Jan Dyer

How effective are the COVID-19 vaccines, third time around? Researchers compared 2 large groups of veterans to find out how well a third dose protected against documented infection, symptomatic COVID-19, and COVID-19–related hospitalization, intensive care unit (ICU) admission, and death.

The research, published in Nature, used electronic health records of 65,196 veterans who received BNT162b2 (Pfizer-BioNTech) and 65,196 who received mRNA-1273 (Moderna). They chose to study the 16 weeks between October 20, 2021 and February 8, 2022, which included both Delta- and Omicron-variant waves.

During the follow-up (median, 77 days), 2994 COVID-19 infections were documented, of which 200 were detected as symptomatic, 194 required hospitalization, and 52 required ICU admission. Twenty-two patients died.

In a previous head-to-head trial comparing breakthrough COVID-19 outcomes after the first doses of the 2 vaccines (given when the Alpha and Delta variants were predominant), the researchers had found a low risk of documented infection and severe outcomes, but lower for the Moderna vaccine. They note that few head-to-head comparisons have been made of third-dose effectiveness.

As expected, in this trial, the researchers found a “nearly identical” pattern for the risk of the 2 vaccine groups. Although the risks for all of the measured outcomes over 16 weeks were low for both vaccines ≤ 4% for documented infection and < 0.03% for death in each group—those veterans who received the Pfizer-BioNTech vaccine had an excess of 45 documented infections and 11 hospitalizations per 10,000 persons, compared with the Moderna group.  The Pfizer-BioNTech group also had a higher risk of documented infection over 9 weeks of follow-up, during which an Omicron-variant predominated.

Given the high effectiveness of a third dose of both vaccines, either vaccine is strongly recommended, the researchers conclude. They point to “evidence of clear and comparable benefits” for the most severe outcomes: The difference in estimated 16-week risk of death between the 2 groups was two-thousandths of 1 %.

They add that, while the differences in estimated risk for less severe outcomes between the 2 groups were small on the absolute scale, they may be meaningful when considering the population scale at which these vaccines are deployed.

How effective are the COVID-19 vaccines, third time around? Researchers compared 2 large groups of veterans to find out how well a third dose protected against documented infection, symptomatic COVID-19, and COVID-19–related hospitalization, intensive care unit (ICU) admission, and death.

The research, published in Nature, used electronic health records of 65,196 veterans who received BNT162b2 (Pfizer-BioNTech) and 65,196 who received mRNA-1273 (Moderna). They chose to study the 16 weeks between October 20, 2021 and February 8, 2022, which included both Delta- and Omicron-variant waves.

During the follow-up (median, 77 days), 2994 COVID-19 infections were documented, of which 200 were detected as symptomatic, 194 required hospitalization, and 52 required ICU admission. Twenty-two patients died.

In a previous head-to-head trial comparing breakthrough COVID-19 outcomes after the first doses of the 2 vaccines (given when the Alpha and Delta variants were predominant), the researchers had found a low risk of documented infection and severe outcomes, but lower for the Moderna vaccine. They note that few head-to-head comparisons have been made of third-dose effectiveness.

As expected, in this trial, the researchers found a “nearly identical” pattern for the risk of the 2 vaccine groups. Although the risks for all of the measured outcomes over 16 weeks were low for both vaccines ≤ 4% for documented infection and < 0.03% for death in each group—those veterans who received the Pfizer-BioNTech vaccine had an excess of 45 documented infections and 11 hospitalizations per 10,000 persons, compared with the Moderna group.  The Pfizer-BioNTech group also had a higher risk of documented infection over 9 weeks of follow-up, during which an Omicron-variant predominated.

Given the high effectiveness of a third dose of both vaccines, either vaccine is strongly recommended, the researchers conclude. They point to “evidence of clear and comparable benefits” for the most severe outcomes: The difference in estimated 16-week risk of death between the 2 groups was two-thousandths of 1 %.

They add that, while the differences in estimated risk for less severe outcomes between the 2 groups were small on the absolute scale, they may be meaningful when considering the population scale at which these vaccines are deployed.

How effective are the COVID-19 vaccines, third time around? Researchers compared 2 large groups of veterans to find out how well a third dose protected against documented infection, symptomatic COVID-19, and COVID-19–related hospitalization, intensive care unit (ICU) admission, and death.

The research, published in Nature, used electronic health records of 65,196 veterans who received BNT162b2 (Pfizer-BioNTech) and 65,196 who received mRNA-1273 (Moderna). They chose to study the 16 weeks between October 20, 2021 and February 8, 2022, which included both Delta- and Omicron-variant waves.

During the follow-up (median, 77 days), 2994 COVID-19 infections were documented, of which 200 were detected as symptomatic, 194 required hospitalization, and 52 required ICU admission. Twenty-two patients died.

In a previous head-to-head trial comparing breakthrough COVID-19 outcomes after the first doses of the 2 vaccines (given when the Alpha and Delta variants were predominant), the researchers had found a low risk of documented infection and severe outcomes, but lower for the Moderna vaccine. They note that few head-to-head comparisons have been made of third-dose effectiveness.

As expected, in this trial, the researchers found a “nearly identical” pattern for the risk of the 2 vaccine groups. Although the risks for all of the measured outcomes over 16 weeks were low for both vaccines ≤ 4% for documented infection and < 0.03% for death in each group—those veterans who received the Pfizer-BioNTech vaccine had an excess of 45 documented infections and 11 hospitalizations per 10,000 persons, compared with the Moderna group.  The Pfizer-BioNTech group also had a higher risk of documented infection over 9 weeks of follow-up, during which an Omicron-variant predominated.

Given the high effectiveness of a third dose of both vaccines, either vaccine is strongly recommended, the researchers conclude. They point to “evidence of clear and comparable benefits” for the most severe outcomes: The difference in estimated 16-week risk of death between the 2 groups was two-thousandths of 1 %.

They add that, while the differences in estimated risk for less severe outcomes between the 2 groups were small on the absolute scale, they may be meaningful when considering the population scale at which these vaccines are deployed.

Black veterans are less likely to have their benefits claims processed and paid than are their White peers because of systemic problems within the US Department of Veterans Affairs, according to a lawsuit filed against the agency.

“A Black veteran who served honorably can walk into the VA, file a disability claim, and be at a significantly higher likelihood of having that claim denied,” said Adam Henderson, a student working with the Yale Law School Veterans Legal Services Clinic, one of several groups connected to the lawsuit.

“The VA has denied countless meritorious applications of Black veterans and thus deprived them and their families of the support that they are entitled to.”

The suit, filed in federal court by the clinic on behalf of Vietnam War veteran Conley Monk Jr., asks for “redress for the harms caused by the failure of VA staff and leaders to administer these benefits programs in a manner free from racial discrimination against Black veterans.”

In a press conference announcing the lawsuit, the effort received backing from Sen. Richard Blumenthal (D, Connecticut) who called it an “unacceptable” situation.

“Black veterans are denied benefits at a very significantly disproportionate rate,” he said. “We know the results. We want to know the reason why.”

The suit stems from an analysis of VA claims records released by the department following an earlier legal action. Between 2001 and 2020, the average denial rate for disability claims filed for Black veterans was 29.5%, significantly above the 24.2% for White veterans.

Attorneys allege the problems date back even further and that VA officials should have known about the racial disparities in the system from previous complaints.

“The negligence of VA leadership, and their failure to train, supervise, monitor and instruct agency officials to take steps to identify and correct racial disparities, led to systematic benefits obstruction for Black veterans,” the suit states.

Monk is a Black disabled Marine Corps veteran who previously sued the military to overturn his less-than-honorable military discharge due to complications from undiagnosed posttraumatic stress disorder.

He was subsequently granted access to a host of veterans benefits but not to retroactive payouts for claims he was denied in the 1970s.

“They didn’t fully compensate me or my family,” he said. “I wasn’t able to give my kids my educational benefits. We should have been receiving checks while they were growing up.”

Along with potential past benefits for Monk, individuals involved with the lawsuit said the move could force the VA to reassess thousands of other unfairly dismissed cases. “For decades [the US government] has allowed racially discriminatory practices to obstruct Black veterans from easily accessing veterans housing, education, and health care benefits with wide-reaching economic consequences for Black veterans and their families,” said Richard Brookshire, executive director of the Black Veterans Project.

“This lawsuit reckons with the shameful history of racism by the Department of Veteran Affairs and seeks to redress long-standing improprieties reverberating across generations of Black military service.”

In a statement, VA press secretary Terrence Hayes did not directly respond to the lawsuit but noted that “throughout history, there have been unacceptable disparities in both VA benefits decisions and military discharge status due to racism, which have wrongly left Black veterans without access to VA care and benefits.”

