Category: Health

The Food and Drug Administation authorized reformulated versions of the Moderna and Pfizer-BioNTech vaccines that aim to protect against the omicron variant.

The new shots target both the original strain of the coronavirus and the omicron BA.4/BA.5 subvariants that most people are catching now. This double-barreled vaccine is called a bivalent vaccine.

“The FDA has been planning for the possibility that the composition of the COVID-19 vaccines would need to be modified to address circulating variants. … We have worked closely with the vaccine manufacturers to ensure the development of these updated boosters was done safely and efficiently,” said Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, in an agency statement. “The FDA has extensive experience with strain changes for annual influenza vaccines. We are confident in the evidence supporting these authorizations.”

The Moderna COVID-19 vaccine is authorized for use as a single booster dose in people 18 and older. The Pfizer-BioNTech booster is authorized for people 12 years and up. People are eligible for the new boosters two months after completing their initial vaccination or their last booster shot.

The federal government plans to make the boosters available starting next week. In advance of the FDA’s decision, Dr. Ashish Jha, the White House COVID-19 Response Coordinator told NPR that the new boosters represented “a really important moment in this pandemic.”

Public health officials hope they will help contain a possible fall and winter surge.

But there is also skepticism about how big a difference the boosters can make. “It could be problematic if the public thinks that the new bivalent boosters are a super-strong shield against infection, and hence increased their behavioral risk and exposed themselves to more virus,” John Moore, an immunologist at Weill Cornell Medicine in New York, told NPR before the FDA decision.

The Centers for Disease Control and Prevention has endorsed the first updated COVID-19 booster shots.

The decision came just hours after advisers to the CDC voted to recommend reformulated versions of the Moderna and Pfizer-BioNTech COVID-19 vaccines. The vote was 13 in favor and one no vote.

“The updated COVID-19 boosters are formulated to better protect against the most recently circulating COVID-19 variant,” Walensky said in a written statement announcing the recommendation.

“If you are eligible, there is no bad time to get your COVID-19 booster and I strongly encourage you to receive it,” Walensky said.

The booster shots target both the original strain of the coronavirus and the omicron BA.4 and BA.5 subvariants that most people are catching now. This double-barreled vaccine is called a bivalent vaccine.

The CDC advisers recommended that anyone age 12 and older get the new Pfizer-BioNTech boosters as authorized by the Food and Drug Administration. The updated Moderna COVID-19 vaccine is authorized for anyone 18 and older.

In both cases people would have to wait two months after completing their initial vaccination or their last booster shot. But many vaccine experts say it would be better to wait at least four months since the last shot or COVID infection, or the boosters won’t work as well.

This is the first time the FDA has authorized COVID vaccines without requiring they get tested in people. To keep up with the rapidly evolving virus, the FDA relied on how well the shots stimulated the immune systems of mice. They also looked at how well similar shots targeted at earlier variants worked on people.

The companies and federal officials say there’s no question the shots are safe and they argue the evidence indicates the reformulated boosters will help reduce the chances people will catch the virus and spread it.

But some people wonder if it would be better to wait for the results from human studies that are already underway.

“It certainly looks very promising,” said CDC advisor Dr. Pablo Sanchez from The Ohio State University at Thursday’s hearing. “I understand the constant shift of these variants but studies with the BA.4 and BA.5 are ongoing in humans and I just wonder if it’s a little premature,” he said. Sanchez was the only adviser to vote no. “I voted no because I feel we really need the human data,” he explained. “There’s a lot of vaccine hesitancy already. We need human data.”

But other advisers were more comfortable, pointing out that flu vaccines are updated every year without being tested in people.

“This is the future that we’re heading for,” says Dr. Jamie Loehr of Cayuga Family Medicine. “We’re going to have more variants and we should be treating this like the flu, where we can use new strain variants every year.” Loehr says he’s comfortable recommending the updated boosters, “even if we don’t have human data.”

