MITOCHONDRIA ARE special compartments (organelles) in our cells that are best known for their role as powerhouses, as they break down food molecules and turn out adenosine triphosphate (ATP), a molecular fuel for the rest of the cell. However, they...

This was announced by AbbVie and was conducted by Jonathan Silverberg, MD, PhD, MPH, director of clinical research and professor of dermatology at the George Washington University School of Medicine and Health Science.

Atopic dermatitis (AD) is a chronic skin condition that can significantly impact patients' quality of life. Both dupilumab and upadacitinib have become important treatments in managing AD, providing options for patients who do not respond adequately to other therapies. The LEVEL UP trial was initiated in 2022 to compare the effects of these agents and guide clinicians in their decision-making.

The LEVEL UP trial included patients aged 12 years and older with moderate-to-severe AD. Participants underwent a 16-week treatment period, followed by an additional 16-week period of treatment with protocol-defined adjustments. The primary endpoint was achieving both a 90% reduction in the Eczema Area and Severity Index (EASI 90) and a Worst Pruritus Numerical Rating Scale of 0 or 1 (WP-NRS 0/1) at the 16-week mark.

Patients in the trial received either upadacitinib starting at 15 mg daily (escalated to 30 mg based on response) or dupilumab at 600 mg initially, followed by 300 mg every two weeks for subjects weighing ≥60 kg. Those weighing less than 60 kg received an initial dose of 400 mg, followed by 200 mg every two weeks.

The key findings of the study were:

• A significantly higher percentage of upadacitinib-treated patients achieved the primary endpoint compared to those treated with dupilumab (19.9% vs 8.9%, P < .0001).

• Upadacitinib also outperformed dupilumab in terms of EASI 90 (40.8% vs 22.5%, P < .0001) and WP-NRS of 0/1 (30.2% vs 15.5%, P < .0001) at the 16-week mark.

• The safety profile of upadacitinib was consistent with previous AD studies, with no new safety concerns identified.

• Both medications had a similar rate of serious adverse events (0.9%).

The results from the LEVEL UP trial suggest that upadacitinib may be a more effective treatment option than dupilumab for patients with moderate-to-severe AD. This can help guide clinicians in selecting the most effective treatments for their patients.

The LEVEL UP trial provides evidence that upadacitinib outperforms dupilumab in treating moderate-to-severe atopic dermatitis, offering higher rates of symptom relief and skin clearance. The safety profile of upadacitinib remains consistent with previous studies, making it a promising option for AD management.

Reference:

New Data Show RINVOQ® (upadacitinib) Demonstrated Superiority Versus DUPIXENT® (dupilumab) Across Primary and All Secondary Endpoints in an Open-Label Head-to-Head Atopic Dermatitis Study. AbbVie. April 25, 2024. https://news.abbvie.com/2024-04-25-New-Data-Show-RINVOQ-R-upadacitinib-D.... Date accessed: April 25, 2024.

Medicaid — the state-federal health insurance program for low-income and disabled Americans — has cut more than 22 million recipients since spring 2023.

One of them was the son of Ashley Eades. Her family lost their Medicaid coverage in the “unwinding” of protections that had barred states from dropping people for years during the covid pandemic.

Many families, including Ashley’s, still qualify for Medicaid but lost it for “procedural reasons.” Basically, missing paperwork.

The unwinding process has been messy.

In this episode, host Dan Weissmann talks with Ashley about the months she spent fighting to get her son reenrolled in 2023 to get an on-the-ground look at how the unwinding is affecting families.

Then, Dan hears from staff at the Tennessee Justice Center, Joan Alker of Georgetown University’s Center for Children and Families, and KFF Health News correspondent Brett Kelman, who has been covering Medicaid in Tennessee for years.

Dan Weissmann

@danweissmann

Host and producer of "An Arm and a Leg." Previously, Dan was a staff reporter for Marketplace and Chicago's WBEZ. His work also appears on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.

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‘An Arm and a Leg’: Medicaid Recipients Struggle To Stay Enrolled

Note: “An Arm and a Leg” uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Dan: Hey there. You know what we have NEVER talked about on this show? Medicaid. The big, federally-funded health insurance program for folks with lower incomes. And I did not realize: That’s been a huge omission. Because it turns out, Medicaid covers a TON of people. Like about a quarter of all Americans. And about forty percent of all children. That’s four out of every ten kids in this country who are insured by Medicaid. 

