'Vaccine Rates Drop Dangerously as Parents Avoid Doctor’s Visits' diff viewer (4/5)

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Vaccine Rates Drop Dangerously as Parents Avoid Doctor’s Visits	Vaccine Rates Drop Dangerously as Parents Avoid Doctor’s Visits
2020-06-09 22:13:37 UTC	2020-06-13 04:06:44 UTC (3 days later)
As parents around the country cancel well-child checkups to avoid coronavirus exposure, public health experts fear they are inadvertently sowing the seeds of another health crisis. Immunizations are dropping at a dangerous rate, putting millions of children at risk for measles, whooping cough and other life-threatening illnesses.	As parents around the country cancel well-child checkups to avoid coronavirus exposure, public health experts fear they are inadvertently sowing the seeds of another health crisis. Immunizations are dropping at a dangerous rate, putting millions of children at risk for measles, whooping cough and other life-threatening illnesses.
“The last thing we want as the collateral damage of Covid-19 are outbreaks of vaccine-preventable diseases, which we will almost certainly see if there continues to be a drop in vaccine uptake,” said Dr. Sean T. O’Leary, a member of the American Academy of Pediatrics’ committee on infectious diseases.	“The last thing we want as the collateral damage of Covid-19 are outbreaks of vaccine-preventable diseases, which we will almost certainly see if there continues to be a drop in vaccine uptake,” said Dr. Sean T. O’Leary, a member of the American Academy of Pediatrics’ committee on infectious diseases.
In the last few years, early childhood immunization rates have been slipping in some hot spots around the country, and in 2019, the United States very nearly lost its measles elimination status. While current nationwide vaccine figures are not available, anecdotal evidence and subsets of data are alarming.	In the last few years, early childhood immunization rates have been slipping in some hot spots around the country, and in 2019, the United States very nearly lost its measles elimination status. While current nationwide vaccine figures are not available, anecdotal evidence and subsets of data are alarming.
PCC, a pediatric electronic health records company, gathered vaccine information from 1,000 independent pediatricians nationwide. Using the week of February 16 as a pre-coronavirus baseline, PCC found that during the week of April 5, the administration of measles, mumps and rubella shots dropped by 50 percent; diphtheria and whooping cough shots by 42 percent; and HPV vaccines by 73 percent.	PCC, a pediatric electronic health records company, gathered vaccine information from 1,000 independent pediatricians nationwide. Using the week of February 16 as a pre-coronavirus baseline, PCC found that during the week of April 5, the administration of measles, mumps and rubella shots dropped by 50 percent; diphtheria and whooping cough shots by 42 percent; and HPV vaccines by 73 percent.
The doses that states distribute in a federally funded program for uninsured patients called Vaccines for Children have also dropped significantly since the beginning of March. The Massachusetts health department said its doses were down 68 percent in the first two weeks of April, compared with the previous year. Minnesota reported that its doses of measles, mumps and rubella vaccine dropped by 71 percent toward the end of March.	The doses that states distribute in a federally funded program for uninsured patients called Vaccines for Children have also dropped significantly since the beginning of March. The Massachusetts health department said its doses were down 68 percent in the first two weeks of April, compared with the previous year. Minnesota reported that its doses of measles, mumps and rubella vaccine dropped by 71 percent toward the end of March.
In Washington State, dozens of practices and clinics have had to reduce hours or even temporarily close. The state already had its biggest measles outbreak in nearly 30 years last year.	In Washington State, dozens of practices and clinics have had to reduce hours or even temporarily close. The state already had its biggest measles outbreak in nearly 30 years last year.
“We know our vaccine rates were already tenuous, so any additional hit to that is a great worry,” said Dr. Elizabeth Meade, president of the state’s chapter of the American Academy of Pediatrics. Dr. Meade leads calls twice a week with physicians throughout the state about how to maintain immunizations and stay solvent.	“We know our vaccine rates were already tenuous, so any additional hit to that is a great worry,” said Dr. Elizabeth Meade, president of the state’s chapter of the American Academy of Pediatrics. Dr. Meade leads calls twice a week with physicians throughout the state about how to maintain immunizations and stay solvent.
The problem is global. National immunization programs in more than two dozen countries have been suspended, which could also leave more than 100 million children vulnerable, a consortium of international organizations, including UNICEF and the World Health Organization, recently reported.	The problem is global. National immunization programs in more than two dozen countries have been suspended, which could also leave more than 100 million children vulnerable, a consortium of international organizations, including UNICEF and the World Health Organization, recently reported.
“Internationally, measles and diphtheria will pop up around the world. Even with limited travel, they can make it into the United States,” Dr. O’Leary, an immunization expert at Children’s Hospital in Denver, said.	“Internationally, measles and diphtheria will pop up around the world. Even with limited travel, they can make it into the United States,” Dr. O’Leary, an immunization expert at Children’s Hospital in Denver, said.
According to immunization experts, the optimum rate of coverage for many vaccines, known as herd immunity, is about 90 to 95 percent.	According to immunization experts, the optimum rate of coverage for many vaccines, known as herd immunity, is about 90 to 95 percent.
The Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American Academy of Family Physicians have each been urging doctors to maintain vaccination schedules as rigorously as reasonably possible, particularly for the youngest children. Vaccinate Your Family, a national nonprofit group, is pushing families to set reminders to reschedule canceled vaccine appointments.	The Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American Academy of Family Physicians have each been urging doctors to maintain vaccination schedules as rigorously as reasonably possible, particularly for the youngest children. Vaccinate Your Family, a national nonprofit group, is pushing families to set reminders to reschedule canceled vaccine appointments.
