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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Goodbye, Johns Hopkins covid tracker

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

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Today’s edition: The Biden administration wants nursing homes to disclose more details on their ownership. Teen girls are “engulfed in a growing wave of violence and trauma,” according to federal researchers. But first … 

The CDC wasn’t able to share covid information in an accessible way. The Johns Hopkins tracker filled the void.

When the pandemic hit, the federal government struggled to publish snapshots of the virus’ spread.

So, academics and journalists quickly filled the void, creating new tools with near real-time estimates of the unfolding pandemic. Since January 2020, Johns Hopkins University has operated one of the most prominent resources for tracking covid-19 case counts and deaths across the world. 

After more than three years, the university will stop updating its tracker on March 10 as the country has moved into a different stage of the pandemic with a different data flow. But the story of the online dashboard — a $13 million project that’s been viewed over 2.5 billion times — is more than just about a tool to track the pandemic. It underscores the country’s fragmented public health systems and its decentralized and underfunded reporting system, which hobbled the U.S. pandemic response. 

  • “The thing that became the biggest surprise was the importance and reliance on it by everyone: by the general public and decision-makers and everyone in between,” said Lauren Gardner, the director of the Johns Hopkins Center for Systems Science and Engineering who started the global tracker with one of her PhD students.
  • “Hopkins filled a gap that nobody else was able to do,” Ali Mokdad, a professor of health metrics sciences at University of Washington’s IHME. “So all of us, reporters, us in academia, we went to Hopkins to get the data.”
Why now?

The Johns Hopkins researchers point out that they don’t believe the pandemic has ended — and the move to stop updating the tracker shouldn’t be conflated as such. Instead, the decision comes amid a different phase of the pandemic and was made for two main reasons. 

The first: The Centers for Disease Control and Prevention and the World Health Organization have built up their capacity to share covid data with the general public, which Gardner called the “appropriate” entities to be providing this information long term. 

The second: The quality of the tracker depends on the quality of publicly available data. At the beginning of the pandemic, states, counties and even cities were providing daily covid updates, which scrapers for the tracker could collect data from. But that’s not the case anymore, and that has a direct impact on what the dashboard can do. 

Looking forward

The country has made some improvements on its data collection efforts, but there’s still a ways to go, according to several experts. 

Beth Blauer, an associate vice provost at Johns Hopkins University who helped run the Coronavirus Resource Center, said that many states closed up their covid reporting with little information on any next steps. 

“Our big question is whether or not they’re making long-term investments in critical public health data infrastructure to navigate lots of challenges that they face,” Blauer said, citing the opioid epidemic and economic mobility. 

As for the CDC, Gardner said she believes the agency recognizes the value in being able to quickly stand up public data reporting if another pandemic strikes, but that it would still take time. “There’s a lot of things that have to change because of this patchwork system that we have, because of the independence of the states from the federal government in the way they do things, and the obligations of data sharing,” she said, “and so I think it's not an easy fix.”

In recent months, Rochelle Walensky, the director of the CDC, has emphasized to lawmakers on Capitol Hill that the agency needs more authority to mandate data reporting from states and other jurisdictions amid frequent criticism that the agency has failed to be agile. The CDC sets up data use agreements with states and various localities, a time-consuming process. 

  • The CDC “lack[s] important data authorities, and unfortunately, it doesn't look likely that Congress is going to give them those authorities,” said Tom Frieden, the agency’s director under former president Barack Obama. “So I think they’re going to have to figure out a way through it if Congress doesn’t act.” 

Agency alert

Biden administration seeks to increase transparency of nursing home ownership

The Post’s Christopher Rowland sends us this dispatch:

The Biden administration announced yesterday that it plans to require private equity firms and real estate investment trusts to disclose when they own nursing homes, citing a need for transparency into investor-owned operations that officials said have been linked to worse outcomes for residents, including higher rates of mortality and excess use of antipsychotic drugs.

The details: Opaque ownership of nursing homes has frustrated advocates for nursing home residents, who say multilayered partnerships and corporations make it difficult to track the performance of chains or even to discern who owns individual facilities. The administration proposed making more ownership data available to the public, and nursing homes will have to make the disclosures as part of their application process, including when nursing homes change hands. 

It’s another incremental step in Biden's efforts to improve conditions in U.S. nursing homes. The plan that has attracted the most attention, announced last year, is to impose minimum federal staffing standards on nursing homes for the first time. Details of that plan are expected to be unveiled in coming months.

HHS cited academic studies that have shown worse outcomes for residents in nursing homes owned by private equity. Inadequate infection controls in nursing homes contributed to waves of infections and deaths in the first two years of the coronavirus pandemic, an argument the industry has pushed back against.

