Post vaccination infection rare but possibly contagious; study refutes another anti-vax pregnancy claim

By Nancy Lapid

(Reuters) – The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

Breakthrough infections rare, but potentially contagious

As of April 30, when roughly 101 million Americans had been fully vaccinated against COVID-19, “breakthrough” infections had been reported in 0.01% of them, the U.S. Centers for Disease Control and Prevention (CDC) reported on Tuesday. Roughly 27% of breakthrough infections were asymptomatic, while in 2% of cases, patients died. The CDC had genetic data for virus samples from 555 breakthrough infections. Mutated variants of the coronavirus, including those first seen in the UK and South Africa, accounted for 64% of the breakthroughs. In a separate study posted Tuesday on medRxiv ahead of peer review, researchers reported that among 20 fully-vaccinated healthcare workers with breakthrough COVID-19 cases, all were infected with variants. An earlier study had linked breakthrough infections with low viral loads, suggesting low transmission risks, but “we found many samples in our breakthrough cohort with high viral load,” said coauthor Pavitra Roychoudhury of the University of Washington. “Our work suggests that not all breakthrough infections are at low risk of initiating transmission and, if they did, these infections could lead to the continued spread of variants of concern, particularly in areas with low vaccination rates.”

Study refutes anti-vaxxers’ pregnancy, breast milk claims

Unfounded claims by anti-vaccine activists that COVID-19 shots from Pfizer/BioNTech and Moderna will damage the placenta and contaminate breast milk have been refuted by new data. The vaccines deliver synthetic messenger RNA (mRNA), which instructs the body to make proteins that in turn induce antibodies to attack the coronavirus. Anti-vaxxers claim, with no evidence, that mRNA also induces antibodies that attack a protein called syncytin-1, which is important for the developing placenta during pregnancy. They also claim mRNA from the vaccines ends up in breast milk. When researchers studied blood samples from 15 women who received at least one dose of the Pfizer/BioNTech vaccine – including two pregnant women and five who were breastfeeding – they saw coronavirus antibodies but no antibodies against syncytin-1. None of the breastfeeding women had vaccine mRNA in their milk, according to a report posted Tuesday on medRxiv ahead of peer review. “This small study tells us that it is unlikely that COVID-19 mRNA vaccination will cause complications in pregnancy or fertility through cross-reacting antibodies against syncytin-1, or for breastfed infants through breast milk,” the authors said.

Vaccines appear safe for “long COVID” survivors

COVID-19 survivors with lingering symptoms can safely be vaccinated against the coronavirus, a small study suggests. Researchers tracked 36 individuals with “long COVID” who had been hospitalized while acutely ill and who later received at least one dose of either the Pfizer/BioNTech or AstraZeneca vaccine. Eight months after admission to the hospital, and before vaccination, participants had at least one lingering symptom and half had at least four symptoms. Before vaccination, their quality-of-life was “markedly reduced” from normal, the researchers reported on Monday in Annals of Internal Medicine. One month after vaccination, 71% of their symptoms remained unchanged, 23% of their symptoms were improved, and 6% of symptoms had worsened. There was no significant worsening in quality-of-life or mental well-being, and outcomes were similar with both vaccines, researchers reported. The results may reassure people with persistent COVID-19 symptoms that the different types of vaccines developed by Pfizer/BioNTech or AstraZeneca are “not associated with a decrease in quality of life or worsening of symptoms,” the researchers said.

Moderna says vaccine safe, effective in adolescents

Moderna’s COVID-19 vaccine was 100% effective in a trial involving 3,732 adolescents aged 12-17, with no major safety problems, the company said on Tuesday. Among participants who received two doses, there were no cases of COVID-19 compared with four cases among those who received a placebo. After only one dose, the vaccine was 93% effective in this age group, Moderna said. Side effects were similar to those reported in earlier studies, including headache, fatigue, body aches and chills. Moderna plans to submit the findings to regulators for emergency use authorization in June. The U.S. Centers for Disease Control and Prevention (CDC) said on Monday it is monitoring rare reports of mild heart inflammation after COVID-19 vaccination in adolescents. The CDC said the condition is not occurring at higher rates than would be expected in the general population, so no causal link to the vaccine has been established. Dr. Amesh Adalja of the Johns Hopkins Center for Health Security said even if vaccines turn out to be the cause, it is important to consider the risk-benefit ratio. “Vaccines are going to unequivocally be much more beneficial,” outweighing any low risk of myocarditis, he said.

(Reporting by Nancy Lapid, Julie Steenhuysen and Radhika Anilkumar; Editing by Bill Berkrot)

Special Report: Why ‘higher risk’ human targets get shocked with Tasers

Taylor Wiggington sits with a photo of her father, Doug Wiggington, in the area where he was shocked by a Taser on May 12, 2017, in Greenfield, Indiana, U.S., December 21, 2017.

By Grant Smith, Jason Szep, Peter Eisler, Linda So and Lisa Girion

NEW YORK (Reuters) – The maker of the Taser says the electroshock weapon is the safest tool on a police officer’s belt – with a few caveats.

In pages of warnings, Axon Enterprise Inc advises police to beware that some people are at higher risk of death or serious injury from the weapons. Pregnant women. Young children. Old people. Frail people. People with heart conditions. People on drugs or alcohol. The list goes on.

Taken together, the tally of people particularly susceptible to harm from a Taser’s powerful shock covers nearly a third of the U.S. population, a Reuters analysis of demographic and health data found. Yet police have repeatedly used Tasers on people who fall into the very groups the company warns about.

Dailene Rosario was one of them. Last winter, a New York City police officer fired his Taser’s electrified barbs into the rib cage of Rosario, 17, as she screamed she was pregnant. Thanks to a viral video taken by a bystander, the world watched as Rosario, 14 weeks into her term, crumpled to the ground, wailing.

