The college senior at California State University-San Bernardino worked 60 hours a week at two jobs. She used birth control. Motherhood was not in the plan. Not yet. “I grew up poor. And I don’t want that for my children, like, ever,” she said.

She wanted a medication abortion. It’s a two-step process: one drug taken at a doctor’s office, and another a day later to induce cramping and bleeding and empty the uterus. Gomez didn’t bother going to the university health clinic, thinking it was only for basic health needs.

She ended up driving more than 300 miles and paying hundreds of dollars in medical and travel expenses to obtain a medication abortion. She missed a month of classes, which put her graduation date in jeopardy. She had no idea she was entitled to a free medication abortion right on campus.

An LAist investigation has found that one year after California became the first state to require its public universities to provide abortion pills to students, basic information on where or how students can obtain the medication is lacking and, often, nonexistent.

“I was really upset when I found out,” Gomez told LAist. “I had to really push myself to make that money happen.”

LAist initially found that 11 of 23 CSU campus clinics did not have any information about medication abortion on their clinic websites, nor did they list it as a service offered. Of the University of California’s 10 campuses, eight mentioned medication abortion on their clinic websites. (Five CSU campuses and one UC campus added information after .)

Through conversations with students and faculty at multiple campuses, LAist found there was little information for students to obtain the pills.

“If I had known that, I would have taken advantage of it,” Gomez said. “I spent a lot of time driving around after work, switching schedules, putting my homework on the back burner.”

California legislators in 2019 passed the law that requires all the state’s 33 public university campuses to provide abortion pills. It took effect in January 2023.

“We wanted to make sure that students, female students, had access to this right,” said Connie Leyva, the former Pomona-area state senator who authored the bill.

The legislature created a $10.3 million fund of privately raised money to help universities implement the new law. Each campus received $200,000 in one-time funding to pay for the medication and cover costs such as facility upgrades, equipment, training, telehealth services, and security upgrades.

The funding did not include any requirement that campus clinics inform students the medication was available to them.

Leyva said she doesn’t recall any conversations about “including something on advertising that you could get a medicated abortion on campus.” She said she’s disappointed in the law’s implementation, but not surprised.

“Everything starts at the top. And if the president or chancellor of the university knows they have to offer it, but if they don’t agree that women should have access to abortion services, then they might just think, ‘We’ll leave it off, we don’t have to worry about it,’” Leyva said.

Spokesperson Ryan King said UC President Michael Drake was not available to comment.

“The student communities at each UC campus are unique,” Heather Harper, a spokesperson for UC Health in Drake’s office, wrote in an email. “As a result, communication to students at each location takes different forms and may include website content, flyers, emails, person-to-person conversations or other methods.”

The office of CSU Chancellor Mildred García did not reply to a request for comment.

At Gomez’s San Bernardino campus, abortion as an option was mentioned only in one place: in small letters on a poster inside exam rooms at the health center.

A student wouldn’t see that until they were already waiting for a doctor or nurse.

“We need to work harder if there is a student who needed the service and wasn’t aware that they could access it through us and not have to pay for it,” said Beth Jaworski, executive director of health, counseling, and wellness at CSU-San Bernardino. “But it’s one student. We haven’t been providing the service very long. It’s been just about a year now.”

Medication abortion has since been added to the list of services on the clinic’s website.

Ray Murillo, California State University’s interim assistant vice chancellor of student affairs, said he and other administrative staffers are developing guidance so campuses share the same information “to help in our training efforts for the frontline staff and providers when they’re being asked questions about the service and what we provide.”

Gomez wants more done, including flyers, emails, and social media posts directed at both faculty and students.

“You want to market the football games, you want to market the volleyball games. Why is that important, and abortions are not?” she said.

Gomez did graduate in December 2023, becoming the first person in her family to earn a bachelor’s degree. But she’s angry at her alma mater for keeping the abortion pills a secret.

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Pero más de un mes después, las versiones pediátricas de las nuevas vacunas contra covid, para niños de 6 meses a 11 años, siguen siendo difíciles de encontrar.

Una combinación de problemas —desde tecnicismos sobre quién puede vacunar a los niños pequeños hasta la falta de información correcta en internet sobre los sitios de vacunación— sigue impidiendo que los padres se aseguren de que sus hijos estén protegidos.

“Nadie tiene información precisa sobre dónde realmente están las dosis. Es simplemente un desastre logístico absoluto tratar de encontrar información y me estaba volviendo loca”, dijo Anne Hamilton, una residente de Los Ángeles, que buscó durante semanas una dosis pediátrica para su hijo Jimmy de 4 años.

Hamilton consultó primero con el sistema de salud de su hijo. El sitio de internet ofrecía citas de vacunación solo para adultos.

En el sitio web, “la ventana que aparece dice ‘se esperan nuevas vacunas para finales de septiembre, inténtelo de nuevo más tarde’. Es frustrante leer ese mensaje cuando estamos en octubre y no te dan ninguna otra información”, dijo.

Un problema que ha causado dolores de cabeza a los padres ha sido intentar encontrar dosis cubiertas por sus aseguradoras. Por primera vez desde el inicio de la pandemia, el gobierno federal no paga directamente a los fabricantes por las dosis de covid, un proceso que permitió a médicos y farmacéuticos recibir envíos de forma gratuita.

Ahora, las farmacias y los médicos tienen que pagar por adelantado las dosis a los proveedores para almacenarlas. Y las familias necesitan usar su seguro médico para pagarles a los proveedores, y eso puede ser complicado.

Después de días de buscar en internet y muchas pistas falsas, Hamilton finalmente encontró una farmacia a más de una hora de distancia, en Palmdale, con dosis pediátricas. Llamó para asegurarse de que realmente tuvieran vacunas, y que también aceptaran , el seguro de su hijo. Después hicieron el viaje de una hora. Pero cuando llegaron, los farmacéuticos dijeron que no podían aplicarle la vacuna a Jimmy porque tenía menos de 18 años. Hamilton llamó a Medi-Cal para aclarar.

“El representante en la línea de Medi-Cal nos explicó que debíamos realizar el proceso a través del programa de Vacunas para Niños”, dijo. “No sabía qué era este programa”.

Según el programa de Vacunas para Niños del gobierno federal, el hijo de Hamilton solo podía recibir la vacuna de un proveedor participante.

“Nadie publicó la información de que los niños con Medi-Cal debían vacunarse a través del programa de Vacunas para Niños”, dijo Hamilton.

“Nadie tiene información sobre cómo encontrar una clínica cercana porque la mitad ni siquiera figuran en el sitio ”, dijo, refiriéndose a un sitio web de citas para vacunas administrado por el estado de California.

Hamilton fue dirigida a un sitio web diferente, también estatal, que se suponía mostraría la ubicación de los proveedores de vacunas para niños en todo el estado.

“El sitio web simplemente no funciona”, dijo Hamilton después de tratar de navegarlo.

Frustrada, envió un correo electrónico al Departamento de Salud Pública de California (CDPH), que le dijo que sabían que el sitio web no funcionaba y que “los técnicos estaban trabajando en ello”. Nadie del CDPH se ofreció a ayudarla ni a indicarle la lista de proveedores que necesitaba, dijo Hamilton.

Después de que �������ýҕ�l Health News y NPR le preguntaran al CDPH por qué el de Vaccines for Children no funcionaba, arreglaron el sitio web. Sin embargo, muestra solo los proveedores participantes y no indica si esos médicos y farmacias tienen vacunas pediátricas contra covid. Los padres deben llamar a los proveedores individualmente para ver si están aceptando pacientes o constatar con el sitio web federal .

Hamilton quedó frustrada y llorando.

“Conozco padres de todo el país que están buscando dosis. Es una búsqueda para todos en este momento”, dijo.

En Estados Unidos hay dos sistemas de vacunas paralelos, y el que usan los niños depende de su seguro. Los que tienen seguro médico comercial reciben vacunas a través del mercado comercial. Pero los que tienen seguros del gobierno, como Medi-Cal, reciben vacunas a través del programa Vacunas para Niños, financiado con fondos federales. Solo los proveedores participantes, como el pediatra del condado de Orange, Eric Ball, pueden administrarles la vacuna.

En el marco del programa Vacunas para Niños, “en realidad hacemos un pedido, las vacunas nos llegan, el gobierno ya las ha pagado y luego las distribuimos a los pacientes que tienen esos seguros, de forma gratuita”, explica Ball.

Para los niños cubiertos por planes comerciales, los proveedores de atención médica deben comprar la cantidad que creen que necesitarán con anticipación. Pero Ball dijo que muchos pediatras no almacenan ni administran la vacuna contra covid a esos niños porque no pueden solventarlo.