Committee chair, Dr. Grace Lee, professor of pediatric infectious diseases at Stanford Medicine recognized there is some uncertainty, “I want to acknowledge it,” she said. “And I just want to say that despite that I think we hopefully made a huge impact in our ability to weather this pandemic together.”

Between 400 and 500 people are still dying every day in the U.S. from COVID-19 and public health officials are worried another surge could hit this fall or winter. The administration hopes the reformulated boosters will help contain a surge and protect people from serious disease or death.

The federal government plans to make the boosters available quickly. In advance of the FDA’s decision, Dr. Ashish Jha, the White House COVID-19 response coordinator told NPR that the new boosters represented “a really important moment in this pandemic.”

Now the CDC has signed off, few shots could be available as early as Friday, with a wider rollout next week.

Receiving opioid use disorder-related telehealth care during the COVID-19 pandemic was associated with lower odds of medically treated overdose and better retention using medications like methadone and buprenorphine, according to a study published in JAMA Psychiatry. 

The research used data from Medicare fee-for-service beneficiaries ages 18 and older who had received a diagnosis for opioid use disorder based on ICD-10 codes. It was divided into two groups: a prepandemic cohort of 105, 240 beneficiaries and a pandemic cohort of 70, 538. 

Researchers found 19.6% of beneficiaries in the pandemic group received OUD-related telehealth services during the study period, compared with only 0.6% of patients in the prepandemic cohort. They were also more likely to access behavioral health-related virtual care at 41%, compared with 1.9% in the prepandemic group. Additionally, 12.6% of pandemic beneficiaries accessed medications for OUD, like methadone, buprenorphine and extended-release naltrexone, compared with 10.8% of the prepandemic beneficiaries. 

Though the percentage who experienced a medically treated overdose was similar in both groups, the study found receiving OUD-related telehealth was associated with increased odds of continuing to use medications for OUD and lowered odds of overdose. 

“Use of telehealth during the pandemic was associated with improved retention in care and reduced odds of medically treated overdose, providing support for permanent adoption,” the study’s authors wrote. “Strategies to expand provision of MOUD [medications for opioid use disorder], increase retention in care and address co-occurring physical and behavioral health conditions are urgently needed in the context of an escalating overdose crisis.”

WHY IT MATTERS

Though telehealth did increase access to medications for OUD, the researchers noted that only a small portion of patients received medications on 80% or more of eligible days. 

They also found racial inequities in access to care. Non-Hispanic African American beneficiaries had lower odds of receiving OUD or behavioral health-related telehealth services and lower odds for medication retention. The study also found higher odds of overdose among patients who were non-Hispanic African American, American Indian or Alaska Native, and Asian or Pacific Islander.

However, researchers said their study demonstrates telehealth could be an important way to deliver care to people struggling with opioid use disorder. 

“The expansion of telehealth services for people with substance use disorders during the pandemic has helped to address barriers to accessing medical care for addiction throughout the country that have long existed,” Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse and senior author of the study, said in a statement. “Telehealth is a valuable service and, when coupled with medications for opioid use disorder, can be lifesaving. This study adds to the evidence showing that expanded access to these services could have a longer-term positive impact if continued.”

THE LARGER TREND

The opioid epidemic continues to be a major challenge for public health. According to the CDC, overdose deaths involving opioids increased from an estimated 70,029 in 2020 to 80,816 in 2021.

At the beginning of the COVID-19 pandemic, the Drug Enforcement Administration loosened regulations to allow providers to prescribe controlled substances, like medications for opioid use disorder, without meeting with patients in person during the public health emergency.

The PHE was extended again earlier this summer. Health and Human Services Secretary Xavier Becerra has promised to give providers 60 days’ notice before it expires. 

GoodRx, a company best known for its prescription price transparency tools, will lay off approximately 140 employees, making up about 16% of its workforce.

According to a filing with the Securities and Exchange Commission, the reduction will primarily affect its technology-focused and marketing segments.