What happened afterward has not been told.

Rosario’s daughter Raileey survived. But the baby is not faring well. In September, Rosario said, the two-month-old was rushed to the hospital, struggling to breathe after developing tremors and coughing fits. Raileey spent nearly all of November at Children’s Hospital at Montefiore in the Bronx, undergoing tests for a possible seizure disorder.

“Now it happens so frequently,” Rosario said of the tremors. “We can only just monitor her and try to keep her relaxed.”

Her lawyer, Scott Rynecki, said he plans to make the baby’s health a central issue in a $5 million legal claim she has filed against the New York Police Department. The NYPD said the incident remains under investigation and declined to comment further.

There’s no telling how often police use Tasers on pregnant women and the other “higher-risk populations” the manufacturer warns about: The stun guns are unregulated as police weapons, and there is no national tracking of their use.

Yet people in those groups account for more than half of the 1,028 cases identified by Reuters in which people died after being shocked by Tasers, often along with other force. Such people, Axon’s warnings say, should be targeted “only if the situation justifies an increased risk” of injury or death.

Particularly vexing for police is the difficulty of determining which potential Taser targets belong to population cohorts deemed to be at increased risk.

Some fatalities examined by Reuters involved people who obviously fell into a higher-risk category. Four, for instance, involved people over 75.

Yet many others involved vulnerabilities difficult to spot, particularly in the chaos of confrontation. Some 245 had a heart condition. And 643 people were drunk or high on drugs – a state often, but not always, easy to identify.

“People don’t walk around with signs” listing their medical conditions, said James Ginger, a former Evansville, Indiana, policeman now working as a consultant and court-appointed monitor of police compliance with judicial orders. The Taser is an important police tool, Ginger said. But if officers avoided anyone who potentially has a higher-risk condition, “you couldn’t use it.”

Axon calls Tasers the “safest force option available to law enforcement.”

The company told Reuters its warnings and training “do not identify any population group as ‘high risk,’ rather, they recognize that certain people may be at increased risk during encounters requiring force, regardless of the force option chosen.”

But the warnings issued to police by Axon, formerly known as Taser International Inc, note explicitly that “some individuals may be particularly susceptible to the effects” of its weapons. They identify an array of “higher-risk populations” and other vulnerable groups.

Law enforcement began embracing Tasers in the early 2000s. The manufacturer began listing higher-risk populations in 2009, when it also warned of possible cardiac effects from shocks to the chest. The list grew in the next few years.

Many in the police community say Tasers nevertheless offer a valuable option for controlling combative subjects without resorting to firearms. “There have been instances where we have saved a person’s life by using this piece of equipment,” said Virginia Beach Police Chief James Cervera. But as warnings on the weapons’ risks have evolved, he added, the department has “tightened up” on their use.

Axon’s warnings and guidelines are not binding on police departments, and while more than 90 percent of police agencies deploy Tasers, there are no universal standards for usage.

The uncertainty raises a challenge, some in law enforcement say. If large swaths of people are potentially at higher risk of death or serious injury from a Taser, how can police ever be sure the weapons are safe to use?

Nearly 80 percent of the population could fit into one of the higher risk groups identified by Taser’s maker, Reuters’ analysis shows. For example, any woman of childbearing age – about 20 percent of the population – could be pregnant. Any adult male could have impaired heart function, another third of the populace.

Police often have mere seconds to weigh such factors, said Chuck Wexler, executive director of the Police Executive Research Forum, a think tank that advises police on policy issues, including use-of-force. As a result, he said, “the Taser may be the most complicated weapon that a police officer wears today.”

A BIG HEART

Michael Mears, 39, was found on the floor in a hallway at his Los Angeles apartment complex on Christmas Eve 2014, bloodied and crying: “Help me. Help me.”

The police called to help the disabled veteran shocked him repeatedly with a Taser.

Mears had a vulnerability the officers couldn’t see: an enlarged heart.

In 2009, the manufacturer introduced the possibility that Taser shocks could affect the heart. By Christmas 2014, it had warned that “serious complications could also arise in those with impaired heart function.”

That didn’t protect Mears, nor many others like him. Of the 750 Taser-involved deaths in which Reuters obtained autopsy information, 245 involved people with pre-existing heart problems. And of the 159 cases in which coroners ruled the Taser shock caused or contributed to the death, 68, or 43 percent, involved cardiac conditions.

Mears grew up in Florida and joined the Marines after high school. At 19, he helped evacuate United Nations troops from Somalia in 1995.

He injured his back in a shipboard fall two years later, said his mother, Joanna Wysocki. Surgery to repair his spine instead left him unable to walk. After years of rehabilitation, he had begun to walk again. But he often lost feeling in his weakened legs and needed a walker or wheelchair.

Wysocki said she talked to her son by phone the morning of his death, and he was excited about having friends over for Christmas Eve dinner. But that afternoon, he began acting strangely, court records show.

He rolled a candlestick across the floor as if he were throwing a grenade, and then ran out of the apartment. A neighbor peeked through a door and saw him lying on the floor, crying for help, she told detectives. Mears was covered in blood from rolling in shards of glass from a broken fire extinguisher case.

“He has PTSD,” a friend told the paramedics who arrived. Several LAPD officers followed. The first two hit Mears with pepper spray and batons because, the autopsy report said, he appeared combative.

The Taser’s log shows Mears was shocked six times totaling 53 seconds over three minutes. The longest: 32 seconds. Taser guidelines advise officers to avoid “repeated, prolonged or continuous” shocks, noting that safety testing typically involved no more than 15 seconds of exposure.

The officer who stunned Mears testified he believed he was applying 5-second shocks and had no idea his Taser delivered electricity for as long as he held the trigger. The LAPD declined to discuss the case or make the officer available for comment.