And this is the perfect time to look at Medicaid because– well: tens of millions of people are losing their Medicaid coverage right now. It seems like a lot of these people? Well, a lot of them may actually still qualify for Medicaid. 

This is all kind of a “Back to the Future” moment, which started when COVID hit: The feds essentially hit pause on a thing that used to happen every year– requiring people on Medicaid to re-enroll, to re-establish whether they were eligible. And back then, tons of people got dropped every year, even though a lot of them probably still qualified. 

The pause lasted through the COVID “public health emergency,” which ended in spring 2023. Since then, states have been un-pausing: Doing years and years of re-enrollments– and un-enrollments– all at once. People call it the “unwinding.” And it’s been messy. And, another thing I’ve been learning: Medicaid operates really differently from one state to another. It even has different names. In California, it’s called Medi-Cal. In Wisconsin, it’s BadgerCare. And this unwinding can look completely different from one state to the next.

We’re gonna look mostly at one state– Tennessee, where the program is called TennCare. And in some ways, according to the numbers on the unwinding, TennCare is… kinda average. 

But the problems some people have had, trying to keep from getting kicked off TennCare? Before this unwinding and during it? They sound pretty bad. We’re gonna hear from one of those people– a mom named Ashley Eades. 

Ashley Eades: Yeah. TennCare. Put me through the wringer, I tell you what. 

Dan: We’ll hear how Ashley spent months fighting to keep her son Lucas from getting kicked off TennCare. And we’ll hear from some folks who can help us put her story in perspective. Including folks who helped Ashley ultimately win her fight. Folks who are fighting– in Tennessee and around the country– to keep programs like TennCare from putting people like Ashley through the wringer. 

This is An Arm and a Leg– a show about why health care costs so freaking much, and what we can maybe do about it. I’m Dan Weissmann. I’m a reporter, and I like a challenge. So the job we’ve chosen around here is to take one of the most enraging, terrifying, depressing parts of American life, and to bring you a show that’s entertaining, empowering, and useful. Ashley Eades is a single mom in Nashville. She works in the kitchen at Red’s Hot Chicken, near Vanderbilt University. 

Ashley Eades: We’re just like every other person in Nashville trying to say they got the best hot chicken. 

Dan: Ashley buys her insurance from the Obamacare marketplace, but her son Lucas– he’s 12 — is on TennCare. In April 2023, Ashley got a notice from TennCare saying, “It’s time to renew your coverage!” Meaning Lucas’s coverage. Meaning, welcome to the unwinding! When I talk with Ashley, she uses one word about a half-dozen times: 

Ashley Eades: it just was a nightmare. It was a nightmare. So that was the nightmare. A terrible nightmare you can’t wake up from. Oh my god, that was a nightmare. 

Dan: So: After Ashley filled out the renewal packet, she got another notice, saying “We need more information from you.” TennCare wanted proof of “unearned income”– like bank statements, or a letter saying she was entitled to something like workers compensation– or a court-ordered payment. But Ashley didn’t have any unearned income. Lucas’s dad was supposed to pay child support, but– as Ashley later wrote to state officials– he didn’t have regular employment so couldn’t pay. 

Ashley says she called TennCare for advice and got told, “Never mind. There’s nothing to send, so you don’t have to send us anything.” Which turned out to be wrong. A few weeks later, in May, TennCare sent Ashley a letter saying “Why your coverage is ending.” 

It gave two reasons: First, it said “We sent you a letter asking for more facts… but you did not send us what we needed.” It also said “We’ve learned that you have other insurance” for Lucas. But she didn’t. And not having insurance for Lucas was going to be an immediate problem. He got diagnosed with epilepsy a few years ago, and he needed ongoing treatment. 

Ashley Eades: he was on three different medications. I mean, that alone would cost me about $1,500 a month with no health insurance. And this is anti-seizure medication. Like we can’t just stop it 

Dan: Yeah. Ashley says she did everything she could think of: mailed in paper forms, submitted information online, and made a lot of phone calls.

Ashley Eades: like back and forth on the phone with people I don’t even know who Italked to, just dozens and dozens of people I talked to. And every single time it was go through the same story over and over and over and over and over again and just get transferred Put on holds, you know disconnected yelled at, told I’m wrong like 

Dan: It went on for months. She reapplied. She was approved. Then she was un-approved. She appealed. The appeal was denied. Then, in July, the full nightmare: Lucas ended up in the emergency room after a seizure. While he was officially uninsured. 