“We are actively working to right these wrongs, and we will stop at nothing to ensure that all Black veterans get the VA services they have earned and deserve,” he said. “We are currently studying racial disparities in benefits claims decisions, and we will publish the results of that study as soon as they are available.”

Hayes said the department has already begun targeted outreach to Black veterans to help them with claims and is “taking steps to ensure that our claims process combats institutional racism, rather than perpetuating it.”

Black veterans are less likely to have their benefits claims processed and paid than are their White peers because of systemic problems within the US Department of Veterans Affairs, according to a lawsuit filed against the agency.

“A Black veteran who served honorably can walk into the VA, file a disability claim, and be at a significantly higher likelihood of having that claim denied,” said Adam Henderson, a student working with the Yale Law School Veterans Legal Services Clinic, one of several groups connected to the lawsuit.

“The VA has denied countless meritorious applications of Black veterans and thus deprived them and their families of the support that they are entitled to.”

The suit, filed in federal court by the clinic on behalf of Vietnam War veteran Conley Monk Jr., asks for “redress for the harms caused by the failure of VA staff and leaders to administer these benefits programs in a manner free from racial discrimination against Black veterans.”

In a press conference announcing the lawsuit, the effort received backing from Sen. Richard Blumenthal (D, Connecticut) who called it an “unacceptable” situation.

“Black veterans are denied benefits at a very significantly disproportionate rate,” he said. “We know the results. We want to know the reason why.”

The suit stems from an analysis of VA claims records released by the department following an earlier legal action. Between 2001 and 2020, the average denial rate for disability claims filed for Black veterans was 29.5%, significantly above the 24.2% for White veterans.

Attorneys allege the problems date back even further and that VA officials should have known about the racial disparities in the system from previous complaints.

“The negligence of VA leadership, and their failure to train, supervise, monitor and instruct agency officials to take steps to identify and correct racial disparities, led to systematic benefits obstruction for Black veterans,” the suit states.

Monk is a Black disabled Marine Corps veteran who previously sued the military to overturn his less-than-honorable military discharge due to complications from undiagnosed posttraumatic stress disorder.

He was subsequently granted access to a host of veterans benefits but not to retroactive payouts for claims he was denied in the 1970s.

“They didn’t fully compensate me or my family,” he said. “I wasn’t able to give my kids my educational benefits. We should have been receiving checks while they were growing up.”

Along with potential past benefits for Monk, individuals involved with the lawsuit said the move could force the VA to reassess thousands of other unfairly dismissed cases. “For decades [the US government] has allowed racially discriminatory practices to obstruct Black veterans from easily accessing veterans housing, education, and health care benefits with wide-reaching economic consequences for Black veterans and their families,” said Richard Brookshire, executive director of the Black Veterans Project.

“This lawsuit reckons with the shameful history of racism by the Department of Veteran Affairs and seeks to redress long-standing improprieties reverberating across generations of Black military service.”

In a statement, VA press secretary Terrence Hayes did not directly respond to the lawsuit but noted that “throughout history, there have been unacceptable disparities in both VA benefits decisions and military discharge status due to racism, which have wrongly left Black veterans without access to VA care and benefits.”

“We are actively working to right these wrongs, and we will stop at nothing to ensure that all Black veterans get the VA services they have earned and deserve,” he said. “We are currently studying racial disparities in benefits claims decisions, and we will publish the results of that study as soon as they are available.”

Hayes said the department has already begun targeted outreach to Black veterans to help them with claims and is “taking steps to ensure that our claims process combats institutional racism, rather than perpetuating it.”

Black veterans are less likely to have their benefits claims processed and paid than are their White peers because of systemic problems within the US Department of Veterans Affairs, according to a lawsuit filed against the agency.

“A Black veteran who served honorably can walk into the VA, file a disability claim, and be at a significantly higher likelihood of having that claim denied,” said Adam Henderson, a student working with the Yale Law School Veterans Legal Services Clinic, one of several groups connected to the lawsuit.

“The VA has denied countless meritorious applications of Black veterans and thus deprived them and their families of the support that they are entitled to.”

The suit, filed in federal court by the clinic on behalf of Vietnam War veteran Conley Monk Jr., asks for “redress for the harms caused by the failure of VA staff and leaders to administer these benefits programs in a manner free from racial discrimination against Black veterans.”

In a press conference announcing the lawsuit, the effort received backing from Sen. Richard Blumenthal (D, Connecticut) who called it an “unacceptable” situation.

“Black veterans are denied benefits at a very significantly disproportionate rate,” he said. “We know the results. We want to know the reason why.”

The suit stems from an analysis of VA claims records released by the department following an earlier legal action. Between 2001 and 2020, the average denial rate for disability claims filed for Black veterans was 29.5%, significantly above the 24.2% for White veterans.

Attorneys allege the problems date back even further and that VA officials should have known about the racial disparities in the system from previous complaints.

“The negligence of VA leadership, and their failure to train, supervise, monitor and instruct agency officials to take steps to identify and correct racial disparities, led to systematic benefits obstruction for Black veterans,” the suit states.

Monk is a Black disabled Marine Corps veteran who previously sued the military to overturn his less-than-honorable military discharge due to complications from undiagnosed posttraumatic stress disorder.

He was subsequently granted access to a host of veterans benefits but not to retroactive payouts for claims he was denied in the 1970s.

“They didn’t fully compensate me or my family,” he said. “I wasn’t able to give my kids my educational benefits. We should have been receiving checks while they were growing up.”

Along with potential past benefits for Monk, individuals involved with the lawsuit said the move could force the VA to reassess thousands of other unfairly dismissed cases. “For decades [the US government] has allowed racially discriminatory practices to obstruct Black veterans from easily accessing veterans housing, education, and health care benefits with wide-reaching economic consequences for Black veterans and their families,” said Richard Brookshire, executive director of the Black Veterans Project.

“This lawsuit reckons with the shameful history of racism by the Department of Veteran Affairs and seeks to redress long-standing improprieties reverberating across generations of Black military service.”

In a statement, VA press secretary Terrence Hayes did not directly respond to the lawsuit but noted that “throughout history, there have been unacceptable disparities in both VA benefits decisions and military discharge status due to racism, which have wrongly left Black veterans without access to VA care and benefits.”

“We are actively working to right these wrongs, and we will stop at nothing to ensure that all Black veterans get the VA services they have earned and deserve,” he said. “We are currently studying racial disparities in benefits claims decisions, and we will publish the results of that study as soon as they are available.”

Hayes said the department has already begun targeted outreach to Black veterans to help them with claims and is “taking steps to ensure that our claims process combats institutional racism, rather than perpetuating it.”

In a new attempt to replenish the constantly draining pool of mental health professionals, the US Department of Veterans Affairs (VA) is establishing a scholarship program for students pursuing graduate degrees in psychology, social work, marriage and family therapy, or mental health counseling. 

Staffing shortages in mental health have reached crisis proportions across the country, driven in part by 3 years of the pandemic. The VA is not immune. VA shortages go back a long way and have never really been resolved. In 2012, for instance, the VA announced that it planned to expand its mental health staff by nearly 10%, hiring about 1600 additional psychiatrists, psychologists, social workers, and other mental health clinicians to reduce long wait times at many VA medical centers. And indeed, between 2018 and 2021, the number of severe shortages reported declined from 3,068 to 2,152.

However, in 2021, the VA Office of the Inspector General (OIG) released its eighth report in a series on occupational staffing shortages for the 139 facilities. According to the OIG report, 136 facilities reported at least 1 severe occupational staffing shortage, an increase from 132 in fiscal year 2020. Psychiatry was the most frequently reported clinical occupation with severe staffing shortages.

In July 2022, the OIG released its ninth report and the fifth to identify “severe occupational staffing shortages” for VA facilities. The OIG found severe shortages were widespread: Facilities identified 2,622 severe occupational staffing shortages across 285 occupations, which ended a downward trend. Of the 139 facilities, 73 identified severe shortage in psychology, 71 listed psychiatry, 44 listed social work, and 30 listed registered nurse staff for inpatient mental health sections. 

In fact, although the Veterans Health Administration has been increasing the number of staff since 2017, psychology and psychiatry have remained in the top 10 most frequently reported severe shortages annually. 

The scholarship program, expected to start in summer 2023, will fund up to 2 years of graduate studies. After completing their degrees, the mental health professionals will serve full time for 6 years at one of the VA’s Vet Centers, specifically in underserved areas and in states with a per capita population of more than 5% veterans. Vet Centers are community-based outpatient counseling centers that provide a wide range of social and psychological services. 

“In 300 communities across the country, Vet Centers provide veterans, service members, and their families with quick and easy access to the mental health care they need and deserve,” said VA Secretary Denis McDonough. “These scholarships will help VA ensure all veterans and service members—including those in historically underserved areas—have access to Vet Centers with highly qualified, trained and compassionate staff.” 

