National

The U.S. faces a range of health care flashpoints — unaffordable drugs, opioids, vaping — as we debate whether to adopt universal care. For now, the Affordable Care Act is the law of the land, but Republicans want to issue it a final death blow.

Health

More than 100,000 people died from drug overdoses in the U.S. in 2021, more than in any other year on record, according to provisional data released by the National Center for Health Statistics Wednesday.

Why it matters: The grim milestone, a 15% increase from overdose deaths in 2020, occurred during the coronavirus pandemic, which also killed over 415,000 in the country that year and almost 1 million in total so far.

The data presented is incomplete, as many deaths require more investigating to confirm a cause, though estimates rarely largely differ from the final totals.

The National Center for Health Statistics said at least 107,622 people died from overdoses in 2021, a major increase from the estimated 93,655 deaths in 2020.

Overdose deaths involving opioids increased from an estimated 70,029 in 2020 to 80,816 in 2021.

Alaska experienced the largest percentage increase in overdose deaths in 2021. Deaths there were up by 75.3%.

The big picture: Overdose deaths passed 100,000 in a 12-month period for the first time in November 2021.

The U.S. experienced its highest yearly death total in 2021 because of coronavirus fatalities and overdose deaths.

Adolescents and young adults lost an estimated 1.2 million years of life from unintentional drug overdoses between 2015 and 2019, according to a study published in JAMA in February.

What they're saying: “It is unacceptable that we are losing a life to overdose every five minutes around the clock," said Dr. Rahul Gupta, Director of the White House Office of National Drug Control Policy. 

"That is why President Biden’s new National Drug Control Strategy signals a new era of drug policy centered on individuals and communities, focusing specifically on the actions we must take right now to reduce overdoses and save lives."

The Biden administration last month sent Congress its first national drug control strategy, which emphasizes addressing untreated addiction through harm reduction strategies and evidence-based treatments and clamping down on drug trafficking.

Go deeper: Walgreens reaches $683 million opioid settlement with Florida

U.S. surpassed 100,000 overdose deaths in 2021

Overdose deaths involving opioids increased by more than 10,000 compared to 2020.

A bag of prescription drugs being poured into a box at a drug reclamation event organized by the Drug Enforcement Administration in Los Angeles in 2021.

A bag of prescription drugs being poured into a box at a drug reclamation event organized by the Drug Enforcement Administration in Los Angeles in 2021. Photo: Patrick Fallon/AFP via Getty Images

Drug overdoses

Politics & Policy

Axios Vitals

More than four in 10 hospitals have seen staffing shortages limit their ability to discharge patients because of a lack of post-acute care, according to a survey provided exclusively to Axios by CarePort Health, a care coordination software company.

The big picture: Health care staffing shortages in the wake of the COVID-19 pandemic have been felt across the industry and are noticed by patients.

Among the hardest hit are the facilities that fall on the spectrum of post-acute care.

Zoom in: This National Hospital Week survey is limited — it captured the responses of care coordination leaders at 71 hospitals and post-acute care providers — but offers a glimpse at the potential real-world impacts of shortages on the health care system.

For instance, 86% of hospitals said COVID-19 made it harder to secure placement for discharged patients.

70% of respondents said hospital length of stay is increasing due to challenges discharging patients.

Editor's note: This story has been corrected to reflect this survey captured the responses at 71 hospitals and post-acute care providers, not 23.

Staffing shortages slam hospitals

More than four in 10 hospitals have seen staffing shortages limit their ability to discharge patients.

Health care

Austin

Axios Austin

Smaller indoor events are more likely to spread COVID than much bigger, outdoor ones, per a new report by University of Texas researchers. 

Driving the news: With COVID deaths and hospitalizations way down from pandemic highs, Americans are convening once more, indoors and out.

And many of them are headed to Austin — for everything from ACL Fest to political rallies and business conferences.

Details: Researchers put together two case studies — a business conference with 3,000 attendees and an outdoor festival with 50,000 attendees.

