The Centers for Disease Control and Prevention (CDC) today announced a plan to invest $2.25 billion over two years to address Coronavirus Disease 2019 (COVID-19)-related health disparities and advance health equity among populations that are at high-risk and underserved, including racial and ethnic minority groups and people living in rural areas. This funding represents CDC’s largest investment to date to support communities affected by COVID-19-related health disparities.
“Everyone in America should have equal opportunity to be as healthy as possible,” said CDC Director Rochelle P. Walensky, MD, MPH. “This investment will be monumental in anchoring equity at the center of our nation’s COVID-19 response—and is a key step forward in bringing resources and focus to health inequities that have for far too long persisted in our country.”
Data show that COVID-19 has disproportionately affected some populations and placed them at higher risk, including those who are medically underserved, racial and ethnic minority groups, and people living in rural communities. These groups may experience higher risk of exposure, infection, hospitalization, and mortality. In addition, evidence shows that racial and ethnic minority groups and people living in rural communities have disproportionate rates of chronic diseases that can increase the risk of becoming severely ill from COVID-19 and may also encounter barriers to testing, treatment, or vaccination.
To stop the spread of the COVID-19 virus and move toward greater health equity, CDC continues to work with populations at higher risk, underserved and disproportionately affected to ensure resources are available to maintain and manage physical and mental health, including easy access to information, affordable testing, and medical and mental health care. For more information and community resources visit: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/index.html
This initiative is funded through the Coronavirus Response and Relief Supplemental Appropriations Act, 2021, (P.L. 116-260) and is expected to award funding to up to 108 state, local, territorial, and freely associated state health departments, or their bona fide agents. CDC will be accepting applications for this initiative through April 30, 2021.
The U.S. flu season is just beginning, and can last until May (with peak infections hitting between December and February). While it’s far too early to predict the severity of this year’s flu season in the U.S., physicians are encouraging everyone to vaccinate ahead of the anticipated peak infection times.
The following flu prevention resources from the CDC serve as a guide for healthcare workers, teachers, and concerned parents seeking additional flu-related facts and information.
In a call for conversations and action between health care providers and their patients about travel health, the Centers for Disease Control and Prevention (CDC) has launched a new travel awareness campaign. The goals of this campaign are to help health care providers protect the health of and diagnose infectious diseases in international travelers.
US residents are traveling to destinations around the world where they can get sick from infections such as yellow fever, Zika, Lassa fever, dengue and travelers’ diarrhea. Resources tied to the “Think Travel” campaign will give primary or urgent care physicians, physician assistants, nurse practitioners, and pharmacists tools to help them keep their patients healthy during and after international travel. Here is how Think Travel can help you in your practice:
Think Travel Can Prevent Disease
While conducting a routine physical exam, your patient mentions an upcoming Amazon cruise through the Brazilian rainforest. You ask if she has scheduled a pre-travel consultation. During the pre-travel consultation, international travelers receive preventive guidance, vaccines (e.g., yellow fever), and medications for prophylaxis (e.g., malaria) or self-treatment (e.g., travelers’ diarrhea) recommended for their destination. She tells you she has not, but will as soon as she leaves. Thinking travel may have helped prevent any number of infections in this traveler.
Think Travel Can Save Lives
A patient presents to your emergency department with fever, chills, and myalgia. The resident on duty prescribes oseltamivir for suspected influenza. From the hall, you overhear the patient sharing with a Ghanaian nurse that his parents live in Ghana. You step in and ask about the last time he visited his family, and it turns out he returned from Ghana only recently. After additional tests, a blood smear reveals Plasmodium falciparum malaria. Thinking travel may have saved this patient’s life.
Think Travel Can Protect Communities
A mother brings her 6-year-old child to your clinic with fever, rash, and upper respiratory symptoms. You ask about travel history and learn that the family just got back from vacation in France, where there is currently a measles outbreak. Upon further questioning, the mother tells you that her child has not received an MMR (measles-mumps-rubella) vaccine. Thinking travel helped identify the exposure risk in your clinic and potentially prevented the spread of measles to other unvaccinated people.
