you touch the surface and then touch your nose or mouth, that could infect you, too.

Symptoms usually appear 10 to 12 days after infection. They include a high fever, runny nose, conjunctivitis (pink eye) and small, painless white spots on the inside of the mouth. A few days after these symptoms begin, many individuals develop a characteristic rash — flat red spots that generally start on the face and then spread downward over the neck, trunk, arms, legs and feet. The spots can become joined together as they spread and can be accompanied by a high fever.

A nurse gives a woman a measles, mumps and rubella virus vaccin at the Utah County Health Department on April 29, 2019 in Provo, Utah.

CNN: What are outcomes of measles infections? Who is most at risk?

Wen: Many individuals recover without incident. Others, however, can develop severe complications.

One in five unvaccinated people with measles are hospitalized, according to the CDC. As many as 1 out of every 20 children with measles will get pneumonia; about 1 in 1,000 who get measles can develop encephalitis, a swelling of the brain that can lead to seizures and leave the child with lasting disabilities. And nearly 1 to 3 out of every 1,000 children who are infected with measles will die.

Measles is not only a concern for children. It can also cause premature births in pregnant women who contract it. Immunocompromised people, such as cancer patients and those infected with HIV, are also at increased risk.

CNN: What makes measles so contagious?

Wen: Measles is one of the most contagious diseases in the world — up to 90% of the unvaccinated people who come into contact with a contagious individual will also become infected. The measles virus can remain in the air for up to two hours after an infected person leaves an area.

Another reason why measles spreads so easily is its long incubation period. In infected people, the time from exposure to fever is an average of about 10 days, and from exposure to rash onset is about 14 days — but could be up to 21 days. In addition, infected people are contagious from four days before rash starts through four days after. That’s a long period of time where they could unknowingly infect others.

CNN: What has been the cause of recent measles outbreaks?

Wen: It’s important to note that this incident in Kentucky is not yet considered an outbreak. Only one person has been diagnosed with measles. That person was possibly exposed to many others given the number of people in attendance at this gathering, but we don’t know yet if any of those people were infected.

But let’s look at a recent example of a confirmed outbreak in the US: In November 2022, health officials in central Ohio raised alarm over young children being diagnosed with measles. In all, 85 children got sick. None of the children died, but 36 needed to be hospitalized. All those infected were either unvaccinated or not yet fully vaccinated.

Health officials were able to contain the outbreak through contact tracing, vaccination and other public health measures in early February, and it was declared over. But there is concern it won’t be the last of its kind. A study from the CDC reported the rate of immunizations for required vaccines among kindergarten students nationwide dropped from 95% in the 2019-20 school year to 93% in the 2021-22 school year. Some communities have far lower rates than this national average, however, which can lead to outbreaks — not only of measles but also diseases like polio that can also have severe consequences.

CNN: How effective is the MMR vaccine?

Wen: The MMR vaccine is a two-dose vaccine. The recommendation is for children to receive the first dose at age 12-15 months and the second dose at age 4-6 years. One dose of the MMR vaccine 93% effective at preventing measles infection. Two doses are 97% effective.

CNN: What is the best way to protect against measles?

Wen: The MMR vaccine is an extremely safe and very effective vaccine and is recognized as a significant public health advance for preventing an otherwise extremely contagious disease from spreading and causing potentially very severe — even fatal — outcomes.

Consider that the vaccine was licensed in the US in 1963. In the four years before that, there were an average of more than 500,000 cases of measles every year and over 430 measles-associated deaths. By 1998, there were just 89 cases and no measles-associated deaths. That’s a huge public health triumph.

Young children should receive the vaccine according to the recommended schedule. Older kids and adults who never received it should also discuss getting it with their health care provider. And clinicians and public health officials in the US and around the world should redouble efforts to increase routine childhood immunizations so as to stop preventable diseases from making a comeback.

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March 8, 2023

Asthma, cancer, erectile drugs sent from abroad make up are most confiscations, despite opioid claims | CNN

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For years, the FDA has defended its efforts to intercept prescription drugs coming from abroad by mail as necessary to keep out dangerous opioids, including fentanyl.