“Muchos consultorios pediátricos somos pequeñas empresas, y esto significa que tenemos que gastar mucho dinero por adelantado para poder comprar estas vacunas y luego esperar semanas o meses para recuperarlo”, dijo.

Si los padres buscan vacunas en una farmacia, pueden enfrentar otro obstáculo: las los tipos de proveedores que pueden administrar vacunas a los niños. Los farmacéuticos pueden vacunar a niños de 3 años o más según . Eso deja fuera a los niños de entre 6 meses y 3 años, que tienen que consultar a un médico.

“En nuestra oficina, tenemos una lista muy larga de familias que están esperando el día en que lleguen nuestras vacunas contra covid para finalmente poder empezar a vacunar. Ha habido mucha frustración”, dijo Ball.

La oficina de Ball participa en ambos sistemas de vacunas pediátricas. A través de Vacunas para Niños, su práctica recibió algunas dosis pediátricas, pero solo puede administrarlas a pacientes que califican.

Esperó un mes por un envío de solo 100 dosis de la vacuna pediátrica contra covid para sus pacientes con seguro comercial. No es suficiente para satisfacer la demanda.

“Es una pena porque hemos perdido muchas oportunidades desde que se aprobó esta vacuna hace más de un mes”, dijo.

“Hemos tenido muchos pacientes que vienen y quieren vacunar a sus hijos, especialmente niños pequeños y bebés que no tienen la protección de las vacunas anteriores”.

es una clínica de una red de seguridad financiada con fondos federales con varios sitios en todo el condado de Los Ángeles. La red atiende a niños y familias de bajos ingresos, y para sus vacunas pediátricas la clínica depende del programa Vacunas para Niños.

Pero Jim Mangia, su presidente, dijo que para la nueva vacuna pediátrica contra covid se están recortando los pedidos y no están recibiendo las dosis que solicitaron.

“Pedimos 3,000 la semana pasada; recibimos 500”, dijo.

Pero Mangia dijo que St. John’s brinda atención a 50,000 niños. Debido al déficit, no anuncian la vacuna contra covid ni envían correos electrónicos o mensajes de texto para correr la voz, como suele hacer el personal.

“Básicamente estamos esperando”, agregó. “Si alguien la pide, le proporcionamos la vacuna, pero no estamos haciendo el nivel de alcance que normalmente hacemos para vacunar a la gente porque todavía no tenemos suficiente suministro”.

El programa Vacunas para Niños está a cargo de los CDC. En una visita reciente a Los Ángeles, la directora de los CDC, , dijo que no tenía conocimiento de ningún problema con el suministro o el pedido de vacunas contra covid.

“No hay límite de pedidos. Estamos escuchando que se están recibiendo los envíos en tres o cuatro semanas”, dijo. “Diré, personalmente, que el pediatra de mi hijo tiene la vacuna y ha tenido una clínica de vacunación contra covid, por lo que la vacuna está disponible”.

Jimmy, el hijo de Anne Hamilton, finalmente recibió la vacuna a través de una clínica temporal administrada por el condado de Los Ángeles. Se siente afortunada de haberla encontrado.

“Le dije a una de mis amigas que iba a vacunar a mis hijos y me dijo: ‘¿Encontraste una vacuna pediátrica? No puedo creerlo’”.

A Ball le preocupa lo que significará la lenta implementación para los bebés y niños pequeños vulnerables, que son demasiado pequeños para haber sido vacunados antes y deben recibir varias inyecciones antes del aumento previsto de covid en invierno.

“Si queremos vacunar a estos niños para el Día de Acción de Gracias y las vacaciones de invierno, es fundamental que comencemos a hacerlo ahora porque no es una situación única. Necesitamos que estos bebés reciban múltiples dosis durante varias semanas antes de que puedan estar adecuadamente protegidos”, dijo.

Mientras tanto, los niños siguen infectándose. Uno de los pacientes de 4 años de Ball dio positivo el mismo día que su consultorio finalmente recibió 100 dosis de la vacuna pediátrica. La madre del niño había intentado vacunarlo antes, pero no pudo encontrar un proveedor que tuviera dosis.

“Como pediatra, lo único que me duele más que ver a un niño enfermarse o estar internado es que se enferme o deba ser internado por algo que yo podría haber evitado. Y si no tengo las herramientas para evitarlo, me duele y es muy triste”, dijo Ball.

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But more than a month later, the pediatric versions of the new covid shots, for children 6 months to 11 years old, are still difficult to find. A confluence of problems — from technicalities about who can give shots to small kids to the lack of accurate information online on where the kid-sized doses can be found — are still preventing parents from making sure their children are protected.

“Nobody has accurate information on where doses actually exist. It’s just an absolute logistical mess trying to find information and it was driving me insane,” said Anne Hamilton, a Los Angeles resident, who searched for weeks to find a pediatric dose for her 4-year-old son, Jimmy.

Hamilton checked first with her son’s health system. The website was offering vaccine appointments only for adults.

On the website, “the popup says ‘new vaccines are expected in late September, try again later.’ Well, that’s a frustrating message to read when it’s October and they’re not giving you any other information,” she said.

One problem that has caused headaches for parents has been trying to find doses covered by their insurance. For the first time since the start of the pandemic, the federal government isn’t paying manufacturers directly for covid shots, a process that allowed doctors and pharmacists to receive shipments for free. Now, pharmacies and doctors have to pay upfront for vaccine doses from suppliers to stock them on-site. And families need to use their health insurance to pay providers for them — and that can be complicated.

After days searching online and many false leads, Hamilton finally found a pharmacy over an hour away in Palmdale with pediatric doses. She called to make sure they actually had the shots and also accepted , her son’s government insurance. After being assured of both, they made the hourlong drive. But when they arrived, the pharmacists said they couldn’t give Jimmy the shot because he was under 18 years old. Hamilton called Medi-Cal to clarify.

“The Medi-Cal phone representative explained to us that they need to go through the Vaccines for Children Program,” she said. “So we’re like, all right, we don’t know what this program is.”

Under the federal government’s Vaccines for Children program, Hamilton’s son could get a shot only from a participating provider.

“Nobody put out the information that children on Medi-Cal needed to be vaccinated through the Vaccines for Children program,” Hamilton said.

“Nobody has information on how to find a pop-up [clinic] near you because half of those aren’t even listed on the ,” she said, referring to a vaccine appointment website run by the state of California.

Hamilton was directed to a different California-run website that was supposed to show the location of Vaccines for Children providers across the state.

“The website just flat-out doesn’t work,” Hamilton said after checking it.

Frustrated, she emailed the California Department of Public Health, which told her they were aware was down and said “IT was working on it.” No one from CDPH offered to help Hamilton or direct her to the provider list she needed, she said.

After �������ýҕ�l Health News and NPR asked CDPH why Vaccines for Children’s was not working, the website was fixed. However, it shows only participating providers while neglecting to indicate if those doctors and pharmacies have pediatric covid vaccines in stock. Parents must either call providers individually to see if they are taking patients and have the shot or try to cross-reference with the federal website.

Hamilton was left frustrated and in tears.

“I know parents all over the country who are looking for doses. It’s a hunt for everyone right now,” she said.

There are two parallel vaccine systems in the U.S., and the one children use depends on their insurance. Children with commercial health insurance get vaccines through the commercial market. But kids with government insurance such as Medi-Cal get shots through the federally funded program — and only participating providers, like Orange County pediatrician Eric Ball, can give them the shot.

Under the Vaccines for Children program, “we actually place an order, the vaccines come to us, the government has paid for them already, and then we distribute them to patients who have those insurances, for free,” Ball explains.

For children covered by commercial insurance plans, health care providers need to purchase the amount they think they’ll need ahead of time. But Ball said many pediatricians aren’t stocking or administering the covid shot for those children, because they can’t afford to.

“A lot of pediatric practices are small businesses, and this means we have to expend a lot of money upfront to be able to buy these vaccines and then wait weeks or months to get that recouped,” he said.

If parents seek shots at a pharmacy, they may confront another obstacle: the types of providers who can administer vaccines to children. Pharmacists can vaccinate children 3 years and older under a. That leaves out children between 6 months and 3 years old, who have to see a medical doctor.

“We have a very long list in our office of families who are waiting for the day that our covid vaccines come in so we can finally start vaccinating them. There’s been a lot of frustration,” Ball said.

Ball’s office participates in both pediatric vaccine systems. Through Vaccines for Children, his practice received some pediatric doses, but he can administer them only to qualifying patients.