What they found: Pre-event testing requirements were more effective at preventing attendees from showing up infected than vaccine mandates.

Outdoor festivals, although larger, had a lower per-person impact on total infections over the following four weeks.

Of note: The report was co-authored by Austin Public Health's Desmar Walkes.

Between the lines: Three key factors determine the risks of COVID transmission and consequences for the surrounding community, the researchers found.

The first is the structure of the event –– its size, duration, density and venue. Limiting the number of attendees, physically spacing out activities and selecting outdoor and well-ventilated sites can significantly mitigate risks. 

The second factor is the state of the pandemic. “If the local healthcare system is strained, the additional spillover infections from the event into the community could be catastrophic,” the researchers write.

The final factor is risk-reduction measures. Event planners can mitigate the immediate and downstream risks by requiring proof of vaccination, a negative COVID test just prior to the event, and/or wearing face masks during the event.

The bottom line: Outdoor events are safer than indoor events. 

"Although the hypothetical outdoor festival is over ten times the size of the hypothetical business conference, we estimate that it will produce only double the number of infections within the community during and following the event," the researchers concluded.

Austin Alerts

A daily look at the most significant and interesting stories affecting Austin. Written by Nicole Cobler and Asher Price.

Axios Austin Thought Bubble

The future of large events and COVID

Smaller indoor events are more likely to spread COVID than bigger, outdoor ones, per a new report by UT researchers.

Illustration of a lanyard badge with requirement checkboxes changing. 

A look at the scientific breakthroughs changing the world, explorations in space and in worlds beyond our own and the threats posed to us by our own planet, both out of our control and of our own making.

Science

A week after the maker of a controversial Alzheimer's drug announced it would largely stop marketing it, Congress is readying legislation that tinkers with the pathway used by the FDA to approve the drug, but avoids making large-scale changes.

Why it matters: Aduhelm's approval created heightened scrutiny around whether the FDA's "accelerated approval" process is being used appropriately. But as the drug fades largely into the background, so are the calls for stringent reforms.

Be smart: Accelerated approval lets drugmakers sell their products based on preliminary evidence and finish clinical trials once they're already on the market. 

14 of the 50 new drugs the FDA approved last year went through the accelerated pathway, including Takeda Pharmaceuticals' Livtencity for post-transplant infections. 

But the process has drawn concern because of the way it could put big-ticket drugs in the public's hands that may wind up being ineffective or unsafe. 

The Aduhelm approval came amid doubts that the criteria used for its approval proved the drug was effective, and the FDA's own advisory board had recommended against its approval. Manufacturer Biogen said last week it's cutting back on marketing the drug as part of efforts to refocus its business.

Driving the news: House Energy and Commerce leaders are proposing fixes as part of a broader legislative package to renew FDA programs that will be marked up today.

They would strengthen the FDA's power to ensure there are clear conditions for completing confirmatory trials and gives regulators the authority to require studies to be underway before approval is granted.

The bipartisan legislation also clarifies conditions under which the FDA could withdraw an accelerated approval and adds labeling requirements for drugs that go through the process.

Between the lines: Democrats and Republicans were divided over how far to go, with Democrats in favor of putting more of the onus on manufacturers to justify keeping the approvals and Republicans wanting to expand the use of the pathway, per Cowen analysts Eric Assaraf and Rick Weissenstein.

The House package focuses on areas where there's consensus and approaches that have been endorsed by the Biden administration, the analysts said.

The big drug industry lobby PhRMA says the process should be left as is, adding just six of 165 products that received accelerated approval in the last decade have been withdrawn, and that another nine sponsors pulled their applications.

The big picture: While experts and policymakers say the pathway can deliver breakthrough therapies faster, there are lingering questions about whether the program could be misused.

As with drug pricing, lawmakers appear set on making changes the pharmaceutical industry can tolerate.

Editor's note: This story has been corrected to reflect that Regeneron's Evkeeza was granted FDA's priority review but not accelerated approval.

