National

An emerging fungal infection that can prove fatal in communal health settings spread further and became more drug-resistant during the pandemic, a Centers for Disease Control review of surveillance data found.

Why it matters: The timing suggests the spread of Candida auris could have been exacerbated by COVID-related stresses like staff and equipment shortages, increased antimicrobial use and changes in patient movement.

The increase in cases underscores the importance of infection control in hospitals and long-term care facilities, researchers said.

What they found: The number of C. auris clinical cases tripled from 2019 to 2021, to 1,471 in 2021.

Most U.S. cases are found in post–acute settings, especially long-term acute care hospitals.

While many early cases were contracted abroad, C. auris has been detected in more than half of the states and is endemic in some areas.

There were 3,270 clinical cases in the U.S. through 2021, along with 7,413 detected through screening.

Between the lines: The CDC is still studying how the fungus spreads, but it's been primarily detected in sick patients, particularly those with weaker immune systems or in need of catheters or feeding tubes.

Drug-resistant varieties varied by region, but the number of cases resistant to the first-line therapy echinocandins substantially increased in 2021, researchers said.

"Several new antifungal medications are in development, but more research is needed to understand outcomes for patients with these highly resistant strains and to guide treatment," they wrote in the Annals of Internal Medicine.

Drug-resistant fungus gained strength during pandemic: CDC

An emerging fungal infection that can prove fatal in communal health settings spread further and became more drug-resistant during the pandemic.

Illustration of a hand holding a petri dish with a shield made from fungi in the dish. 

Fungus

Public health

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

The Centers for Disease Control and Prevention last month warned about an increase in cases of the drug-resistant bacterial infection Shigella. 

Driving the news: There are an estimated 450,000 infections in the U.S. each year. The percentage of shigellosis that were resistant to antibiotic treatments increased from 0% in 2015 to 5% in 2022, per the CDC.

The CDC called the diarrhea-causing bacteria Shigella a "serious public health threat," noting that it can spread easily.

"Clinicians treating patients infected with XDR strains have limited antimicrobial treatment options," the CDC said. 

The first case of extensively drug-resistant Shigella was discovered in the U.S. in 2016. 

People with Shigella infection may experience diarrhea, which can be bloody, fever, stomach pain and the feeling of needing to pass stool even when the bowels are empty, per the CDC.

Symptoms typically begin 1-2 days after infection and can last for a week. The infection can affect bowel habits for several months after infection. 

For children, the American Academy of Pediatrics says that parents should call a doctor if there is blood in a child's stool, there’s no improvement or the child is showing symptoms of dehydration.

Shigella can spread easily, per the CDC, as it takes just a small number of bacteria to make somebody sick. Plus, a person can spread the infection for "several weeks" after their symptoms end. 

An individual can get infected by accidentally ingesting the bacteria, such as through contaminated food or water, or touching your mouth with the bacteria on your hand. 

To reduce your chances of getting sick, the CDC recommends washing your hands with soap and water, especially before eating and after changing a diaper. 

Additionally, the CDC says to avoid swallowing water from ponds, lakes or untreated pools and to drink filtered or bottled water when traveling internationally. 

Who is most at risk for Shigella infection? 

Children under 5 are most likely to get infected and many outbreaks occur in schools and early care settings, per the CDC.

The CDC said that other groups at risk for shigellosis include men who have sex with men, travelers who eat contaminated food or water and people who have weakened immune systems. 

What are the treatments for Shigella infection?

Most people with shigellosis get better without any treatment in 5 to 7 days, typically with fluids and rest. 

In cases of severe illness, doctors can order lab tests to determine if antibiotics would be effective in treating the illness. 

The CDC says to notify your doctor if your sickness does not get better after a couple of days of starting the antibiotics.

To prevent antimicrobial resistance, the CDC recommends "using antibiotics only when needed and exactly as prescribed."

Go deeper... The bad business of developing new antibiotics

The bad business of developing new antibiotics

What to know about the antibiotic-resistant Shigella bacteria

The CDC called the diarrhea-causing bacteria Shigella a "serious public health threat."