The VA has posted a final rule for public inspection in the Federal Register 86 FR 81094 to create the scholarship program. 

In a new attempt to replenish the constantly draining pool of mental health professionals, the US Department of Veterans Affairs (VA) is establishing a scholarship program for students pursuing graduate degrees in psychology, social work, marriage and family therapy, or mental health counseling. 

Staffing shortages in mental health have reached crisis proportions across the country, driven in part by 3 years of the pandemic. The VA is not immune. VA shortages go back a long way and have never really been resolved. In 2012, for instance, the VA announced that it planned to expand its mental health staff by nearly 10%, hiring about 1600 additional psychiatrists, psychologists, social workers, and other mental health clinicians to reduce long wait times at many VA medical centers. And indeed, between 2018 and 2021, the number of severe shortages reported declined from 3,068 to 2,152.

However, in 2021, the VA Office of the Inspector General (OIG) released its eighth report in a series on occupational staffing shortages for the 139 facilities. According to the OIG report, 136 facilities reported at least 1 severe occupational staffing shortage, an increase from 132 in fiscal year 2020. Psychiatry was the most frequently reported clinical occupation with severe staffing shortages.

In July 2022, the OIG released its ninth report and the fifth to identify “severe occupational staffing shortages” for VA facilities. The OIG found severe shortages were widespread: Facilities identified 2,622 severe occupational staffing shortages across 285 occupations, which ended a downward trend. Of the 139 facilities, 73 identified severe shortage in psychology, 71 listed psychiatry, 44 listed social work, and 30 listed registered nurse staff for inpatient mental health sections. 

In fact, although the Veterans Health Administration has been increasing the number of staff since 2017, psychology and psychiatry have remained in the top 10 most frequently reported severe shortages annually. 

The scholarship program, expected to start in summer 2023, will fund up to 2 years of graduate studies. After completing their degrees, the mental health professionals will serve full time for 6 years at one of the VA’s Vet Centers, specifically in underserved areas and in states with a per capita population of more than 5% veterans. Vet Centers are community-based outpatient counseling centers that provide a wide range of social and psychological services. 

“In 300 communities across the country, Vet Centers provide veterans, service members, and their families with quick and easy access to the mental health care they need and deserve,” said VA Secretary Denis McDonough. “These scholarships will help VA ensure all veterans and service members—including those in historically underserved areas—have access to Vet Centers with highly qualified, trained and compassionate staff.” 

The VA has posted a final rule for public inspection in the Federal Register 86 FR 81094 to create the scholarship program. 

In a new attempt to replenish the constantly draining pool of mental health professionals, the US Department of Veterans Affairs (VA) is establishing a scholarship program for students pursuing graduate degrees in psychology, social work, marriage and family therapy, or mental health counseling. 

Staffing shortages in mental health have reached crisis proportions across the country, driven in part by 3 years of the pandemic. The VA is not immune. VA shortages go back a long way and have never really been resolved. In 2012, for instance, the VA announced that it planned to expand its mental health staff by nearly 10%, hiring about 1600 additional psychiatrists, psychologists, social workers, and other mental health clinicians to reduce long wait times at many VA medical centers. And indeed, between 2018 and 2021, the number of severe shortages reported declined from 3,068 to 2,152.

However, in 2021, the VA Office of the Inspector General (OIG) released its eighth report in a series on occupational staffing shortages for the 139 facilities. According to the OIG report, 136 facilities reported at least 1 severe occupational staffing shortage, an increase from 132 in fiscal year 2020. Psychiatry was the most frequently reported clinical occupation with severe staffing shortages.

In July 2022, the OIG released its ninth report and the fifth to identify “severe occupational staffing shortages” for VA facilities. The OIG found severe shortages were widespread: Facilities identified 2,622 severe occupational staffing shortages across 285 occupations, which ended a downward trend. Of the 139 facilities, 73 identified severe shortage in psychology, 71 listed psychiatry, 44 listed social work, and 30 listed registered nurse staff for inpatient mental health sections. 

In fact, although the Veterans Health Administration has been increasing the number of staff since 2017, psychology and psychiatry have remained in the top 10 most frequently reported severe shortages annually. 

The scholarship program, expected to start in summer 2023, will fund up to 2 years of graduate studies. After completing their degrees, the mental health professionals will serve full time for 6 years at one of the VA’s Vet Centers, specifically in underserved areas and in states with a per capita population of more than 5% veterans. Vet Centers are community-based outpatient counseling centers that provide a wide range of social and psychological services. 

“In 300 communities across the country, Vet Centers provide veterans, service members, and their families with quick and easy access to the mental health care they need and deserve,” said VA Secretary Denis McDonough. “These scholarships will help VA ensure all veterans and service members—including those in historically underserved areas—have access to Vet Centers with highly qualified, trained and compassionate staff.” 

The VA has posted a final rule for public inspection in the Federal Register 86 FR 81094 to create the scholarship program. 

Black veterans hospitalized with COVID-19 were less likely to be treated with evidence-based treatments, in a study conducted in 130 US Department of Veterans Affairs (VA) medical centers between March 1, 2020, and February 28, 2022.

The study involved 12,135 Black veterans and 40,717 White veterans. Most patients hospitalized during period 1 (March-September 2020) were Black veterans and the proportion of White patients increased over time. The latter 3 periods, which included the Delta- and Omicron-predominant periods, saw the most admissions.

Controlling for the site of treatment, Black patients were equally likely to be admitted to the intensive care unit (40% vs 43%). However, they were less likely to receive steroids, remdesivir, or immunomodulatory drugs.

The researchers say their data confirm other findings from 41 US health care systems participating in the National Patient-Centered Clinical Research Network (PCORNet), which found lower use of monoclonal antibody treatment for COVID infection for patients who identified as Asian, Black, Hispanic, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, or multiple races.

The researchers did not observe consistent differences in clinical outcomes between Black and White patients. After adjusting for demographics, chronic health conditions, severity of acute illness, and receipt of COVID-19–specific treatments, there was no association of Black race with hospital mortality or 30-day readmission. Black and White patients had a similar burden of preexisting health conditions. Of 38,782 patients discharged, 14% were readmitted within 30 days; the median time to readmission for both groups was 9 days.

Differences in care were partially explained by within- and between-hospital differences, the researchers say. They also cite research that demonstrated a poorer quality of care for hospitals with higher monthly COVID-19 discharges and hospital size.

The study results contradict the assumptions that differences in inpatient treatment by race and ethnicity may be due to differences in clinical indications for medication use based on age and comorbidities, such as chronic kidney or liver disease, the researchers say. For one thing, the VA issued a systemwide COVID-19 response plan that included specific treatment guidelines and distribution plans. But they also point to recent reports that have suggested that occult hypoxemia not detected by pulse oximetry occurs “far more often in Black patients than White patients,” which could result in delayed or missed opportunities to treat patients with COVID-19.

Black veterans hospitalized with COVID-19 were less likely to be treated with evidence-based treatments, in a study conducted in 130 US Department of Veterans Affairs (VA) medical centers between March 1, 2020, and February 28, 2022.

The study involved 12,135 Black veterans and 40,717 White veterans. Most patients hospitalized during period 1 (March-September 2020) were Black veterans and the proportion of White patients increased over time. The latter 3 periods, which included the Delta- and Omicron-predominant periods, saw the most admissions.

Controlling for the site of treatment, Black patients were equally likely to be admitted to the intensive care unit (40% vs 43%). However, they were less likely to receive steroids, remdesivir, or immunomodulatory drugs.

The researchers say their data confirm other findings from 41 US health care systems participating in the National Patient-Centered Clinical Research Network (PCORNet), which found lower use of monoclonal antibody treatment for COVID infection for patients who identified as Asian, Black, Hispanic, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, or multiple races.

The researchers did not observe consistent differences in clinical outcomes between Black and White patients. After adjusting for demographics, chronic health conditions, severity of acute illness, and receipt of COVID-19–specific treatments, there was no association of Black race with hospital mortality or 30-day readmission. Black and White patients had a similar burden of preexisting health conditions. Of 38,782 patients discharged, 14% were readmitted within 30 days; the median time to readmission for both groups was 9 days.

Differences in care were partially explained by within- and between-hospital differences, the researchers say. They also cite research that demonstrated a poorer quality of care for hospitals with higher monthly COVID-19 discharges and hospital size.

The study results contradict the assumptions that differences in inpatient treatment by race and ethnicity may be due to differences in clinical indications for medication use based on age and comorbidities, such as chronic kidney or liver disease, the researchers say. For one thing, the VA issued a systemwide COVID-19 response plan that included specific treatment guidelines and distribution plans. But they also point to recent reports that have suggested that occult hypoxemia not detected by pulse oximetry occurs “far more often in Black patients than White patients,” which could result in delayed or missed opportunities to treat patients with COVID-19.