“The company is focused on efficiently growing its core prescriptions business, accelerating its pharma manufacturer solutions business and doubling down on consumer engagement,” Karsten Voermann, GoodRx’s chief financial officer, wrote in the SEC filing. “As the company focuses on these goals, it is consolidating functions and eliminating or reducing investment in areas of lower focus.”

THE LARGER TREND

GoodRx posted a $1.4 million net loss during the second quarter, compared with $31.1 million in income during the prior-year quarter. It reported revenue of $191.8 million, a 9% increase from $176.6 million in the second quarter last year. 

The company also said it had resolved an issue with an unnamed national grocery chain – which analysts suspected was Kroger – that had affected the acceptance of pharmacy benefit discounts for some drugs. 

During its second quarter earnings call, GoodRx said it was focusing on developing new services and incentives to ensure users would create accounts on their platform, which it doesn’t require to provide a “frictionless” experience. 

“We believe the benefits of deeper relationships with our consumers will allow us to help them better navigate their healthcare journey with even more compelling GoodRx value proposition and user experience,” cofounder and co-CEO Trevor Bezdek said. 

“We also believe that allowing users to provide us more information will increase the LTV [lifetime value] of each user in prescription transactions and other areas of the business over time as we leverage it to create new tools and products for our users in quarters and years to come.” 

GoodRx’s announcement marks the latest in a line of digital health and health tech companies that have laid off workers this summer. Insider recently reported that telehealth services vendor Wheel cut 17% of its workforce in mid-August. 

AI-backed genomic and clinical data company Sema4 announced it had laid off around 250 workers, about 13% of its workforce, last month. Its founder Eric Schadt also stepped down from his roles at the company. Meditation app Calm also recently let go of 20% of its staffers. 

Others announcing layoffs over the past few months include Pear Therapeutics, Included Health, Olive, Cedar, Ro and Carbon Health.

Research of the Week

More ultra-processed food, more colorectal cancer.

More fasting insulin, higher mortality.

Better glucose control, better cognitive function (in adolescent type 1 diabetics).

Low-salt diets promote osteoporosis.

Omega-3s help older adults gain more muscle strength.

New Primal Kitchen Podcasts

Primal Kitchen Podcast: The Link Between Dairy Intolerance and Dairy Genes with Alexandre Family Farm Founders Blake and Stephanie

Primal Health Coach Radio: If You’re Not Showing Up, Someone Else Will with Libby Rothschild

Media, Schmedia

Do octopuses deserve rights?

Chinese scientists create the first mammal with fully reprogrammed genes.

Interesting Blog Posts

Every which way the wind blows.

Why sausages need salt.

Social Notes

How long before Musk is eating raw liver and going barefoot?

Guess who’s back?

Everything Else

Environmental policies in ancient Athens.

Interesting n=1 writeup about someone using grounding to fight sickness.

Love this.

Things I’m Up to and Interested In

Interesting paper: Functional brain imaging hasn’t produced any useable results or diagnoses.

Not good: Many commonly used face masks emit titanium dioxide particles.

Not a big surprise: Restricting social media use doesn’t have an effect on well being or academic performance if you just let them use other apps to make up for it.

Inconvenient truth: What lowers lipoprotein A?

Unique warmup for the day: The slow crawl.

Question I’m Asking

How do you start each day?

Recipe Corner

Time Capsule

One year ago (Aug 27 – Sep 2)

Comment of the Week

“Tiny nitpick: One doesn’t “flâneur,” flâneurs (or flâneuses, let’s not exclude people) flânent; you (pl.) flânez.

Putting the grammar-Nazi away… there is so much truth to your thoughts on creating – rather than passively consuming – experience. To me, it’s the difference between men like Sir Hillary and Norgay (truly intrepid souls) and all those tourists who pay to be all but carried up Everest.

That’s not to knock those who follow that set guide rope, it’s still a dangerous and no-doubt memorable time, and I’ve personally never stood on top of the world – it’s just not the same.

Too much planning can kill pristine joy. Adventure with security is a lie. Granted, reckless adventure can simply be stupidity (the first time I saw a hyena in the wild, I tried to pet it – I’m forever grateful that it ran away), but I’d rather live stupid than live boring.”