Get Your Patients Travel-Ready
US-based travelers made nearly 90 million international trips in 2017, with only an estimated 14% seeking any sort of pre-travel advice. A pre-travel consultation is your opportunity to provide patients with the protection they need against travel-associated diseases: recommended vaccines, medications, and guidance about preventive behaviors (such as insect bite prevention and food safety). If you have patients planning international travel, make sure to provide pre-travel care with Think Travel support resources. If your clinic does not offer these services, help patients find a travel health clinic here: https://wwwnc.cdc.gov/travel/page/find-clinic.
CDC offers several resources to help you conduct pre-travel consultations, including:
A Pre-Travel Guide: highlights major topics of discussion to support pre-travel consultations with patients traveling abroad.
A Destination Finder Tool: provides destination-specific information on disease risk, CDC recommendations for vaccines and medications, and topics for patient counseling.
A Pre-Travel Tool: offers step-by-step tool for clinicians conducting pre-travel assessments and generates customized recommendations for vaccines, medications, and counseling.
Always Ask About Recent Travel
People who live in the US are traveling internationally more now than ever before. Increasingly, they are traveling to areas where tropical infections, such as Zika, dengue, and Lassa fever, are a risk. Taking a travel history from an ill patient can help you expand your differential diagnosis to include etiologies that would be much less likely for patients who had not left the United States.
CDC posts travel health notices (https://wwwnc.cdc.gov/travel/notices) that identify international disease outbreaks or notify clinicians and travelers about diseases appearing in new or unexpected locations or outbreaks that exceed baseline disease-endemic case rates. Being aware of these notices can assist you, if you think to ask about recent international travel or include questions about recent travel as part of the patient intake.
When providers have conversations with their patients about travel, they can help them have a safer, healthier time abroad. Thinking travel can also help clinicians arrive at solutions to diagnostic challenges. Thinking travel can help prevent disease, save lives, and protect communities. Go to www.cdc.gov/ThinkTravel to find CDC resources to help with pre-travel consultations and post-travel evaluations.
Now that spring is upon most of the country, it’s a good time to refresh yourself about understanding tick-borne disease, learning how to protect yourself, and recognizing signs and symptoms of infections in yourself and in your patients.
Lyme disease gets most of the tick-borne disease headlines, but there are plenty of other illnesses caused by ticks that cause just as much misery and potentially life-changing harm.
Ticks tend to live in wooded areas and fields with tall grasses. The feed on blood, so small rodents like mice or larger animals like deer, moose, or human beings make perfect hosts for these bugs. Household pets that go outside are also known to bring ticks into your home where they can drop off on floors and furniture and attach to people. They will attach to their host and can remain attached for days, transmitting diseases along the way. According to the Centers for Disease Control and Prevention, some of the more well known tick-borne diseases include Lyme, bartonella, babesiosis, anaplasmosis, tularemia, and Rocky Mountain spotted fever.
Most people can see the larger ticks, but they can get into areas that you won’t notice immediately – like your back, your feet, under your arms, or your scalp. But the ticks in the larval stage are nearly microscopic and are almost invisible unless you are searching for them. Even then, they are tough to see. And many ticks transmit a chemical that acts like an anesthetic, so your skin might not be irritated when they are biting you.
The first step in tick-borne illness is preventing yourself from ever getting it. That means treating your indoor/outdoor pets with tick medication that will both repel ticks from your animals and kill any that attach.
When you are outside, cover up with long pants tucked into socks and long sleeves if you are taking a hike or gardening. Use bug spray containing DEET to keep ticks off your exposed skin, but make sure you wash it off when you come in. And when you do come in from outside, head straight to the shower. Take your clothes off (from underwear to socks to coats) and pout them in plastic bags if you can’t get them right into the washing machine. Wash your clothes and then put everything in the dryer to kill off any ticks that might still be attached.
If you do notice a tick, pull it off with tweezers by grabbing the tick at the head and pulling hard enough to remove the whole tick. You want to make sure the head is not still burrowed into the skin. If that happens, you might need to get it removed (yet another bonus when you are working with nurses!). Wash the area and your hands and then apply an antibiotic and a bandage. Watch for signs of infection around the bite (or a Lyme-alert of a bulls-eye rash). Also pay attention to how you feel—any joint pain, fevers, flu-like symptoms, headaches—could signal a tick-borne illness.