For his commercially insured patients, it took over a month to get a delivery of just 100 pediatric covid vaccine doses. It’s not nearly enough to meet the demand.

“It’s a shame because we’ve had so many missed opportunities since this vaccine was approved over a month ago,” he said.

“We’ve had lots of patients who come in who want to get their kids vaccinated, especially young children and babies who don’t have the protection of previous vaccines.”

is a federally funded safety-net clinic with multiple sites across Los Angeles County. The network serves low-income children and families, and for its pediatric vaccines the clinic is dependent on the Vaccines for Children program.

But President Jim Mangia said that for the new covid pediatric vaccine, their orders are being cut and they aren’t receiving the doses they requested.

“We ordered 3,000 last week; we got 500,” he said.

But St. John’s provides care for 50,000 children, Mangia said. Because of the shortfall, St. John’s isn’t advertising the covid vaccine or doing email or text blasts to spread the word, as the staff typically might.

“We’re basically holding back,” he said. “If someone asks for it, we’re providing the vaccine, but we’re not doing the level of outreach that we normally do to get people vaccinated because we don’t have enough supply yet.”

The Vaccines for Children program is run by the CDC. On a recent visit to Los Angeles, said she was not aware of any covid vaccine supply or ordering issues.

“There’s no ordering caps. We’re hearing that folks are getting shipments within three or four weeks,” she said. “I will say, personally, my kid’s pediatrician has vaccine and has had a covid vaccine clinic, so the vaccine is out there.”

Anne Hamilton’s son Jimmy finally got the shot through a pop-up clinic run by LA County. She feels lucky to have found it.

“I told one of my friends that I was going to get my kids their shots, and she said, ‘You found pediatric vaccine? I can’t believe it.'”

Ball is concerned about what the slow rollout will mean for vulnerable babies and toddlers, who are too young to have been vaccinated before and should get multiple shots before the predicted winter covid surge.

“If we want to get these children vaccinated for gatherings such as Thanksgiving and the winter holidays, it’s critical that we start doing this now because this is not a one-and-done kind of situation. We need these babies to get multiple doses over multiple weeks before they can be adequately protected,” he said.

Meanwhile, children continue to get infected. One of Ball’s 4-year-old patients tested positive on the same day Ball’s medical office finally received 100 doses of the pediatric vaccine. The boy’s mother had tried to get him vaccinated earlier but couldn’t find a provider with the shots.

“As a pediatrician, the only thing that hurts me worse than seeing a child get sick or hospitalized is them getting sick or hospitalized by something that I could have prevented. And if I don’t have the tools to prevent that, it hurts me and it’s very sad,” Ball said.

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Coming off a year with a record number of opioid-related overdose deaths in the United States — in 2022, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics — community health workers and addiction medicine experts were hopeful that the arrival of Narcan on retail shelves might make it easier for people to get the medication.

And, ultimately, prevent more fatal overdoses.

But it’s unclear whether the move will actually expand access to Narcan. Experts worry that its unpredictable retail price, sporadic availability on store shelves, or general consumer confusion about potentially having to ask a pharmacist to retrieve it will mean that fewer people than expected will purchase Narcan to have it at the ready when an overdose occurs.

“It’s not by any means a game changer,” said , a family nurse practitioner and assistant professor at the University of Pennsylvania’s School of Nursing in Philadelphia. “I don’t think it’s a step in the wrong direction. I just think it’s a tiny, tiny baby step that does not deserve a round of applause.”

“We should not be under any illusion that this is going to meaningfully change things for a lot of people,” she said. “But we need to be moving in this direction. We just need to be doing it faster and with an understanding that this is just way overdue.”

The over-the-counter marketing and sales of Narcan in March. Manufactured by Emergent BioSolutions, it started arriving in stores in early September, with a for a two-dose package with a .

Enduring Barriers to Access

As an over-the-counter product, Narcan ideally would appear on store shelves in the same way as ibuprofen and cough medication.

But at several drugstore locations in Philadelphia, “over the counter” means it is stocked and sold from behind the pharmacy counter. That requires people to wait in line and ask a pharmacist to buy Narcan.

“Having to go talk to the pharmacist who may or may not know you, it’s not comfortable for people, and that’s a barrier that this is supposed to eliminate,” Aronowitz said. “It’s counterintuitive. It needs to just be on the shelf, and someone can take it.”

Keeping Narcan behind the counter will especially deter people who use drugs, said , chair of the Department of Emergency Medicine and director of the Division of Medical Toxicology at Rutgers New Jersey Medical School.

“For those who don’t have substance use concerns, they might go in and just ask for the product and not be concerned about what the other person’s thinking,” he said. “But that’s a mental state that’s very hard for most of us to put ourselves into if we don’t live the life of somebody with the stigma and the marginalization that is so associated with substance use.”

Another potential barrier is related to affordability. Despite the suggested price of $44.99 for a two-dose pack, nothing is stopping individual pharmacies and other retailers from charging more. At least one drugstore in Philadelphia was selling it from behind the pharmacy counter for $72 a box.

“The higher the price, the fewer people who are going to splurge to have this with them in case somebody else needs it,” Nelson said.

That’s especially true for people with low incomes who are facing other daily financial challenges, Aronowitz said. Even $44.99 may be too steep for many consumers.

“That’s a lot of money to be spending on something if you need food today, if you have a headache and need ibuprofen today,” she said. “You think you’ll probably need naloxone, but it’s not a guarantee that you’ll need today, so why spend the money?”

are also available at most pharmacy stores, but consumers need a prescription from a medical professional.

Most states have also adopted some kind of , which authorizes pharmacists to dispense naloxone immediately to someone even without an individual prescription.

For some consumers, purchasing naloxone via prescription could remain cheaper than buying it over the counter. Many private health insurers — and public programs like Medicaid and Medicare — cover the cost of these prescription sales.

State officials in Pennsylvania, New Jersey, and Delaware confirmed to NPR and �������ýҕ�l Health News that their Medicaid programs, which offer health insurance to people with low incomes, will cover the cost of the new Narcan spray if a pharmacist puts the order through as a prescription.

In California, a bill is headed to Democratic Gov. Gavin Newsom’s desk that — both public and private — to cover most of the cost of naloxone, and other FDA-approved opioid-overdose reversal drugs, in the nation’s most populous state. The bill would allow insurance plans to charge a maximum copay of $10 per package, and it would sunset in five years.

Aronowitz predicted that if cost deters people from buying over-the-counter Narcan, it will fall upon nonprofit organizations and so-called harm reduction programs, which already distribute naloxone for free, to continue efforts to distribute it to a larger population of people.

Health Departments Try to Do More

In Los Angeles County, health officials have launched a unique push to get Narcan into the hands of an overlooked demographic when it comes to the overdose epidemic: Latino immigrants.

The rate of fentanyl deaths among Latinos in L.A. County , according to the county Department of Public Health.

In 2016, 25 Latino residents died of fentanyl overdoses. By 2021, 551 Latinos had died. It’s unknown how many of those people were immigrants because country of origin isn’t a required data point in overdose reported data. Still, county health officials are proactively reaching out to immigrant communities with their harm reduction efforts.

While Mexico doesn’t report an opioid use epidemic as the one in the U.S., overdoses in that country are increasing — — and there’s a growing need for Narcan.

In Los Angeles, Martha Hernandez, a county community health worker, makes frequent visits to local consulates for Spanish-speaking nations, where she gives short, sharp demonstrations tailored to her audience, instructing them on how to effectively use Narcan.

“I go to five Latin consulates,” Hernandez explained during a recent visit to the city’s Mexican consulate near MacArthur Park. “I use myself as an example. A lot of us go to our hometown, Tijuana is the closest one, and we go and get medication, especially painkillers. [I tell them] ‘a lot of them have fentanyl in the medications’ and you’ll see their wide-open eyes, like ‘Whoa, that is true.’”

Narcan is , so immigrants are unlikely to know much about it. But in the U.S., Narcan’s new availability without a prescription, along with the ongoing surge in overdoses, has made consulates a new priority for enhanced outreach and training.

One common misconception Hernandez runs into surrounds Narcan’s packaging, which says “nasal spray” in large letters on the box.

“People do mistake the fact that it’s nasal [spray]; they think it’s for allergies,” she said. “That’s where you see the necessity of educating our community because a lot of people will say, ‘Oh I need it, I have allergies.’”

A Captive Audience

The main room of the Mexican consulate in L.A. feels like the lobby of a department of motor vehicles, with long waits amid rows of hard plastic chairs. On a recent morning, about 30 people sat waiting for their new Mexican passports or ID cards.