Fast-track drug approval process marked for limited changes

Illustration of a stopwatch made from a large round prescription pill

Food and Drug Administration (FDA)

The Solomon R. Guggenheim Museum has removed the Sackler name from an education center following years-long controversies over the family's role in the opioid crisis.

Why it matters: The Sacklers made billions from the sale of highly addictive opioid painkillers and were embroiled in several litigation battles until March, when they reached a $6 billion settlement with U.S. states.

The Guggenheim's removal of the Sackler name took place quietly last week and was not publicly announced, the New York Times reports.

What they're saying: "The Guggenheim and the Mortimer D. Sackler family have agreed to rename the arts education center," museum spokesperson Sara Fox said Tuesday in a statement.

"We believe this decision is in the best interest of the Museum and the vital work it does."

The big picture: The Guggenheim, based in New York City, is the latest institution to cut ties with the disgraced family.

The National Gallery in London said Monday that it would remove the Sackler name from its walls, according to Forbes.

The Metropolitan Museum of Art dropped the name from one of its most popular galleries as well as six other exhibition spaces in December, per the Times.

Several museums have outright rejected donations from the family.

Guggenheim becomes latest museum to drop Sackler name

More museums are cutting ties with the Sacklers after they were embroiled in litigation over their role in the opioid crisis.

Photo of people milling about several floors of art galleries

Museum-goers look at paintings on Dec. 12, 2021, at the Guggenheim Museum in New York City. Photo: Robert Nickelsberg via Getty Images

Opioid epidemic

Opioids

After a record economic expansion, the coronavirus pandemic sent the U.S. economy into a recession as unemployment soared to staggering heights. The country now faces urgent questions about how much stimulus is needed for reeling consumers and businesses, and what a recovery might look like.

Economy & Business

The Food and Drug Administration (FDA) said Tuesday that it is "doing everything in our power" to improve the supply of baby formula.

Driving the news: The nation's baby formula shortage has intensified in recent weeks due to supply chain issues and a recent recall of Abbott Nutrition products.

What they're saying: “We recognize that many consumers have been unable to access infant formula and critical medical foods they are accustomed to using and are frustrated by their inability to do so," said FDA commissioner Robert Califf in a statement.

"We are doing everything in our power to ensure there is adequate product available where and when they need it,” he said.

"Ensuring the availability of safe, sole-source nutrition products like infant formula is of the utmost importance to the FDA."

The shortage is "a top priority to the White House and this administration,” said White House press secretary Karine Jean-Pierre at a briefing Wednesday.

"This is an urgent issue that the FDA as you all know and the White House is working 24/7 to address. They are committed to pulling every lever and are ready to making progress in getting more supply onto the market.”

Abbott Nutrition said in a statement it's been working to address issues the FDA pointed out.

"Some of these actions have included reviewing and updating education, training and safety procedures for both employees and visitors, as well as updating our protocols regarding water and cleaning and maintenance procedures at the facility," Abbott said.

Abbott said within two weeks, it could reopen its site in Sturgis, Michigan, where the recalled baby powder was first produced, pending FDA approval. That development "will help alleviate this shortage," the company said.

EleCare, Alimentum and other formulas would be produced there first, before it would start production of Similac again. Baby formula products would be available on shelves six to eight weeks after the site restarts, the company said.

The big picture: About 3-in-4 babies are fed formula for the first six months of their lives as a substitute for human milk products, Axios' Nathan Bomey writes.

Shortages — likely started by distribution issues and production woes — have recently plagued the United States.

What's next: Califf said the FDA "will continue doing everything within our authority to ensure the production of safe infant formula products.”

White House press secretary Jen Psaki said Monday the FDA is "working around the clock" to address the shortage, CNN reports.

Go deeper: "Terrifying" baby formula shortage worsens

Editor's note: This post was updated with additional details throughout. 

FDA says it is "doing everything in our power" to improve baby formula supply

The shortage has intensified in recent weeks due to supply chain issues and a devastating recall.