The pharmaceutical industry frequently cites such concerns in its battle to stymie numerous proposals in Washington to allow Americans to buy drugs from Canada and other countries where prices are almost always much lower.

But the agency’s own data from recent years on its confiscation of packages containing drugs coming through international mail provides scant evidence that a significant number of opioids enters this way. In the two years for which KHN obtained data from the agency, only a tiny fraction of the drugs inspected contained opioids.

The overwhelming majority were uncontrolled prescription drugs that people had ordered, presumably because they can’t afford the prices at home.

The FDA still stops those drugs, because they lack U.S. labeling and packaging, which federal authorities say ensure they were made under U.S. supervision and tracking.

The FDA said it found 33 packages of opioids and no fentanyl sent by mail in 2022 out of nearly 53,000 drug shipments its inspectors examined at international mail facilities. That’s about 0.06% of examined packages.

According to a detailed breakdown of drugs intercepted in 2020, the lion’s share of what was intercepted — and most often destroyed — was pharmaceuticals. The No. 1 item was cheap erectile dysfunction pills, like generic Viagra. But there were also prescribed medicines to treat asthma, diabetes, cancer, and HIV.

FDA spokesperson Devin Koontz said the figures don’t reflect the full picture because U.S. Customs and Border Protection is the primary screener at the mail facilities.

But data obtained from the customs agency shows it likewise found few opioids: Of more than 30,000 drugs it intercepted in 2022 at the international mail facilities, only 111 were fentanyl and 116 were other opioids.

On average, Americans pay more than twice the price for exactly the same drugs as people in other countries. In polling, 7% of U.S. adults say they do not take their medicines because they can’t afford them. About 8% admit they or someone else in their household has ordered medicines from overseas to save money, though it is technically illegal in most cases. At least four states — Florida, Colorado, New Hampshire, and New Mexico — have proposed programs that would allow residents to import drugs from Canada.

While the FDA has found only a relatively small number of opioids, including fentanyl, in international mail, Congress gave the agency a total of $10 million in 2022 and 2023 to expand efforts to interdict shipments of opioids and other unapproved drugs.

“Additional staffing coupled with improved analytical technology and data analytics techniques will allow us to not only examine more packages but will also increase our targeting abilities to ensure we are examining packages with a high probability of containing violative products,” said Dan Solis, assistant commissioner for import operations at the FDA.

But drug importation proponents worry the increased inspections targeting opioids will result in more uncontrolled substances being blocked in the mail.

“The FDA continues to ask for more and more taxpayer money to stop fentanyl and opioids at international mail facilities, but it appears to be using that money to refuse and destroy an increasing number of regular international prescription drug orders,” said Gabe Levitt, president of PharmacyChecker.com, which accredits foreign online pharmacies that sell medicines to customers in the U.S. and worldwide. “The argument that importing drugs is going to inflame the opioid crisis doesn’t make any sense.”

“The nation’s fentanyl import crisis should not be conflated with safe personal drug importation,” Levitt said.

He was not surprised at the low number of opioids being sent through the mail: In 2022, an organization he heads called Prescription Justice received 2020 FDA data through a Freedom of Information Act request. It showed that FDA inspectors intercepted 214 packages with opioids and no fentanyl out of roughly 50,000 drug shipments. In contrast, they found nearly 12,000 packages containing erectile dysfunction pills. They also blocked thousands of packages containing prescription medicines to treat a host of other conditions.

Over 90% of the drugs found at international mail facilities are destroyed or denied entry into the United States, FDA officials said.

In 2019, an FDA document touted the agency’s efforts to stop fentanyl coming into the United States by mail amid efforts to stop other illegal drugs.

Levitt was pleased that Congress in December added language to a federal spending bill that he said would refocus the FDA mail inspections. It said the “FDA’s efforts at International Mail Facilities must focus on preventing controlled, counterfeit, or otherwise dangerous pharmaceuticals from entering the United States. Further, funds made available in this Act should prioritize cases in which importation poses a significant threat to public health.”