-Indeed, Hate_me.

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By Ernie Mundell HealthDay Reporter
HealthDay Reporter

FRIDAY, Sept. 2, 2022 (HealthDay News) — A total of 97 people across six states have now been made ill by E. coli, in an outbreak possibly tied to contaminated lettuce used in sandwiches sold at Wendy’s restaurants.

“Since the last update on August 25, 2022, 13 more illnesses have been reported to CDC,” the U.S. Centers for Disease Control and Prevention said in an updated statement released Thursday. Two states — Kentucky and New York (with one case each) — have now been added to the list of states reporting cases, which also includes Michigan (58 cases), Ohio (24), Indiana (11) and Pennsylvania (2).

Illnesses from infection with the gastrointestinal bacterium have often been severe.

“Of 81 people with information available, 43 have been hospitalized and 10 developed hemolytic uremic syndrome, a serious condition that can cause kidney failure,” the CDC said, although “no deaths have been reported.”

The exact source of the outbreak has still not been officially confirmed, but the CDC said that in 67 cases where investigators asked what people had eaten in the week prior to becoming ill, 81% reported that they had eaten at Wendy’s.

“Of 54 people with detailed information about what they ate at Wendy’s, 37 [69%] reported eating romaine lettuce served on burgers and sandwiches,” the agency noted.

On Aug. 19, Wendy’s announced that it had removed romaine lettuce from its sandwiches in Michigan, Ohio and Pennsylvania.

“Wendy’s is taking the precautionary measure of removing the romaine lettuce being used in sandwiches from restaurants in that region,” the CDC said at the time. “Investigators are working to confirm whether romaine lettuce is the source of this outbreak, and whether romaine lettuce used in Wendy’s sandwiches was served or sold at other businesses.”

Romaine lettuce sold in grocery stores does not appear to be affected, the CDC said, and people can still eat at Wendy’s and eat the romaine lettuce in the salads it sells. Wendy’s explained in a statement that the lettuce used in its salads is not the same as that used in its sandwiches.

“We are fully cooperating with public health authorities on their ongoing investigation of the regional E. coli outbreak reported in certain midwestern states,” the company said at the time. “While the CDC has not yet confirmed a specific food as the source of that outbreak, we are taking the precaution of discarding and replacing the sandwich lettuce at some restaurants in that region.”

Most people with an E. coli infection “start feeling sick 3 to 4 days after eating or drinking something that contains the bacteria,” the CDC said. “However, illnesses can start anywhere from 1 to 10 days after exposure.” Illnesses typically last from 5 to 7 days.

What to Do:

• Watch for symptoms of severe E. coli, which include diarrhea lasting more than three days or diarrhea accompanied by a fever higher than 102˚F, bloody diarrhea, vomiting and a lack of urination.
• If you suffer from these symptoms, call your doctor immediately.
• Keep track of what and where you ate in the week before you got sick and report it to your local or state health department.

More information

For more on the outbreak, head to the U.S. Centers for Disease Control and Prevention.

SOURCES: U.S. Centers for Disease Control and Prevention, news release, Aug. 25, 2022; Wendy’s, statement, Aug. 19, 2022

You may have heard that you shouldn’t eat soy if you are at risk for breast cancer. But then you see headlines saying that it could protect against the disease. So what’s the truth?

Even for health-savvy people, telling fact from fiction can be tricky.

Knowing the real deal is important, especially now that soy is more common in the American diet. Along with its traditional forms of edamame, tofu, tempeh, and miso, soy is also a popular low-fat source of protein. It’s in soy milk, meat substitutes, cereal, baked goods, energy bars, and more.

Should you avoid these foods or eat more of them? The simplest answer is to think “whole” — as in, as close to nature as possible — so you don’t get too much.

For more clarity, get the truth behind these five common myths.

1. Myth: All soy foods raise your risk for breast cancer.

There’s no need to banish tofu and edamame from your diet.