Ashley Eades: I just didn’t know what to do. Like, I was shutting down mentally. 

Dan: And then, out of nowhere, a relative mentioned that a nonprofit called the Tennessee Justice Center had helped *her* out with a TennCare application. Ashley called the group right away. 

Ashley Eades: and I’m not a spiritual person, but they were like a fudging godsend. You know what I mean? Like, it was amazing

 Dan: A client advocate named Luke Mukundan looked at all of TennCare’s letters to Ashley and confirmed one thing right away: Ashley wasn’t wrong to be confused. 

Ashley Eades: He’s like going through all of these letters and he’s like, it doesn’t even make sense 

Dan: Later I talked with Luke, on kind of a lousy Zoom connection. But he said to me: This was confusing, even to him. 

Luke Mukundan: she was providing the information that they asked for, um, 

Dan: But they kept asking the same questions. And they kept saying that her son had some other insurance. 

Luke Mukundan: when I knew and she knew that wasn’t the case

Dan: Luke’s boss at the Tennessee Justice Center, Diana Gallaher, told me she wasn’t surprised that Ashley got confused by that early question about un-earned income. She says the process can be really confusing. 

Diana Gallaher: Heck, I get confused. I still, I’ll look at a question and say, you know, wait, what are they asking? How do I answer this one? 

Dan: And you’ve been doing this for a while, right? 

Diana Gallaher: Oh, yeah. Yeah. 

Dan: How long have you been doing this? 

Diana Gallaher: Since 2003, 2004. 

Dan: More than twenty years. Of course, Ashley’s been going through this process at an especially rough time: The unwinding. When so many people were going through this process at once. 

For instance, Luke and Diana say the help lines at TennCare were super-jammed– like, it wasn’t unusual to spend 45 minutes or an hour on hold. 

By the time Ashley found the Tennessee Justice Center, it was August. She’d been fighting alone for months. Luke helped Ashley with a new appeal. And on September 22, TennCare sent Ashley an update. Her son is approved. “You qualify for the same coverage you had before,” it says. “And you’ll have no break in coverage.” 

So Ashley’s “nightmare” was one person’s experience of the unwinding. But it’s not a one-off: According to reports from KFF and Georgetown University, more than two-thirds of the people who lost Medicaid in the last year were disenrolled, like Ashley, for what are called “procedural reasons.” Missing paperwork.

Now, some of those people who got dropped for “procedural reasons” probably didn’t even try to renew Medicaid because they didn’t need it anymore. They had new jobs that came with insurance.

But we know those folks are in a minority. Researchers at KFF– the parent group of our journalist pals at KFF Health News– did a survey of folks who got dropped from Medicaid. Most of them– seventy percent– ended up either uninsured or, the biggest group, back on Medicaid. And again, more than two-thirds of the folks who got dropped were cut for “procedural reasons”– paperwork. Like Ashley’s son Lucas. 

So, when a lot of people can’t renew their Medicaid for “procedural” reasons, it seems worth looking at that procedure. And what’s happening in the unwinding isn’t actually a new phenomenon. It’s just un-pausing an old procedure– a system that always had these problems. And that’s really clear in Tennessee, because people in Tennessee have been documenting– and fighting– these problems for a long time. 

Next up: Taking TennCare to court. 

This episode of An Arm and a Leg is a co-production of Public Road Productions and KFF Health News. The folks at KFF health news are amazing journalists– and in fact, we’re about to hear from one of them, right now. 

Brett Kelman: My name is Brett Kelman. 

Dan: Brett’s an enterprise correspondent with KFF Health News 

Brett Kelman: And I report from the city of Nashville, where I have lived for about seven years. 

Dan: Brett came to Nashville initially to cover health care for the local daily, the Tennessean. Which meant he heard about Medicaid– about people losing medicaid– a lot. 

Brett Kelman: You hear two versions of the same story. You hear patients who get to the doctor’s office and suddenly discover they don’t have Medicaid when they used to, and they thought they still did. And then you hear the other side of that coin. You hear doctors, particularly a lot of pediatricians, where their patients get to their office and then discover in their waiting rooms they don’t have Medicaid. 

Dan: And by the way– you noticed how Brett said he heard especially from pediatricians about this issue in Tennessee. That’s because Tennessee is one of the states that never expanded Medicaid after the Affordable Care Act took effect. In those states, Medicaid still covers a lot of kids but a lot fewer adults than other states. Docs treating patients with Medicaid– a lot of them are gonna be pediatricians. 

