The longstanding racial gap in U.S. stroke death rates widened dramatically during the COVID-19 pandemic, government researchers said Thursday.
Stroke death rates increased for both Black and white adults in 2020 and 2021, according to the Centers for Disease Control and Prevention study. But the difference between the two groups grew about 22%, compared with the five years before the pandemic.
“Any health inequity that existed before seems to have been made larger during the pandemic,” said Dr. Bart Demaerschalk, a stroke researcher at the Mayo Clinic in Phoenix who was not involved in the new study. “This is another example of that.”
During a stroke, something blocks or reduces blood flow to part of the brain or a blood vessel in the brain bursts. It can result in brain damage or long-term disability and is the nation’s fifth leading cause of death.
Until about a decade ago, the U.S. stroke death rate was falling because of improved treatment and reduced smoking rates. The decline halted in 2013 at about 70 per 100,000 adults 35 and older. Experts think increases in obesity and related conditions finally offset some of things that had been driving stroke deaths down.
It climbed the last few years, rising to nearly 77 in 2021.
Black Americans have long had a higher stroke death rate than their white counterparts, a gap that was fairly steady for decades.
In 2021, according to the new study, the Black stroke death rate rate for Americans aged 35 and older rose from about 101 per 100,000 before the pandemic to about 113. The white rate rose from about about 70 per 100,000 to 75. The difference between those two measures rose from 31 to 38, a 22% increase.
The paper joins a growing number of studies that detected a disproportionately large increase in minority stroke death rates since the pandemic began.
What drove the increases?
Doctors say COVID-19 infection can raise the risk of stroke. This mainly happens in severe COVID-19 illness, and the problem is worse in people that already have partially blocked blood vessels because of other conditions.
Patients with diabetes, high blood pressure, high cholesterol and a history of smoking seemed to be at highest risk, according to a study led by Demaerschalk that was published last year.
But the virus probably wasn’t the only factor, Demaerschalk said.
Obesity may have worsened, he said. People probably saw their doctors less often. And many were reluctant to go to a hospital when stroke symptoms developed — especially in the early days of the pandemic, when fear of catching the new virus may have surpassed concerns about stroke symptoms, he added.
“Time is absolutely of the essence” in treating strokes, Demaerschalk said.
So people were less likely to get medical care at the same time the risk of stroke was rising. And that “mismatch” may have been more pronounced for some Black people, because of lack of access of medical care and risk factors for COVID-19 and stroke, he said.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
The Florida Board of Education on Wednesday approved a ban on classroom instruction about sexual orientation and gender identity in all grades, expanding the law critics call “Don’t Say Gay” at the request of Gov. Ron DeSantis as he gears up for an expected presidential run.
The proposal will take effect after a procedural notice period that lasts about a month, according to an education department spokesman.
The rule change would ban lessons on sexual orientation and gender identity from grades 4-12, unless required by existing state standards or as part of reproductive health instruction that students can choose not to take. Florida currently bans such lessons in kindergarten through third grade.
The DeSantis administration put forward the proposal last month as part of the Republican’s aggressive conservative agenda, with the governor leaning heavily into cultural divides ahead of his looming White House candidacy.
DeSantis has not commented on the proposal. He previously directed questions to Education Commissioner Manny Diaz Jr., who said it was meant to clarify confusion around the existing law and reinforce that teachers should not deviate from existing curriculums.
“We’re not removing anything here,” Diaz Jr. said on Wednesday. “All we are doing is we are setting the expectations so our teachers are clear: that they are to teach to the standards.”
The prohibition, which began last year with the law banning sexual orientation and gender identity lessons in kindergarten through third grade, has drawn intense backlash from critics who argue it marginalizes LGBTQ+ people and has vague terms that result in self-censorship from teachers. Democratic President Joe Biden has called it “hateful.”
The current law is also the root of an ongoing feud with Disney, one of the state’s largest employers and political donors.
“Let’s put it plainly: This is part of the governor’s assault on freedom,” Joe Saunders, senior political director of the LGBTQ advocacy group Equality Florida, said in a statement, adding the policy will “further stigmatize and isolate a population of young people who need our support now more than ever.”
The entertainment giant publicly opposed the legislation last year, and as punishment, DeSantis pushed lawmakers to give him control of a self-governing district that Disney oversees in its theme park properties.
Before a set of new DeSantis appointees could assume control of the district, Disney’s board passed restrictive covenants that strip the incoming members of most of their powers, blunting the governor’s retaliation.
DeSantis has directed the chief inspector general to investigate the Disney board’s move and vowed to take additional revenge against the company through legislation.
U.S. regulators on Tuesday cleared another COVID-19 booster dose for older adults and people with weak immune systems so they can shore up protection this spring — while taking steps to make coronavirus vaccinations simpler for everyone else.
The Food and Drug Administration said anyone 65 or older can opt to roll up their sleeves again as long as it’s been at least four months since their first dose of the so-called bivalent vaccine that targets omicron strains.
And most people who are immune-compromised can choose another bivalent booster shot at least two months later, with additional doses in the future at the discretion of their physician.