The Los Angeles County Medical Examiner-Coroner ruled Mears’ death a homicide, concluding that cocaine and police efforts to restrain him, including the Taser shocks, were too much for his heart.

His parents sued the city. Jurors blamed the city for being “deliberately indifferent” to officer training and awarded them $5.5 million.

Mears died Christmas morning, while his mother was flying from Florida. “I’ll never get to say goodbye,” she said.

NURSING HOME TRAGEDY

Sometimes, the vulnerabilities are more obvious.

There was no mistaking Stanley Downen was elderly when Columbia Falls police answered a call from the Montana Veterans’ Home for help with a wandering resident in June 2012. Downen, 77 with advanced Alzheimer’s, was just outside the gate, circled by several staffers urging him to come back inside.

A retired ironworker and Navy vet, Downen had scooped up landscaping rocks, one as big as a softball, and was threatening to throw them at anyone who came near. Officers Mike Johnson and Gary Stanberry approached, asking him to put down the rocks.

Downen cursed at the officers and said he wanted to go home.

They tried again; same response.

Johnson drew his Taser and fired. He later testified that Downen had reared back as if to throw one of the rocks. “I believed that I was going to be physically harmed.”

Paralyzed by the Taser’s electrified darts, Downen’s body seized and he fell forward, his head smacking the pavement. Handcuffed, he continued cursing and struggling.

Downen was taken to a nearby hospital, but his dementia worsened. He died there three weeks later.

Axon has warned since 2008 about using its weapons on “elderly” people and advises that doing so “could increase the risk of death or serious injury.” A model Taser policy from the Police Executive Research Forum includes similar warnings.

But neither designates an age threshold for “elderly,” and dozens of police department policies reviewed by Reuters specify no age limit.

Reuters identified 13 cases in which people 65 and older – the eligibility age for Medicare – died after being stunned by police with Tasers. All but two occurred well after the manufacturer’s first warnings.

By the time Columbia Falls police confronted Stanley Downen in 2012, the warnings had been in place for years. Officer Johnson later testified he never saw them.

In depositions and court records from a lawsuit filed by Tamara Downen, Stanley’s granddaughter, Johnson and the police department acknowledged he had not been trained or certified on Taser use since 2006 – two years before the manufacturer first warned against shocking the elderly. Officers are supposed to be re-trained and certified on the weapons annually, according to guidelines from the manufacturer and independent law enforcement groups.

The department also had no formal policy on Taser use, court records show, and its procedures manual never mentioned the weapon.

Tamara Downen sued the state-run nursing home and city police, alleging unsafe practices and improper Taser use in her grandfather’s death. “It just wasn’t right, what he went through,” she said. The city settled for $150,000; the state for $20,000.

Columbia Falls later hired a new police chief, Clint Peters. Citing the litigation, he declined to comment on the case or make the officers available for interviews. But he said the force now has a Taser policy based on guidelines from national law enforcement groups.

‘TOTALLY INTOXICATED’

Axon has warned since 2005 that people agitated or intoxicated by drugs may face higher risks of medical consequences from Tasers’ electrical current. Data collected by Reuters underline that risk: More than 60 percent of 1,028 people who died in police confrontations involving Tasers were either drunk or on drugs.

Some who died were unmistakably intoxicated – like Doug Wiggington.

In Greenfield, Indiana, last May 12, Wiggington stumbled out of the local Elks Lodge just after 6 p.m., falling as he walked near a two-lane highway. James Fornoff, 74, called police. “He had no clue what he was doing,” Fornoff said.

When the first officer arrived at 6:27 p.m., Wiggington, 48, was lying in the grass, wiggling his feet, police dash-cam videos showed. “What have you taken?” Officer Dillon Silver asked.

As officer Rodney Vawter joined him, Silver rolled Wiggington onto his side, patting him down. Silver began to pull him onto his back but Wiggington stiffened. Silver grabbed his arm, saying, “Do not tense up on me.” Wiggington, 6 feet and 230 pounds, rolled onto his stomach.

“Tase him,” said Silver. Vawter pulled the trigger and the barbs struck Wiggington’s back. He writhed and grunted. “I’m going to do it again if you don’t listen!” Vawter said. The struggle continued. Vawter fired again.

When the officers turned him over, Wiggington was unconscious. They gave him two shots of Narcan, an overdose antidote for opioids, and started CPR. When the ambulance arrived, Wiggington had no pulse. Thirty minutes later, he was pronounced dead.

The autopsy said Wiggington died from “acute cocaine and methamphetamine intoxication.” The Taser was listed first among contributing factors.

“We have a lot of unanswered questions,” said Wiggington’s daughter, Brittany, 30, who has filed legal notice of her intent to sue the department.

By the time Wiggington was shocked, the company’s training materials had noted explicitly for years that Tasers cause “physiologic and/or metabolic effects that may increase the risk of death or serious injury” – and drug users “may be particularly susceptible.”

None of that language appeared in the Greenfield Police Department’s Taser policy at the time. The officer who shocked Wigginton, Vawter, hadn’t been re-certified on the Taser in more than three years.

Greenfield Police Chief Jeff Rasche said the two officers did not violate department policy and were cleared by an internal investigation and a separate state probe. Axon, he added, does not explicitly bar using the weapon on people under the influence of drugs or alcohol, but instead warns of the risks.

Rasche, chief since last January, said he had ordered his 42 officers to undergo a six-hour Taser re-certification class before the death. At the time of the incident, nine had completed it. Vawter wasn’t among them.

Since the death, Rasche has ordered all officers to undergo “crisis intervention training,” emphasizing de-escalation strategies in lieu of using force such as Tasers.

“We can’t just do the same thing we’ve been doing forever because it’s not working,” the chief said. “People are unfortunately dying and officers are having to use lethal force when they, you know, probably shouldn’t be.”