So, Brett’s hearing all of this seven years ago– the before-time. Before the unwinding. Before COVID. People kept losing Medicaid and not knowing about it until they got to the doctor’s office. And Brett wanted to know: how did that happen? He and a colleague ended up doing a huge investigation. And came back with a clear finding: 

Brett Kelman: Most of the time, when people lose their Medicaid in Tennessee, it is not because the state looked at their finances and determined they aren’t qualified. Paperwork problems are the primary reason that people lose Medicaid coverage in Tennessee. 

Dan: Brett and his reporting partner used a public-records request to get a database with the form letters sent to about three hundred thousand people who needed to renew their Medicaid coverage. 

Brett Kelman: And what we determined was that, you know, 200,000 plus children, had been sent a form letter saying that they were going to lose their Medicaid in Tennessee, again, not because the state determined they were ineligible, but because they couldn’t tell. 

Dan: About two thirds of people in that database got kicked off Medicaid for “procedural reasons”– paperwork issues. This is years before the current “unwinding” but that two-thirds number, it’s pretty similar to what we’re seeing today.

Brett Kelman: And, you know, that raises a lot of questions about if we’re doing the system correctly, because do we really want to take health care away from a family who is low income? Because somebody messed up a form or a form got lost in the mail. 

Dan: Around the time Brett published that story in 2019, the Lester family found out that they had lost their Medicaid– because a form had gotten lost in the mail. It took them three years to get it back. Brett met them at the end of that adventure 

Brett Kelman: they were a rural Tennessee family, a couple of rambunctious boys who seemed to injure themselves constantly. And honestly, I saw him almost get hurt while I was there doing the interview. One of the young boys had. Climbed up to the top of a cat tower. And I believe jumped off as I was interviewing his parents and I could see the insurance, I could see the medical claims racking up before my eyes. 

Dan: In 2019, one of the boys had broken his wrist jumping off the front porch. And when the Lesters took him to the doctor, that’s when they learned they’d been cut from Medicaid. Over the next three years, they racked up more than a hundred thousand dollars in medical debt– dealing with COVID, with more injuries, with the birth of another child. Finally, the Tennessee Justice Center helped them get Medicaid back– and figure out what had gone wrong. 

Brett Kelman: And when it all came down to it, we eventually determined that this paperwork that their health insurance hinged on, the health insurance that they were entitled to, they had lost it because the state had mailed that paperwork to the wrong place. 

Dan: Oh, and where had the state been mailing that paperwork to? A horse pasture. 

Brett Kelman: It wasn’t far from their house, but there was certainly no one receiving mail there 

Dan: Was there like a mailbox for the horses? Like where did they, where did it even go? Get left. 

Brett Kelman: I don’t remember if there was a mailbox for the horses. I don’t think so. I mean, if you think about this chain of events, they were sent paperwork they were supposed to fill out and return to keep their health insurance, but it went to the horse pasture, so they didn’t fill it out. Then they were sent a letter saying, Hey, you never filled out that paperwork. We’re gonna take your health insurance away. But it went to the horse pasture, so they didn’t fix it, and then they were sent paperwork saying, we’ve cut off your health insurance. You won’t have health insurance as of this date But it was sent to the horse pasture, so they didn’t know about it. 

Dan: And their three-year fight to get Medicaid back took place AFTER Brett published his initial story. So, some things, it seemed, hadn’t changed a whole lot. But one thing had happened: In 2020, the Tennessee Justice Center had filed a class-action lawsuit, demanding that TennCare re-enroll about a hundred thousand people who had gotten cut off– the lawsuit alleges, without due process. Here’s Brett’s take: 

Brett Kelman: And yes, I recognize that there could just have a Medicaid recipient who is not on top of this and ignores the paperwork and lets it rot in a pile of mail on their kitchen counter. I have some mail like that. I’m not going to pretend like I have never done this, but how do you tell the difference between that person and somebody who never got this paperwork that their child’s health care hinges upon? 

Dan: This exact question comes up in the lawsuit. In a filing, the state’s lawyers say TennCare does not owe a hearing to anybody who says they just didn’t get paperwork. “The simple reason for this policy is that it is well known that mail is ordinarily delivered as addressed, TennCare enrollees have a responsibility to keep the program apprised of address changes (as explained to them in TennCare’s notices), and it is exceedingly common for individuals who have missed a deadline to claim they did not receive notice.” 