Hernandez walked in front of the assembled group, holding brightly colored public health brochures above her head.

“Simple words, colorful brochures, nice and easy. The way you approach them is the key to getting your message across,” she said.

She told the captive audience they’ll learn how to save someone from dying of an opioid overdose.

Hernandez told them Narcan is not a substitute for medical care, but it can quickly prevent an overdose from becoming fatal. And it’s so easy to use that the training can take as little as 10 minutes, she said.

It’s not always clear if someone is experiencing an overdose, but Hernandez told the group that they should still call 911 and administer Narcan.

“I tell them, ‘If I saw my mom on the floor, I would administer Narcan,’” Hernandez said. “Why? Because my mom will go to her sister’s house and say, ‘My neck …’ or ‘My knee hurts,’ and her sister will pop out a pain medicine [that she has]. A lot of us, being Latinos, will pop it into our mouth. How do I know what she put in her mouth?”

Fake prescription pills are , especially in Western states. The share of overdose deaths involving counterfeit pills more than doubled comparing a three-month period in 2019 to the last quarter of 2021, and the percentage more than tripled in Western states, according to a from the CDC.

The report found those who died from overdoses with evidence of counterfeit pill use, compared with those without it, were more often younger, Hispanic, and had misused prescription drugs in the past.

Jose Magaña Lozano, 67, works in cement construction in L.A. and has lived in the U.S. for 30 years.

“I’ve only seen opioid overdoses on TV,” he said in Spanish. “Hopefully I never have to witness an overdose happen, but if in case I do see it happen, at least you know what to do, and at the very least you can help a little.”

But for younger generations who went to high school in the U.S., and who grew up during the raging opioid epidemic, the problem is all too familiar.

“I’ve actually learned it [Narcan] in high school because you’d be surprised, lots of people were doing drugs and overdosing,” said Luis Armas Ramirez, who was part of the group at the Mexican consulate in L.A.

“Latinos, we don’t really take it seriously like that, especially because it’s something very private,” he said.

Armas was excited to receive a free box of Narcan while waiting for his travel documents.

“[Narcan] is, like, crazy expensive. I believe that things happen for a reason, so if I’m seeing it [Narcan] now, God’s timing is never wrong, I may see an overdose next week, you never know,” he said.

Hernandez gave three demonstrations at the Mexican consulate and gave out a total of 45 boxes of Narcan. The next day, she headed over to the Guatemalan consulate to teach more immigrants about the increased danger of opioid overdoses in America, and how they might help.

Gillian Moran-Pérez contributed Spanish translation assistance to this report.

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A-list stars have been out in force snapping selfies on picket lines in the bright California sun, but it’s the people who may have never walked the red carpet who are forgoing a paycheck and potentially their health insurance as the negotiations drag on and work dries up.

The health insurance offered by both unions is predicated on the notion that it is for members who work consistently and lucratively enough to make a minimum amount of money. That makes the insurance difficult first to attain and then to sustain. In exchange, it is very, very good health insurance.

Often referred to in hushed, reverent tones as the “Cadillac of health insurance” by those who have it, the policy offered by the Writers Guild of America, formerly the Screen Writers Guild, feels like a holdover from a bygone age. It has , costs $600 a year to cover the rest of your immediate family, and has deductibles in the hundreds — not thousands — of dollars.

But the biggest strike in more than six decades in Hollywood threatens that security. The WGA has been on strike since May 2, and the actors’ union, SAG-AFTRA, since mid-July. Together they represent over 170,000 workers, who have refused to perform any part of their job since talks with studios and streamers stalled. Writers and actors could lose their eligibility for insurance simply because they aren’t working while striking.

Filmmaker and Writers Guild member Susanna Fogel said no matter how good her union health insurance is, members are always at risk of losing it. “If we’re this close to not having it, then we’re already on a razor’s edge,” she said, “which is kind of why we’re striking, even though in the short term it sort of just shines a light on the problem.”

A Complicated Formula for Writers

For writers to qualify for health insurance, they a little over $41,700 in covered union work within a year. Residuals don’t count. The income requirement , which, coupled with the increasingly uncertain reliability of employment, means even experienced writers can have a hard time qualifying.

Writers can accumulate credits by qualifying for WGA health insurance for 10 years and by earning more than $100,000 in covered work. Top earners can rack up three points per year, which can be cashed in when writers experience a dry spell and can’t make the minimum income requirement, but health coverage ends the quarter after the credits are used up.

For example, a writer who qualifies for health insurance for 10 years but earns less than $100,000 can cash in all their points and continue their insurance for up to a year and a half if they are insuring only themselves.

But insuring dependents uses up more credits, meaning people with families have less of a stopgap to fall back on.

As the strike stretches into another quarter, many union writers are furtively calculating how many credits they have and how long this temporary measure will buy them, if they have credits at all.

Actors’ Good Deal Is Precarious

By contrast, residual payments do count toward the $26,000 per year that members of SAG-AFTRA must earn to qualify for health insurance offered by the actors’ union. So boosting residual payments, especially from streamers like Netflix, , is a high priority for members on the margins.

Plan are $125 a month for union members. For a family of four or more, the monthly cost rises to $249 a month, or $2,988 a year. That’s less than half of the $6,680 that the average California worker with employer-sponsored health insurance paid for coverage for a family of four in 2022, according to by the California Health Care Foundation. (�������ýҕ�l Health News produces California Healthline, an editorially independent service of the California Health Care Foundation.)

Members of both unions say it took them years to make enough money to qualify for the union health insurance, while other union members who have worked in the industry for years never have.

“The moments that I’ve been at risk of or have lost health insurance in the past, pre-strike, were when I was working,” said filmmaker Fogel, who is also a member of the Directors Guild of America. “I was working, but there were particulars to the work that just made it fall short or fall in the wrong month to stay covered. So it was just always a stress.”

Should the unions simply drop the income requirement to a lower amount so more members could qualify? Alex Winter, a longtime member of three industry unions, doesn’t think so.

“It seems draconian to turn back to the unions and say, ‘Well, since we have these oligarchs who are hoovering up all the profits, let’s try to take what few squirrel nuts we have and scatter them out amongst whoever survived staying in the industry,’ as opposed to fighting to get equitable pay, which is what we’re doing,” Winter said.

Both SAG-AFTRA and WGA were approached for interviews about their health insurance offerings. SAG-AFTRA declined to be interviewed and WGA sent LAist a .

SAG-AFTRA sent members saying health insurance would be extended for certain members who would otherwise have lost eligibility on Oct. 1. Members who made at least $22,000 before the strike began will continue to get union health insurance through the end of the year.

A New California Law Could Help Strikers on the Margins

All California workers who lose their employer-sponsored health insurance may be eligible for the state’s Medicaid program, known as Medi-Cal, or qualify to buy health insurance through Covered California, where their costs could be low if they have minimal income. Still, it would be a disruption to lose their low-cost SAG-AFTRA or WGA plans, and an additional expense at a time when striking workers are making much less money.

Writers and actors who lose their union health insurance because of the strike could benefit from a new California law that took effect July 1 aimed at averting just that situation.

received $2 million in funding under the new state budget. To qualify, a union worker must first lose coverage as a result of the strike. According to Covered California spokesperson Craig Tomiyoshi, eligible workers will have their premiums covered as if their incomes were .

Not all striking workers will enroll in a free plan. Striking workers will be able to pick plans that are more expensive than the benchmark plan. If they do, they will pay the difference in premiums.

“Covered California has seen fewer than 150 applicants who have identified an affiliation to WGA or SAG-AFTRA apply for coverage,” said spokesperson Kelly Green. She added that they expect to see more if the strikes continue and that people who anticipate losing their union health insurance should get in touch.

On Jan. 1, another new law kicks in. Covered California will end deductibles on the middle-tier benchmark plans, meaning a striking worker could receive free premiums under one law and no deductibles in the new year, if the labor dispute lasts that long.

These new rules don’t cover crew members who are not part of the striking unions but have lost health insurance due to the work stoppage.

A new mutual aid group was created to fill that gap.

, known by the acronym TUSC, has raised more than $315,000 to give assistance to International Alliance of Theatrical Stage Employees and Teamsters members, said founding member Winter.

“I don’t know anyone, honestly, in a lot of the primary crew areas who isn’t in danger of losing their health insurance, and I know a lot of people who have lost their health insurance,” Winter said.

The idea for the nonprofit began with conversations between crews and filmmakers, said Fogel, a fellow founding TUSC member.