: Dr. Kate Williamson examines a child during a yearly routine exam at Southern Orange County Pediatric Associates in Ladera Ranch, CA on Tuesday, July 28, 2020

Kate Williamson examines a child during a yearly routine exam at Southern Orange County Pediatric Associates in Ladera Ranch, Calif., on July 28, 2020. Photo: Paul Bersebach/MediaNews Group/Orange County Register via Getty Images

Viruses

Wyoming became the first state to ban abortion pills this week after Gov. Mark Gordon (R) signed the controversial bill into law on Friday.

Why it matters: The demand for abortion pills has surged since the Supreme Court overturned Roe v. Wade. The new law also comes as the nation awaits a ruling from a federal judge in Texas who could suspend the FDA's approval of a widely-used abortion pill.

Medication abortion accounted for more than half of all U.S. abortions in 2020, according to the reproductive policy nonprofit Guttmacher Institute.

Abortion pills are frequently prescribed via telehealth and mailed to patients, allowing abortion seekers to circumvent state restrictions on the procedure.

Driving the news: The new law bans the use of abortion medication with a few exceptions, including in the treatment of a "natural miscarriage according to currently accepted medical guidelines," according to the text of the legislation.

Any physician or person who prescribes, distributes or otherwise provides abortion medication could face prison for a maximum of six months and a fine of up to $9,000.

Women who attempt chemical abortions would not be criminally prosecuted.

Gordon has said that legal challenges are expected and that "this question needs to be decided as soon as possible so that the issue of abortion in Wyoming can be finally resolved," AP reports.

The new law will have "no practical impact on abortion in the state of Wyoming, as all abortions were already outlawed by a bill that the Governor signed last year," Michael Pearlman, Gordon’s communications director, said in a statement to Axios. 

Pearlman noted that the abortion ban is currently being challenged in court and that this new law "only establishes new penalties for physicians who provide chemical abortion."

What they're saying: Gordon's decision to sign the bill is "disappointing," Antonio Serrano, ACLU of Wyoming advocacy director, said in a statement. 

Deeply private, personal and unique decisions about abortion should be "made by pregnant people in consultation with their doctors – who should be able to treat their patients according to their best medical judgment."

"A person’s health, not politics, should guide important medical decisions – including the decision to have an abortion," Serrano added.

Don't forget: Wyoming's trigger abortion ban is currently tied up in courts after health providers filed a lawsuit last July challenging the law's constitutionality.

The big picture: Wyoming isn't the only state moving to outlaw or restrict abortion pills. 

Fifteen states already restrict access to medication abortion, including six that require an in-person visit with a physician, per the Guttmacher Institute.

What to watch: In Texas, District Judge Matthew Kacsmaryk, a Trump appointee who openly opposed Roe v. Wade, is poised to order the FDA to temporarily withdraw its approval of mifepristone, one of two drugs used to end pregnancies, after holding a closely watched hearing this week.

Doing so would effectively lead to a nationwide ban on medication abortions.

Wyoming becomes first state to ban abortion pills

It's one of several red states that have moved to restrict access to abortion medication in recent months.

Photo of a set of pills lying next to a box of Mifeprex

Mifepristone and misoprostol pills as displayed at a Carafem clinic for medication abortions in Skokie, Ill. Photo: Erin Hooley/Chicago Tribune/Tribune News Service via Getty Images

Abortion

Officials in Texas have released a transcript of this week's hearing in a major federal case that could limit access to abortion pills for millions of people across the country. 

Why it matters: The legal challenge was brought by a coalition of anti-abortion groups that argued the FDA did not properly authorize the pill for terminating pregnancies — and a decision in their favor could reverse the agency's authority on drug regulation for the first time.

The groups are asking the judge to grant a preliminary injunction on the FDA's approval of mifepristone, used alongside misoprostol for medication abortion.