Class action lawsuits move slowly. This one, filed more than four years ago, only went to trial recently. A judge’s decision is … pending. In a post-trial filing, the Tennessee Justice Center tells the stories of 17 people cut off from Medicaid allegedly due to errors by TennCare. 

In TennCare’s filings, the state’s lawyers say, in effect: None of this proves there’s a systemic problem. And as a couple people have said to me: You don’t have to set out to build a bad system. If you don’t take care to build a good one, your system will definitely have problems.

 We sent TennCare a long note about what we’ve been learning: About Brett Kelman’s reporting, about the class-action lawsuit, and about what happened to Ashley Eades. We asked them for any comment– or to let us know if they thought we’d gotten anything wrong. We haven’t heard back from them. 

So, let’s zoom out a little bit to look at how these systems are working across 50 states. The person to talk to here is Joan Alker. She’s a professor at Georgetown, and she runs the university’s Center for Children and Families. 

Joan Alker: Yeah, Medicaid really is my jam. I have been working on Medicaid issues for about 25 years now, which is a little frightening. 

Dan: So of course she and her colleagues have been tracking how all 50 states have been dealing with the unwinding, compiling all kinds of data. When we talked, they’d just updated a ticker showing how many kids have been dropped in each state. 

Joan Alker: We just hit 5 million net child Medicaid decline just today. Um, so that’s very troubling. 

Dan: And according to Joan Alker’s report, kids were even more likely to be dropped for “procedural reasons”– paperwork issues– than adults. 

Joan Alker: Most of these children are probably still eligible for Medicaid and many of them won’t have another source of coverage. And that’s what I worry a lot about. 

Dan: But it varies a TON. A couple states– Maine and Rhode Island– actually have MORE kids enrolled than when the unwinding started. A half-dozen others have dropped very few kids. 

Joan Alker: But then we had some states that went out really assertively and aggressively to, um, to To have fewer people enrolled in Medicaid 

Dan: Her numbers show that Texas is a standout. They’ve got one point three million fewer kids enrolled in Medicaid than they did before the unwinding… Tennessee– with all the problems documented by Brett Kelman and the Tennessee Justice Center– is kind of around the middle of the pack. 

Joan Alker: Unfortunately, this is the norm. Right? When you look at the number of disenrollments nationwide, the average for procedural red tape reasons is 70%. Only 30 percent of those people losing Medicaid nationwide have lost it because they’ve clearly been determined to be ineligible. 

Dan: Obviously, Joan Alker is not happy about this. But she is also not hopeless! The unwinding has been an example of what happens– what can happen– when you require people to renew their enrollment every year. But now some states are experimenting with … not requiring that anymore, at least not for young kids. 

Joan Alker: …because we know so many of them are going to remain eligible. They’re cheap to insure. They’re not where the money is being spent in our healthcare system. But they need regular care. 

Dan: Oregon, Washington, and New Mexico now keep kids enrolled through age six. Another seven states are aiming to do the same. 

Joan Alker: This is an idea that we’ve been promoting for like 15 years and we were kind of crying out in the wilderness for a long time, but it’s breaking through now 

Dan: I’m not gonna lie. There’s a ton that’s not gonna get fixed with Medicaid anytime soon. We don’t know yet how the judge in the Tennessee Justice Center’s class-action lawsuit is gonna rule. But seeing these fights, it reminds me of something I’ve said before on this show: We are not gonna win them all. But we don’t have to lose them all either.

By the way, a little news about Ashley Eades– our mom in Nashville, who fought to keep her son on TennCare. 

Ashley Eades: Last year, I started going back to school, and I’m going to school full time, and I’m working full 

Dan: Oh my gosh! 

Dan: And she’s home-schooling Lucas. 

Ashley Eades: I was like, “we’re going to go to school together, buddy.” Like, we share a desk, you know, and he’s like in class and I’m in class. 

Dan: Wow 

Ashley Eades: I had to get creative. um, so, yeah, I’m like, working this really crappy, stinky job and going to school 

Dan: And it’s working out. 

Ashley Eades: I, um, made Dean’s List this semester, like got straight A’s. 

Dan: Yeah! 

Dan: Ashley wants to go to Medical school. I thought you’d want to know. 