Black veterans hospitalized with COVID-19 were less likely to be treated with evidence-based treatments, in a study conducted in 130 US Department of Veterans Affairs (VA) medical centers between March 1, 2020, and February 28, 2022.

The study involved 12,135 Black veterans and 40,717 White veterans. Most patients hospitalized during period 1 (March-September 2020) were Black veterans and the proportion of White patients increased over time. The latter 3 periods, which included the Delta- and Omicron-predominant periods, saw the most admissions.

Controlling for the site of treatment, Black patients were equally likely to be admitted to the intensive care unit (40% vs 43%). However, they were less likely to receive steroids, remdesivir, or immunomodulatory drugs.

The researchers say their data confirm other findings from 41 US health care systems participating in the National Patient-Centered Clinical Research Network (PCORNet), which found lower use of monoclonal antibody treatment for COVID infection for patients who identified as Asian, Black, Hispanic, American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, or multiple races.

The researchers did not observe consistent differences in clinical outcomes between Black and White patients. After adjusting for demographics, chronic health conditions, severity of acute illness, and receipt of COVID-19–specific treatments, there was no association of Black race with hospital mortality or 30-day readmission. Black and White patients had a similar burden of preexisting health conditions. Of 38,782 patients discharged, 14% were readmitted within 30 days; the median time to readmission for both groups was 9 days.

Differences in care were partially explained by within- and between-hospital differences, the researchers say. They also cite research that demonstrated a poorer quality of care for hospitals with higher monthly COVID-19 discharges and hospital size.

The study results contradict the assumptions that differences in inpatient treatment by race and ethnicity may be due to differences in clinical indications for medication use based on age and comorbidities, such as chronic kidney or liver disease, the researchers say. For one thing, the VA issued a systemwide COVID-19 response plan that included specific treatment guidelines and distribution plans. But they also point to recent reports that have suggested that occult hypoxemia not detected by pulse oximetry occurs “far more often in Black patients than White patients,” which could result in delayed or missed opportunities to treat patients with COVID-19.

The US Department of Veterans Affairs (VA) is pushing further deployments of the system to June 2023 “to address challenges” and make sure it’s functioning optimally.

Among the challenges: Safety concerns “voluminous enough and prevalent enough” to prompt the VA to disclose to 41,500 veterans enrolled in Washington, Idaho, Oregon, Montana, and Ohio that their care “may have been impacted as a result of the system’s deployment as it is currently configured,” VA Undersecretary for Health Shereef Elnahal said in a news conference.

The plan was to launch in the first quarter of 2023 in Western Washington, Michigan, and Ohio. But in a recent release, the VA said an investigation had found several technical and system issues, such as latency and slowness, and problems with patient scheduling, referrals, medication management, and other types of medical orders. During this “assess and address” period, the VA says, it will correct outstanding issues—especially those that may have patient safety implications—before restarting deployments at other VA medical centers.

“Right now, the Oracle Cerner [EHR] system is not delivering for veterans or VA health care providers—and we are holding Oracle Cerner and ourselves accountable to get this right,” said VA Deputy Secretary Donald Remy, who has oversight over the EHR program. “We are delaying all future deployments of the new EHR while we fully assess performance and address every concern. Veterans and clinicians deserve a seamless, modernized health record system, and we will not rest until they get it.”

The modernized EHR, intended to replace the Veterans Health Information Systems and Technology Architecture (VistA), has been plagued by problems from the very first launch in October 2020 at Mann-Grandstaff VA Medical Center and associated clinics in the Northwest. Deputy Inspector David Case, of the Office of Inspector General (OIG), reported to the House Committee on Veterans’ Affairs on oversight between 2020 and July 2021. Among other things, the OIG identified problems with the infrastructure and with users’ experiences. Clinical and administrative staff at Mann-Grandstaff and a Columbus clinic shared their frustration with OIG personnel about the “significant system and process limitations that raised concerns about the continuity of and prompt access to quality patient care.”

For example, according to an OIG report from July 2022, the new EHR sent thousands of orders for medical care to an “undetectable location, or unknown queue” instead of the intended location. The mis-delivery caused 149 patient harm events.

On October 11, the VA confirmed to The Spokesman-Review, a Spokane-based newspaper, that a patient had died at the VA clinic in Columbus. The death was attributed to the patient not receiving medication due to incorrect information. The incident is being treated as a potential “sentinel event.”

Elnahal, who met with employees in September at the Columbus clinic where the Oracle Cerner system was launched in April, said he found that the highly complex system made it hard for clinicians to perform routine tasks, such as ordering tests or follow-up appointments. Delays in follow-ups—including a yearlong delay in treatment for a veteran ultimately diagnosed with terminal cancer—were the main cause of the cases of harm cited in the July OIG report.

The veterans who received the letter about the potential impact on their health care “got caught up in this phenomenon of commands not getting where they need to go,” Elnahal said in a news conference in September.

Senator Patty Murray (D-WA), a senior member of the Veterans Affairs Committee, has been consistently pressing the VA to do something about the EHR system’s flaws. “It’s painfully clear,” she said in a statement, “we need to stop this program until the VA can fix these serious issues before they hurt anyone else.”

After finding more than 200 orders in the unknown queue in May 2022, the OIG said, it “has concerns with the effectiveness of Cerner’s plan to mitigate the safety risk.” While executing its “assess and address” plan, the VA will continue to focus on the 5 facilities where the new system has been deployed. “Sometimes, you’re not presented with options to immediately resolve the safety concerns that are in front of you,” Elnahal told reporters. “It is simply the case that the best option in front of us to resolve these patient safety concerns is to work with Oracle Cerner over the next several months to resolve the Cerner system issues at the sites where it exists. We know that this is possible, because other health systems have gone through this journey before, and I think we can do it.”

Veterans who believe their care may have been affected can call a dedicated call center at 800.319.9446. A VA health care team will follow up within 5 days.

The US Department of Veterans Affairs (VA) is pushing further deployments of the system to June 2023 “to address challenges” and make sure it’s functioning optimally.

Among the challenges: Safety concerns “voluminous enough and prevalent enough” to prompt the VA to disclose to 41,500 veterans enrolled in Washington, Idaho, Oregon, Montana, and Ohio that their care “may have been impacted as a result of the system’s deployment as it is currently configured,” VA Undersecretary for Health Shereef Elnahal said in a news conference.

The plan was to launch in the first quarter of 2023 in Western Washington, Michigan, and Ohio. But in a recent release, the VA said an investigation had found several technical and system issues, such as latency and slowness, and problems with patient scheduling, referrals, medication management, and other types of medical orders. During this “assess and address” period, the VA says, it will correct outstanding issues—especially those that may have patient safety implications—before restarting deployments at other VA medical centers.

“Right now, the Oracle Cerner [EHR] system is not delivering for veterans or VA health care providers—and we are holding Oracle Cerner and ourselves accountable to get this right,” said VA Deputy Secretary Donald Remy, who has oversight over the EHR program. “We are delaying all future deployments of the new EHR while we fully assess performance and address every concern. Veterans and clinicians deserve a seamless, modernized health record system, and we will not rest until they get it.”

The modernized EHR, intended to replace the Veterans Health Information Systems and Technology Architecture (VistA), has been plagued by problems from the very first launch in October 2020 at Mann-Grandstaff VA Medical Center and associated clinics in the Northwest. Deputy Inspector David Case, of the Office of Inspector General (OIG), reported to the House Committee on Veterans’ Affairs on oversight between 2020 and July 2021. Among other things, the OIG identified problems with the infrastructure and with users’ experiences. Clinical and administrative staff at Mann-Grandstaff and a Columbus clinic shared their frustration with OIG personnel about the “significant system and process limitations that raised concerns about the continuity of and prompt access to quality patient care.”

For example, according to an OIG report from July 2022, the new EHR sent thousands of orders for medical care to an “undetectable location, or unknown queue” instead of the intended location. The mis-delivery caused 149 patient harm events.

On October 11, the VA confirmed to The Spokesman-Review, a Spokane-based newspaper, that a patient had died at the VA clinic in Columbus. The death was attributed to the patient not receiving medication due to incorrect information. The incident is being treated as a potential “sentinel event.”

Elnahal, who met with employees in September at the Columbus clinic where the Oracle Cerner system was launched in April, said he found that the highly complex system made it hard for clinicians to perform routine tasks, such as ordering tests or follow-up appointments. Delays in follow-ups—including a yearlong delay in treatment for a veteran ultimately diagnosed with terminal cancer—were the main cause of the cases of harm cited in the July OIG report.

The veterans who received the letter about the potential impact on their health care “got caught up in this phenomenon of commands not getting where they need to go,” Elnahal said in a news conference in September.