The FDA first approved mifepristone in 2000. Now, medication abortion accounts for the majority of abortions in the U.S., according to the Guttmacher Institute.

What happened: District Judge Matthew Kacsmaryk, a Trump appointee who openly opposed Roe v. Wade, asked attorneys in the case a series of questions about legal precedent and the drug approval process during the hearing Wednesday.

Kacsmaryk at one point asked Erik Baptist, one of the anti-abortion groups' attorneys, if he could name any other cases in which a court had intervened when a drug had already been on the market for several years.

Baptist responded that he could not, and proceeded to explain that his clients had been trying for years to challenge the approval through citizen petitions that they say the FDA did not respond to in time.

The judge also asked the defendants, represented by the Department of Justice, about the FDA's use of a specific process known as Subpart H to originally approve mifepristone, noting that it had typically been used for drugs that treat diseases such as cancer and HIV.

The big picture: While Wednesday’s court hearing was open to the public, attendance was limited. Fewer than 19 reporters and 19 members of the public were allowed in the courtroom, according to the Center for Reproductive Rights.

"We represent and advise clinics who provide abortion care to patients across the country, and who could be directly impacted by this lawsuit, yet we were not allowed entry to the hearing despite traveling to Amarillo at a moment’s notice and waiting in line for hours," said Elisabeth Smith, the Center's director of state advocacy.

Worth noting: Kacsmaryk had initially planned to delay telling the public about the hearing due to security concerns, per a previous court transcript.

After The Washington Post reported his plans and several news outlets demanded that the hearing schedule be made public, the judge announced the details on Monday evening.

What we’re watching: A decision to suspend the FDA’s authorization of mifepristone would make it unavailable nationwide, and would impact how health providers across the country offer abortion care.

Some abortion providers have already said they plan to switch to a misoprostol-only regimen for medication abortions, and others say they plan to solely focus clinical abortions.

State of play: Kacsmaryk said after the hearing that he would issue a ruling "as soon as possible."

2023mar15-hippocratic-medicine-pi-hrg

Editor's note: This story has been updated with additional details from the transcript. 

READ: Transcript from high-stakes hearing on abortion pills

The case could potentially reverse the agency's authority on drug regulation for the first time.

Photo of Mifeprex pills laid out next to the brand's box

Mifepristone tablets. Photo: Stormi Greener/Star Tribune via Getty Images

The fight over abortion pills has been escalating since before Roe v. Wade was overturned, but the pills' availability is in danger now more than ever.

Why it matters: With pills now accounting for the majority of abortions, opponents of the procedure are focusing on legislatures and courts to erect barriers. But that's triggering thorny legal questions, foremost of which is playing out in a federal court in Texas over whether the FDA has the final say on whether the pills are safe.

Abortion pills have been available in the U.S. for decades, and while the FDA says that medical evidence shows they are safe and effective, the drugs have been subject of fights over manufacturing, distribution, insurance coverage and who can provide them.

Confusion around the drugs continues in the U.S., where nearly half of adults say they are not sure whether medication abortion is legal in the state they live in, according to a recent KFF survey.

Over half of abortions in the U.S. occur via abortion pills, according to the Guttmacher Institute, a research organization that supports abortion rights. 

Abortion pills are often accessed online and mailed to patients, effectively working to circumvent state bans and restrictions that took effect after the Supreme Court overturned Roe v. Wade.

Medication abortion normally consists of two pills: mifepristone and misoprostol.    

Mifepristone is approved by the FDA to be used alongside misoprostol to end a pregnancy during the first 10 weeks — this includes elective abortions and miscarriages. 

A patient first takes 200 milligrams of mifepristone orally to stop the pregnancy from growing. This is followed 1-2 days later by 800 milligrams of misoprostol taken buccally — placed between the gums and cheek — which causes cramping and bleeding to empty the uterus.

The mifepristone-misoprostol combination regimen has been found to be at least 95% effective at terminating a pregnancy.