Before we go, I just want to say THANK YOU. In our last episode, we asked you to help us understand sneaky facility fees, by sending your own medical bills, and you have been coming through in a big way. We’ve heard from more than 30 people at this point. Some of you have been annoyed by these fees for years– a couple of you have told us about driving 30 or 40 miles across town, hoping to avoid them. And we’ve been hearing from folks inside the medical billing world, offering us some deeper insight. And I could not be pleased-er. Thank you so much! 

If you’ve got a bill to share, it’s not too late to pitch in, at arm-and-a-leg-show, dot com, slash FEES. I’ll catch you in a few weeks. Till then, take care of yourself. 

This episode of An Arm and a Leg was produced by me, Dan Weissmann, with help from Emily Pisacreta, and edited by Ellen Weiss. Thanks this time to Phil Galewitz of KFF Health News, Andy Schneider of Georgetown University’s Center for Children and Families, and Gordon Bonnyman of the Tennessee Justice Center for sharing their expertise with us. Adam Raymonda is our audio wizard. Our music is by Dave Weiner and blue dot sessions. Gabrielle Healy is our managing editor for audience. Gabe Bullard is our brand-new engagement editor. Bea Bosco is our consulting director of operations. Sarah Ballama is our operations manager. 

And Armand a Leg is produced in partnership with KFF Health News. That’s a national newsroom producing in-depth journalism about healthcare in America and a core program at KFF, an independent source of health policy research, polling and journalism. Zach Dyer is senior audio producer at KFF Health News. He’s editorial liaison to this show. 

And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor, allowing us to accept tax exempt donations. You can learn more about INN at INN. org. Finally, thanks to everybody who supports this show financially– you can join in any time at arm and a leg show dot com, slash, support– thanks for pitching in if you can, and thanks for listening.

“An Arm and a Leg” is a co-production of KFF Health News and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and the social platform X. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

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And subscribe to “An Arm and a Leg” on Spotify, Apple Podcasts, Pocket Casts, or wherever you listen to podcasts.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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World Health Assembly agreement reached on wide-ranging, decisive package of amendments to improve the International Health Regulations, and sets date for finalizing negotiations on a proposed Pandemic Agreement

Cristina Mitchell

1 Jun 2024

Santo Domingo – Private clinics and clinical laboratories are receiving a significant increase of patients in their consultation and emergency areas, as well as clinical laboratories of people with flu-like symptoms seeking tests to determine the presence of Covid-19, influenza or any other respiratory virus.

The number of people with fever, sore throat and muscle pain, headache and general malaise and in some cases diarrhea, vomiting and loss of smell and taste, has increased in recent weeks in the country, which is attributed by specialists to the rains and high temperatures that have been recorded.

The high demand of patients with indications to undergo respiratory panels, to determine the type of virus affecting them, or only Covid-19 and influenza tests has been increasing in the main clinical laboratories of the country, according to patients’ reports.

In addition, the search for information from people interested in knowing where the Ministry of Public Health is performing the free Covid test is increasing.

INFLUENZA A AND B
A similar situation is also being experienced in private clinics, with an increase of patients with respiratory processes, mostly with influenza A and B, both in their consultation services, emergencies and in some cases, hospitalization, confirmed Rafael Mena, president of the National Association of Private Clinics and Hospitals (ANDECLIP).

He said that so far it is a moderate increase, which has not overflowed the capacity of the centers, and that when the test is done most of the cases are influenza A and B.

The doctor explained that hospitalizations are occurring mostly in those patients who have comorbid conditions, among them those suffering from asthma.

Special attention to hygiene
Avoid conglomerates, use masks when going to health centers or where people are crowded, cover your mouth when coughing using handkerchiefs or your elbow, stay at home isolated, do not go to work, school, or places where there are more people, are among the recommendations made by doctors specialized in the management of viral processes to avoid spreading the disease.

They consider it essential not to self-medicate and to go to the doctor, because there is also circulation of dengue and other diseases and it is important to know what type of virus is affecting the patient and to sanitize hands frequently.

Equitable access key to ensuring health resilience in small island developing states

Cristina Mitchell

31 May 2024

The World Health Organization (WHO) and its global partners recognize May 31 annually as World No Tobacco Day. The significance of this special day is to encourage people who smoke to quit and those who don’t to never start. World No Tobacco Day is often celebrated by highlighting the health risks associated with tobacco use and advocating for the effective monitoring of the sale, distribution, consumption and promotion of tobacco products. Every year tobacco kills more than 8 million people, 7 million of which are due to tobacco use while approximately 1.2 million are due to non-smokers being exposed to second-hand smoke.