Senator Patty Murray (D-WA), a senior member of the Veterans Affairs Committee, has been consistently pressing the VA to do something about the EHR system’s flaws. “It’s painfully clear,” she said in a statement, “we need to stop this program until the VA can fix these serious issues before they hurt anyone else.”

After finding more than 200 orders in the unknown queue in May 2022, the OIG said, it “has concerns with the effectiveness of Cerner’s plan to mitigate the safety risk.” While executing its “assess and address” plan, the VA will continue to focus on the 5 facilities where the new system has been deployed. “Sometimes, you’re not presented with options to immediately resolve the safety concerns that are in front of you,” Elnahal told reporters. “It is simply the case that the best option in front of us to resolve these patient safety concerns is to work with Oracle Cerner over the next several months to resolve the Cerner system issues at the sites where it exists. We know that this is possible, because other health systems have gone through this journey before, and I think we can do it.”

Veterans who believe their care may have been affected can call a dedicated call center at 800.319.9446. A VA health care team will follow up within 5 days.

The US Department of Veterans Affairs (VA) is pushing further deployments of the system to June 2023 “to address challenges” and make sure it’s functioning optimally.

Among the challenges: Safety concerns “voluminous enough and prevalent enough” to prompt the VA to disclose to 41,500 veterans enrolled in Washington, Idaho, Oregon, Montana, and Ohio that their care “may have been impacted as a result of the system’s deployment as it is currently configured,” VA Undersecretary for Health Shereef Elnahal said in a news conference.

The plan was to launch in the first quarter of 2023 in Western Washington, Michigan, and Ohio. But in a recent release, the VA said an investigation had found several technical and system issues, such as latency and slowness, and problems with patient scheduling, referrals, medication management, and other types of medical orders. During this “assess and address” period, the VA says, it will correct outstanding issues—especially those that may have patient safety implications—before restarting deployments at other VA medical centers.

“Right now, the Oracle Cerner [EHR] system is not delivering for veterans or VA health care providers—and we are holding Oracle Cerner and ourselves accountable to get this right,” said VA Deputy Secretary Donald Remy, who has oversight over the EHR program. “We are delaying all future deployments of the new EHR while we fully assess performance and address every concern. Veterans and clinicians deserve a seamless, modernized health record system, and we will not rest until they get it.”

The modernized EHR, intended to replace the Veterans Health Information Systems and Technology Architecture (VistA), has been plagued by problems from the very first launch in October 2020 at Mann-Grandstaff VA Medical Center and associated clinics in the Northwest. Deputy Inspector David Case, of the Office of Inspector General (OIG), reported to the House Committee on Veterans’ Affairs on oversight between 2020 and July 2021. Among other things, the OIG identified problems with the infrastructure and with users’ experiences. Clinical and administrative staff at Mann-Grandstaff and a Columbus clinic shared their frustration with OIG personnel about the “significant system and process limitations that raised concerns about the continuity of and prompt access to quality patient care.”

For example, according to an OIG report from July 2022, the new EHR sent thousands of orders for medical care to an “undetectable location, or unknown queue” instead of the intended location. The mis-delivery caused 149 patient harm events.

On October 11, the VA confirmed to The Spokesman-Review, a Spokane-based newspaper, that a patient had died at the VA clinic in Columbus. The death was attributed to the patient not receiving medication due to incorrect information. The incident is being treated as a potential “sentinel event.”

Elnahal, who met with employees in September at the Columbus clinic where the Oracle Cerner system was launched in April, said he found that the highly complex system made it hard for clinicians to perform routine tasks, such as ordering tests or follow-up appointments. Delays in follow-ups—including a yearlong delay in treatment for a veteran ultimately diagnosed with terminal cancer—were the main cause of the cases of harm cited in the July OIG report.

The veterans who received the letter about the potential impact on their health care “got caught up in this phenomenon of commands not getting where they need to go,” Elnahal said in a news conference in September.

Senator Patty Murray (D-WA), a senior member of the Veterans Affairs Committee, has been consistently pressing the VA to do something about the EHR system’s flaws. “It’s painfully clear,” she said in a statement, “we need to stop this program until the VA can fix these serious issues before they hurt anyone else.”

After finding more than 200 orders in the unknown queue in May 2022, the OIG said, it “has concerns with the effectiveness of Cerner’s plan to mitigate the safety risk.” While executing its “assess and address” plan, the VA will continue to focus on the 5 facilities where the new system has been deployed. “Sometimes, you’re not presented with options to immediately resolve the safety concerns that are in front of you,” Elnahal told reporters. “It is simply the case that the best option in front of us to resolve these patient safety concerns is to work with Oracle Cerner over the next several months to resolve the Cerner system issues at the sites where it exists. We know that this is possible, because other health systems have gone through this journey before, and I think we can do it.”

Veterans who believe their care may have been affected can call a dedicated call center at 800.319.9446. A VA health care team will follow up within 5 days.

Some 80,000 active-duty women are stationed in states with abortion restrictions or bans. That’s 40% of active-duty service women in the continental United States, according to research sponsored by the US Department of Defense (DoD) and released in September. Nearly all (95%) are of reproductive age. Annually, an estimated 2573 to 4126 women have an abortion, but just a handful of those are done at military treatment facilities. Moreover, roughly 275,000 DoD civilians also live in states with a full ban or extreme restrictions on access to abortion. Of those, more than 81,000 are women. Nearly 43% have no access to abortion or drastically abridged access.  

The recent Supreme Court ruling in Dobbs v Jackson Women’s Health Organization has created uncertainty for those women and their families, and potential legal and financial risk for the health care practitioners who would provide reproductive care, Defense Secretary Lloyd Austin said in an October 20, 2022 memo.

Therefore, he has directed the DoD to take “all appropriate action… as soon as possible to ensure that our service members and their families can access reproductive health care and our health care providers can operate effectively.”

Among the actions he has approved: Paying for travel to reproductive health care—essentially, making it more feasible for members to cross state lines. Service members, he noted in the memo, are often required to travel or move to meet staffing, operational, and training requirements. The “practical effects,” he said, are that significant numbers of service members and their families “may be forced to travel greater distances, take more time off from work, and pay more out-of-pocket expenses to receive reproductive health care.” 

Those effects, Austin said, “qualify as unusual, extraordinary, hardship, or emergency circumstances for service members and their dependents and will interfere with our ability to recruit, retain, and maintain the readiness of a highly qualified force.”

Women, who comprise 17% of the active-duty force, are the fastest-growing subpopulation in the military. For the past several years, according to the DoD research report, the military services have been “deliberately recruiting women”—who perform essential duties in every sector: health care and electrical and mechanical equipment repair, for example.

“The full effects of Dobbs on military readiness are yet to be known,” the report says, but it notes several potential problems: Women may not join the service knowing that they could end up in a state with restrictions. If already serving, they may leave. In some states, women face criminal prosecution.

The long arm of Dobbs reaches far into the future, too. For instance, if unintended pregnancies are carried to term, the DoD will need to provide care to women during pregnancy, delivery, and the postpartum period—and the family will need to care for the child. Looking only at women in states with restricted access or bans, the DoD estimates the number of unintended pregnancies annually would be 2800 among civilian employees and between 4400 and 4700 among active-duty service women.

Men are also directly affected: More than 40% of male service members are married to a civilian woman who is a TRICARE dependent, 20% of active-duty service women are married to a fellow service member, and active-duty service men might be responsible for pregnancies among women who are not DoD dependents but who might be unable to get an abortion, the DoD report notes.

Austin has directed the DoD to create a uniform policy that allows for appropriate administrative absence, to establish travel and transportation allowances, and to amend any applicable travel regulations to facilitate official travel to access noncovered reproductive health care that is unavailable within the local area of the service member’s permanent duty station.

So that health care practitioners do not have to face criminal or civil liability or risk losing their licenses, Austin directed the DoD to develop a program to reimburse applicable fees, as appropriate and consistent with applicable federal law, for DoD health care practitioners who wish to become licensed in a state other than that in which they are currently licensed. He also directed the DoD to develop a program to support DoD practitioners who are subject to adverse action, including indemnification of any verdict, judgment, or other monetary award consistent with applicable law.

“Our greatest strength is our people,” Austin wrote. “There is no higher priority than taking care of our people, and ensuring their health and well-being.” He directed that the actions outlined in the memorandum “be executed as soon as possible.”

Some 80,000 active-duty women are stationed in states with abortion restrictions or bans. That’s 40% of active-duty service women in the continental United States, according to research sponsored by the US Department of Defense (DoD) and released in September. Nearly all (95%) are of reproductive age. Annually, an estimated 2573 to 4126 women have an abortion, but just a handful of those are done at military treatment facilities. Moreover, roughly 275,000 DoD civilians also live in states with a full ban or extreme restrictions on access to abortion. Of those, more than 81,000 are women. Nearly 43% have no access to abortion or drastically abridged access.  