An empty baby formula display. Photo: Paul Hennessy via Getty Images

If abortion were illegal and you had an unwanted or unplanned pregnancy, what would you do?

Data: Generation Lab; Chart: Simran Parwani/Axios

Over half of young women aged 18-29 say they would get an abortion if they had an unwanted or unplanned pregnancy — even if it were illegal, according to a new Generation Lab flash poll first provided to Axios.

Why it matters: Last week's news that the Supreme Court is prepared to overturn Roe v. Wade has raised questions on what access would look like without a federal right to an abortion. Even in states where they remain legal, abortions could be harder to access because those clinics could be flooded with patients from states that have cracked down.

Women in their 20s accounted for the majority of abortions between 2010 and 2019. 

By the numbers: 56% of respondents who identified as women said they would seek out an abortion provider even if it was illegal and they had an unwanted or unplanned pregnancy.

34% said they would have the baby in the event abortion was illegal, while 10% said they'd attempt to end the pregnancy at home.

45% of respondents who identified as men said they would take additional precautions like using physical contraceptives more often if abortion were illegal, while 43% said they would not change anything and 11% said they would be more likely to get a vasectomy.

49% of all respondents said abortion should be legal in all cases, 27% said it should be legal in most cases, 16% said it should be illegal in most cases and 8% said it should be illegal in all cases.

46% of respondents said they have a "mostly unfavorable" opinion of the Supreme Court, while 22% said their opinion was "very unfavorable." 28% said it was "mostly favorable," and only 4% said they had a "very favorable" opinion.

The big picture: Approximately six in 10 U.S. adults believe abortion should be legal in "all or most cases," according to a recent Pew Research Center survey.

Abortion clinics are already preparing to shift people and resources away from red states, while blue states are taking steps to plan for a potential influx in patients if Roe falls.

Methodology: This poll surveyed 813 people ranging from ages 18 to 29 between May 5 and 8. 460 people self-identified as women and 353 self-identified as men. 

Go deeper: The state of abortion in America

Poll: Over half of young women say they would get an abortion even if it were illegal

Women in their 20s accounted for the majority of abortions between 2010 and 2019.

Abortion

Public health

The firearm homicide rate in the U.S. reached its highest level since 1994 during the first year of the COVID pandemic, with significant racial and class disparities, according to a CDC report published Tuesday.

Driving the news: 2020 saw a historic rise in homicides in the U.S., and the upward trend continued into 2021.

About 79% of homicides and 53% of suicides in the U.S. involved firearms in 2020, according to the CDC report.

The big picture: The nation's firearm homicide rate increased 34.6% from 2019 to 2020, with the largest increases occurring among Black men aged 10-44 years old and Native American or Alaska Native men aged 25-44 years old, per the new report.

"The firearm homicide rate among Black males aged 10–24 years was 20.6 times as high as the rate among white males of the same age in 2019, and this ratio increased to 21.6 in 2020," the report says.

Larger increases were also observed at higher poverty levels, with racial and ethnic minorities more likely to live in communities with high surrounding poverty.

Counties with the highest poverty levels in 2020 experienced firearm homicide and suicide rates that were 4.5 and 1.3 times as high, respectively, as counties with the lowest poverty levels.

While overall firearm suicide rates remained "relatively unchanged" from 2019 to 2020, increasing only slightly, the highest increases were observed among Native Americans or Alaska Natives "at the two highest poverty levels," the report noted.

What they're saying: The CDC noted that firearm homicides and suicides are a "persistent and significant" public health concern in the U.S. 

During the pandemic, "longstanding systemic inequities and structural racism have resulted in limited economic, housing, and educational opportunities associated with inequities in risk for violence and other health conditions among various racial and ethnic groups," the report stated.

The bottom line: The study's findings "underscore the importance of comprehensive strategies that can stop violence" by addressing underlying factors that contribute to homicide and suicide rates, including economic and social inequalities that drive racial disparities in health outcomes, per the report.

