Opinion | Top 10 health policy issues for 2023

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Happy New Year! In early 2023, here is a list of the top 10 public health policy issues that I am monitoring and plan to write about in future columns and newsletters.

COVID-19: Readers continue to have many questions about the coronavirus, and the coming months will bring answers to many of the most pressing. Will new variants emerge regarding? When will another booster be recommended for those who want it?

This month I’m going to delve into the question of who, precisely, is dying of covid. And what do we know about the long covid? Can we distinguish between people with mild, bothersome symptoms such as a persistent cough and those with conditions so debilitating that they can no longer work?

Political implications of the pandemic: Last year, I wrote about the impact of the pandemic on telehealth adoption, nursing workforce shortages, and Medicaid expansion. There’s a lot more to go into here, especially since the Biden administration is expected to end declaring a public health emergency soon. (I expect it to happen by spring.)

Many entities have been deeply affected by covid. Hospitals are in trouble. And local health departments, which were already severely underfunded and understaffed before the pandemic, are in desperate need of more support. Will these resources materialize or will the weak public health infrastructure wear out further?

Infant immunizations: A measles epidemic is rapidly spreading in Ohio. Polio has returned to the United States. According to a recent survey by the Kaiser Family Foundation, more than a third of parents with children under 18 say parents should be able to decide not to vaccinate their children in order to attend public schools.

Growing vaccine hesitancy has terrifying implications. What can be done to increase vaccination and restore public health confidence?

Mental health: This is one of many areas that have long been neglected and which the pandemic has exacerbated. I will try to understand the scale of the problem and examine policies and programs that work to address unmet needs.

This includes new therapies such as the use of psychedelics. Expect more about the benefits — and harms — of marijuana, too.

The opioid epidemic: Deaths from the powerful opioid fentanyl continue to skyrocket, but there are concerted bipartisan efforts to ramp up treatment. In March, the Food and Drug Administration is expected to make the opioid antidote, naloxone, available over the counter. Other harm reduction approaches, including controversial safe injection frameworks, are finally being tested. I will cover these developments.

Maternal health: Why are women today more likely to die in childbirth than their mothers and what can be done about it? This issue is near and dear to my heart. In the coming months, I plan to cover one particular policy solution that is crucial to reversing this trend.

Abortion Care: Just this week, the Food and Drug Administration changed its regulations to allow some retail pharmacies to dispense mifepristone, a pill used for drug-induced abortions. This has huge implications for abortion access. I will examine this, as well as the impact of abortion restrictions on other aspects of reproductive care, such as IVF and miscarriage management.

Chronic diseases: Heart disease and cancer are the leading causes of death in the United States. The main risk factors for both are obesity and tobacco use, which I have written about and intend to update this year. President Biden’s cancer moonshot also aims to reduce the cancer death rate by 50% over the next 25 years. What is the progress on this front?

Accident prevention: Over the past few months, I’ve written about how to make soccer and other contact sports safer. I was impressed by how the professional leagues have taken steps that youth sports haven’t. My column this week was about the need for high school gymnasiums and other youth training facilities to have automated external defibrillators. Expect more on this topic.

Social determinants of health: A fundamental principle of public health is that health is not just about the health care we receive in hospitals. It is also profoundly influenced by the environment in which we live, learn, work and play. I’d like to explore these other areas further, including the impact of major housing, education, and economic policies on health.

What else should I write? I’d love to hear from you. Please send your messages via this submission form!

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“A member of my family had covid last week. I was exposed to him before the quarantine started in another part of the house. I felt extremely tired for a few days after the exposure but never tested positive or showed any other symptoms. We haven’t had the bivalent booster yet but we plan to get it. I understand that he should wait three months since he just had the covid, but me? Would my tiredness indicate that my body was fighting covid, but effectively enough that I didn’t actually “have” it? What does this imply for the booster? – Anonymous

If you haven’t tested positive for covid, we can’t say you’ve had it. While it’s possible that your tiredness reflects your body fighting the virus, you haven’t contracted covid and don’t have the added immune protection from recovering.

Therefore, I would not recommend waiting for your booster. If you owed it and would have it anyway, I wouldn’t put it off.

“I am 78 years old, suffer from asthma and recently recovered from bronchitis. I’ve been vaccinated four or five times, but I’m worried that I might get one of the “tripledemic” diseases. I wear one of the favorite masks you wrote about everywhere I go and even in my house when a worker arrives. It has become progressively more and more difficult to breathe while wearing these masks. I want all the protection possible. Is there a way to wear one of these masks, but breathe easier? — Sharon from Georgia

Here are two tips: First, try different types of respirator masks. Some people find N95s uncomfortable but can breathe easily through KN95s or KF94s or vice versa. Certain design features, such as straps behind the ears versus straps around the head, can also make a difference.

Second, decide which settings pose the highest risk and then put on your respirator. I often see people walking outdoors wearing N95, which is unnecessary. Maybe the N95s don’t bother them, but if they do, they should limit their use to settings where masks are really needed. You may change some habits as a result; for example, go shopping early in the morning when the store is empty and you may not need to disguise yourself.

You didn’t ask, but you might also consider finding out why it’s gotten progressively harder to breathe in the masks. Perhaps you could consult your doctor about your asthma status and progress since your bronchitis recovery.

“My extended family wants to go out for a special dinner. They live in red and are vaccinated, but otherwise they no longer take precautions such as wearing a mask. My husband and I will be staying with them for about a week. We don’t want to join them for indoor dining but suggest they go out a few days before we arrive. Since they’ll eat indoors and generally don’t dress up anyway, should we just break down and hang out with them anyway? Does forgoing that restaurant meal really make a difference in our potential exposure to covid? — Charla from California

Could you compromise and dine in at home in a low-risk setting? Choose a restaurant with high ceilings and where the tables are well spaced. Depending on how many people are in your party, maybe you could even get a private or semi-private room.

There is one more important point here: while staying with your relatives, share their expositions. If they don’t take precautions, their high-risk behavior affects your risk as well. Would they consider some measures for the length of time you are with them, such as not going to crowded bars just for this time?

On Wednesday, I answered questions from readers at the Washington Post Live event. Here is the video. The Post also compiled questions and answers from my previous newsletters. You can read them here.

A study published in Medicine of Nature shows that the new bivalent booster produced a strong antibody response against offshoots of BA.4 and BA.5, but not against other strains, especially BA.2.75.2, BQ1.1 and XBB.1. This is concerning, although according to the authors, recovery from a previous infection significantly improved “the magnitude and extent of BA.5-bivalent-booster-elicited-neutralization.” This is further evidence that hybrid immunity, from previous infections and vaccinations, might offer the best and longest-lasting protection.

New research from Hong Kong published in JAMA network open found that the incidence of viral rebound after antiviral treatment is low. Among people who took Paxlovid, only 1% experienced a rebound, comparable to the percentages of people who took molnupiravir (0.8%) and those who took neither (0.6%). These numbers are different from other studies, including from the same manufacturer, which show significantly higher rebound rates, suggesting more research is needed.

This had escaped me New York Times editorial by Anthony Fauci, outgoing director of the National Institute of Allergy and Infectious Diseases. In it he summarizes the lessons learned from over fifty years of public service. Many people know him because he has been the face of the federal response to covid, but he was also instrumental in establishing the Presidential Emergency Plan for AIDS Relief, which has saved countless lives around the world. He was also a physician-scientist who continues to treat patients while translating laboratory research into clinical innovation. “As I think of that 27-year-old who arrived on the NIH campus in 1968, I am humbled by the tremendous privilege and honor I’ve had serving the American and global public,” writes Fauci.

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