“Because their coverage is based on the hours that they get within a certain window of time, some of the [crew members] mentioned they or people they knew were at risk for not making their hours due to productions shutting down, or if they opted not to cross a picket line, that could cost them their health insurance,” she said.

TUSC has partnered with the Motion Picture and Television Fund and its Entertainment Health Insurance Solutions, which acts as an insurance navigator for people in the industry.

Fogel said it’s about making sure that everyone in the industry has access to high-quality health care no matter the current industry conditions.

“Every so often, when there’s one group of people that are going on strike, and it’s our turn to strike right now, we just wanted to kind of let the other unions know that we consider ourselves to be part of a collective, and we hope that they feel that love from us,” Fogel said.

Could studios and streamers continue the industry members’ coverage? They could, but it’s unlikely because decision-makers are on the other side of the bargaining table.

Half of the trustees of the are represented by companies involved in the strike. The WGA’s strike FAQ tells members “there is no Health Fund requirement that the Health Plan extend health insurance coverage during a strike, and Trustees are 50% management and 50% Guild.”

In July, Matt Loeb, president of that represents behind-the-scenes workers, called for studios and streamers to to those who may lose them if they fall short of qualifying during the strikes. IATSE is not on strike.

“Make no mistake — if the studios truly cared about the economic fallout of their preemptive work slowdown … they could continue to pay crewmembers and fully fund their health care at any moment, as they did in 2020 during the onset of the COVID-19 pandemic,” Loeb wrote.

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Estas son algunas de las luchas emocionales y económicas que enfrentan las personas con síndrome de covid-19 de largo plazo, años después de la infección.

Físicamente, se sienten debilitadas y doloridas: no pueden subir las escaleras, concentrarse en un proyecto o mantener un trabajo.

A un paso del fin de la emergencia nacional de salud pública en mayo, muchas personas con síntomas prolongados de covid se sienten abandonadas por legisladores que están ansiosos por dar vuelta la página.

“Los pacientes están perdiendo la esperanza”, dijo Shelby Hedgecock de Knoxville, Tennessee, quien se identifica como sobreviviente de covid-19 de largo plazo y ahora aboga por pacientes como ella. “Nos sentimos olvidados”.

En marzo, los Centros para el Control y la Prevención de Enfermedades (CDC) estimaron que el , unas 16 millones de personas, sufren de lo que se llama síndrome de covid de largo plazo o covid prolongado: problemas de salud persistentes que continúan o emergen después de la infección.

Investigadores estiman que el 1.6% de los adultos estadounidenses, alrededor de 4 millones de personas, tienen síntomas que afectan su capacidad para realizar actividades diarias.

Si bien estos pacientes ya no son contagiosos, sus problemas de salud pueden prolongarse y extenderse a casi todos los sistemas del cuerpo. Más de 200 síntomas y afecciones, incluyendo fatiga y depresión, están relacionados con este síndrome, dijo la doctora Linda Geng, que trata a pacientes en la clínica de del centro médico de la Universidad de Stanford.��

Su gravedad y duración puede variar. Algunas personas se recuperan en unas pocas semanas, mientras que un número menor tiene problemas de salud persistentes y debilitantes. Actualmente no existe ninguna prueba, tratamiento o cura. Ni siquiera hay una definición médica aceptada.

“Cuando no existen pruebas para comprobar que hay algo anormal, puede causar ansiedad y las personas pueden sentir que no las toman en serio”, dijo Geng.

El costo físico y emocional ha dejado a muchos sin esperanzas. Un estudio de 2022 de adultos en Japón y Suecia encontró que las personas con síntomas prolongados de covid tienen de desarrollar problemas de salud mental, como depresión, ansiedad y estrés postraumático, que aquellas que se recuperan totalmente de la enfermedad.

“Una de mis amigas se suicidó en mayo de 2021”, dijo Hedgecock. “Tuvo una infección de covid leve y empezó a tener complicaciones médicas recurrentes, y se puso tan mal que decidió terminar con su vida”.

En el condado de Los Ángeles, el 46% de los adultos que contrajeron covid se recuperaron por completo en un mes, pero el resto —la mayoría— tuvo uno o más síntomas persistentes, según un realizado por el COVID-19 Pandemic Research Center de la Universidad del Sur de California.

De acuerdo con los investigadores, la fatiga crónica es el problema más común, seguido por la niebla cerebral y la tos persistente, síntomas que afectan la vida diaria de las personas.

Entre los encuestados que informaron sufrir de covid prolongado, el 77% dijo que su condición limitaba las actividades diarias como ir a la escuela o al trabajo, o socializar. Una cuarta parte dijo que experimentaba limitaciones severas.

Los antivirales reducen el riesgo de desarrollar covid de largo plazo en personas recién infectadas. Pero para aquellas que ya sufren de la enfermedad, la ciencia médica todavía se está poniendo al día.

A continuación, los casos de Hedgecock y otros dos pacientes.

Una lesión cerebral debilitante

Antes de contraer covid durante la primavera de 2020, la vida de Hedgecock giraba en torno al ejercicio. Trabajaba como entrenadora personal en Los Ángeles y participaba en competencias de resistencia los fines de semana.

A los 29 años, estaba a punto de lanzar su propio negocio��de salud y bienestar, pero empezó a tener problemas para respirar.

“Una de las cosas más aterradoras que me pasó fue que no podía respirar por la noche”, dijo Hedgecock. “Fui a la sala de emergencias en tres ocasiones, y cada vez me dijeron: ‘Estás aquí, te puedes mover, eres joven, estás sana. Vas a estar bien’”.

En ese momento, su médico de cabecera le dijo que no necesitaba oxígeno suplementario, a pesar de que sus niveles de oxígeno descendían por debajo de lo normal en la noche, dejándola sin aliento y llorando de frustración.

Por un año y medio, su afección le impidió disfrutar de uno de sus pasatiempos favoritos, la lectura.

“No podía mirar una página y decirte lo que decía. Era como si hubiera una desconexión entre las palabras y mi cerebro”, dijo. “Era una sensación tan extraña y desalentadora”.

Meses después, bajo la dirección de un especialista, Hedgecock se sometió a una prueba que mide la actividad eléctrica en el cerebro. La prueba reveló que su cerebro había estado privado de oxígeno durante meses, dañando la zona que controla la memoria y el lenguaje.

Desde entonces, Hedgecock se mudó de vuelta a Tennessee para estar cerca de su familia. No sale de su departamento sin un dispositivo de alerta médica que puede usar para llamar a una ambulancia.

Está bajo el cuidado de un equipo de especialistas y se siente afortunada, ya que conoce a personas con covid prolongado en grupos de ayuda en línea que van a perder su seguro de salud a medida que . Otras personas siguen sin poder trabajar.

“Muchos de ellos han perdido todos sus ahorros. Algunos no tienen donde vivir”, dijo.

En cama por un año

Julia Landis llevaba una vida plena como terapeuta antes de contraer covid en la primavera de 2020.

“Estaba ayudando a la gente, me encantaba mi trabajo y amaba mi vida, y he perdido todo eso”, dijo la mujer de 56 años, que vive con su esposo y su perro en Ukiah, en el condado de Mendocino.

En 2020, Landis vivía en un departamento en Phoenix y hacía un tratamiento por telemedicina para su bronquitis, que fue provocada por covid. Lo que había comenzado como un caso leve se convirtió en una depresión severa.

“Estuve en cama durante un año”, dijo.

Todavía está deprimida, y tiene dolores debilitantes y ansiedad. Para compensar la pérdida de ingresos, el esposo de Landis trabaja más horas, lo que profundiza su soledad.

“Me gustaría vivir en un lugar donde hubiera gente los siete días de la semana para no sentirme tan aterrada de estar sola todo el día”, dijo Landis. “Si esto fuera cáncer, estaría viviendo con mi familia, de eso estoy segura”.

Landis se refiere a sí misma como una paciente profesional, llenando sus días con fisioterapia y citas médicas. Está mejorando gradualmente, y puede socializar con otros de vez en cuando, aunque esto la deja exhausta y puede tardar días en recuperarse.

“Es aterrador porque no hay forma de saber si será así por el resto de mi vida”, dijo.

“Me sentí traicionada”

Linda Rosenthal, una asistente de escuela secundaria jubilada de 65 años, tiene síntomas prolongados de covid, incluyendo una inflamación en el pecho que hace que le cueste respirar. Le ha resultado difícil obtener atención médica.

Llamó a un cardiólogo en Laguna Woods, en el condado de Orange, quien le dio un tratamiento. Pero cinco días después recibió por correo una carta del doctor en la que le decía que ya no podría brindarle servicios médicos. La carta no explicaba por qué.