These could include policies that improve economic and household stability — such as child care subsidies and housing assistance — and community outreach programs.

Firearm homicides hit highest level since 1994

In 2020, about 79% of homicides and 53% of suicides in the U.S. involved firearms.

Photo: Dylan Bouscher/MediaNews Group/East Bay Times via Getty Images

Gun violence

China's "zero-COVID" strategy isn't sustainable given the virus' ever-evolving nature, World Health Organization director-general Tedros Adhanom Ghebreyesus said at a media briefing Tuesday.

The big picture: Tedros said WHO officials have spoken to Chinese experts about the policy. The extreme measures have saved lives, but they've also led to food shortages, a lack of workers and movement restrictions, writes Axios' Bethany Allen-Ebrahimian.

What he's saying: "When we talk about the zero-COVID strategy, we don't think that it's sustainable, considering the behavior of the virus now and what we anticipate in the future," Tedros said.

"I think a shift will be very important. ... Now we know a lot about the virus and we have better tools, so these are the additional opportunities that we have to make a shift."

Chinese President Xi Jinping during a meeting with top leaders said the country will stick to its strategy, and officials vowed to "resolutely fight" against any questioning of its virus control policies, according to CNBC.

“We have won the battle to defend Wuhan, and can certainly win the battle to defend Shanghai,” read the official readout from the meeting, per CNBC.

State of play: In March, China instituted a lockdown in Shanghai, its largest city and financial capital, to tamp down a rise in cases.

Shanghai authorities two weeks later eased the lockdown amid a food crisis that saw residents scrambling for access to food and medicine.

Shanghai officials again tightened pandemic restrictions on Tuesday, AP reported. 

Parts of the city have been forced into "quiet periods," with officials revoking permits allowing residents to go out for limited shopping and closing supermarkets except for delivery services.

Service on the city's two metro lines that were still operating has also been suspended.

WHO chief: China's zero-COVID strategy not "sustainable"

"Considering the nature of the virus, I think a shift will be very important."

Tedros Adhanom Ghebreyesus. Photo: Andreas Arnold/picture alliance via Getty Images

Coronavirus

China

China is becoming the most formidable rival America has faced, and the risk of confrontation with Russia, North Korea or Iran still looms. Authoritarians are rising, the chaotic Afghanistan exit revealed the limits of U.S. power, and the pandemic, climate change and other critical challenges continue to pose grave threats.

World

Between 5.3 million and 14.2 million people could lose their health coverage when temporary pandemic-inspired reforms to Medicaid expire at the end of the public health emergency, according to a new Kaiser Family Foundation analysis.

The big picture: Democrats who hoped they'd enact transformational health legislation with control of the White House and Congress could instead face a historic jump in the U.S. uninsured rate.

Background: Congress in 2020 included measures in pandemic relief legislation that increased the share of federal Medicaid spending if states offered continuous coverage to enrollees, suspending the program's usual churn.

The extra allowances sunset with the end of the public health emergency, which is due to expire July 15 unless the Biden administration extends it again.

Go deeper: Kaiser examined scenarios for how states can determine whether their Medicaid enrollees are still eligible for coverage when policy changes hit the safety net program.

The biggest losses are expected to be among adults who gained coverage through the Affordable Care Act's Medicaid expansion, other adults eligible for reasons other than a disability, as well as children.

Medicaid enrollment is expected to grow 25%, or by 22.2 million people, from fiscal 2019 through 2022, mostly because of the pandemic-driven allowances, the researchers project.

Millions could lose coverage when COVID public health emergency ends

Democrats who hoped to enact transformational health legislation could instead face a historic jump in the U.S. uninsured rate.

Illustration of a person looking over the edge of a large cliff chasm shaped like a medical cross

If the U.S. Supreme Court overturns Roe v. Wade, it could begin a ripple effect that subsumes many other facets of reproductive health care — a reflection, in part, of decades' worth of medical advances that make the subject much more complicated than it was 50 years ago. 