THE PREGNANCY PROBLEM

At any given time, 6 percent of women of childbearing age are pregnant. But, in the early stages, the signs of pregnancy are rarely obvious.

Since 2003, Axon has warned that pregnant women are at particular risk of injury from falls after being shocked. Still, the company suggested then that the weapons’ electrical charge posed no other special risks to women or fetuses. In 2004, it cited lab tests in which an electric charge was delivered to the abdomens of pregnant pigs with “no adverse effect on fetuses.”

In 2009, Axon identified pregnant women as a “higher risk population.” By 2011, news reports described nearly a dozen women who had suffered miscarriages or other pregnancy complications after stun-gun shocks.

Definitively measuring the risks of shocking a pregnant woman is impossible: There has never been a controlled study of the Taser’s effects on pregnant women. Such tests, by their nature, are too risky to undertake.

Yet since electricity is a known cardiac hazard, doctors theorize it poses some risk.

“There may be an instantaneous fetal effect when the Taser discharges, but you may not know about that until when he is a small child,” said Michael Cackovic, an obstetrician who heads the maternal cardiac disease program at the Ohio State University Wexner Medical Center.

Cackovic said risks from a Taser shock include disrupting the flow of oxygen from the mother, potential fatal cardiac arrhythmia, damage affecting the brain and other problems that may emerge years after birth.

No government authorities track miscarriages or other problems linked to pregnant women stunned by Tasers. A Reuters review of court filings and news articles found 19 incidents of women stunned while pregnant, at least 11 of which were followed by a miscarriage, since 2001.

One such case played out on a hot August morning in Lima, Ohio, in 2016. Brittany Osberry, 24, stumbled into a crime scene as she pulled into her friend’s driveway to pick up her nieces and nephews. Police were monitoring the home because they mistakenly thought a suspect in a shooting may be inside. Within seconds, three officers swarmed her car.

“You need to leave!” officer Mark Frysinger shouted, gun drawn, the altercation captured on a neighbor’s cellphone. “This is a crime scene.”

When she asked why, Frysinger accused her of disorderly conduct and told her to leave again. She protested: She wanted first to pick up the children. The officers moved in. “Show me your hands,” Frysinger yelled, pulling her from the car. Three officers pushed her up against the door.

“You all better know I’m pregnant,” she shouted. “You all better know that.”

One officer put her in a choke-hold and lifted the 104-pound woman back so high the tips of her toes touched the driveway. Another officer, Zane Slusher, drove a Taser into her abdomen. “Oh my God!” she screamed.

In an incident report, police said Osberry was combative and struck an officer – assertions a federal judge said were “not conclusively” borne out by the video. Osberry was arrested for obstructing official business, resisting arrest, disorderly conduct and assault. The charges were later dismissed. No official reason was given.

Within hours, she said, she felt stomach cramps. A month later, ultrasounds couldn’t detect the baby’s heartbeat. Other tests found a beating heart, but her doctors identified another problem: Osberry was suffering from preeclampsia, a dangerous spike in blood pressure during pregnancy that can interfere with blood flow to the placenta and fetus.

She underwent tests twice a week. The fetus wasn’t gaining weight.

Then, that New Year’s Eve, with Osberry 30 weeks pregnant, her doctor said the baby was coming. Contractions began and the baby’s heartbeat plunged, she said. On the way to the hospital, she wept, “not knowing if I would lose him.”

Kannon was born at 2 pounds, 2 ounces and stayed at the hospital nearly two months. Today, he’s generally healthy but struggles to use his left leg; doctors aren’t sure if he’ll face long-term developmental problems.

In February, Osberry filed suit against Lima Police and the officers involved. The department said it had “probable cause” to arrest her and cited “qualified immunity,” a concept providing legal protection to officers unless police violate “clearly established’’ legal principles.

In November, a federal judge rejected the department’s attempt to have the case dismissed. Lima Police have appealed the ruling.

“Given the factual allegations, I am hard-pressed to imagine a scenario less deserving of qualified immunity,” wrote U.S. District Judge James Carr. A “reasonable officer,” he said, should know not to use a Taser on a “non-resisting pregnant woman.”

(Reported by Grant Smith, Jason Szep, Peter Eisler, Linda So and Lisa Girion. Editing by Ronnie Greene)

More hospital closings in rural America add risk for pregnant women

Dr. Nicole Arthur (R), visits Tariyana Wiggins, a high school teacher, shortly after the birth of Troy O’Brien Williams in the hospital room at the North Baldwin Infirmary, a 70-bed hospital in rural Bay Minette, Alabama, U.S. on June 22, 2017. REUTERS/Jilian Mincer

By Jilian Mincer

Bay Minette, Alabama (Reuters) – Dr. Nicole Arthur, a family practice physician, was trained to avoid Cesarean deliveries in child-birth, unless medically necessary, because surgery increases risks and recovery time.

But she has adjusted her approach since arriving last year at the 70-bed North Baldwin Infirmary in rural, southern Alabama.

Low patient admissions and high costs mean the hospital does not have doctors on site around-the-clock to administer anesthesia in the case of an unexpected emergency Cesarean.

As a result, Dr. Arthur performs the surgery if there are any signs of complication, rather than waiting and running the risk that comes with the 20 to 30 minutes it takes for an anesthesiologist to arrive in the middle of the night.

“It’s better for me to do a C-section when I suspect that something may happen,” she said of her new strategy. “Getting the baby out healthy and happy outweighs some of the risk.”

Physicians in rural communities across America are facing the same tough choices as Dr. Arthur. Hospitals are scaling back services, shutting their maternity wards or closing altogether, according to data from hospitals, state health departments, the federal government and rural health organizations.

Nationally, 119 rural hospitals that have shut since 2005, with 80 of those closures having occurred since 2010, according to the most recent data from the North Carolina Rural Health Research Program.