Generally, treatment will consist of several weeks of antibiotics, but some people suffer longer-term issues. According to the Lyme Disease Association, there’s debate in the medical community, as some health practitioners believe Lyme is exceptionally difficult to diagnose and eradicate. Other believe the lingering symptoms some patients feel are related more to an autoimmune issue.
Either way, a tick-borne illness is miserable to deal with and your best course of action is prevention. You don’t have to avoid the outdoors, but take precautions and check yourself, your family members, and your pets when you all come in from the outside.
The first national study on Hispanic health risks and leading causes of death in the United States by the Centers for Disease Control and Prevention (CDC) showed that similar to non-Hispanic whites (whites), the two leading causes of death in Hispanics are heart disease and cancer. Fewer Hispanics than whites die from the 10 leading causes of death, but Hispanics had higher death rates than whites from diabetes and chronic liver disease and cirrhosis. They have similar death rates from kidney diseases, according to the new Vital Signs.
Health risk can vary by Hispanic subgroup. For example, nearly 66% more Puerto Ricans smoke than Mexicans. Health risk also varies partly by whether Hispanics were born in the United States or in another country. Hispanics are almost three times as likely to be uninsured as whites. Hispanics in the United States are on average nearly 15 years younger than whites, so taking steps now to prevent disease could mean longer, healthier lives for Hispanics.
“Four out of 10 Hispanics die of heart disease or cancer. By not smoking and staying physically active, such as walking briskly for 30 minutes a day, Hispanics can reduce their risk for these chronic diseases and others such as diabetes,” says CDC Director Tom Frieden, MD, MPH. “Health professionals can help Hispanics protect their health by learning about their specific risk factors and addressing barriers to care.”
This Vital Signs report recommends that doctors, nurses, and other health professionals
• work with interpreters to eliminate language barriers when patients prefer to speak Spanish.
• counsel patients with or at high risk for high blood pressure, diabetes, or cancer on weight control and diet.
• ask patients if they smoke and, if they do, help them quit.
• engage community health workers (promotores de salud) to educate and link people to free or low-cost services.
Hispanic and other Spanish-speaking doctors and clinicians, as well as community health workers or promotores de salud, play a key role in helping to provide culturally and linguistically appropriate outreach to Hispanic patients.
The Vital Signs report used recent national census and health surveillance data to determine differences between Hispanics and whites, and among Hispanic subgroups. Hispanics are the largest racial and ethnic minority group in the United States. Currently, nearly one in six people living in the United States (almost 57 million) is Hispanic, and this is projected to increase to nearly one in four (more than 85 million) by 2035.
Despite lower overall death rates, the study stressed that Hispanics may face challenges in getting the care needed to protect their health. Sociodemographic findings include:
• About one in three Hispanics have limited English proficiency.
• About one in four Hispanics live below the poverty line, compared with whites.
• About one in three has not completed high school.
These sociodemographic gaps are even wider for foreign-born Hispanics, but foreign-born Hispanics experience better health and fewer health risks than U.S.-born Hispanics for some key health indicators, such as cancer, heart disease, obesity, hypertension, and smoking, the report said.
The report also found different degrees of health risk among Hispanics by country of origin:
• Mexicans and Puerto Ricans are about twice as likely to die from diabetes as whites. Mexicans also are nearly twice as likely to die from chronic liver disease and cirrhosis as whites.
• Smoking overall among Hispanics (14%) is less common than among whites (24%), but is high among Puerto Rican males (26%) and Cuban males (22%).
• Colorectal cancer screening varies for Hispanics aged 50 to 75 years.
• About 40% of Cubans get screened (29% of men and 49% of women).
• About 58% of Puerto Ricans get screened (54% of men and 61% of women).
• Hispanics are as likely as whites to have high blood pressure. But Hispanic women with high blood pressure are twice as likely as Hispanic men to get it under control.
“This report reinforces the need to sustain strong community, public health, and health care linkages that support Hispanic health,” says CDC Associate Director for Minority Health and Health Equity, Leandris C. Liburd, PhD, MPH, MA.