The recent Supreme Court ruling in Dobbs v Jackson Women’s Health Organization has created uncertainty for those women and their families, and potential legal and financial risk for the health care practitioners who would provide reproductive care, Defense Secretary Lloyd Austin said in an October 20, 2022 memo.

Therefore, he has directed the DoD to take “all appropriate action… as soon as possible to ensure that our service members and their families can access reproductive health care and our health care providers can operate effectively.”

Among the actions he has approved: Paying for travel to reproductive health care—essentially, making it more feasible for members to cross state lines. Service members, he noted in the memo, are often required to travel or move to meet staffing, operational, and training requirements. The “practical effects,” he said, are that significant numbers of service members and their families “may be forced to travel greater distances, take more time off from work, and pay more out-of-pocket expenses to receive reproductive health care.” 

Those effects, Austin said, “qualify as unusual, extraordinary, hardship, or emergency circumstances for service members and their dependents and will interfere with our ability to recruit, retain, and maintain the readiness of a highly qualified force.”

Women, who comprise 17% of the active-duty force, are the fastest-growing subpopulation in the military. For the past several years, according to the DoD research report, the military services have been “deliberately recruiting women”—who perform essential duties in every sector: health care and electrical and mechanical equipment repair, for example.

“The full effects of Dobbs on military readiness are yet to be known,” the report says, but it notes several potential problems: Women may not join the service knowing that they could end up in a state with restrictions. If already serving, they may leave. In some states, women face criminal prosecution.

The long arm of Dobbs reaches far into the future, too. For instance, if unintended pregnancies are carried to term, the DoD will need to provide care to women during pregnancy, delivery, and the postpartum period—and the family will need to care for the child. Looking only at women in states with restricted access or bans, the DoD estimates the number of unintended pregnancies annually would be 2800 among civilian employees and between 4400 and 4700 among active-duty service women.

Men are also directly affected: More than 40% of male service members are married to a civilian woman who is a TRICARE dependent, 20% of active-duty service women are married to a fellow service member, and active-duty service men might be responsible for pregnancies among women who are not DoD dependents but who might be unable to get an abortion, the DoD report notes.

Austin has directed the DoD to create a uniform policy that allows for appropriate administrative absence, to establish travel and transportation allowances, and to amend any applicable travel regulations to facilitate official travel to access noncovered reproductive health care that is unavailable within the local area of the service member’s permanent duty station.

So that health care practitioners do not have to face criminal or civil liability or risk losing their licenses, Austin directed the DoD to develop a program to reimburse applicable fees, as appropriate and consistent with applicable federal law, for DoD health care practitioners who wish to become licensed in a state other than that in which they are currently licensed. He also directed the DoD to develop a program to support DoD practitioners who are subject to adverse action, including indemnification of any verdict, judgment, or other monetary award consistent with applicable law.

“Our greatest strength is our people,” Austin wrote. “There is no higher priority than taking care of our people, and ensuring their health and well-being.” He directed that the actions outlined in the memorandum “be executed as soon as possible.”

Some 80,000 active-duty women are stationed in states with abortion restrictions or bans. That’s 40% of active-duty service women in the continental United States, according to research sponsored by the US Department of Defense (DoD) and released in September. Nearly all (95%) are of reproductive age. Annually, an estimated 2573 to 4126 women have an abortion, but just a handful of those are done at military treatment facilities. Moreover, roughly 275,000 DoD civilians also live in states with a full ban or extreme restrictions on access to abortion. Of those, more than 81,000 are women. Nearly 43% have no access to abortion or drastically abridged access.  

The recent Supreme Court ruling in Dobbs v Jackson Women’s Health Organization has created uncertainty for those women and their families, and potential legal and financial risk for the health care practitioners who would provide reproductive care, Defense Secretary Lloyd Austin said in an October 20, 2022 memo.

Therefore, he has directed the DoD to take “all appropriate action… as soon as possible to ensure that our service members and their families can access reproductive health care and our health care providers can operate effectively.”

Among the actions he has approved: Paying for travel to reproductive health care—essentially, making it more feasible for members to cross state lines. Service members, he noted in the memo, are often required to travel or move to meet staffing, operational, and training requirements. The “practical effects,” he said, are that significant numbers of service members and their families “may be forced to travel greater distances, take more time off from work, and pay more out-of-pocket expenses to receive reproductive health care.” 

Those effects, Austin said, “qualify as unusual, extraordinary, hardship, or emergency circumstances for service members and their dependents and will interfere with our ability to recruit, retain, and maintain the readiness of a highly qualified force.”

Women, who comprise 17% of the active-duty force, are the fastest-growing subpopulation in the military. For the past several years, according to the DoD research report, the military services have been “deliberately recruiting women”—who perform essential duties in every sector: health care and electrical and mechanical equipment repair, for example.

“The full effects of Dobbs on military readiness are yet to be known,” the report says, but it notes several potential problems: Women may not join the service knowing that they could end up in a state with restrictions. If already serving, they may leave. In some states, women face criminal prosecution.

The long arm of Dobbs reaches far into the future, too. For instance, if unintended pregnancies are carried to term, the DoD will need to provide care to women during pregnancy, delivery, and the postpartum period—and the family will need to care for the child. Looking only at women in states with restricted access or bans, the DoD estimates the number of unintended pregnancies annually would be 2800 among civilian employees and between 4400 and 4700 among active-duty service women.

Men are also directly affected: More than 40% of male service members are married to a civilian woman who is a TRICARE dependent, 20% of active-duty service women are married to a fellow service member, and active-duty service men might be responsible for pregnancies among women who are not DoD dependents but who might be unable to get an abortion, the DoD report notes.

Austin has directed the DoD to create a uniform policy that allows for appropriate administrative absence, to establish travel and transportation allowances, and to amend any applicable travel regulations to facilitate official travel to access noncovered reproductive health care that is unavailable within the local area of the service member’s permanent duty station.

So that health care practitioners do not have to face criminal or civil liability or risk losing their licenses, Austin directed the DoD to develop a program to reimburse applicable fees, as appropriate and consistent with applicable federal law, for DoD health care practitioners who wish to become licensed in a state other than that in which they are currently licensed. He also directed the DoD to develop a program to support DoD practitioners who are subject to adverse action, including indemnification of any verdict, judgment, or other monetary award consistent with applicable law.

“Our greatest strength is our people,” Austin wrote. “There is no higher priority than taking care of our people, and ensuring their health and well-being.” He directed that the actions outlined in the memorandum “be executed as soon as possible.”

In an intensive push to fill acute workforce shortages, the US Department of Veterans Affairs (VA) is holding a “national onboarding surge event” the week of November 14. The goal is to get people who have already said yes to a job in the VA on that job more quickly. Every VA facility has been asked to submit a list of the highest-priority candidates, regardless of the position.

One of the most pressing reasons for getting more workers into the pipeline faster is that more and more veterans are entering VA care. As of October 1, tens of thousands of veterans will be eligible for VA health care, thanks to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), passed in August, which expanded benefits for post-9/11 service members with illnesses due to toxic exposures.

Another reason is the need to fill the gaps left by attrition. In an October 19 press briefing, VA Undersecretary for Health Shereef Elnahal said the agency needs to hire about 52,000 employees per year just to keep up with the rate of health care professionals (HCPs) leaving the agency. At a September breakfast meeting with the Defense Writers Group, VA Secretary Denis McDonough said July 2022 marked the first month this year that the VA hired more nurses than it lost to retirement. He said the VA needs to hire 45,000 nurses over the next 3 years to keep up with attrition and growing demand for veteran care.

“We have to do a better job on hiring,” McDonough said. Streamlining the process is a major goal. Hiring rules loosened during the pandemic have since tightened back up. He pointed out that in many cases, the VA takes 90 to 100 days to onboard candidates and called the long-drawn-out process “being dragged through a bureaucratic morass.” During that time, he said, “They’re not being paid, they’re filling out paperwork… That’s disastrous.” In his press briefing, Elnahal said “we lose folks after we’ve made the selection” because the process is so long.

Moreover, the agency has a critical shortage not only of HCPs but the human resources professionals needed to fast-track the hirees’ progress. McDonough called it a “supply chain issue.” “We have the lowest ratio of human resource professionals per employee in the federal government by a long shot.” Partly, he said, because “a lot of our people end up hired away to other federal agencies.”

McDonough said the VA is also interested in transitioning more active-duty service members with in-demand skills, certifications, and talent into the VA workforce. “Cross-walking active duty into VA service much more aggressively,” he said, is another way to “grow that supply of ready, deployable, trained personnel.” The PACT Act gives the VA new incentives to entice workers, such as expanded recruitment, retention bonuses, and student loan repayment. The VA already provides training to about 1500 nurse and nurse residency programs across the VA, McDonough said but has plans for expanding to 5 times its current scope. He also addressed the question of a looming physician shortage: “Roughly 7 in 10 doctors in the United States will have had some portion of their training in a VA facility. We have to maintain that training function going forward.” The VA trains doctors, he added, “better than anybody else.”