Zoom in: Misoprostol — which is approved for the prevention and treatment of gastric ulcers — can also be taken on its own for medication abortion, a method that is supported by the World Health Organization.

While misoprostol is not specifically FDA-approved for abortions, it can still be used to terminate a pregnancy. A health provider has the authority to prescribe the drug for off-label use if they consider it to be medically appropriate.

The misoprostol-only method is slightly less effective than the combination regimen. A February study with over 1,000 U.S. participants found that using misoprostol alone was 88% effective at ending a pregnancy. 

How are the pills used in miscarriage care?

The mifepristone-misoprostol method is considered the most effective medication regimen for managing early miscarriages, per Planned Parenthood. 

The drugs are used to make sure that pregnancy tissue passes after there has been a miscarriage, which makes the patient experience bleeding.

While pregnancy tissue can pass naturally and take a few weeks to do so, the experience can be incredibly distressing for the pregnant person, so they can take mifepristone and misoprostol to ease and speed up that process.

Details: A 2018 study from the New England Journal of Medicine found that the combination regimen was more effective than the use of misoprostol alone, and reduced the likelihood for additional treatments — which might include additional doses of misoprostol or potentially surgical intervention.

Abortion pills are considered safe and effective by major medical groups, such as the American Medical Association and the American College of Obstetricians and Gynecologists.

"Medication abortion using mifepristone and misoprostol has always been part of my practice. It's incredibly safe and effective for people to end their pregnancies or to treat their pregnancy losses or miscarriages," said Jamila Perritt, president and CEO of Physicians for Reproductive Health and an OB-GYN in Washington, D.C., during a roundtable with abortion providers.

Zoom out: Mifepristone is approved for abortion use in over 80 countries.

Why is mifepristone at risk of becoming unavailable?

A coalition of anti-abortion groups in November filed a lawsuit challenging the FDA's overall approval of mifepristone. The plaintiffs argue that that the FDA did not properly authorize mifepristone for terminating pregnancies.

The lawsuit was filed in the Northern District of Texas, where a Trump-appointed federal judge who has openly opposed Roe v. Wade is considering whether to temporarily block the FDA's approval of mifepristone, which would make the medication unavailable even in states that protect access to abortion.

Meanwhile: Two lawsuits in North Carolina and West Virginia are challenging restrictions in those states to settle the question on whether states can regulate or limit drugs that have been approved by the FDA.

Another lawsuit brought by Democratic attorneys general challenges the FDA's dispensing restrictions on mifepristone, arguing that they are "unnecessary" because they drug is considered to be safe and effective.

The FDA first approved mifepristone for pregnancy termination in 2000 under the agency's Risk Evaluation and Mitigation Strategy, a program that adds dispensing restrictions to certain drugs, including requiring specific certifications for those who prescribe them. 

Since its initial approval, the FDA has loosened mifepristone's REMS restrictions over the years, including getting rid of the original in-person requirement and allowing the drug to be accessible via telehealth, as well as letting pharmacists become dispensing-certified.

State of play: Patients can go on websites like Aid Access, Hey Jane and Choix to get the drugs online and have them mailed.

Yes, but: At least 17 states have laws in place that prohibit the use of telemedicine to access abortion medication, and instead require patients to take the treatments in a health care facility.

So-called trigger laws took effect that can make it impossible for people to access abortion pills. Since then, pill providers have experienced soaring demand online.

Most of these bans and restrictions are specific to the pill provider, not the patient. As a result, a user could travel across state lines to pick up the pills. 

Some telemedicine providers — such as Aid Access — are located overseas and mail the pills to all 50 states. However, people who live in red states face a higher risk of prosecution.

What's happening: The FDA recently made a regulatory change to allow retail pharmacies to offer abortion pills, an update that looks to expand access as more red states move to ban or restrict access to abortion.

Walgreens and CVS, two of the largest U.S. pharmacy chains, have said that they plan to have some of their pharmacies certified to dispense mifepristone, as long as it does not conflict with state and federal law. 