“Estaba tan sorprendida”, dijo. “Y entonces me sentí traicionada, porque es terrible recibir una carta de un médico diciendo que ya no te quiere como paciente, aunque esté en su derecho rechazarte, porque te hace dudar de ti misma”.

Rosenthal encontró a otro cardiólogo dispuesto a hacer visitas de telemedicina. En su consultorio, los asistentes usan máscaras aunque la regla estatal ha expirado. Sin embargo, el consultorio está a más de una hora en auto de donde ella vive.

Si te encuentras en una crisis, comunícate con la llamando al 988 o con la palabra “HOME” al 741741.

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These are some of the emotional and financial struggles long covid patients face years after their infection. Physically, they are debilitated and in pain: unable to walk up the stairs, focus on a project, or hold down a job. Facing the end of the federal public health emergency in May, many people experiencing lingering effects of the virus say they feel angry and abandoned by policymakers eager to move on.

“Patients are losing hope,” said Shelby Hedgecock, a self-described long covid survivor from Knoxville, Tennessee, who now advocates for patients like herself. “We feel swept under the rug.”

The Centers for Disease Control and Prevention estimated in March that , or about 16 million, were experiencing long covid, or ongoing health problems that continue or emerge after a bout of covid-19. Researchers estimate that 1.6% of U.S. adults, or about 4 million, have symptoms that have significantly reduced their ability to carry out day-to-day activities.

While patients are no longer contagious, their health issues can stretch on and affect almost every system in the body. More than 200 symptoms and conditions, including fatigue and depression, are linked to long covid, said Linda Geng, a physician who treats patients at Stanford Medicine’s .

The severity and duration of long covid vary. Some people recover in a few weeks, while a smaller number have debilitating and lingering health issues. There is currently no test, treatment, or cure. There’s not even an accepted medical definition.

“When you don’t have any tests that show that anything’s abnormal, it can be quite invalidating and anxiety-provoking,” Geng said.

The physical and emotional toll has left some feeling hopeless. A 2022 study of adults in Japan and Sweden found that those with post-covid conditions were to develop mental health issues, including depression, anxiety, and post-traumatic stress, as people without them.

“One of my friends committed suicide in May of 2021,” Hedgecock said. “She had a mild covid infection, and she progressively had medical complications continuously pop up, and it just got so bad that she decided to end her life.”

In Los Angeles County, 46% of adults who contracted covid were fully recovered a month later, but the rest — a majority — reported one or more continuing symptoms, according to a by the University of Southern California’s COVID-19 Pandemic Research Center. The researchers found chronic fatigue topped the list of health issues, followed by brain fog and persistent cough, all of which affect people’s daily lives.

Among the respondents who identified as living with long covid, 77% said their condition limited daily activities such as going to school or work or socializing. One-quarter reported experiencing severe limitations.

Taking antivirals cuts the risk of developing long covid in people who are newly infected. But for people already suffering, medical science is trying to catch up.

Here’s a look at Hedgecock and two other patients who have had long covid for years.

A Debilitating Brain Injury

Before contracting covid during spring 2020, Hedgecock’s life revolved around fitness. She worked as a personal trainer in Los Angeles and competed in endurance competitions on the weekends. At 29, she was about to launch an online wellness business, then she started having trouble breathing.

“One of the scariest things that happened to me was I couldn’t breathe at night,” Hedgecock said. “I did go to the emergency room on three different occasions, and each time I was told, ‘You’re up and you’re moving. You’re young; you’re healthy. It’s going to be fine.’”

Her primary care physician at the time told her she didn’t need supplemental oxygen even though her oxygen saturation dipped below normal at night, leaving her gasping for breath and crying in frustration.

Her condition kept her from one of her favorite hobbies, reading, for 19 months.

“I couldn’t look at a page and tell you what it said. It was like there was a disconnect between the words and my brain,” she said. “It was the strangest, most discouraging thing ever.”

Months later, under the direction of a specialist, Hedgecock underwent a test measuring electrical activity in the brain. It revealed her brain had been starved of oxygen for months, damaging the section controlling memory and language.

Since then, she has moved back to Tennessee to be close to family. She doesn’t leave her apartment without a medical alert button that can instantly call an ambulance. She works with a team of specialists, and she feels lucky; she knows people in online long covid groups who are losing health coverage as , while others remain unable to work.

“A lot of them have lost their life savings. Some are experiencing homelessness,” she said.

In Bed for a Year

Julia Landis led a fulfilling life as a therapist before she contracted covid in spring 2020.

“I was really able to help people and it was great work and I loved my life, and I’ve lost it,” said the 56-year-old, who lives with her husband and dog in Ukiah, California.

In 2020, Landis was living in an apartment in Phoenix and received treatment via telehealth for her covid-related bronchitis. What started out as a mild case of covid spiraled into severe depression.

“I just stayed in bed for about a year,” she said.

Her depression has continued, along with debilitating pain and anxiety. To make up for her lost income, Landis’ husband works longer hours, which in turn exacerbates her loneliness.

“It would be nice to be living somewhere where there were people around seven days a week so I wouldn’t have to go through days of being just terrified to be alone all day,” Landis said. “If this were cancer, I’d be living with family. I’m sure of it.”

Landis refers to herself as a professional patient, filling her days with physical therapy and medical appointments. She’s gradually improving and can socialize on occasion, though it leaves her exhausted and can take days to recover.

“It’s terrifying because there’s just no way of knowing if this is going to be for the rest of my existence,” she said.

‘I Felt Betrayed’

Linda Rosenthal, a 65-year-old retired high school paraprofessional, has long covid symptoms, including inflammation in her chest that makes breathing difficult. She has found it hard to get medical care.

She called and set up a treatment plan with a local cardiologist near her home in Orange County, California, but received a letter five days later telling her he would no longer be able to provide her medical services. The letter gave no reason for the cancellation.

“I was so surprised,” she said. “And then I felt betrayed because it is terrible to get a letter where a doctor, although within their rights, says that they don’t want you for a patient anymore, because it causes self-doubt.”

Rosenthal found another cardiologist willing to do telehealth visits and who has staff wear masks in the office even though the state rule has expired. The practice, however, is more than an hour’s drive from where she lives.

If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

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Last week, the FDA told health care providers to split a one-dose vial of the monkeypox vaccine . The shift was good news for vaccine-strapped cities throughout the country because it meant what little supply is available could be stretched much further.

But then L.A. County and other cities and states were told that they would get significantly less vaccine than they’d requested. L.A. County expected to receive 14,000 vials of the vaccine this week, which would have yielded, when split, 70,000 doses for eligible residents. Instead, the county will receive 5,600 vials, which will yield only 28,000 doses.

At a news conference last week, L.A. County health officials said they expected the full shipment and with it could fully vaccinate up to 90,000 people — about half of what it believes to be the at-risk population. Now with far fewer vaccine doses, that goal may take weeks to achieve.

Monkeypox cases in L.A. County have . Most cases are among men who have sex with men. California has reported , ranking it second among states in case numbers after New York, according to the Centers for Disease Control and Prevention.

The vaccine, named , is a smallpox vaccine that can also be used to prevent monkeypox amid the ongoing outbreak. The full-vial dose is injected into muscle tissue, but giving a smaller dose between layers of the skin — known as an intradermal injection — is also effective in preventing the painful viral infection.

The shift by federal officials from allotting vials to allotting doses took local public health officials by surprise. The Administration for Strategic Preparedness and Response within the Department of Health and Human Services is responsible for .

Other places with active outbreaks also got word to expect significantly fewer vaccine vials in the next shipments. Philadelphia officials expected to receive 3,600 vials but will instead receive just over 700.

“We have thousands of people who are at risk that should be vaccinated preventively before they get exposed,” Dr. Cheryl Bettigole said Tuesday. “We are advocating to our federal partners to reconsider and restore Philadelphia’s allocation of vaccine, which is urgently needed.”

L.A. County was an early adopter of the new dosing and injection strategy.

“We communicated that Public Health would implement these changes when the next tranche of doses were received, but if providers felt ready to implement the new strategy, they could proceed,” said the department’s statement.

The L.A. County Public Health department said it received assurances from federal leadership that more doses would be available in the coming weeks. But fewer doses means will remain tight.

L.A. County has a population of 10 million people, and public health officials estimate about 180,000 are at elevated risk for monkeypox. The virus causes painful skin lesions and is spread through skin-to-skin contact with someone who has the lesions. Although anyone can contract monkeypox, gay and bisexual men who have had multiple partners in the past two weeks are at the highest risk in this outbreak. The U.S. has more than 13,500 identified cases as of Aug. 17, .