Levitt said the language should shift the FDA from stopping shipments containing drugs for cancer, heart conditions, and erectile dysfunction to blocking controlled substances, including opioids.

But the FDA’s Koontz said the language won’t change the type of drugs FDA inspectors examine, because every drug is potentially dangerous. “Importing drugs from abroad simply for cost savings is not a good enough reason to expose yourself to the additional risks,” he said. “The drug may be fine, but we don’t know, so we assume it is not.”

He said even drugs that are made in the same manufacturing facilities as drugs intended for sale in the United States can be dangerous because they lack U.S. labeling and packaging that ensure they were made properly and handled within the U.S. supply chain.

FDA officials say drugs bought from foreign pharmacies are 10 times as likely to be counterfeit as drugs sold in the United States.

To back up that claim, the FDA cites congressional testimony from a former agency official in 2005 who — while working for a drug industry-funded think tank — said between 8% and 10% of the global medicine supply chain is counterfeit.

The FDA said it doesn’t have data showing which drugs it finds are unsafe counterfeits and which drugs lack proper labeling or packaging. The U.S. Customs and Border Protection data shows that, among the more than 30,000 drugs it inspected in 2022, it found 365 counterfeits.

Pharmaceutical Research and Manufacturers of America, the trade group for the industry, funds a nonprofit advocacy organization called Partnership for Safe Medicines, which has run media campaigns to oppose drug importation efforts with the argument that it would worsen the fentanyl epidemic.

Shabbir Safdar, executive director of the Partnership for Safe Medicines, a group funded by U.S. pharmaceutical manufacturers, said he was surprised the amount of fentanyl and opioids found by customs and FDA inspectors in the mail was so low. He said that historically it has been a problem, but he could not provide proof of that claim.

He said federal agencies are not inspecting enough packages to get the full picture. “With limited resources we may be getting fooled by the smugglers,” he said. “We need to be inspecting the right 50,000 packages each year.”

For decades, millions of Americans seeking to save money have bought drugs from foreign pharmacies, with most sales done online. Although the FDA says people are not allowed to bring prescription drugs into the United States except in rare cases, dozens of cities, county governments, and school districts help their employees buy drugs from abroad.

The Trump administration said in 2020 that drugs could be safely imported and opened the door for states to apply to the FDA to start importation programs. But the Biden administration has yet to approve any.

A federal judge in February threw out a lawsuit filed by PhRMA and the Partnership for Safe Medicines to block the federal drug importation program, saying it’s unclear when, if ever, the federal government would approve any state programs.

Levitt and other importation advocates say the process is often safe largely because the drugs being sold to people with valid prescriptions via international mail are FDA-approved drugs with labeling different from that found at U.S. pharmacies, or foreign versions of FDA-approved drugs made at the same facilities as drugs sold in the U.S. or similarly regulated facilities. Most drugs sold at U.S. pharmacies are already produced abroad.

Because of the sheer volume of mail, even as the FDA has stepped up staffing at the mail facilities in recent years, the agency can physically inspect fewer than 1% of packages presumed to contain drugs, FDA officials said.

Solis said the agency targets its interdiction efforts to packages from countries from which it believes counterfeit or illegal drugs are more likely to come.

Advocates for importation say efforts to block it protect the pharmaceutical industry’s profits and hurt U.S. residents trying to afford their medicines.

“We have never seen a rash of deaths or harm from prescription drugs that people bring across the border from verified pharmacies, because these are the same drugs that people buy in American pharmacies,” said Alex Lawson, executive director of Social Security Works, which advocates for lower drug prices. “The pharmaceutical industry is using the FDA to protect their price monopoly to keep their prices high.”

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March 5, 2023

Naloxone nasal spray may soon be in your pharmacy. Our medical analyst explains what it is and who can use it | CNN

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CNN
—

Two advisory committees to the US Food and Drug Administration have voted unanimously to recommend that a nasal spray version of the opioid overdose antidote, naloxone (also called Narcan), be made available over the counter.