To save on insurance and staffing costs, maternity departments are often among the first to get shuttered inside financially stressed rural hospitals, according medical professionals and healthcare experts.

“It’s been a slow and steady decline,” said Michael Topchik, the National Leader for the Chartis Center for Rural Health, about maternity ward closings. “It’s very expensive care to offer, especially when it’s lower volume.”

More than 200 maternity wards closed between 2004 and 2014 because of higher costs, fewer births and staffing shortages, leaving 54 percent of rural counties across the United States without hospital-based obstetrics, data from the University of Minnesota’s Rural Health Research Center show.

The trend has escalated recently even though the national healthcare law, known as Obamacare, was designed in part to help rural hospitals thrive. But unpaid patient debt has risen among rural hospitals by 50 percent since the Affordable Care Act was passed, according to the National Rural Health Association, especially in states that decided not to expand Medicaid – the state and federal insurance program for the poor.

The outlook for these hospitals was not poised to improve had Congress approved legislation to replace Obamacare. Senate Republicans’ proposed cuts to Medicaid would have pushed about 150 more rural hospitals into the red, according to the Chartis Center for Rural Health, mainly in states that voted Republican in the last election.

But late on Monday, Senate Majority Leader Mitch McConnell said the Republican effort to repeal and immediately replace Obamacare will not be successful, after two of McConnell’s Senate conservatives announced that they would not support the bill.

PAIN FELT BEYOND THE BELTWAY

The consequences go beyond politics.

When local doctors and midwives leave town, rural women lose access to essential services. Many skip or delay prenatal care that could prevent complications, premature birth or even death. The U.S. infant mortality rate is among the highest in developing countries at 5.8 deaths per 1,000 births.

Pregnant woman in rural areas are more likely to have their deliveries induced or by Cesarean section that, while potentially life-saving, are more expensive and risky than a normal vaginal birth, according to patients, medical professionals and researchers.

Almost a year after her second son’s birth, Courtney Cross is still repaying money she borrowed because of the smaller paychecks and larger gas bills she had from driving 60 minutes each way to a specialist in Mobile, Alabama.

“There were some days I had to reschedule because of the money factor,” said Cross, a medical technician and mother of two, who some months made the trip multiple times. “I had to make money.”

Cross is not alone. The most common reasons for the hospital closures are people and money. More and more people are moving to urban areas in pursuit of work and a better paycheck. And in most states, lower revenue from insurance and U.S. government payments are pushing these hospitals into financial stress, particularly in states that did not build out their Medicaid programs as Obamacare allowed.

“The majority of births in rural America are paid for by Medicaid, and Medicaid is not the most generous payer,” said Diane Calmus, government affairs and policy manager for the National Rural Health Association. “For most hospitals it is a money losing proposition.”

This is the main reason why Connie Trujillo shuttered her midwife practice this spring in Las Vegas, New Mexico. The local hospital had closed its maternity ward, and the closest hospital to deliver babies was at least 60 miles away. She sees more elective inductions because the patients live far away and can’t afford to go back and forth.

“Some of them just don’t have the resources,” she said. A year after shuttering, the hospital is trying to hire additional staff to reopen the ward.

MORE SCHEDULED DELIVERIES

The number of induced U.S. deliveries nationally has doubled since 1990 to about 23.3 percent, but rates are significantly higher in rural areas, where it is routinely offered to women traveling long distances, especially if the weather is bad.

Induced labor and surgery come at a high cost. Commercial insurance and Medicaid paid about 50 percent more for Cesarean than vaginal births, according to a 2013 Truven Health Analytics report. The report said Medicaid payments for maternal and newborn care for a vaginal birth was $9,131 versus $13,590 for a C-section.

In largely rural West Virginia – where the Summersville Regional Medical Center became the latest hospital to stop delivering newborns earlier this year – elected inductions for first time mothers rose to 28.7 percent in 2015 from 24.1 percent in 2011, according to data provided to Reuters by the West Virginia Perinatal Partnership, a statewide effort to improve care.

“Inductions allow the physicians to manage their case loads and timing of deliveries,” said Amy Tolliver, director of the Perinatal Partnership. “We know that inductions are happening in small hospitals that have difficulty with staffing.”

To address staffing issues at Dr Arthur’s hospital in Alabama, the facility paid temporary doctors for a year to keep the department open when one of its two maternity doctors stopped doing deliveries.

“It’s important to have access (to obstetrics),” said hospital president Benjamin Hansert, who also organized a group of doctors from Mobile about 40 minutes away to cover some of the shifts so that staff doctors would not always be on call. “Where the mother goes for care, the rest of the family will follow.”

For the full graphic on hospital closures, click http://tmsnrt.rs/2us7qDM

(Editing by Caroline Humer and Edward Tobin)

Iowa Supreme Court blocks portion of 20-week abortion ban

Iowa Governor Terry Branstad testifies before a Senate Foreign Relations Committee confirmation hearing on his nomination to be U.S. ambassador to China at Capitol Hill in Washington D.C., U.S. on May 2, 2017. REUTERS/Carlos Barria/File Photo

By Timothy Mclaughlin

(Reuters) – The Iowa Supreme Court on Friday granted an emergency temporary injunction halting a portion of a 20-week abortion ban that was signed into law by Republican Governor Terry Branstad just hours earlier.

The law, passed by Iowa’s Republican-controlled House and Senate last month, bans abortions once a pregnancy reaches 20 weeks and stipulates a three-day waiting period before women can undergo any abortion.

The law does not make exceptions for instances of rape or incest but does allow for abortions if the mother’s life or health is at risk.

The American Civil Liberties Union (ACLU) and Planned Parenthood, a group that provides family planning services, including abortions, challenged the waiting-period part of the legislation in court as well as the requirement for an additional clinical visit women must make before an abortion.

The state Supreme Court on Friday issued the injunction after it was denied Thursday by a district judge.