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“Todo empeoró rápidamente”, dijo el residente de Emeryville. “Aparecieron más manchas, en la cara, y empezaron a salir fluidos. La erupción se extendió a mis codos, manos y tobillos”.

Después de seis citas virtuales con médicos y enfermeras, una llamada a una línea de atención de enfermería, una visita a una clínica de urgencias, dos a una sala de emergencia y dos diagnósticos incorrectos, un especialista en enfermedades infecciosas le diagnosticó a Kwong, de 33 años, viruela del simio (del mono o símica) a principios de julio.

A pesar de hacerse dos pruebas, nunca dio positivo.

Como el número de casos se ha disparado en Estados Unidos en el último mes, el sistema de salud pública se esfuerza por difundir el peligro del virus y distribuir un .

Pero el problema va más allá. Las personas que pueden estar infectadas se enfrentan a callejones sin salida, retrasos, diagnósticos incorrectos y tratamientos inadecuados mientras navegan por un sistema de atención de salud poco preparado y mal informado.

Este virus, poco conocido, hace que los hospitales se apresuren a enseñar al personal de urgencias a identificarlo y analizarlo correctamente. El doctor Peter Chin-Hong, especialista en enfermedades infecciosas de la Universidad de California-San Francisco que finalmente diagnosticó a Kwong, dijo que su caso fue un punto de inflexión para su hospital.

“Kevin llegó en mitad de la noche, cuando no había muchos recursos disponibles. Así que creo que después de su caso, nos estamos educando mejor sobre la enfermedad. Pero creo que los médicos no siempre saben qué hacer”, señaló Chin-Hong.

La viruela del simio es causada por , aunque no es tan transmisible ni mortal. Normalmente, los pacientes tienen fiebre, dolores musculares y luego una erupción en la cara, la boca, las manos y posiblemente los genitales que puede durar varias semanas.

El brote actual se propaga por , como tocar una herida o intercambiar saliva u otros fluidos corporales. Las personas también pueden infectarse al tocar objetos o superficies, como juguetes sexuales o sábanas, compartidos con alguien con la enfermedad.

El primer caso de viruela del simio en Estados Unidos se notificó el 17 de mayo, y desde entonces el número se ha elevado hasta probables o confirmados que representan a casi todos los estados, además de Washington, DC, y Puerto Rico.

El gobernador de California, Gavin Newsom, declaró el 1 de agosto el para coordinar la respuesta y reforzar las iniciativas de vacunación del estado. Alrededor de en California se han concentrado en la zona de la Bahía de San Francisco.

Aunque cualquiera puede infectarse, el brote parece haber afectado en gran medida a los hombres que tienen relaciones sexuales con hombres. Kwong explicó que probablemente contrajo la viruela del mono en un encuentro sexual durante los eventos del New York Pride.

“Este es el primer brote multicontinental de la historia, así que no va a desaparecer sin más”, afirmó , profesor de la Universidad de California-Irvine que estudia las enfermedades infecciosas.

“Esto no va a explotar como covid, pero este brote va a tener su recorrido”, añadió. “Puede que sea como la sífilis y permanezca”.

Pero la mayoría de los médicos no saben cómo reconocerlo. A finales de junio, cuando Kwong empezó a experimentar los síntomas, la mayoría de los médicos y enfermeras con los que habló durante las visitas virtuales ni siquiera mencionaron la viruela del mono. Eso no le sorprende al , profesor de medicina y epidemiología de la UCLA.

“Aunque he trabajado de forma intermitente en varios países del África subsahariana durante los últimos 25 años, nunca he tratado un caso de viruela del simio”, explicó Brewer. “Antes de este brote, era una enfermedad muy inusual”.

Una erupción limitada a la zona genital o rectal puede confundirse con una infección de transmisión sexual. Pero, según Brewer, incluso si los médicos no han sido capacitados para reconocer la viruela del simio, sus consejos a los pacientes podrían ayudar a contener la propagación.

“Deberían aconsejar que no se tenga actividad sexual hasta que sus lesiones estén curadas y tratadas”, apuntó Brewer.

Aunque muchos casos son leves y se resuelven por sí solos, algunos se agravan rápidamente, como el de Kwong.

“Tu cuerpo está siendo invadido por esta cosa que no entiendes. Y no tienes a dónde ir, así que es doloroso y aterrador”, dijo Kwong.

Al principio, Kwong trató la erupción con los esteroides tópicos que utiliza para el eczema. Cuando eso no funcionó, tuvo una cita en línea con una enfermera que le diagnosticó herpes y le recetó un medicamento antiviral.

En las horas siguientes, la erupción se extendió rápidamente a más partes de su cuerpo. Alarmado, Kwong fue a una clínica de urgencias. El médico coincidió con el diagnóstico de herpes y añadió otro: sarna, . “Mis manchas se concentraban en las manos, las muñecas, los pies y los codos, que son lugares privilegiados para la sarna”, contó Kwong.

Este médico pensó en la viruela del mono, pero las manchas de Kwong estaban agrupadas y tenían un aspecto diferente al de las imágenes de la erupción con las que este médico estaba familiarizado. “Dependiendo de dónde estuviera con mis síntomas, y de con quién hablara, recibía respuestas diferentes”, dijo Kwong.

Durante el fin de semana del 4 de julio, “intenté contactar a médicos, conocía a amigos de amigos que eran dermatólogos”, agregó. “Cada vez que hablaba con alguien, empeoraba rápidamente. Y era realmente extraño”.

Durante otra cita virtual, en mitad de la noche, una enfermera se dio cuenta de que la erupción se había extendido hacia los ojos y le dijo que fuera a la sala de emergencias de inmediato. Fue allí, en el Alta Bates Summit Medical Center de Oakland, donde los médicos dijeron que Kwong podría tener viruela del simio.

“Estuvieron investigando mientras yo estaba en la habitación, y llamaron a los Centros para el Control y la Prevención de Enfermedades (CDC). Como paciente, sentía que no sabía qué me estaba pasando, pero no me di cuenta de la poca información con que contaban los profesionales y de lo poco preparados que estaban ellos también”, expresó.

Pasó 12 horas en la sala de emergencias, donde las enfermeras le hicieron una prueba de viruela del simio. Le dijeron que volviera si tenía fiebre o empezaba a vomitar.

“En ese momento, me sentía muy mal. Tenía llagas en la parte posterior de la garganta, en la boca, por todo el cuerpo”, dijo. “Simplemente deliraba porque no podía dormir más de una o dos horas seguidas”.

Más tarde, esa misma noche, Kwong decidió ir al (UCSF). Se había enterado por un amigo de que el UCSF Health estaba tratando casos de viruela símica, y una enfermera de atención virtual le había dicho que fuera allí.

Cuando llegó, lo separaron de los demás pacientes, le dieron oxicodona para el dolor y le hicieron una prueba de viruela del simio.

Al día siguiente, Chin-Hong empezó a tratar a Kwong de viruela del simio. “Pensé, vaya, esta es una enfermedad muy, muy extendida”, contó Chin-Hong. “He visto otros casos de viruela del mono antes, pero muy concentrados. Diría que Kevin está probablemente en el 5% superior de la gravedad de las enfermedades”.

Como la erupción estaba cerca de los ojos de Kwong, Chin-Hong temía que pudiera quedarse ciego si no se trataba la enfermedad. Le recetó Tecovirimat, un medicamento antiviral con la marca TPOXX, que ha recibido la autorización especial de la FDA para tratar la viruela del mono en determinadas circunstancias.

Tras el primer día de tratamiento, Kwong notó que la erupción había dejado de extenderse. En los dos días siguientes, los cientos de manchas hinchadas se aplanaron en discos rojos. “Me sorprendió lo rápido que mejoró Kevin. Era como un turbo-cohete en el camino de la recuperación”, explicó Chin-Hong.

Cuando Kwong empezó a curarse, recibió el primer resultado de la prueba: negativo. Luego el segundo: negativo.

Chin-Hong dijo que era posible que losque tomaron las muestras de las lesiones no hubieran frotado con la suficiente fuerza como para obtener células vivas para la prueba.

“Como médico, es muy difícil obtener una buena muestra en este tipo de lesiones porque el paciente suele sentir dolor. Y no te gusta ver a la gente sufrir”, comentó Chin-Hong.

Casos como el de Kwong pueden pasar desapercibidos si las pruebas no se realizan correctamente. El para los médicos que proporcionan los CDC es adecuado, dijo Brewer, pero solo si se toma el tiempo para leer las 59 páginas.