If the FDA agrees with this recommendation, naloxone may soon be sold without a prescription in pharmacies and made available in grocery stores, big-box stores, gas stations, and corner stores around the country.

This development comes at a time when opioid overdoses are at a record high, rising more than 15% in one year. Deaths attributed to opioids rose from around 70,000 in 2020 to 80,800 in 2021, according to the US Centers for Disease Control and Prevention. The highly potent and lethal opioid, fentanyl, is implicated in the majority of these deaths.

What is naloxone, and how does it work to save lives from opioid overdose? How do you know if someone is overdosing, and how can bystanders administer the antidote? How can people get access to it now, and what will it mean if the FDA approves it for over-the-counter use? What more needs to be done to reduce overdose deaths?

To guide us through these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also the chair of the advisory board for Behavioral Health Group, a network of outpatient opioid treatment and recovery centers around the United States. Previously, she was Baltimore’s health commissioner, where she led the city’s overdose prevention strategy.

CNN: How does naloxone work to save people overdosing on opioids?

Dr. Leana Wen: Naloxone is a medicine that rapidly reverses the effect of an opioid overdose. It is an antagonist to opioids, meaning that it attaches to the opioid receptors in the brain, and in doing so, reverses and blocks the effects of opioids.

Someone who has taken too large of a quantity of opioids can become unconscious and stop breathing. This is deadly — a person can die within minutes after they stop breathing. Naloxone reverses the effect of the opioid overdose and can restore normal breathing within a couple of minutes.

CNN: What are the different versions of naloxone? Does it work against illicit drugs like heroin and fentanyl as well as prescription drugs?

Wen: Naloxone comes in two main forms. There is the nasal spray version, with one manufacturer calling its product Narcan Nasal Spray. This version is sprayed into the nostril, similar to some allergy medications.

Naloxone also comes as a liquid. This form can be injected either intravenously through an IV, if a patient already has an IV inserted, or intramuscularly, usually as a shot through the quadriceps muscle in the leg.

Several years ago, there was another version of naloxone that was in an autoinjector, similar to an EpiPen that’s given to people with life-threatening allergic reactions. In 2019, the manufacturer made a business decision to stop making that version available to the public. (An autoinjector is still approved for use by the military and for chemical incident responders.)

The nasal spray, intravenous and intramuscular versions all work very well, and they all work against various versions of opioids. That includes not only heroin and fentanyl but also common opioid medications like oxycodone, hydrocodone, codeine and morphine. It’s important to note that one dose may not be enough, depending on how potent and how much opioid was taken. Often, several doses are needed to revive someone.

CNN: How do you know if someone is overdosing, and how can bystanders administer the antidote?

Wen: Signs of overdose include being unable to be awakened, breathing slowly or not breathing at all, and fingernails and lips taking on a blue or purple color while the skin becomes pale and clammy to the touch. Their pupils are often described as “pinpoint,” or very small.

Someone can overdose from taking too much of an opioid by accident. This often happens when fentanyl, an extremely potent opioid, is mixed with whatever the person is taking without their knowledge. Also, if an opioid is mixed with alcohol or benzodiazepines or other opioids, they can also become unresponsive. And there are instances when someone may not realize they are taking opioids, but the pill they obtained is contaminated with fentanyl.

If someone is overdosing, you or someone who is with you must call 911 immediately. In the meantime, administer naloxone. Naloxone reverses an overdose for up to about 90 minutes, but opioids can stay in the system for longer, so it’s still important for the person to receive medical attention after receiving the drug. Depending on the opioid the person took, they may need to be monitored in the hospital for hours after in case naloxone wears off while the opioid continues to have an effect.

If you have the nasal spray version, insert the tip of the device into the nostril and squeeze. Another spray may be given in the other nostril in two to three minutes if the patient remains unresponsive, and another one in another two to three minutes until either the patient responds or emergency help arrives. If you are trained to perform CPR, and the person isn’t breathing, you should administer CPR as well, in between giving naloxone.

CNN: Is naloxone safe to use? What if you’re not sure if someone is overdosing from opioids?