“We are pleased that the court granted the temporary injunction, ruling on the side of Iowa women who need access to, and have a constitutional right, to safe, legal abortion,” Suzanna de Baca, chief executive of Planned Parenthood of the Heartland said in a statement.

The state will have an opportunity to respond to the court’s decision on Monday.

“This is all part of the process and we’re confident that the stay will be lifted very shortly,” said Ben Hammes, a spokesman for the Republican governor.

Women in the United States have the right under the Constitution to end a pregnancy, but abortion opponents have pushed for tougher regulations, particularly in conservative states.

There are 24 states that impose prohibitions on abortions after a certain number of weeks, according to the Guttmacher Institute, which tracks reproductive policy.

Seventeen of these states ban abortion at about 20 weeks and after.

Iowa’s law, Hammes said after the signing, marked a “return to a culture that once again respects human life.”

In Tennessee, a bill similar to the Iowa measure was sent to the desk of that state’s Republican governor on Wednesday to possibly be signed into law.

(Reporting by Timothy Mclaughlin in Chicago; Editing by Jonathan Oatis)

Myanmar trains midwives to tackle maternal death rate

Midwives attend pacients in Central Women's Hospital in Yangon, Myanmar March 17, 2017. REUTERS/Pyay Kyaw Aung

By Aye Win Myint

YANGON (Reuters) – Myanmar is training up hundreds of midwives in an effort to reduce the number of women who die in childbirth, one of many social policy reforms launched by the country as it emerges from decades of military rule.

Statistics show childbirth and pregnancy-related complications are the leading causes of death among women in Myanmar, mainly due to delays in reaching emergency care.

According to the most recent census, 282 women die per 100,000 births in the country, equivalent to about eight deaths every day, double the regional average and far above the mortality ratio of 20 deaths per 100,000 in neighboring Thailand or six per 100,000 in Singapore.

Nay Hnin Lwin, 19, is among 200 midwifery students currently studying at the Central Midwifery School in Yangon.

She said her parents, who live in a rural area, still do not recognize the importance of midwives, relying instead on traditional birth attendants.

“If there is an emergency situation, they cannot save lives. Mothers are losing their lives because of them. I’m proud to be a midwife to save them from these situations,” she told Reuters Television.

At the end of the two-year course, Nay Hnin Lwin and other trainee midwives will be deployed to remote clinics with poor infrastructure and bare-bones medical facilities.

“The role of midwives is very important because two thirds of our country is in rural areas. They are not only working on healthcare, but also documenting and compiling data for the country,” said Dashi Hkwan Nu, head teacher at the Central Midwifery School.

Myanmar’s healthcare — particularly in far-flung areas — is plagued by ramshackle services, with hospitals lacking basic equipment because the military junta diverted funds away from services benefiting the general population to the army.

The government of Myanmar’s first de-facto civilian leader in about half a century, Aung San Suu Kyi, has launched a series of social reforms such as national health and education plans, and the introduction of a bus transport system in Yangon.

A year after sweeping to power, however, Suu Kyi acknowledged earlier this week public frustration with the slow pace of reforms and development.

The midwives’ training program is being supported by the United Nations Population Fund (UNFPA), which says Myanmar must tackle maternal mortality in order to raise living standards.

“Maternal mortality needs to come down if Myanmar wants to graduate from the least developed into a middle-income country,” said Hla Hla Aye, assistant representative to the Fund.

(Reporting by Aye Win Myint; Writing by Antoni Slodkowski; Editing by Helen Popper)

Exclusive: Abortion by prescription now rivals surgery for U.S. women

By Jilian Mincer

NEW YORK (Reuters) – American women are ending pregnancies with medication almost as often as with surgery, marking a turning point for abortion in the United States, data reviewed by Reuters shows.

The watershed comes amid an overall decline in abortion, a choice that remains politically charged in the United States, sparking a fiery exchange in the final debate between presidential nominees Hillary Clinton and Donald Trump.

When the two medications used to induce abortion won U.S. approval 16 years ago, the method was expected to quickly overtake the surgical option, as it has in much of Europe. But U.S. abortion opponents persuaded lawmakers in many states to put restrictions on their use.

Although many limitations remain, innovative dispensing efforts in some states, restricted access to surgical abortions in others and greater awareness boosted medication abortions to 43 percent of pregnancy terminations at Planned Parenthood clinics, the nation’s single largest provider, in 2014, up from 35 percent in 2010, according to previously unreported figures from the nonprofit.

The national rate is likely even higher now because of new federal prescribing guidelines that took effect in March. In three states most impacted by that change – Ohio, Texas and North Dakota – demand for medication abortions tripled in the last several months to as much as 30 percent of all procedures in some clinics, according to data gathered by Reuters from clinics, state health departments and Planned Parenthood affiliates.

Among states with few or no restrictions, medication abortions comprise a greater share, up to 55 percent in Michigan and 64 percent in Iowa.

Denise Hill, an Ohio mother who works full time and is pursuing a college degree, is part of the shift.

Hill, 26, became extremely ill with her third pregnancy, sidelined by low blood pressure that made it challenging to care for her son and daughter. In July, eight weeks in, she said she made the difficult decision to have a medication abortion. She called the option that was not available in her state four months earlier “a blessing.”

The new prescribing guidelines were sought by privately-held Danco Laboratories, the sole maker of the pills for the U.S. market. Spokeswoman Abby Long said sales have since surged to the extent that medication abortion now is “a second option and fairly equal” to the surgical procedure.

“We have been growing steadily year over year, and definitely the growth is larger this year,” Long said.

Women who ask for the medication prefer it because they can end a pregnancy at home, with a partner, in a manner more like a miscarriage, said Tammi Kromenaker, director of the Red River Women’s Clinic in Fargo, North Dakota.