The onboarding event will serve as a “national signal that we take this priority very seriously,” Elnahal said. “This will be not only a chance to have a step function improvement in the number of folks on board, which is an urgent priority, but to also set the groundwork for the more longitudinal work that we will need to do to improve the hiring process.”

Bulking up the workforce, he said, is “still far and away among our first priorities. Because if we don’t get our hospitals and facility staffed, it’s going to be a really hard effort to make process on the other priorities.”

In an intensive push to fill acute workforce shortages, the US Department of Veterans Affairs (VA) is holding a “national onboarding surge event” the week of November 14. The goal is to get people who have already said yes to a job in the VA on that job more quickly. Every VA facility has been asked to submit a list of the highest-priority candidates, regardless of the position.

One of the most pressing reasons for getting more workers into the pipeline faster is that more and more veterans are entering VA care. As of October 1, tens of thousands of veterans will be eligible for VA health care, thanks to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), passed in August, which expanded benefits for post-9/11 service members with illnesses due to toxic exposures.

Another reason is the need to fill the gaps left by attrition. In an October 19 press briefing, VA Undersecretary for Health Shereef Elnahal said the agency needs to hire about 52,000 employees per year just to keep up with the rate of health care professionals (HCPs) leaving the agency. At a September breakfast meeting with the Defense Writers Group, VA Secretary Denis McDonough said July 2022 marked the first month this year that the VA hired more nurses than it lost to retirement. He said the VA needs to hire 45,000 nurses over the next 3 years to keep up with attrition and growing demand for veteran care.

“We have to do a better job on hiring,” McDonough said. Streamlining the process is a major goal. Hiring rules loosened during the pandemic have since tightened back up. He pointed out that in many cases, the VA takes 90 to 100 days to onboard candidates and called the long-drawn-out process “being dragged through a bureaucratic morass.” During that time, he said, “They’re not being paid, they’re filling out paperwork… That’s disastrous.” In his press briefing, Elnahal said “we lose folks after we’ve made the selection” because the process is so long.

Moreover, the agency has a critical shortage not only of HCPs but the human resources professionals needed to fast-track the hirees’ progress. McDonough called it a “supply chain issue.” “We have the lowest ratio of human resource professionals per employee in the federal government by a long shot.” Partly, he said, because “a lot of our people end up hired away to other federal agencies.”

McDonough said the VA is also interested in transitioning more active-duty service members with in-demand skills, certifications, and talent into the VA workforce. “Cross-walking active duty into VA service much more aggressively,” he said, is another way to “grow that supply of ready, deployable, trained personnel.” The PACT Act gives the VA new incentives to entice workers, such as expanded recruitment, retention bonuses, and student loan repayment. The VA already provides training to about 1500 nurse and nurse residency programs across the VA, McDonough said but has plans for expanding to 5 times its current scope. He also addressed the question of a looming physician shortage: “Roughly 7 in 10 doctors in the United States will have had some portion of their training in a VA facility. We have to maintain that training function going forward.” The VA trains doctors, he added, “better than anybody else.”

The onboarding event will serve as a “national signal that we take this priority very seriously,” Elnahal said. “This will be not only a chance to have a step function improvement in the number of folks on board, which is an urgent priority, but to also set the groundwork for the more longitudinal work that we will need to do to improve the hiring process.”

Bulking up the workforce, he said, is “still far and away among our first priorities. Because if we don’t get our hospitals and facility staffed, it’s going to be a really hard effort to make process on the other priorities.”

In an intensive push to fill acute workforce shortages, the US Department of Veterans Affairs (VA) is holding a “national onboarding surge event” the week of November 14. The goal is to get people who have already said yes to a job in the VA on that job more quickly. Every VA facility has been asked to submit a list of the highest-priority candidates, regardless of the position.

One of the most pressing reasons for getting more workers into the pipeline faster is that more and more veterans are entering VA care. As of October 1, tens of thousands of veterans will be eligible for VA health care, thanks to the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), passed in August, which expanded benefits for post-9/11 service members with illnesses due to toxic exposures.

Another reason is the need to fill the gaps left by attrition. In an October 19 press briefing, VA Undersecretary for Health Shereef Elnahal said the agency needs to hire about 52,000 employees per year just to keep up with the rate of health care professionals (HCPs) leaving the agency. At a September breakfast meeting with the Defense Writers Group, VA Secretary Denis McDonough said July 2022 marked the first month this year that the VA hired more nurses than it lost to retirement. He said the VA needs to hire 45,000 nurses over the next 3 years to keep up with attrition and growing demand for veteran care.

“We have to do a better job on hiring,” McDonough said. Streamlining the process is a major goal. Hiring rules loosened during the pandemic have since tightened back up. He pointed out that in many cases, the VA takes 90 to 100 days to onboard candidates and called the long-drawn-out process “being dragged through a bureaucratic morass.” During that time, he said, “They’re not being paid, they’re filling out paperwork… That’s disastrous.” In his press briefing, Elnahal said “we lose folks after we’ve made the selection” because the process is so long.

Moreover, the agency has a critical shortage not only of HCPs but the human resources professionals needed to fast-track the hirees’ progress. McDonough called it a “supply chain issue.” “We have the lowest ratio of human resource professionals per employee in the federal government by a long shot.” Partly, he said, because “a lot of our people end up hired away to other federal agencies.”

McDonough said the VA is also interested in transitioning more active-duty service members with in-demand skills, certifications, and talent into the VA workforce. “Cross-walking active duty into VA service much more aggressively,” he said, is another way to “grow that supply of ready, deployable, trained personnel.” The PACT Act gives the VA new incentives to entice workers, such as expanded recruitment, retention bonuses, and student loan repayment. The VA already provides training to about 1500 nurse and nurse residency programs across the VA, McDonough said but has plans for expanding to 5 times its current scope. He also addressed the question of a looming physician shortage: “Roughly 7 in 10 doctors in the United States will have had some portion of their training in a VA facility. We have to maintain that training function going forward.” The VA trains doctors, he added, “better than anybody else.”

The onboarding event will serve as a “national signal that we take this priority very seriously,” Elnahal said. “This will be not only a chance to have a step function improvement in the number of folks on board, which is an urgent priority, but to also set the groundwork for the more longitudinal work that we will need to do to improve the hiring process.”

Bulking up the workforce, he said, is “still far and away among our first priorities. Because if we don’t get our hospitals and facility staffed, it’s going to be a really hard effort to make process on the other priorities.”

It took 609 days, but the US Senate has finally (unanimously) confirmed President Biden’s choice to head the Indian Health Service (IHS: Roselyn Tso.)

President Biden nominated Tso in March 2022, and she was formally sworn in on September 27, 2022. The long-awaited confirmation filled a space that hadn’t had a permanent director since Michael Weahkee, a Pueblo of Zuni citizen, stepped down in 2021. In the interim, Elizabeth Fowler, of the Comanche Nation, served as acting director.

Tso’s resume includes almost 40 years of professional experience working at all levels of the IHS. Before taking over as IHS director, she led the IHS Navajo area, the largest IHS regional area, managing more than 4000 employees and a budget of nearly $1 billion.

She also brings “decades of lived experience as a member of the Navajo Nation,” she said in a 40-minute Senate hearing with the US Senate Committee on Indian Affairs in May.

The first Navajo Nation citizen to head the IHS (and only the second woman to do so), Tso introduced herself in Navajo: Deeschii’nii (Start of the Red Streak People) and born for Hashk’aa hadzohi (Yucca Fruit Strung Out). “This is a historic achievement for all of our Navajo people and tribal nations across the country,” Navajo Nation President Jonathan Nez said. “To have one of our own Navajo members in the highest position with IHS is remarkable.”

Tso spoke of having to “navigate the services provided by the Agency for myself, family, and friends.” Her personal and professional backgrounds, she said, help her understand how patients experience the system and how that can be improved. “The health care provided at IHS is critical for those we serve. I understand this not just because I work there,” she said. “My family relies on IHS. My friends rely on IHS. I rely on the IHS.”

The long lacuna in confirming a permanent IHS director left the Native peoples particularly vulnerable—when the COVID-19 pandemic essentially worsened the existing problems they faced, such as diabetes mellitus and cancer. Life expectancy for Native people fell by more than 6 years between 2019 and 2021, to 65 years, compared with the US average of 76 years.

Without a full-time IHS leader, the National Council of Urban Indian Health said in a statement, tribal nations and other Native health care providers struggled to raise and address the issues they were facing amid the pandemic. “Since the resignation of Rear Admiral Weahkee, there have been countless requests from Indian Country calling on Congress and the Administration to nominate a new IHS director to address the growing health disparities experienced by AI/ANs.”