Wen: Yes, naloxone is extremely safe. If someone is not on opioids and is unresponsive, say, because they drank too much alcohol or has had a stroke, naloxone will have no adverse effect for them. That’s why emergency medical personnel routinely administer naloxone to patients who are found to be unresponsive; there is no harm to people who are unresponsive from non-opioid-related reasons.

If someone overdosed on opioids, naloxone reversal will send them into withdrawal. This could be unpleasant for the individual and could lead to vomiting, agitation, shivering, tearing up and having a runny nose. These aren’t desirable side effects, of course, but in cases when naloxone must be given, the alternative is death.

CNN: How can people get access to naloxone now? What will it mean if the FDA approves it for over-the-counter use?

Wen: As an emergency physician, I’ve given naloxone many times. First responders like paramedics and emergency medical technicians also routinely administer naloxone. When I served as Baltimore’s health commissioner, I felt strongly that everyone should be able to save someone else’s life.

Nonmedical personnel may already obtain and carry naloxone with them, but specific requirements and regulations vary by the state. Health departments and some community nonprofit groups have low-priced or free naloxone that they distribute to community members. Often, the naloxone is distributed to individuals who use drugs, because they are most likely to be around others who are overdosing. Also, their family members can use naloxone to revive them.

If the FDA approves the nasal spray naloxone for over-the-counter use, that means it will be more accessible. People should be able to purchase the spray from pharmacies, grocery stores, gas stations and perhaps even vending machines.

The problem is cost. We don’t yet know how the over-the-counter naloxone spray will be priced, and whether and how much insurance companies cover it will probably vary.

CNN: What more needs to be done to reduce overdose deaths?

Wen: Naloxone access is an important step. Someone who is overdosing has no chance for a better tomorrow if they are dead today. I would encourage everyone with a family member who is on opioids for chronic pain or has an opioid addiction to carry naloxone with them, so that they could save their loved one’s life.

Longer-term, a person who has an opioid use disorder needs treatment with a combination of medications and psychosocial supports. Much more needs to be done to expand treatment access, as well as to reduce the supply of illicitly manufactured drugs like fentanyl that are worsening the overdose crisis.

Finally, I want to remind everyone of 988, a new 24/7 phone and chat hotline that provides suicide counseling, crisis supports and referral for people in need of mental health and addiction support.

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March 4, 2023

One month later, people living near a toxic train derailment wonder if their lives will ever be back on track | CNN

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East Palestine, Ohio
CNN
—

This had been a quiet little town of about 4,700 people nestled in the rolling hills of Northeast Ohio. A sign posted on State Road 14 welcomes visitors to East Palestine, “the place to be.”

But for the past month, ever since a freight train derailed and caught fire, the town has been bustling with responders and reporters. Residents say they’re grateful for the help, but the attention and uncertainty have begun to strain the town’s hospitality.

Town halls and news conferences have taken over the school auditoriums and municipal buildings and shut down its main street. A clinic opened to address worrisome health questions and symptoms, and government workers have been going door-to-door to survey residents about health impacts.

Gov. Mike DeWine has traveled to East Palestine four times since the derailment and US Environmental Protection Agency Administrator Michael Regan three times, each with entourages of aides and press wranglers. Some business owners near the downtown area are so tired of answering questions, they posted signs asking reporters to stay out.

The streets are busy with utility trucks for environmental clean-up companies TetraTech, Arcadis and AEComm. Plastic hoses snake into Leslie Run and Sulphur Run, two creeks that run through town that were contaminated by the accident. Large pieces of equipment that look like showerheads churn and bubble the water in these streams, hoping to speed the breakdown of chemicals in them.

Still, the floral, fruity odor of the chemical butyl acrylate still wafts up from the streams.

Many residents say they are angry.

Donna Reidy, 62, lives about a mile and a half away from the site in a white house on a hill that overlooks Leslie Run, one of the area waterways contaminated by the spill. On Thursday, she answered questions for a government health study that’s being conducted by the Agency for Toxic Substances and Disease Registry, a division of the US Centers for Disease Control and Prevention.