For everyone else, regardless of whether it’s a first shot or a booster, the FDA also said the original versions of the Pfizer and Moderna vaccines are outdated and will no longer be used. Instead, anyone getting a Pfizer or Moderna shot will receive the newer omicron-targeted version. For most people, if it’s their first-ever vaccine, just one combo dose will be enough.
Anyone who’s gotten their original vaccinations but hasn’t yet had an omicron-targeted booster can still get one — but the agency will decide over the summer if younger, healthy people will eventually be offered a second bivalent booster.
“At this stage of the pandemic, data support simplifying the use” of the Pfizer and Moderna vaccines, FDA vaccine chief Dr. Peter Marks said in a statement. “The agency believes this approach will help encourage future vaccination.”
Authorities in Britain and Canada already have made similar recommendations for an extra spring booster for vulnerable populations. And high-risk Americans who last got a dose in the fall have anxiously wondered when they could get another.
The Centers for Disease Control and Prevention must sign off on the newest round of boosters. Its advisers are set to meet on Wednesday.
The Pfizer and Moderna boosters contain protection against both the original coronavirus strain and omicron versions known as BA.4 and BA.5. While newer omicron cousins now are circulating, recent studies show the bivalent shots still are effective.
For many Americans, COVID-19 has become less of a health fear and more of an inconvenience, and masking, routine testing and other precautions have largely fallen by the wayside.
COVID-19 vaccines have saved millions of lives. And while protection against mild infections is short-lived, booster doses continue to do a good job fighting severe disease and death even as more contagious variants have popped up.
But at least 250 people in the U.S. a day still die from COVID-19, many of them elderly or frail, and protection can wane.
For eligible, high-risk groups, a spring second booster is a reasonable choice, said Dr. Matthew Laurens of the University of Maryland School of Medicine.
“We do have vaccines that are available to protect against these severe consequences, so why not use them?” he said. “They don’t do any good just sitting on a shelf. So let’s give them to individuals who are at the highest risk who can benefit the most.”
Still, only 42% of Americans 65 and older — and just 20% of all adults — got their first bivalent vaccine when they rolled out last fall, according to CDC data.
The FDA’s simplification also means changes for unvaccinated children. If their parents now want them vaccinated, tots under 5 may receive two doses of bivalent Moderna vaccine or three doses of the Pfizer-BioNTech bivalent vaccine. Those who already are 5 may get a single bivalent Pfizer shot or two Moderna doses.
Children already fully or partially vaccinated with the original Pfizer or Moderna shots may get a bivalent vaccine, but how many doses will depend on their vaccination history, the FDA said.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
Total Doses Distributed = 976,711,975. Total Doses Administered = 674,711,945. Number of People Receiving 1 or More Doses = 270,142,789. Number of People Fully Vaccinated = 230,467,642.
The Republican-dominated Florida Legislature on Thursday approved a ban on abortions after six weeks of pregnancy, a proposal supported by GOP Gov. Ron DeSantis as he prepares for an expected presidential run.
DeSantis is expected to sign the bill into law. Florida currently prohibits abortions after 15 weeks.
A six-week ban would give DeSantis a key political victory among Republican primary voters as he prepares to launch a presidential candidacy built on his national brand as a conservative standard bearer.
The policy would also have wider implications for abortion access throughout the South in the wake of the U.S. Supreme Court’s decision last year overturning Roe v. Wade and leaving decisions about abortion access to states. Alabama, Louisiana and Mississippi have banned abortion at all stages of pregnancy, while Georgia forbids the procedure after cardiac activity can be detected, which is around six weeks.
“We have the opportunity to lead the national debate about the importance of protecting life and giving every child the opportunity to be born and find his or her purpose,” said Republican Rep. Jenna Persons-Mulicka, who carried the bill in the House.
Democrats and abortion-rights groups have criticized Florida’s proposal as extreme.
“This ban would prevent four million Florida women of reproductive age from accessing abortion care after six weeks — before many women even know they’re pregnant,” White House press secretary Karine Jean-Pierre said in a statement issued after Thursday’s vote. “This ban would also impact the nearly 15 million women of reproductive age who live in abortion-banning states throughout the South, many of whom have previously relied on travel to Florida as an option to access care.”
The bill contains some exceptions, including to save the woman’s life. Abortions for pregnancies involving rape or incest would be allowed until 15 weeks of pregnancy, provided a woman has documentation such as a restraining order or police report. DeSantis has called the rape and incest provisions sensible.
Drugs used in medication-induced abortions — which make up the majority of those provided nationally — could be dispensed only in person or by a physician under the Florida bill. Separately, nationwide access to the abortion pill mifepristone is being challenged in court.
Florida’s six-week ban would take effect only if the state’s current 15-week ban is upheld in an ongoing legal challenge that is before the state Supreme Court, which is controlled by conservatives.
“I can’t think of any bill that’s going to provide more protections to more people who are more vulnerable than this piece of legislation,” said Republican Rep. Mike Beltran, who said the bill’s exceptions and six-week timeframe represented a compromise.
Abortion bans are popular among some religious conservatives who are part of the GOP voting base, but the issue has motivated many others to vote for Democrats. Republicans in recent weeks and months have suffered defeats in elections centered on abortion access in states such as Kentucky, Michigan and Wisconsin.