“For years, soy got a bad rap because of its isoflavones,” says Marleen Meyers, MD, director of the Perlmutter Cancer Center Survivorship Program at NYU Langone Medical Center.

These plant-based chemicals are similar in structure to estrogen. Most breast cancers are sensitive to estrogen (or, as doctors say, “estrogen-receptor-positive” or “ER-positive,”) which means that estrogen fuels their growth.

“So there was a fear that soy could act as estrogen in the body and stimulate cancer cells,” Meyers says. “It was spread on blogs, and people would tell each other to avoid soy.”

But a steady stream of studies showed that a diet high in soy didn’t increase the chances of developing breast cancer and may even reduce that risk.

In one study of more than 73,000 Chinese women, researchers found that those who ate at least 13 grams of soy protein a day, roughly one to two servings, were 11% less likely to develop breast cancer than those who got less than 5 grams.

“In Asian cultures, where people eat a lot of soy from a young age, there are lower rates of breast cancer,” Meyers says. And in those societies, people still eat soy in its traditional forms.

Meanwhile, another analysis of eight studies showed that those who got the most soy isoflavones — about the amount in a serving of tofu – were 29% less likely to get the disease compared to those who got the least.

“As part of a healthy diet, whole soy foods are safe,” says Denise Millstine, MD, director of integrative medicine at the Mayo Clinic in Scottsdale, AZ.

2. Myth: All types of soy have the same effect on the body.

Your body may process the natural soy in tofu, miso, and soy milk differently than the kind that’s added to processed foods.

The soy protein isolate found in supplements, protein powders, and meat substitutes is usually stripped of nutrients, such as fiber.

“It’s also a more concentrated form of soy,” Millstine says. “So you’re much more likely to get a high dose if you’re having protein shakes and soy hot dogs than if you’re eating edamame.”

Researchers aren’t certain how large amounts of soy affect breast cancer risk. In one early study, soy supplements were shown to “switch on” genes that encourage cancer growth in women with early-stage breast cancer.

Experts recommend sticking with a moderate amount, or about one to two servings, of whole soy a day. One serving includes:

• Half a cup of cooked edamame
• 1 cup of soy milk
• 1 ounce of soy nuts
• 3 ounces of tofu

3. Myth: Eat soy to protect against breast cancer.

While eating a moderate amount of soy is fine, it’s too soon to suggest eating more to protect your breasts.

“The results are promising, but there’s still not enough information,” Meyers says. Experts now believe that soy isoflavones may actually block estrogen from attaching to breast cancer cells instead of spurring growth like once thought.

Meyers notes that many of the hallmark studies are done in Asian countries, where people grow up eating soy in its traditional forms. “That may influence the way their body processes soy,” she says. “We need to look at if having soy later in life has the same effect.”

More research also needs to be done on how much soy you get at different ages. “Soy may have more of an impact on a postmenopausal woman who’s not producing as much estrogen as a healthy 20-year-old,” Millstine says.

4. Myth: If you have or had breast cancer, avoid all soy foods.

Just as eating a moderate amount of whole soy doesn’t make you more likely to get breast cancer, it also doesn’t seem to raise your risk for recurrence.

“Still, I’d recommend that breast cancer patients avoid soy supplements,” Millstine says.

In one report, researchers analyzed data from diet surveys completed by more than 9,500 American and Chinese women. Those who said they ate the most soy were 25% less likely to have their cancer return compared to those who had the least.

Some experts worried that soy might interfere with breast cancer drugs that lower estrogen levels, such as tamoxifen. But the same study showed that soy also protected against recurrence in patients who took tamoxifen.

The soy foods that the study included were tofu, soy milk, and fresh soybeans. As you might expect, the Chinese women ate far more of it than those in the U.S. The results still held when the researchers considered that fact.

5. Myth: Soy only affects breast cancers that are sensitive to estrogen.

While it’s true that soy isoflavones play a bigger role in estrogen-receptor positive breast cancers, early research links it to a lower risk of other types of breast cancer.