Reidy said that neither she or her husband – who has lung problems and requires supplemental oxygen – experienced any new or worsening physical symptoms since the derailment. However, her daughter, who also lives in East Palestine, had, she told investigators.

Reidy said her daughter had to gone to the hospital after vomiting and developing a rash. Donna said the stress of trying to protect her husband and worry for her daughter had worsened some anxiety she already struggled with, and she’s afraid of health problems that could arise later on.

“I’ve already had cancer, I don’t want to get it again,” she told Dr. Dallas Shi, an officer in the CDC’s Epidemic Intelligence Service, as they stood in the front yard outside her home.

For the study, called an assessment of chemical exposure, or ACE, Shi is working with a mapping specialist Ian Dunn, a geospatial health scientist and CDC contractor, to interview residents in some of the areas believed to be most impacted by the contamination.

After Reidy answered pages of required questions, Shi and Dunn ask her if there was anything else she wanted them to know.

“Yeah,” she said. “This stuff sucks.”

“We got roots here,” she told them. Five generations of her family lived in East Palestine. Her husband’s father saved money during World War II and sent it home to his wife so they could buy the home they live in today. Her children and grandchildren have gone to the local schools.

“They just ruined everything,” Reidy says, speaking of Norfolk Southern.

“My kids are moving, my grandkids are moving away. They just ruined everything,” she said as she started to cry.

“I’m so sorry,” Shi said, “Can I give you a hug?”

Shi, who was dressed in her dark blue public health service uniform and black work boots, put her arms around Reidy. “I can’t imagine,” she said.

“I’m so mad at them because they’re so cheap and all they cared about was money for themselves,” Reidy went on, speaking through tears. “They should have huge fines against them.”

Then Reidy apologized for getting upset.

On Thursday night, some area residents came to the local high school auditorium for a town hall meeting – their first chance to confront Norfolk Southern since the spill – and expressed similar anger and frustration.

The company was ordered to appear at the town hall by the EPA after declining to participate in earlier events.

“One thing I would like to say … is that we are sorry. We’re very sorry. We feel horrible about it,” said Darrell Wilson, who was representing the company.

The room erupted with shouts of “Buy us out!”

“Do the right thing,” one man shouted. “Tell Alan to buy us out,” referring to Norfolk Southern CEO Alan Shaw.

Several people said they believed staying in their homes was making them ill, but they couldn’t afford to go anywhere else. They want the railroad to buy their homes, which they feel have lost value since the spill.

“Get us out!” some yelled.

“We are going to do the right thing,” Wilson said, responding to the shouts.

Wilson said the company had leased office space in town and “and we signed a long lease. So we’re gonna be here for a long time,” he said..

But when asked whether there had been talk of the company relocating residents, he said there had not.

Some said they had experienced health problems since returning to their homes after the derailment. Others said they had lost their jobs or stopped going to work at jobs they felt were too close to the site. They are worried about their children or grandchildren potentially being exposed to toxins and having health problems down the road.

Some people say they continue to experience symptoms such as headaches, vomiting, dizziness and persistent coughs, and they feel puzzled by ongoing tests of the town’s air and water that have not detected chemicals at levels that are known to pose health risks.

“Why are people getting sick if there are no toxins?” East Palestine resident Jamie Cozza asked the panel answering questions at Thursday’s town hall.

“We do have a team here that is trying to collect health information so that we have a better understanding of the potential exposures and health effects,” said Capt. Jill Shugart, who is an associate director of emergency management at CDC’s Agency for Toxic Substances and Disease Registry, or ATSDR.

The agency is conducting a total of three Assessment of Chemical Exposure, or ACE, investigations – one for Ohio residents, one for people in Pennsylvania, and another for first responders to the accident scene.

Shugart said it would take about three weeks to collect enough information to get an understanding of the full picture, then the agency has to work with Pennsylvania and Ohio to present their findings to residents.

Data from some surveys are starting to come available. On Friday, the Ohio Department of Health released preliminary data from its ACE survey, and out of 168 completed, 74% of people said they experienced headaches, 64% reported anxiety, 61% reported coughing, 58% listed fatigue, and 52% said they had irritation, pain or burning of their skin. The health department is still collecting surveys through its health assessment clinic, which will be open again next week.