Editor's note: This story has been updated with information about the lawsuit from Democratic attorneys general. 

How abortion pills work and why they're in the spotlight

Demand for abortion pills has soared since the Supreme Court decided to overturn Roe v. Wade.

A combination pack of mifepristone (left) and misoprostol tablets, two medicines used together as the abortion pill. Photo: Elisa Wells/ Plan C/AFP via Getty Images

Axios Explains: Abortion

President Biden has made the COVID-19 crisis and a post-Trump return to national unity and traditional democratic ideals his top priorities. From vaccinations to stimulus to schools, Biden is seeking bipartisan compromise while showing a willingness to use executive authority and bare Democratic majorities in the U.S. House and Senate to implement his policies. Republican leaders are navigating deep party divisions over if and how to move beyond former President Trump.

Politics & Policy

Three women are facing a lawsuit for wrongful death after a man accused them of helping his ex-wife obtain medication for an abortion. 

Driving the news: The lawsuit is the first of its kind under Texas' near-total abortion ban, which could make it a crime for anyone to help a pregnant person access the procedure.

Marcus Silva has alleged that his now ex-wife realized she was pregnant in July 2022, a month after Roe v. Wade was overturned and a month before Texas' trigger ban went into effect.

Two of his ex-wife's friends allegedly texted her with information about Aid Access, an international group that provides abortion pills via mail, before appearing to decipher a way to obtain the medication in Houston, according to the complaint.

The third woman delivered the medication, the lawsuit alleges. 

Details: Court records show that Silva's wife filed for divorce in May 2022; it was finalized in February, the Texas Tribune reports.

In text messages attached to the complaint, she expressed concern that Siva would "use it against me" and try to make her stay with him. "And after the fact, I know he will try to act like he has some right to the decision."

Her friends appeared to agree, with one texting: "I just worry about your emotional state and he’ll be able to snake his way into your head." They also encouraged her to delete their text conversation.

The lawsuit argues that obtaining a self-managed abortion is a crime of murder and that Silva as such has ground to sue the three women, who have not been criminally charged, under the wrongful death statute. 

Silva's wife is not named in the suit; Texas' laws exempt the pregnant person from prosecution.

Between the lines: The lawsuit says the abortion took place in July. However, at the time, the state’s trigger ban had not yet taken effect — the law became enforceable in late August.

Our thought bubble: The lawsuit brings attention to the idea that anyone other than a health provider could be punished under Texas’ trigger ban, which does not specifically state that penalties apply only to "licensed physicians."

Abortion bans have so far specifically focused on penalizing doctors, and this case could potentially change that, even as anti-abortion groups say the focus for prosecution should be on providers.

Of note: While Texas’ trigger ban states that providing an abortion could be considered a first-degree felony — punishable by life imprisonment or a term between five to 99 years — it makes no mention that abortion should be considered murder.

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3 Texas women sued for allegedly helping friend access abortion pills

Marcus Silva has sued the three women for wrongful death for allegedly assisting his now ex-wife.

Protesters march during an abortion rights rally on June 25, 2022 in Austin, Texas. Photo: Sergio Flores via Getty Images

The dropoff in cancer screenings during the pandemic didn't result in significantly more breast, cervical and colon cancer cases, or how advanced those cases were, according to a review of nearly 375,000 diagnoses in electronic health records.

Why it matters: The findings from Epic Research could ease concerns about countless hidden cases and more advanced stages of disease stemming from millions of missed screenings during the height of the pandemic.

Previous research showed the decline in primary care visits and routine tests early in the pandemic resulted in 94% decreases in both breast cancer and cervical cancer screenings and an 86% decrease in colon cancer screenings before rebounding somewhat in 2021.

What they found: There was a clear drop in cancer cases early in the pandemic that accompanied the decrease in screening. However, as screening rates returned to normal, cancer detection rates did, too. 

There wasn't a significant increase in the rate of cancer diagnoses in 2020-2022 compared to pre-pandemic, and new diagnoses of advanced cancers also didn’t rise.