The other side: “Focusing on ownership and private equity is a red herring,” Mark Parkinson, the head of the American Health Care Association, a major nursing home trade group, said in a statement. “If we truly want to improve America’s nursing homes, we need policymakers to prioritize investing in our caregivers and this chronically underfunded health care sector.”

HHS Secretary Xavier Becerra:

On the Hill

House panel targets senior Biden administration officials in pandemic origin probe

Republicans on the House select subcommittee on the coronavirus pandemic kicked off their first investigation into the origins of covid-19 while in the majority by renewing their calls for testimony and documents from top current and former Biden administration officials. 

Reps. Brad Wenstrup (R-Ohio), chair of the panel, and James Comer (R-Ky.), leader of the House Oversight and Accountability Committee, are pressing for information on the source of the outbreak and details on federal funds supporting research in Wuhan, China. Officials include Anthony Fauci, the former head of the National Institute of Allergy and Infectious Diseases

In the last Congress, Comer and Rep. Jim Jordan (R-Ohio) sent letters demanding the same information, but they claim they were snubbed. Now that Republicans have taken control of the chamber, the GOP has the authority to subpoena members of the administration if needed. 

In other news …

Remember association health plans? Top Democrats on the House Education and Workforce Committee are urging the Biden administration to rescind a Trump-era rule that allowed businesses to band together to buy health coverage.

The regulation was vacated by a federal judge in 2019, but the rule is still on the books. In a letter shared first with The Health 202, Rep. Bobby Scott (Va.), the top Democrat on the panel, and Mark DeSaulnier (Calif.), a subcommittee ranking Democrat, are expressing concern that the delay in getting rid of the rule “has generated confusion among stakeholders while potentially encouraging the proliferation of other harmful 19 arrangements.”

The letter was sent to Lisa Gomez, the assistant secretary for the Labor Department’s Employee Benefits Security Administration. The department didn’t respond to a request for comment. The Biden administration’s rulemaking agenda included exploring whether to withdraw the Trump-era rule, but those notices are nonbinding.

Democrats pressure Biden on abortion: A dozen senators are pressing the administration to take new steps to protect abortion rights amid concerns a federal judge in Texas could block access to a drug used in medication abortions, our pals at The Early 202 report.

In a letter, the senators — led by Sens. Elizabeth Warren (D-Mass.) and Mazie Hirono (D-Hawaii) — urged Biden to consider nearly a dozen ideas to make it easier for women to seek abortions, such as revoking executive orders they argue restrict abortion rights and make it easier for federal prisoners to get abortions.

Mental health

Teen girls ‘engulfed’ in violence and trauma, CDC finds

Teen girls across the United States are “engulfed in a growing wave of violence and trauma,” according to federal researchers who released data yesterday showing high levels of sadness and sexual violence, our colleague Donna St. George reports. 

By the numbers: Nearly 3 in 5 teenage girls reported feeling so persistently sad or hopeless in 2021 that they stopped regular activities, a figure that is double the share of boys and the highest in a decade, according to new findings from the Centers for Disease Control and Prevention. About 1 in 3 high school girls reported that they seriously considered suicide, up by nearly 60 percent since 2011. 

Sexual violence has also risen. In 2021, almost 15 percent of teen girls said they were forced to have sex, a 27 percent jump over the last two years and the first increase since the agency began tracking it. Agency officials said the rise of sexual violence almost certainly contributed to the glaring spike of depressive symptoms. 

Christina Johns, pediatric emergency physician: 

In other health news

  • Sixty-seven members of Congress signed onto a brief filed by the antiabortion advocacy group Americans United for Life in support of a lawsuit in Texas seeking to reverse the Food and Drug Administration’s approval of the abortion pill mifepristone.
  • The U.S. government extended its partnership with the drugmaker Novavax, agreeing to purchase 1.5 million additional doses of its protein-based coronavirus vaccine and provide funds for the development of an updated shot for the fall. 
  • Hospitals seeking to reduce their expenses are increasingly replacing doctors with nurse practitioners and physician assistants who can perform many of the same duties and generate much of the same revenue for less than half the pay, Kaiser Health News reports. 

Health reads

Your Money or Your Life: Patient on $50,000-a-Week Cancer Drug Fears Leaving Behind Huge Medical Debt (By Fred Schulte l Kaiser Health News)

Sen. Tammy Baldwin criticizes Ascension’s for-profit investment activities, requests returns and fees info (By Rachel Cohrs | Stat)

How Teens Recovered From the ‘TikTok Tics’ (By Azeen Ghorayshi | The New York Times)

Sugar rush

Thanks for reading! See y'all tomorrow.