Many at the town hall said they felt that the evacuation order had been lifted too soon – less than a week after the derailment – and may have put them in harm’s way, before any potential dangers were fully assessed.

On Thursday, the EPA capitulated to demands from residents and said it would require Norfolk Southern to test for dioxins, cancer-causing chemicals that form during combustion. The EPA had previously declined to require testing for dioxins, saying that these chemicals are already present in the environment, so it’s hard to interpret what their levels mean. The EPA said it would require the railroad company to study background levels of dioxins in comparable areas in order to give some context to the test results.

Authorities have focused much of their concern on a 2-mile radius around the spill, but residents that live farther away, including some farmers in nearby Pennsylvania, say they’ve been impacted, too.

Dave Anderson raises grass fed beef 4 miles downwind of East Palestine, in nearby Darlington Township, Pennsylvania. After the derailment, fire and controlled burn of toxic chemicals, the thick black smoke drifted over his Echo Valley Farm.

“As far as the smoke, you could probably see 100 yards,” Anderson told CNN’s Miguel Marquez.

Anderson said his eyes, throat and mouth burned.

The cloud from the spill settled on his pastures and ponds. Anderson said now he’s not sure whether the grassfed cattle he’s raised for years are safe for human consumption.

So far, there’s been no testing of his water, soil or air on his farm.

Pennsylvania’s Department of Environment Protection, or DEP, just visited Anderson’s farm for the first time this week, nearly four weeks after the event.

In a written statement provided to CNN, the Pennsylvania Department of Agriculture said it launched a hotline encouraging those impacted to reach out if they have concerns about livestock or crops.

Also this week, Pennsylvania opened a community resource center in Darlington to help people who want to get their soil or wells tested. The center is also conducting medical exams for residents with health concerns. Adam Ortiz, regional administrator for EPA’s region 3 office, which includes Pennsylvania, said the center has seen about 100 people a day since it opened.

The crash occurred just feet from the Pennsylvania border. The winds typically blow east, toward Pennsylvania. The state is going house to house, testing soil and water in areas closest to the derailment. Anderson said officials are still trying to figure out if they should extend that testing to other areas.

Samuel Wenger and his wife Joyce had their fourth child, Jackson Hayes, a week ago. Wenger said the state’s response has been too slow and lacking in information to know whether Darlington is still a safe place to raise a family.

They only recently were able to get their well tested, and they were told it would take another three weeks to get the results of that testing. They said it was agonizing to bring their newborn son back to their house when they don’t have answers about contamination.

“I feel like I possibly regret the decision every day but here we live paycheck to paycheck, we live within our means, and we don’t have the financial luxury to pack up and move,” Samuel said. “It’s scary.”

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February 28, 2023

High levels of chemicals could pose long-term risks at Ohio train derailment site, researchers say | CNN

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An analysis of data from the US Environmental Protection Agency’s measurements of pollutants released from the Norfolk Southern train derailment in East Palestine, Ohio, suggests that nine of the dozens of chemicals that the EPA has been monitoring are higher than would normally be found in the area, according to a group of scientists from Texas A&M and Carnegie Mellon University.

If the levels of some of these chemicals remain high, it could be a problem for residents’ health in the long term, the scientists say. Temperature changes or high winds might stir up the chemicals and release them into the atmosphere.

The highest levels found in East Palestine were of a chemical called acrolein, the analysis says.

Acrolein is used to control plants, algae, rodents and microorganisms. It is a clear liquid at room temperature, and it is toxic. It can cause inflammation and irritation of the skin, respiratory tract and mucous membranes, according to the US Centers for Disease Control and Prevention.

“It’s not elevated to the point where it’s necessarily like an immediate ‘evacuate the building’ health concern,” said Dr. Albert Presto, an associate research professor of mechanical engineering at Carnegie Mellon’s Wilton E. Scott Institute for Energy Innovation, who is working on the university’s chemical monitoring effort in East Palestine. “But, you know, we don’t know necessarily what the long-term risk is or how long that concentration that causes that risk will persist.”