Yes, but: It could take years to fully assess the impact of missed screenings, especially for cancers with longer intervals between screenings.

COVID-driven drop in cancer screenings didn't result in more new cases

The findings could ease concerns about countless hidden cases and more advanced stages of disease stemming from millions of missed screenings.

Doctors review scans of scans of a patient being treated at the Kimmel Comprehensive Cancer Center at Johns Hopkins

Dr. Julie Brahmer (R) and Katie Thornton review PET scans of a patient being treated at the Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore. Photo: Win McNamee/Getty Images

Cancer screening

Share of Americans who say they are dissatisfied with U.S. abortion policy, by reasoning

People in America are more dissatisfied with the U.S.'s abortion policy than they have ever been in the 23 years, according to a new Gallup poll released Friday.

Driving the news: Democrats' dissatisfaction with laws have jumped after the fall of Roe last June and nationwide GOP-led efforts to enforce abortion restrictions. For over 20 years, Republicans were more likely than Democrats to express dissatisfaction, per Gallup. 

By the numbers: A record-high 69% of U.S. adults are dissatisfied with abortion laws, per the Gallup poll — compared to the 26% who are satisfied with abortion policies, which is on par with last year's 24%.

46% of respondents are dissatisfied and say they want the laws to be made less strict — a 16-percentage-point jump since January 2022.

15% are dissatisfied and favor stricter laws while 8% are also dissatisfied but want the laws to stay the same.

50% of women are dissatisfied with U.S. abortion laws and support less strict policies, an 18-point jump and the highest on Gallup's record. Dissatisfied Catholics and Protestants are also increasingly backing less strict laws.

Worth noting: 74% of Democrats are dissatisfied and calling for less strict laws — a 31 percentage-point jump in one year. Independents who responded the same way saw a 13-point increase to 44%.

The percentage of Republicans who are dissatisfied and urging for a loosening of policies remained statistically unchanged at 17%.

The big picture: Women in states with abortion bans are nearly three times more likely to die during pregnancy, childbirth or soon after giving birth.

People have turned to abortion pills as a result, leading to a surge in demand after the Supreme Court overturned Roe v. Wade.

Abortion rights are expected to play a major role in the 2024 election. 

Dissatisfaction with abortion policy highest since 2001

Half of the women surveyed say they are dissatisfied with U.S. abortion laws and support less strict policies.

Policymaking

The extra food assistance benefits put into place during the COVID-19 pandemic will end nationwide in February, per the U.S. Department of Agriculture’s Food and Nutrition Service.

The big picture: After almost three years, the amount of aid provided to low-income families to combat food insecurity through the Supplemental Nutrition Assistance Program (SNAP) will return to pre-pandemic levels. 

The emergency allotments allowed SNAP households to receive an additional $95 or more in monthly benefits. 

Details: The emergency allotments have already ended in 17 states, including Alaska, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, Missouri, Montana, Nebraska, North Dakota, South Dakota, Tennessee and Wyoming.

In South Carolina, the emergency allotments will expire after the January payment is issued.

For the remaining 32 states, plus Washington, D.C., Guam and the U.S. Virgin Islands, the extra funding will end with the March benefit.

By the numbers: More than 41 million Americans used SNAP benefits in 2022, USDA data shows.

SNAP benefits returning to pre-COVID amounts in February

More than 41 million Americans used SNAP benefits in 2022.

Public health

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Mail-order abortion pill requests surged after Roe reversal, study finds

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All Public health stories

Drug-resistant fungus gained strength during pandemic: CDC

What to know about the antibiotic-resistant Shigella bacteria

Wyoming becomes first state to ban abortion pills

READ: Transcript from high-stakes hearing on abortion pills

How abortion pills work and why they're in the spotlight

3 Texas women sued for allegedly helping friend access abortion pills

COVID-driven drop in cancer screenings didn't result in more new cases

Dissatisfaction with abortion policy highest since 2001

SNAP benefits returning to pre-COVID amounts in February