That finding comes from a study of 756 Chinese women who had breast cancer and about 1,000 others who didn’t have the disease. All of the women answered questions about their diets, including how much soy they ate. Those who said they ate more soy were less likely to have any type of breast cancer, compared to those who ate the least.

That finding doesn’t prove that soy prevented breast cancer in any of the women. Other things could be involved.

“More research still needs to be done,” Meyers says. “It could be that people who eat more soy have healthier lifestyles in general.”

Stay tuned to see if that proves to be helpful across the board, whether you eat tofu regularly, pour soy milk on your breakfast cereal, or snack on edamame.

Sept. 2, 2022 – Many patients dealing with debilitating long COVID symptoms that interfere with their day-to-day lives might be tempted to go straight to a specialist – whether it’s a pulmonologist for breathing difficulties or a physiatrist for muscle fatigue – to see if they have long COVID. But medical experts – including many specialists who treat the most complex long COVID cases – recommend starting in a different place: primary care.

“Their primary care physicians are often most knowledgeable about the patients’ complete medical history, and that context is important in the process of diagnosing someone with long COVID,” says Benjamin Abramoff, MD, who leads the long COVID collaborative for the American Academy of Physical Medicine and Rehabilitation.

Primary care providers have been on the front lines of diagnosing long COVID since the early months of the pandemic, when it became clear that a large number of patients had lingering symptoms many weeks after their original COVID-19 infections cleared up.

One early guide for diagnosing long COVID in primary care, published in The BMJ in August 2020, estimated that 1 in 10 patients had a long illness after COVID infections. That estimate now looks low. A July 2022 report from the CDC found 1 in 5 people infected by the virus currently have long COVID symptoms.

Diagnosing long COVID has been a challenge because there’s no simple way to screen for the condition, and no single set of symptoms that definitively lead to the right diagnosis. Primary care providers, who often do detective work to sort out what conditions might explain patients’ health complaints, are well positioned to cast a wide net in exploring possible reasons for the complex mix of symptoms that is par for the course with long COVID.

Symptoms of long COVID Include fatigue, a cough that won’t go away, shortness of breath, lack of smell or taste, a hard time focusing, insomnia, sexual dysfunction, chest pain, and dizziness, among others, says Kristin Englund, MD, director of the Cleveland Clinic reCOVer Clinic, which treats long COVID patients.

Given how complex this is, there are many good reasons to seek a diagnosis in primary care, experts say.

Easier access to care is one big reason. Primary care providers tend to be closer to the patient’s home, and many set aside time to see sick patients quickly. Specialty clinics dedicated to long COVID care tend to be concentrated at academic medical centers in major cities and may have long waits for new patients. The sooner patients are seen, the sooner they may start getting care for symptoms that are interfering with their daily lives.

A primary care doctor who knows the patient well may be able to better distinguish symptoms unique to the COVID infection from old health problems that are resurfacing.

“Working with a primary care provider can avoid unwarranted and expensive diagnostic testing initially,” says Kathleen Bell, MD, a neuro-rehabilitation specialist at the University of Texas Southwestern O’Donnell Brain Institute who helped establish their COVID Recover program. “Patients should always start exploring questions of health care with their primary care physicians.”

Even if many experts agree that primary care is the best place to go for a long COVID diagnosis, they also agree that the process is imperfect and that not all of these doctors are up to the task. There aren’t yet evidence-based guidelines for diagnosing long COVID. And sometimes this diagnosis can get overlooked in primary care, especially when symptoms closely resemble those of other chronic health problems that have become more common during the pandemic – like depression, burnout, and chronic fatigue.

When patients show up with too many unexplained symptoms, primary care providers may also opt to refer patients to local specialists who can explore each issue separately, says Alba Miranda Azola, MD, co-director of the Post-Acute COVID-19 Team at Johns Hopkins University School of Medicine.

“What ends up happening in reality sometimes is patients see their primary care provider, they come in, they have 15 minutes, and they are ranting about all of these symptoms that are multisystemic,” she says. “The primary care provider doesn’t have time to deal with all of these symptoms – it’s gastroenterology and cardiology and neurology – and they refer to all of these different specialists.”