Los médicos necesitan recoger al menos dos muestras de varios lugares del cuerpo del paciente, añadió. Según Brewer, la clave es tomar muestras de las lesiones “en diferentes etapas de desarrollo” y no concentrarse solo en los primeros bultos.

Durante dos semanas, Kwong tomó seis pastillas antivirales al día para eliminar el virus de su cuerpo. Ya no necesita medicación para el dolor. “Mi cara fue la primera en curarse, lo que me ayudó mucho a ser capaz de reconocerme en el espejo”, dijo Kwong.

Contó que, ahora que ha pasado más de un mes desde que comenzó su calvario, las manos y los pies se están curando por fin. Las cutículas y la piel de las manos se desprendieron y están en proceso de regeneración, mientras que las uñas se han vuelto negras y han empezado a caerse.

Kwong dijo que el daño psicológico tardará más en superarse. “Me siento menos invulnerable, porque fue una enfermedad que me debilitó muy rápidamente. Así que sigo trabajando en mi estado mental más que en el físico”.

Esta historia es parte de una alianza que incluye a KPCC, NPR y KHN.

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“Everything started rapidly getting worse,” the Emeryville, California, resident said. “I started to get more spots, on my face, more redness and they started leaking fluid. The rash expanded to my elbows and my hands and my ankles.”

It took Kwong, 33, six virtual appointments with doctors and nurses, one call to a nurse hotline, a trip to an urgent care clinic, two emergency room visits, and two incorrect diagnoses before an infectious disease specialist diagnosed him with monkeypox in early July.

Despite taking two tests, he never tested positive.

As the number of monkeypox cases has exploded in the U.S. in the past month, the public health system is struggling to spread the word about the virus’s danger and distribute a . But the problem extends even further. People who may be infected are grappling with dead ends, delays, incorrect diagnoses, and inappropriate treatments as they navigate an unprepared and ill-informed health care system.

The once-obscure virus has hospitals racing to teach emergency room staffers how to correctly identify and test for it. Dr. Peter Chin-Hong, the infectious disease specialist at the University of California-San Francisco who ultimately diagnosed Kwong, said his case was a tipping point for the research hospital.

“Kevin came in the middle of the night when a lot of resources weren’t available. So I think after his case, we’re doing a lot more education of the general condition. But I think your average clinician doesn’t always know what to do,” Chin-Hong said.

Monkeypox is , though it’s not as transmissible or fatal. Typically, patients have a fever, muscle aches, and then a rash on their face, mouth, hands, and possibly genitals that can last for several weeks.

The current outbreak is spreading via , such as touching a lesion, or exchanging saliva or other bodily fluids. People can also become infected by touching objects or surfaces, such as sex toys or sheets, shared with someone with the illness.

The first U.S. monkeypox case of this outbreak was reported May 17, and since then, the number has grown to probable or confirmed cases representing almost every state, plus Washington, D.C., and Puerto Rico.

California Gov. Gavin Newsom on Monday to coordinate response and bolster the state’s vaccination efforts. have been concentrated in the San Francisco Bay Area.

Although anyone can get infected, the outbreak appears to have largely affected men who have sex with men. Kwong said he likely contracted monkeypox from a sexual encounter during New York Pride events.

“This is the first-ever multicontinental outbreak, so it’s not just going to vanish,” said , an associate professor at the University of California-Irvine who studies infectious diseases.

“This is not going to blow up like covid, but this outbreak is going to have legs,” he said. “It may be like syphilis and it’ll just sort of be around.”

But most doctors don’t know how to recognize it. In late June, when Kwong began experiencing symptoms, most of the doctors and nurses he spoke with during virtual visits didn’t even mention monkeypox. That doesn’t surprise Dr. , a professor of medicine and epidemiology at UCLA.

“Even though I’ve worked on and off in several sub-Saharan African countries over the last 25 years, I’ve actually never treated a case of monkeypox,” Brewer said. “Before this current outbreak, monkeypox was a very unusual disease.”

A rash limited to the genital or rectal area may be mistaken for a sexually transmitted infection. But even if doctors haven’t been trained to recognize monkeypox, Brewer said, their advice to patients could help contain the spread.

“You would be advising people to not engage in sexual activity until their lesions are healed and treated,” Brewer said.

Although many cases are mild and resolve on their own, some rapidly become serious — like Kwong’s.

“Your body is being taken over by this thing that you don’t understand. And you have nowhere to go, so it’s both painful and terrifying,” Kwong said.

Kwong initially treated the rash with the topical steroids he uses for eczema. When that didn’t work, he attended an online appointment with a nurse who diagnosed him with herpes and prescribed an antiviral medication.

Over the next few hours, the rash quickly spread to more of his body. Alarmed, Kwong went to an urgent care clinic. The doctor agreed with the herpes diagnosis, and added another: scabies, . “My spots were concentrated on my hands and my wrists and feet and elbows, which are prime locations for scabies,” Kwong said.

The urgent care doctor had considered monkeypox but Kwong’s spots were clustered together and looked different from the monkeypox rash pictures the doctor had seen. “Depending on where I was with my symptoms, and who I was speaking to, I was getting different answers,” Kwong said.

Over the July Fourth holiday weekend, Kwong frantically reached out to anyone he thought could help as his symptoms worsened.

“I tried to contact doctors, I knew friends of friends who were dermatologists,” he said. “After each time I spoke with someone, I just got rapidly worse. And it was really freaky.”

During another virtual appointment, in the middle of the night, a nurse noticed the rash had spread toward his eyes and told him to go to the emergency room immediately. It was there, at the Alta Bates Summit Medical Center in Oakland, that doctors said Kwong may have monkeypox.

“They were researching while I was in this room, and back-and-forth on the phone with the CDC. I expected myself, as a patient, to be in the dark, but I didn’t realize how little information was also given to providers and how unprepared they were as well,” he said.

He spent 12 hours in the emergency room, where nurses swabbed his lesions for a monkeypox test. They told him to come back if he developed a fever or started vomiting.

“At this point, I was just miserable. I had sores in the back of my throat, in my mouth, all over my body,” he said. “I was just delirious because I couldn’t sleep more than an hour or two at any given time.”

Later that night, Kwong decided to make the trip to the . He’d heard through a friend that UCSF Health was treating monkeypox cases, and a virtual care nurse had urged him to go.

When he arrived, he was separated from the other patients, received oxycodone for pain, and was swabbed for another monkeypox test.

The next day, Chin-Hong started treating Kwong for monkeypox. “I thought, wow, this is really, really extensive disease,” Chin-Hong said. “I’ve seen other cases of monkeypox before, but they’re very limited. I would say Kevin is probably in the top 5% of severity of diseases.”

Because the rash was close to Kwong’s eyes, Chin-Hong feared he could go blind if the disease were left untreated. He prescribed Tecovirimat, an antiviral medication branded as TPOXX, that has received special clearance from the FDA to treat monkeypox in certain circumstances.

After the first day on the drug, Kwong noticed that his rash stopped spreading. Over the next two days, the hundreds of swollen spots flattened into red disks. “I was shocked by how fast Kevin improved. It was almost like he was a turbo-rocket on the way to recovery,” Chin-Hong said.

As Kwong started to heal, he got his first test result back: negative. Then the second: negative.

Chin-Hong said health workers might not have rubbed his lesions hard enough to get live cells for the monkeypox test. “It’s very difficult as a clinician to really get a good sample in these kinds of lesions because the patient is often in pain. And you don’t like to see people suffer,” Chin-Hong said.

Cases like Kwong’s may be missed if tests aren’t conducted correctly. The Centers for Disease Control and Prevention’s is adequate, Brewer said, but only if you take the time to read all 59 pages.

Clinicians need to collect at least two samples from multiple locations on the patient’s body, he said. The key, Brewer said, is to sample lesions “at different stages of development” and not concentrate only on the early bumps.

For two weeks, Kwong took six antiviral pills a day to rid his body of the virus. He no longer needs pain medication. “My face was the first to heal, which I think helped me a lot, to be able to recognize who I was in the mirror again,” Kwong said.

Now more than a month since the ordeal began, Kwong’s hands and feet are finally healing. His cuticles and the skin on his hands peeled off and are in the process of regrowing, while his fingernails have turned black and started to fall off, he said.

Kwong said the psychological toll will take longer to overcome. “I feel less invulnerable, because it was such a rapidly debilitating disease. And so I’m still working on my mental state more than my physical one.”

This story is part of a partnership that includes��,��,��and KHN.

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This story can be republished for free (details).