Why it matters: Striking down the federal right to abortion could impact how people prevent becoming pregnant, how families grow and how miscarriages are managed.

Where it stands: If a leaked draft of the SCOTUS opinion to overturn abortion rights is finalized, states would decide whether abortion is legal, under what terms and even how abortion is defined. 

More than a dozen states already have laws in place that would automatically ban abortions if Roe is overturned. 

The language of these laws varies. But legal experts say they and other state laws create a hornet's nest of legal ambiguities.

"Banning abortion definitely has implications for other aspects of care, without a doubt. And it is everything from how you deal with miscarriages all the way to thinking about which methods of contraception are going to be acceptable," said Kaiser Family Foundation's Alina Salganicoff. "It's very complicated, and I think we're going to see a lot of laws as well as legal challenges to laws that we haven't seen before."

Between the lines: One immediate issue is the way state laws define "unborn human beings," and the way some definitions potentially make bans apply to embryos created through the IVF process and some forms of birth control.  

Some states' trigger laws define life as beginning at fertilization, or when a sperm penetrates an egg. 

Louisiana's trigger law, for example, specifies that "'unborn human being' means an individual living member of the species, homo sapiens, throughout the entire embryonic and fetal stages of the unborn child from fertilization to full gestation and childbirth."

The IVF process works by fertilizing eggs with sperm in a lab and then transferring that fertilized egg — or embryo — to a uterus. But it's common for surplus embryos to be created that wind up going unused. 

Some state laws may confer legal protections to those unused embryos, experts say.

"There are going to be a lot of ancillary effects, and this could be quite catastrophic on the fertility industry," said Traci Keen, CEO of Mate Fertility. If a fertilized egg is declared life by law, then discarding that embryo "would be considered an abortion."

Some forms of birth control may also prevent a fertilized egg from implanting in a uterus and are considered forms of abortion by some conservatives.

The other side: Some other state laws contain language that experts say make them less likely to apply to IVF or contraception.

In Missouri's trigger law, for example, abortion is defined as terminating "the life of an embryo or fetus in his or her mother's womb," which may exclude embryos outside of the womb. 

Utah defines abortion as the termination of a pregnancy "after implantation of a fertilized ovum," suggesting protection only applies to embryos that have already implanted into the uterus. 

Arkansas, Kentucky and Louisiana laws specify that their abortion bans don't apply to contraception that's administered before a pregnancy can be detected through medical testing. 

The ruling could also have unintended consequences for managing miscarriages, which often uses the same methods as abortions.

"There's concerns about whether clinicians who are going to be working in states that will effectively ban abortion are going to be concerned about using a medication that is considered an abortifacient to manage the miscarriage," Salganicoff said.

State laws factor a provider's intent. That means providers may have to take additional steps to show they gave care after a fetus was already nonviable, to distinguish from providing the same care with the aim of terminating a pregnancy.

"I suspect in states where abortion is banned medical providers will develop appropriate techniques to determine compliance with the law. So I think it'll change the standard of care," said Naomi Cahn, co-director of UVA Law's Family Law Center. "I would imagine that they would want to be very careful in documenting this."

Experts say women may also be forced to carry pregnancies in which the baby won't survive after birth.

State laws generally allow abortions when the life of the mother is at risk, and some contain clauses saying that abortion is permissible to remove a "dead fetus" or a "dead, unborn child." That generally means the same procedure used for an abortion can be used for the removal of a dead fetus in the event of miscarriage or stillbirth.

But some women whose lives aren't at imminent risk could be imperiled as the pregnancy continues. Abortion may not be an option for them, nor for some women with nonviable pregnancies.

Texas' six-week abortion ban makes no exceptions for these scenarios, the New York Times reported last year.

What we're watching: Courts will likely have to interpret the scope of existing state laws. But in the meantime, states may move to write new policies.

Overturning Roe creates a tempest for reproductive health

Overturning Roe could have ripple effect on other reproductive care

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