Much of what scientists know about chemical exposure comes from people’s contact with chemicals at work, Preston said, which generally means exposure for about eight hours a day. People now living in East Palestine are in constant contact with the chemicals, he said, and the impact of that kind of exposure on the human body is not fully understood.

The EPA and local government officials have repeatedly said that their tests show the air quality in the area is safe and that the chemicals should dissipate. As of Sunday, officials have tested air in 578 homes, and they say chemical pollution levels have not exceeded residential air quality standards.

EPA’s air monitoring data shows that levels of monitored chemicals “are below levels of concern for adverse health impacts from short-term exposures,” an agency spokesperson told CNN on Monday. “The long-term risks referenced by this analysis assume a lifetime of exposure, which is constant exposure over approximately 70 years. EPA does not anticipate levels of these chemicals will stay high for anywhere near that. We are committed to staying in East Palestine and will continue to monitor the air inside and outside of homes to ensure that these levels remain safe over time.”

However, residents have reported rashes and trouble breathing, sometimes even in their own homes, Presto said.

“When someone says to them then, ‘everything is fine everywhere,’ if I were that person, I wouldn’t believe that statement,” he said.

So who’s right? The scientists say it’s not a black-and-white issue.

“I think it’s important for the public to understand that all sides are right. No one’s lying to them,” said Dr. Ivan Rusyn, director of the Texas A&M University Superfund Research Center and part of the team that did the analysis. “It’s just that every time you’re sharing information, whether it’s Administrator of EPA Michael Regan or Governor [Mike] DeWine or someone from Ohio EPA, when they say certain things are ‘safe,’ they really need to explain what they mean.”

Rusyn says the EPA and local officials need to do a better job of communicating with the public about the risk to residents when they are exposed to chemicals released in the crash.

Communication struggles have been a consistent pattern over the years and over numerous environmental disasters, he said. Officials will often do a good job of collecting and releasing data but then fail to give the proper context that the public will understand.

“That’s what I would like to encourage all parties to do rather than to point fingers,” Rusyn said. “The general public has to trust authorities. Cleanup is continuing. They are doing monitoring. We just need to do a better job communicating the results.”

Government communication about residents’ real level of risk has been a significant source of frustration in East Palestine, Presto said.

“People are furious. They feel like they’re getting this black-and-white answer – things are safe or not safe – when it’s not a black-and-white sort of situation,” Presto said.

The EPA says it will continue to monitor the air quality in the area and in residents’ homes. It is also setting up a community center so residents and business owners can ask questions about agency activity there.

The agency said it is collecting outdoor air samples for contaminants of concern, including vinyl chloride, a hard plastic resin used to make plastic products like pipes or packaging material that can be a cancer concern; n-butyl acrylate a clear liquid used to make resins and paint products that can cause eye, throat, nose and lung irritation or damage as well as a skin allergy; and ethylhexyl acrylate, another colorless liquid used to make paints, plastics and adhesives that can cause skin and eye irritation.

The EPA also collected field measurements for hydrogen sulfide, benzene, hydrogen cyanide, hydrogen chloride, phosgene and particulate matter.

Scientists from Texas A&M and Carnegie Mellon are monitoring the chemicals in the area using a mobile lab that they’ve used for the past decade to measure air pollution in real time in cities across the country. They expect to release data from their own tests in East Palestine on Tuesday.

The mobile lab has extremely sensitive equipment that can measure pollution in the parts per trillion. Scientists would then be able to plot them on a graph to show, in real time, where the concentrations of chemicals may be and at what level, Presto said.

Mobile lab workers will try to determine whether there are chemicals in the air that the EPA isn’t monitoring. They are also looking at pollution levels in places where the agency did not set up monitoring stations.

“The situation has to be monitored, and the EPA should continue measurements, and they should also communicate to the general public as to what they’re seeing and put this into context of risk, rather than use the numbers and expect people to figure it out for themselves,” Rusyn said.

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