GAME CHANGER

Medication abortion involves two drugs, taken over a day or two. The first, mifepristone, blocks the pregnancy sustaining hormone progesterone. The second, misoprostol, induces uterine contractions. Studies have shown medical abortions are effective up to 95 percent of the time.

Approved in France in 1988, the abortion pill was supposed to be a game changer, a convenient and private way to end pregnancy. In Western Europe, medication abortion is more common, accounting for 91 percent of pregnancy terminations in Finland, the highest rate, followed by Scotland at 80 percent, according to the Guttmacher Institute, a nonprofit research organization that supports abortion rights.

In the United States, proponents had hoped the medication would allow women to avoid the clinics that had long been targets of protests and sometimes violence.

But Planned Parenthood and other clinics remain key venues for the medication option. Of the more than 2.75 million U.S. women who have used abortion pills since they were approved in 2000, at least 1 million got them at Planned Parenthood.

Many private physicians have avoided prescribing the pills, in part out of concern that it would expose their practices to the type of protests clinics experienced, say doctors, abortion providers and healthcare organizations.

At the same time, the overall U.S. abortion rate has dropped to a low of 16.9 terminations per 1,000 women aged 15-44 in 2011, down from 19.4 per 1,000 in 2008, according to federal data. The decline has been driven in part by wider use of birth control, including long lasting IUDs.

In March, the U.S. Food and Drug Administration changed its prescribing guidelines for medication abortion. The agency now allows the pills to be prescribed as far as 10 weeks into pregnancy, up from seven. It cut the number of required medical visits and allowed trained professionals other than physicians, including nurse practitioners, to dispense the pills. It also changed dosing guidelines.

The changes were supported by years of prescribing data and reflect practices already common in most states where doctors are free to prescribe as they deem best.

Ohio, Texas and North Dakota took the unusual step of requiring physicians to strictly adhere to the original guidelines. Many abortion providers were reluctant to prescribe the pills under the older guidelines, which no longer reflected current medical knowledge, said Vicki Saporta, President and CEO of the National Abortion Federation.

Randall K. O’Bannon, a director at the anti-abortion National Right to Life organization, criticized the new guidelines but said his organization had no plans to fight them.

“What they did was make it more profitable,” O’Bannon said. “It will increase the pool of potential customers.”

Planned Parenthood said both types of abortion typically cost from $300 to $1,000, including tests and examinations. The group charges a sliding fee based on a patient’s ability to pay, regardless of which type of abortion they choose.

VARIED ACCESS

Despite a landmark U.S. Supreme Court ruling that abortion is a woman’s right, access varies widely by state. Some states maintain restrictions on both surgical and medication abortions; others have worked to increase access.

In rural Iowa, where clinics are few and far between, Planned Parenthood is using video conferencing, known as telemedicine, to expand access.

The way it works is, a woman is examined in her community by a trained medical professional, who checks vital signs and blood pressure and performs an ultrasound. The information is sent to an off-site doctor, who talks with the woman via video conference and authorizes the medications.

Since the telemedicine program began in Iowa in 2008, medication abortions increased to 64 percent of all pregnancy terminations, the highest U.S. rate.

In New York, Hawaii, Washington and Oregon, a private research institute, Gynuity Health Projects, works with clinics to send abortion pills by mail to pre-screened women.

“Medication abortion is definitely the next frontier,” said Gloria Totten, president of the Public Leadership Institute, a nonprofit that advises advocates.

And in Maryland and Atlanta, the nonprofit organization Carafem opened centers in the last 18 months that offer birth control and medication, but not surgical, abortions. It promotes its services with ads that read: “Abortion. Yeah, we do that.”

(Reporting By Jilian Mincer; Editing by Michele Gershberg and Lisa Girion)

Florida declares neighborhood Zika free; CDC remains cautious

Florida Gov. Rick Scott speaks at a press conference about the Zika virus in Doral, Florida,

By Julie Steenhuysen and Ransdell Pierson

(Reuters) – U.S. health officials on Monday continued to advise pregnant women and their partners to consider postponing non-essential travel to Miami to avoid the risk of exposure to Zika, even as Florida Governor Rick Scott declared the city’s Wynwood neighborhood Zika-free and invited visitors to return.

The U.S. Centers for Disease Control and Prevention said in a statement that the Wynwood neighborhood of Miami had been considered an area of active Zika virus transmission from June 15 to Sept. 18, 2016. It urged pregnant women who lived in or traveled to the neighborhood to consider getting tested for Zika.

“We want to continue to emphasize to pregnant women that they still should consider postponing non-essential travel for all of Miami-Dade (County). That is still in effect,” said CDC spokesman Tom Skinner.

Wynwood is the first neighborhood in the continental United States to have a local outbreak of Zika, a mosquito-borne virus that has been shown to cause birth defects.

Florida’s governor, at a news conference earlier on Monday, said there have not been any cases of Zika in the Wynwood neighborhood in the past 45 days, and declared that “everybody should be coming back here and enjoying themselves.”

“We had an issue, everybody took it seriously and we solved it,” he said.

Scott’s pronouncement followed news on Friday that the state had expanded the zone with active Zika transmission to nearby Miami Beach after five new cases of the virus were detected.

The Zika zone in Miami Beach, a popular tourist destination, tripled in size, growing from 1.5 square miles to 4.5 square miles. As of Friday, Florida has a total of 93 cases of Zika caused by local mosquitoes.

Zika is a particular threat to pregnant women because the virus can cause serious birth defects in babies whose mothers were infected during pregnancy, including microcephaly, a condition in which the brain is undersized, reflecting arrested development.

Scott also called on the U.S. government to approve spending to arrest any future spread of the virus in Florida and elsewhere, including funds for mosquito abatement, education and testing for Zika. A spending bill has been delayed in Congress.