This year’s theme for World No Tobacco Day, “Protecting children from tobacco industry interference”, cuts to the core of a disturbing truth – The tobacco industry needs replacement users and youth are a primary target. Many of us use social media and are constantly bombarded with advertisements. Disturbingly, among these ads, the tobacco industry has found a way to infiltrate the screens of youth with flashy, colourful promotions for their products. These ads are meticulously designed to appeal to youthful sensibilities, making smoking and vaping seem attractive and harmless.

The Rising Threat of New and Emerging Tobacco Products

Traditional cigarettes are no longer the only threat. The rise of electronic cigarettes, oral nicotine products etc., have introduced a new dimension to the problem. These products are often marketed as safer alternatives or cessation tools, but they pose significant risks, especially to young, developing brains. The appeal of e-cigarettes to adolescents is particularly troubling. A 2022 study of 47 countries found that 8.6% of youth reported using e-cigarettes in the last 30 days. In the Caribbean a handful of countries are regulating e-cigarettes including Jamaica, Guyana, and Barbados, who have banned e-cigarette use in public places. Antigua and Barbuda, along with Suriname, have taken an even stronger stance by prohibiting the import, distribution, and sale of e-cigarettes altogether. Despite these measures, the Global Youth Tobacco Survey (GYTS) data showed current use of e-cigarettes among 13-15-year-old students ranging from 4.0% in Antigua and Barbuda to 17.2% in Trinidad and Tobago. Trinidad and Tobago has the second-highest rate of youth e-cigarette use in all of the Americas, following the United States. Traditional cigarette smoking among youth still continues to be a major concern because they are regarded as the smokers of tomorrow as three to four out of every ten ever-smokers, in the Caribbean region, initiated smoking before the age of 10 years.

Tobacco use, in any form, is linked to numerous health risks, including an increased likelihood of developing cancer, heart disease, and respiratory conditions. Electronic nicotine delivery systems (ENDS) or e-cigarettes containing nicotine are particularly harmful as they can lead to nicotine addiction, which adversely affects brain development in adolescents, potentially impairing memory, concentration, and learning abilities. Even e-cigarettes without nicotine or electronic non-nicotine delivery systems (ENNDS) can be dangerous due to the inhalation of harmful chemicals and flavourings that can cause respiratory issues and other health problems. Nicotine pouches, though marketed as a safer alternative, still deliver highly addictive nicotine and can lead to dependency, oral health issues, and an increased risk of transitioning to other tobacco products. The link between vaping and mental health issues is becoming increasingly evident.  A U.S study published in 2019, examined the association between e-cigarette use and depression and found that current e-cigarette users had more than twice the odds of reporting a history of clinical depression compared to those who had never used e-cigarettes. Specifically, current e-cigarette users were 2.10 times more likely to report depression, with the odds increasing with the frequency of use.

The Tobacco Industry’s Pervasive Marketing Strategies

As a youth tobacco control advocate, I am especially concerned with the tobacco industry’s persistent marketing in the Caribbean. With social media being widely used, especially among young people, tobacco companies are leveraging platforms like Facebook, Instagram, X formerly known as Twitter, and TikTok to promote their addictive products. These companies, having honed their skills in targeting youth, are now implementing online marketing strategies that are both sophisticated and pervasive. These strategies include lifestyle campaigns that link tobacco and nicotine with freedom, rebellion, and youthfulness, creating an appealing image that resonates strongly with adolescents. Additionally, tobacco companies are compensating social media influencers to endorse their brands subtly, seamlessly integrating their products into the daily lives of young followers. A report from the Campaign for Tobacco-Free Kids, titled #SponsoredByBigTobacco, reveals that promotional content for Velo, IQOS and Vuse (products by British American Tobacco and Phillip Morris) has accumulated over 3.4 billion views on social media and reached more than 150 million young people under the age of 25.

The tobacco industry is also using carnivals and festivals as a marketing opportunity. For example, British American Tobacco heavily promoted their vaping device, Vuse, during the Jamaican Carnival. They used social media to advertise a promotion where purchasing Vuse products gave participants a chance to win a t-shirt package to Play Mas. They even had their own carnival truck and tents where Vuse products were prominently displayed. This type of marketing not only targets young adults but also attracts young children and teenagers, embedding the presence of tobacco products in the festive and culturally significant atmosphere of carnival. This concerted effort has allowed Big Tobacco to reach a massive young audience, making addictive products seem normal and even desirable through extensive in-person and social media exposure.