While referrals often help get patients diagnosed properly, it doesn’t always work because not all of these specialists are experienced with diagnosing long COVID, Azola says. “They see the cardiologist who says all of the tests are fine and I can’t help you, then it’s the same with all the different specialists.”

Patients who suspect long COVID, but don’t get this diagnosis despite persistent symptoms, may want to go to a specialized long COVID clinic for a second opinion, says Monica Verduzco-Gutierrez, MD, chair of rehabilitation medicine and director of the COVID-19 Recovery Clinic at the University of Texas Health Science Center at San Antonio.

“If the primary care provider has limited knowledge on the topic or limited options for treatments, or in the case where patients may become more chronic and have multiple conditions and symptoms to manage, this is where a multi-disciplinary long COVID clinic would be an excellent option,” she says.

Long COVID can be diagnosed when patients have persistent symptoms at 4 four weeks after infections start, according to the CDC. Many specialized long COVID clinics focus on more severe, complex cases and won’t see patients unless their symptoms don’t clear up for at least 3 months.

This makes sense, since many long COVID patients can be effectively diagnosed and treated in primary care, says, Tochi Iroku-Malize, MD, founding chair and professor of family medicine for the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. And primary care remains the best place for patients to go whenever they have concerning, unexplained symptoms – whether it’s long COVID or not.

“As the health care community continues to learn more about long COVID, it’s important to start with a health care professional you know and trust – your primary care physician,” she says.

As the new school year begins, teachers at many schools across the country are adding a new component to their routines: a mental health check-in with their students. The idea is to open up conversations around how kids are feeling emotionally, and to connect them to help before issues escalate to a crisis.

“I’ve been really impressed with the proactive position that school systems have taken,” says Dr. Tami Benton, psychiatrist-in-chief at the Children’s Hospital of Philadelphia, and the president-elect of the American Academy of Child and Adolescent Psychiatry.

Many schools that Benton works with are spending less time focusing on academics in the first few weeks of the school year, and more time checking in on kids’ mental health and school readiness. “They’re actually starting to develop their own approaches to assessing the social-emotional development status of kids,” she says.

The new approach comes after two and a half rocky years of pandemic, with kids’ lives disrupted by bouts of remote schooling and many families in economic stress, which worsened the already shaky state of children’s mental health in the U.S.

In 2020, the CDC reported a greater proportion of kids showing up at emergency rooms in a mental health crises: serious suicide attempts, eating disorders, aggressive behaviors.

“The thing that’s most concerned us was really the number of significant self-harm and suicidal ideation that we’ve seen in an emergency room,” says Dr. Smriti Khare, pediatrician and the chief mental and behavioral health office at Children’s Wisconsin, in Milwaukee, which saw a 40% rise in visits to the ER after the start of the pandemic in 2020 compared to the year before.

In the fall of 2020, three professional organizations including the American Academy of Child and Adolescent Psychiatry declared the state of children’s mental health a national emergency.

And last fall, when kids returned to classrooms after a year of virtual learning, schools had hoped the return to in-person teaching would ease kids’ emotional troubles, but they saw the opposite.

“We had a lot of kids with elevated levels of anxiety and stress, and we were seeing students manifesting mental health symptoms that had not existed prior to the pandemic,” Robert Mullaney, superintendent of Millis Public Schools in Massachusetts. “We had an increase in suicidal ideation.”

These experiences primed educators to be proactive at the start of school this year.

Fallout from a national crisis

In the 2021-22 academic year, 76% of public schools in the country reported increased concerns around students showing symptoms of anxiety, depression and trauma, according to the National Center for Education Statistics. And only about half the schools said they were equipped to address students’ mental health needs.

Life may be starting to get back to normal but many kids are struggling to feel motivated – a result of the trauma and chronic stress they have experienced in the past two years, says Dr. Vera Feuer, a child and adolescent psychiatrist at Cohen’s Children’s Medical Center in Long Island, who oversees the hospital’s emergency psychiatry, urgent care and school mental health services.