“Have we learned nothing?” House Democratic Minority Leader Fentrice Driskell said of recent elections in other states. “Do we not listen to our constituents and to the people of Florida and what they are asking for?”
DeSantis, who often places himself on the front lines of culture war issues, has said he backs the six-week ban but has appeared uncharacteristically tepid on the bill. He has often said, “We welcome pro-life legislation,” when asked about the policy.
DeSantis is expected to announce his presidential candidacy after the session ends in May, with his potential White House run in part buoyed by the conservative policies approved by the Republican supermajority in the Statehouse this year.
Democrats, without power at any level of state government, have mostly turned to stall tactics and protests to oppose the bill, which easily passed both chambers on largely party-line votes. The Senate approved it last week, and the House did so Thursday.
A Democratic senator and chairwoman of the Florida Democratic Party were arrested and charged with trespassing during a protest in Tallahassee against the six-week ban. In a last ditch move to delay the bill’s passage in the House on Thursday, Democrats filed dozens of amendments to the proposal, all of which were rejected by Republicans.
“Women’s health and their personal right to choose is being stolen,” said Democratic Rep. Felicia Simone Robinson. “So I ask: Is Florida truly a free state?”
When the COVID-19 public health emergency ends in the U.S. next month, you’ll still have access to a multitude of tests but with one big difference: Who pays for them.
For the first time, you may have to pick up some or all of the costs, depending on insurance coverage and whether the tests are done at home or in a doctor’s office.
But there’s still time to get some free tests before the May 11 change, and there could still be free ones available afterward. Some state and local governments may continue to distribute free home tests through clinics, libraries and community centers. And the federal government, for now, is still sending free tests through the U.S. Postal Service to households that haven’t already received two shipments.
And don’t discount those old tests you haven’t used. The expiration date on the package may have been extended. The Food and Drug Administration’s website provides a list to check and see which tests are still good.
Here’s a look at what the end of the government’s emergency declaration on May 11 means for testing:
AT-HOME TESTS
The biggest changes will be for over-the-counter tests, which account for the vast majority of screening in the U.S. today.
Since early 2021, the federal government has required all private insurers to cover up to eight COVID-19 tests per month. That requirement will soon go away. Coverage is also scheduled to lapse for tens of millions of seniors in the federal government’s Medicare program, though some members of Congress are pushing to extend the benefit.
While some private insurers may continue to cover all or some home tests, there will be no longer be a nationwide rule. A two-pack of tests typically costs between $20 and $24.
“What we will see is a hodgepodge of approaches by different insurance companies, which is going to make it difficult for individuals to know what they’re going to be paying,” said Christina Silcox, of the Duke Margolis Center for Health Policy, which recently issued a report on the outlook for testing.
One exception will be for those enrolled in the government Medicaid program for low-income individuals and families, who will continue to receive free tests until September 2024.
IN-OFFICE TESTS
Americans can also expect to pay more for any COVID-19 tests performed at a hospital, clinic or doctor’s office.
Insurers have been barred from charging copays, or any other cost-sharing fees related to COVID-19 testing. That requirement also ends next month.
While insurers will still cover basic testing costs, some people could face new fees for a portion of the test’s price or for the services of the health professional performing it. Lab tests have typically ranged between $70 and $100 and some of that could be passed along to patients.
COVID-19 vaccines and drugs will remain free because they are not paid for through insurance, but by the federal government. One concern is that uncertainty around testing costs could lead to delays in treatment. Current treatments for high-risk patients, like Paxlovid, generally need to be taken within the first few days of symptoms to be effective.
If people are worried about testing costs, “they may wait a couple days to see if things clear up and miss that five-day treatment window,” Silcox said.
TESTING CAPACITY
The U.S. struggled to build up its test manufacturing capacity during the first two years of the pandemic, with demand waning after each surge. Experts worry that the country could again be caught flat-footed after the federal government stops purchasing tests in bulk.
Only after the U.S. government said it would buy 1 billion tests did production stabilize, reaching a peak of 900 million monthly tests in February 2022.
“Those bulk purchases basically guaranteed the market for test manufacturers,” said Jennifer Kates, a senior vice president with the nonprofit Kaiser Family Foundation.
As of September, manufacturers were still producing over 400 million tests per month, far exceeding U.S. testing levels, according to Duke researchers.
Companies including Abbott Labs say they will be able to ramp up test production as needed. But the company declined to discuss specific production targets or how they will be impacted by the end of the health emergency.
Congress has shown little willingness to buy more tests and the Biden administration did not propose new spending in its latest budget.
“That upfront guarantee by the federal government that takes care of testing volatility won’t be there anymore,” Kates said.
TESTING TECHNOLOGY
The hundreds of different COVID-19 tests authorized by the Food and Drug Administration over the last three years will remain available after May 11. That’s because the FDA OK’d those products under a separate emergency measure that isn’t affected by the end of the national declaration.
Still, FDA officials have been encouraging test makers to apply for full regulatory approval, which will allow their products to stay on the market indefinitely. Last month, the FDA formally approved the first rapid COVID test.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