From conversations with my peers, it’s clear why vapes are so enticing: the wide range of flavours, their trendy image, affordability, and the misleading perception that they are harmless.Companies like Philip Morris and the West Indian Tobacco Company Limited have capitalised on these perceptions by advancing their own “smoke-free vision” – marketing their vaping devices as “risk-reduced alternatives” and a way for adult smokers to quit tobacco. However, the evidence shows a different story. Studies have shown that youth often misunderstand these claims, and are led to believe that these products are without harm, leading to an increased likelihood of nicotine and tobacco-use initiation.

The Urgent Need for Comprehensive Regulations

The WHO’s newly published report, Hooking the Next Generation: how the tobacco industry captures young customers, has revealed the strategies employed by the tobacco and nicotine industry to entice youth. Recent statistics show that 85% of 15–30-year-olds have been exposed to e-cigarette advertising, with higher exposure linked to increased use. In light of this data, Caribbean youth are joining the call to action on World No Tobacco Day 2024, urging our governments to protect us from the manipulative tactics of the tobacco industry. This call to action aims to raise awareness and mobilise efforts to prevent the targeting and exploitation of young people by these harmful products and deceptive strategies. It is crucial to reveal how the industry markets new products as “reduced risk” alternatives, misleading young consumers. Moreover, comprehensive regulations are essential to protect youth from new tobacco and nicotine products. Extending smoke-free laws to include e-cigarettes and other novel products, as well as banning flavours that appeal to young users, are vital steps in preventing the renormalization of smoking behaviours.

In collaboration with the HCC, I developed the Youth Tobacco Advocacy Portal, which serves as a platform to share information, strategies, and resources to combat tobacco use and influence policy changes. For WNTD 2023, the HCC launched a report developed in collaboration with PAHO:, Vaping Among Adolescents and Youth in the Caribbean Situation, Policy Responses and Recommended Actions, which provides guidance to Caribbean governments. Governments play a crucial role in this fight and should take decisive actions to safeguard youth. Based on this report’s recommendations,  I urge our governments to implement and enforce the WHO Framework Convention on Tobacco Control (FCTC):

• Implement and enforce comprehensive bans on tobacco advertising, promotion, and sponsorship (TAPS), including guidelines for digital and cross-border marketing, to prevent tobacco companies from exploiting new media platforms to target youth.
• Raise prices and taxes on tobacco and nicotine products to make them less affordable and less accessible to young people.
• Strictly enforce bans on the sale of tobacco and nicotine products to children.
• Address tobacco industry interference and conflict of interest. The tobacco industry’s persistent interference in policy-making demands stringent measures. Rejecting any partnerships or agreements with the industry is paramount, given their history of undermining tobacco control efforts. Moreover, enhancing transparency in the industry’s lobbying and marketing practices is imperative to safeguard policy-making processes from undue influence. Good governance policies must be enacted to ensure transparency and address conflict of interest and industry interference, aligning with the principles outlined in the 2023 Bridgetown Declaration on NCDs and Mental Health and Article 5.3 of the WHO FCTC.
• Update legislation to include ENDS and ENNDS to address the evolving landscape of tobacco products and ensure comprehensive protection for youth.

As we commemorate World No Tobacco Day 2024, we must remember that safeguarding our youth from the tobacco industry’s predatory practices is non-negotiable. The rise of new and alluring tobacco products, coupled with the relentless barrage of social media marketing, underscores the urgency of our response. Our governments must heed the call to action, enacting comprehensive regulations and enforcing existing frameworks like the WHO FCTC with unwavering determination. By prioritising transparency, accountability, and the well-being of our youth, we can dismantle the tobacco industry’s web of deceit and protect future generations from the grip of addiction and disease.

Let this day serve as a catalyst for change, uniting us in our resolve to build a nicotine and tobacco-free Caribbean.

Dorial Quintyne is the Project Assistant for the Healthy Caribbean Coalition’s Healthy Food Policy Project and holds a Master’s degree in Public Health from Seoul National University, South Korea. She is a passionate youth tobacco control advocate and an active member of Healthy Caribbean Youth.

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