“So, really having this after-effect, where there is numbness, lack of motivation, not feeling like we can get back into those routines. It might still be a lingering effect from that initial stress and trauma,” she says.

Many American families are still under financial strain, creating parental stress which has a big impact on children, says Kendall Roach, a therapist in Jefferson City, Missouri, who works with kids through the telehealth company, Babylon Health. Others have lost homes, adds Roach.

“I have kids that I see who are technically homeless,” she says. “They’re living in tents. They’re waking up and going maybe to a family’s house to get their shower, and hopefully a hot breakfast and then going to school.”

Schools take a proactive approach

The U.S. Surgeon General’s advisory on youth mental health last year helped raise national awareness and more open conversations about kids’ mental health, says Benton. And educators have realized that unless they addressed student mental health, students would struggle academically.

In fact, new data shows a stark decline in test scores among school kids during the pandemic, the largest drop in reading scores in 30 years.

“I have a third grader who has to be reading to learn,” says Elisa Villanueva Beard, the CEO of Teach for America, which primarily serves marginalized communities. “But I also know that my son cannot be reading unless he is happy, in a state where his brain allows access to learning. And that means that we’ve got to tend to our kids, and meet them where they are.”

That realization has pushed schools to be better prepared to pay attention to student mental health. And many have worked closely with health care providers to educate staff on ways to incorporate mental health discussions into their daily routines.

“We’ve spent a lot of time through the year as well as through the summer trying to be available for teachers, administrators as well as parents to figure out how to help them, give them tools to help [students] cope,” says Khare.

“We have to actually equip our teachers to be able to approach classrooms in a trauma-informed way,” says Villanueva Beard. “What that would mean is that a student walks into a classroom and the teacher has set up a system where they’re able to get on a device and right away share how they’re feeling.”

That’s exactly what psychologist Janice Beal advised teachers in schools in Houston that she works closely with.

“Every morning, [for] 5 minutes, check in with the students and have everybody share how they’re feeling for that particular day,” she says.

It’s not that she thinks teachers – who’ve already stepped up and done more than ever before during the pandemic – should now become mental health professionals, explains Beal.

“We want you to be able to understand what mental health concerns may be in your classroom and to be able to recognize them, so that you can refer them for help.”

Schools in New York have integrated mental health discussions and healthy habits as “sort of a fabric of the day,” says Feuer

“For example, in a classroom, allowing time for kids to take a moment, to focus, to recognize, to have the space where they can express concerns,” she explains.

Schools are also helping students, especially younger ones learn to label emotions and talk about emotions. And teachers “listen to them with an empathic ear,” she adds.

“Unfortunately, there have been so many other things that have shaken kids’ sense of safety when it comes to being in schools, including, gun violence at the end of the year,” she adds.

So, having more of these open conversations around mental health will help kids cope better.

Tapping into new funding

But schools also need additional resources to connect kids who are struggling to mental health care.

“We’ve just heard from more and more teachers that they’re really struggling to meet the mental health needs of kids in the school setting,” says Benton.

The recent influx of federal dollars to provide school based mental health care has certainly helped, she adds.

Mullaney says he was able to hire more behavioral and mental health professionals in the past year to address growing needs of his students. But he knows many school districts who are still struggling to attract new staff.

Today, the US Department of Health and Human Services announced additional $87 million in grant funding to address youth mental health, including for school-based mental health.

However, school districts around the country are just starting to tap into some of these recent funding. “I think it’s going to take a while before we see implementation and change related to those things,” says Benton.

But she is hopeful that this national attention, the bipartisan support in Congress in addressing youth mental health, and the more open conversations on the topic will start to help kids most in need.

“People are involved, people are engaged, new projects are happening,” says Benton. “People are experimenting with new methods for providing care. More young people have become involved as advocates in their own mental health care. So I think all of the activity has really made a difference in supporting children’s mental health.”