Though many doctors note that vaccine-preventable diseases can be more deadly to children than Covid-19 seems to be, parents are understandably focused on the threat at hand. Over the last six weeks, the loud, consistent public message has been to keep children at home, and to take them to the doctor only if necessary.	Though many doctors note that vaccine-preventable diseases can be more deadly to children than Covid-19 seems to be, parents are understandably focused on the threat at hand. Over the last six weeks, the loud, consistent public message has been to keep children at home, and to take them to the doctor only if necessary.
Initially, medical practices were apprehensive too. In early March, the health clinic in Barre, Mass., called Emily Hoag to say it had postponed her baby’s vaccine appointment for a month to prevent the spread of coronavirus infection. Ms. Hoag felt conflicted: If her baby, Karson, missed his two-month immunization, she feared, he would be susceptible to any number of diseases. But if she took him to the clinic for his shots, they both might be exposed to Covid-19.	Initially, medical practices were apprehensive too. In early March, the health clinic in Barre, Mass., called Emily Hoag to say it had postponed her baby’s vaccine appointment for a month to prevent the spread of coronavirus infection. Ms. Hoag felt conflicted: If her baby, Karson, missed his two-month immunization, she feared, he would be susceptible to any number of diseases. But if she took him to the clinic for his shots, they both might be exposed to Covid-19.
A few hours later, Dr. Kristina Gracey, a family medicine physician at the Barre Family Health Clinic, reached out to the new mother: Would she like a house call?	A few hours later, Dr. Kristina Gracey, a family medicine physician at the Barre Family Health Clinic, reached out to the new mother: Would she like a house call?
That afternoon, Dr. Gracey showed up at Ms. Hoag’s doorstep. After removing her shoes, meticulously washing her hands and wiping her stethoscope and baby scale, Dr. Gracey gave Karson his shots. Both mother and baby immediately burst into tears.	That afternoon, Dr. Gracey showed up at Ms. Hoag’s doorstep. After removing her shoes, meticulously washing her hands and wiping her stethoscope and baby scale, Dr. Gracey gave Karson his shots. Both mother and baby immediately burst into tears.
“Karson cried for a minute and then calmed down, and I was just so grateful that Dr. Gracey was there and able to give him the vaccinations he needed,” Ms. Hoag said.	“Karson cried for a minute and then calmed down, and I was just so grateful that Dr. Gracey was there and able to give him the vaccinations he needed,” Ms. Hoag said.
Dr. Gracey, who has a degree in public health and has practiced in Uganda, has no qualms about home visits, which she and her colleagues are making several times a week.	Dr. Gracey, who has a degree in public health and has practiced in Uganda, has no qualms about home visits, which she and her colleagues are making several times a week.
“We have so many women who are struggling with what it feels like to have a child in the setting of Covid-19,” she said. “And especially for a new mom who has concerns about the risks of coming into the office, it can feel comfortable to receive care within the home.”	“We have so many women who are struggling with what it feels like to have a child in the setting of Covid-19,” she said. “And especially for a new mom who has concerns about the risks of coming into the office, it can feel comfortable to receive care within the home.”
Dr. Gracey’s colleagues and other medical practices are experimenting with other ways to boost vaccine rates during the outbreak, including setting up a vaccination tent in a field.	Dr. Gracey’s colleagues and other medical practices are experimenting with other ways to boost vaccine rates during the outbreak, including setting up a vaccination tent in a field.
Many practices now schedule well-child visits exclusively in the morning and sick visits in the afternoon, so that an office can be decontaminated at the end of the day. Some have families wait in the car and, when an exam room is ready, a gowned nurse escorts parent and child in for the vaccine.	Many practices now schedule well-child visits exclusively in the morning and sick visits in the afternoon, so that an office can be decontaminated at the end of the day. Some have families wait in the car and, when an exam room is ready, a gowned nurse escorts parent and child in for the vaccine.
Dr. Jeanne M. Marconi’s practice in Norwalk, Conn., which had been doing flu clinics in parking lots for years, has adapted that procedure for vaccines generally: Parents pull up, briefly roll down a car window, the child extends an arm, and a masked, gowned healthcare worker does a quick jab. Over and out.	Dr. Jeanne M. Marconi’s practice in Norwalk, Conn., which had been doing flu clinics in parking lots for years, has adapted that procedure for vaccines generally: Parents pull up, briefly roll down a car window, the child extends an arm, and a masked, gowned healthcare worker does a quick jab. Over and out.
“We’re trying to alleviate all of the fears they have and keep up with the care,” Dr. Marconi said.	“We’re trying to alleviate all of the fears they have and keep up with the care,” Dr. Marconi said.
Last week, the pediatric ambulatory department at Boston Medical Center, which treats nearly 15,000 children, began sending vaccination mobile units into city neighborhoods. It also stationed a dedicated van for vaccines and well-baby checkups in front of the hospital.	Last week, the pediatric ambulatory department at Boston Medical Center, which treats nearly 15,000 children, began sending vaccination mobile units into city neighborhoods. It also stationed a dedicated van for vaccines and well-baby checkups in front of the hospital.
In the early weeks of the shelter-in-place orders, doctors concentrated efforts on vaccinating infants up to 2 years old, and waved off the disruption to the schedule for older children as temporary, saying it could readily be addressed once the restrictions lifted. But the longer that the orders continue, the more worried doctors have also become about vaccine protection for older children.	In the early weeks of the shelter-in-place orders, doctors concentrated efforts on vaccinating infants up to 2 years old, and waved off the disruption to the schedule for older children as temporary, saying it could readily be addressed once the restrictions lifted. But the longer that the orders continue, the more worried doctors have also become about vaccine protection for older children.
~~Updated June 5, 2020~~	Updated June 12, 2020
	Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.	So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.	A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.	The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.	Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.	Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.	States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.	Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)	If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.	Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.	The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.	If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.