(Reporting by Colleen Jenkins, Julie Steenhuysen and Ransdell Pierson; Editing by Dan Grebler)

Health agency reports U.S. babies with Zika-related birth defects

Mosquito under microscope, studying Zika

By Bill Berkrot

(Reuters) – Three babies have been born in the United States with birth defects linked to likely Zika virus infections in the mothers during pregnancy, along with three cases of lost pregnancies linked to Zika, federal health officials said on Thursday.

The six cases reported as of June 9 were included in a new U.S. Zika pregnancy registry created by the Centers for Disease Control and Prevention. The agency said it will begin regular reporting of poor outcomes of pregnancies with laboratory evidence of possible Zika virus infection in the 50 states and the District of Columbia.

Zika has caused alarm throughout the Americas since numerous cases of the birth defect microcephaly linked to the mosquito-borne virus were reported in Brazil, the country hardest hit by the current outbreak. The rare birth defect is marked by unusually small head size and potentially severe developmental problems.

The U.S. cases so far involve women who contracted the virus outside the United States in areas with active Zika outbreaks, or were infected through unprotected sex with an infected partner. There have not yet been any cases reported of local transmission of the virus in the United States. Health experts expect local transmission to occur as mosquito season gets underway with warmer weather, especially in Gulf Coast states, such as Florida and Texas.

The CDC declined to provide details of the three cases it reported on Thursday, but said all had brain abnormalities consistent with congenital Zika virus infection. Two U.S. cases of babies with microcephaly previously were reported in Hawaii and New Jersey.

The poor birth outcomes reported include those known to be caused by Zika, such as microcephaly and other severe fetal defects, including calcium deposits in the brain indicating possible brain damage, excess fluid in the brain cavities and surrounding the brain, absent or poorly formed brain structures and abnormal eye development, the CDC said.

“The pattern that we’re seeing here in the U.S. among travelers is very similar to what we’re seeing in other places like Colombia and Brazil,” Dr. Denise Jamieson, co-leader of the CDC Zika pregnancy task force, said in a telephone interview.

Authorities in Brazil have confirmed more than 1,400 cases of microcephaly in babies whose mothers were exposed to Zika during pregnancy.

Lost pregnancies include miscarriage, stillbirths and terminations with evidence of the birth defects. The CDC did not specify the nature of the three reported lost pregnancies, citing privacy concerns about pregnancy outcomes.

The CDC established its registry to monitor pregnancies for a broad range of poor outcomes linked to Zika. It said it plans to issue updated reports every Thursday intended to ensure that information about pregnancy outcomes linked with the Zika virus is publicly available.

The CDC said the information is essential for planning for clinical, public health and other services needed to support pregnant women and families affected by Zika.

“We’re hoping this underscores the importance of pregnant women not traveling to areas of ongoing Zika virus transmission if possible, and if they do need to travel to ensure that they avoid mosquito bites and the risk of sexual transmission,” Jamieson said.

(Reporting by Bill Berkrot; Editing by Will Dunham)

CDC says 157 pregnant women in U.S. test positive for Zika

A pair of Aedes albopictus mosquitoes are seen during a mating ritual while the female feeds on a blood meal in a 2003 image

By Ransdell Pierson and Bill Berkrot

(Reuters) – Some 157 pregnant women in the United States and another 122 in U.S. territories, primarily Puerto Rico, have tested positive for infection with the Zika virus, the U.S. Centers for Disease Control and Prevention said on Friday.

The CDC, in a conference call, said that so far fewer than a dozen of the infected pregnant women it has tracked in the United States and Puerto Rico have had miscarriages or babies born with birth defects. This was the first time the agency had disclosed the number of Zika-infected pregnant women in the United States and its territories.

U.S. health officials have determined that the mosquito-borne virus, which can also be transmitted through unprotected sex with an infected person, can cause microcephaly, a birth defect marked by unusually small head size, and can lead to severe brain abnormalities and developmental problems in babies.

The agency told reporters on the call it has dramatically increased its testing capacity for Zika in the United States as it girds for an increase in cases during the summer mosquito season.

Virtually all the Zika cases in the continental United States so far have been in people returning from countries where Zika is prevalent, such as Brazil, or through sexual transmission by travelers.

The latest report comes at a time when U.S. health officials have been clamoring for adequate funding to support mosquito protection and eradication, development of anti-Zika vaccines and better diagnostics, and long-term studies needed to follow children born to infected mothers and to better understand the sexual transmission risk.

The Obama Administration has requested $1.9 billion in emergency Zika funding. The U.S. Senate approved $1.1 billion of that request. The U.S. House of Representatives, however, voted to allocate $622.1 million financed through cuts to existing programs, such as for Ebola, which U.S. health officials have called inadequate and shortsighted.

The World Health Organization has said there is strong scientific consensus that Zika can also cause Guillain-Barre, a rare neurological syndrome that causes temporary paralysis in adults.

The connection between Zika and microcephaly first came to light last fall in Brazil, which has now confirmed more than 1,300 cases of microcephaly that it considers to be related to Zika infections in the mothers.

(Reporting by Ransdell Pierson and Bill Berkrot; Editing by Chizu Nomiyama and James Dalgleish)

 

CDC issues guidelines for pregnant women during Zika outbreak

CHICAGO (Reuters) – The U.S. Centers for Disease Control and Prevention on Tuesday issued guidelines for doctors caring for pregnant women during the Zika outbreak, a mosquito-borne illness linked with microcephaly marked by unusually small head size and brain damage.

The new guidelines urge doctors to ask their pregnant patients about their travel history to areas with Zika virus transmission.

Women who had traveled to regions in which Zika virus is active and who report symptoms during or within two weeks of travel should be offered a test for Zika virus infection. Pregnant women who had no clinical symptoms associated with the infection such be offered an ultrasound to check the fetus’ head size or check for calcium, two signs of microcephaly.

(Reporting by Julie Steenhuysen, editing by G Crosse)