Tso laid out her priorities in her May testimony: creating a more unified health care system using the latest technology to develop centralized systems; improving accountability, transparency, and patient safety; addressing workforce needs and challenges, improving recruitment and retention.

Meeting her goals, she noted, would take “strong partnerships and communication with our Tribal partners…. Each tribe has unique needs, and those needs cannot be met if you do not understand them.”

Last year, President Joseph R. Biden asked Congress to significantly increase IHS funding, but his proposal was cut to $400 million. “For years, IHS has been funded at a rate that is far below its level of need, and the results of this historical neglect can be seen in the disparities in health outcomes for AI/AN people,” William Smith, Valdez Native Tribe, Chairman of the National Indian Health Board (NIHB), wrote to the Senate Committee on Indian Affairs, on the topic of the next IHS director. “Perhaps one of the greatest challenges facing the [Indian, tribal and urban] system is the chronic and severe underfunding and budgetary instability for health care and public health services infrastructure and delivery. Since its creation in 1955, IHS has been chronically underfunded, with annual appropriations never exceeding 50% of demonstrated need. This underfunding has contributed to substandard investment in health delivery systems, some of the worst health disparities among any US population and a severe lack of public health infrastructure and services for our people. At the start of the COVID-19 pandemic these vulnerabilities were starkly exposed and while Congress moved decisively to invest into Tribal health and public health, the new Director must work to maintain these one-time investments.”

Stacy Bohlen, NIHB chief executive, told The Oklahoman that tribal leaders will look to Tso to press Congress for more money and to secure mandatory full funding for IHS—in contrast with the current annual appropriations, where Congress includes IHS in much larger budget bills. “When those bills stall, so does the money tribal clinics need to pay employees and suppliers,” making it hard to recruit and retain employees. “In the Indian Health System,” Bohlen says, “we simply can’t afford that kind of vulnerability.”

Securing advance appropriations and, ultimately, full mandatory funding for IHS, Smith wrote in his letter to the Senate committee, “fulfills the commitment made to our people generations ago and breaks down the systemic healthcare funding inequities the federal government tolerates for Tribes.”

Tso emphasized her intent to “improve the physical, mental, social, and spiritual health and well-being of all American Indians and Alaskan Natives served by the Agency.” Tso “understands the healthcare needs that many first people of this country deal with,” President Nez said. “Her work ethic, value system and approach to problem solving demonstrates the resilience of Indigenous peoples and the commitment to combat the systemic inequities that impact tribal nations.”

It took 609 days, but the US Senate has finally (unanimously) confirmed President Biden’s choice to head the Indian Health Service (IHS: Roselyn Tso.)

President Biden nominated Tso in March 2022, and she was formally sworn in on September 27, 2022. The long-awaited confirmation filled a space that hadn’t had a permanent director since Michael Weahkee, a Pueblo of Zuni citizen, stepped down in 2021. In the interim, Elizabeth Fowler, of the Comanche Nation, served as acting director.

Tso’s resume includes almost 40 years of professional experience working at all levels of the IHS. Before taking over as IHS director, she led the IHS Navajo area, the largest IHS regional area, managing more than 4000 employees and a budget of nearly $1 billion.

She also brings “decades of lived experience as a member of the Navajo Nation,” she said in a 40-minute Senate hearing with the US Senate Committee on Indian Affairs in May.

The first Navajo Nation citizen to head the IHS (and only the second woman to do so), Tso introduced herself in Navajo: Deeschii’nii (Start of the Red Streak People) and born for Hashk’aa hadzohi (Yucca Fruit Strung Out). “This is a historic achievement for all of our Navajo people and tribal nations across the country,” Navajo Nation President Jonathan Nez said. “To have one of our own Navajo members in the highest position with IHS is remarkable.”

Tso spoke of having to “navigate the services provided by the Agency for myself, family, and friends.” Her personal and professional backgrounds, she said, help her understand how patients experience the system and how that can be improved. “The health care provided at IHS is critical for those we serve. I understand this not just because I work there,” she said. “My family relies on IHS. My friends rely on IHS. I rely on the IHS.”

The long lacuna in confirming a permanent IHS director left the Native peoples particularly vulnerable—when the COVID-19 pandemic essentially worsened the existing problems they faced, such as diabetes mellitus and cancer. Life expectancy for Native people fell by more than 6 years between 2019 and 2021, to 65 years, compared with the US average of 76 years.

Without a full-time IHS leader, the National Council of Urban Indian Health said in a statement, tribal nations and other Native health care providers struggled to raise and address the issues they were facing amid the pandemic. “Since the resignation of Rear Admiral Weahkee, there have been countless requests from Indian Country calling on Congress and the Administration to nominate a new IHS director to address the growing health disparities experienced by AI/ANs.”

Tso laid out her priorities in her May testimony: creating a more unified health care system using the latest technology to develop centralized systems; improving accountability, transparency, and patient safety; addressing workforce needs and challenges, improving recruitment and retention.

Meeting her goals, she noted, would take “strong partnerships and communication with our Tribal partners…. Each tribe has unique needs, and those needs cannot be met if you do not understand them.”

Last year, President Joseph R. Biden asked Congress to significantly increase IHS funding, but his proposal was cut to $400 million. “For years, IHS has been funded at a rate that is far below its level of need, and the results of this historical neglect can be seen in the disparities in health outcomes for AI/AN people,” William Smith, Valdez Native Tribe, Chairman of the National Indian Health Board (NIHB), wrote to the Senate Committee on Indian Affairs, on the topic of the next IHS director. “Perhaps one of the greatest challenges facing the [Indian, tribal and urban] system is the chronic and severe underfunding and budgetary instability for health care and public health services infrastructure and delivery. Since its creation in 1955, IHS has been chronically underfunded, with annual appropriations never exceeding 50% of demonstrated need. This underfunding has contributed to substandard investment in health delivery systems, some of the worst health disparities among any US population and a severe lack of public health infrastructure and services for our people. At the start of the COVID-19 pandemic these vulnerabilities were starkly exposed and while Congress moved decisively to invest into Tribal health and public health, the new Director must work to maintain these one-time investments.”

Stacy Bohlen, NIHB chief executive, told The Oklahoman that tribal leaders will look to Tso to press Congress for more money and to secure mandatory full funding for IHS—in contrast with the current annual appropriations, where Congress includes IHS in much larger budget bills. “When those bills stall, so does the money tribal clinics need to pay employees and suppliers,” making it hard to recruit and retain employees. “In the Indian Health System,” Bohlen says, “we simply can’t afford that kind of vulnerability.”

Securing advance appropriations and, ultimately, full mandatory funding for IHS, Smith wrote in his letter to the Senate committee, “fulfills the commitment made to our people generations ago and breaks down the systemic healthcare funding inequities the federal government tolerates for Tribes.”

Tso emphasized her intent to “improve the physical, mental, social, and spiritual health and well-being of all American Indians and Alaskan Natives served by the Agency.” Tso “understands the healthcare needs that many first people of this country deal with,” President Nez said. “Her work ethic, value system and approach to problem solving demonstrates the resilience of Indigenous peoples and the commitment to combat the systemic inequities that impact tribal nations.”

It took 609 days, but the US Senate has finally (unanimously) confirmed President Biden’s choice to head the Indian Health Service (IHS: Roselyn Tso.)

President Biden nominated Tso in March 2022, and she was formally sworn in on September 27, 2022. The long-awaited confirmation filled a space that hadn’t had a permanent director since Michael Weahkee, a Pueblo of Zuni citizen, stepped down in 2021. In the interim, Elizabeth Fowler, of the Comanche Nation, served as acting director.

Tso’s resume includes almost 40 years of professional experience working at all levels of the IHS. Before taking over as IHS director, she led the IHS Navajo area, the largest IHS regional area, managing more than 4000 employees and a budget of nearly $1 billion.

She also brings “decades of lived experience as a member of the Navajo Nation,” she said in a 40-minute Senate hearing with the US Senate Committee on Indian Affairs in May.

The first Navajo Nation citizen to head the IHS (and only the second woman to do so), Tso introduced herself in Navajo: Deeschii’nii (Start of the Red Streak People) and born for Hashk’aa hadzohi (Yucca Fruit Strung Out). “This is a historic achievement for all of our Navajo people and tribal nations across the country,” Navajo Nation President Jonathan Nez said. “To have one of our own Navajo members in the highest position with IHS is remarkable.”

Tso spoke of having to “navigate the services provided by the Agency for myself, family, and friends.” Her personal and professional backgrounds, she said, help her understand how patients experience the system and how that can be improved. “The health care provided at IHS is critical for those we serve. I understand this not just because I work there,” she said. “My family relies on IHS. My friends rely on IHS. I rely on the IHS.”

The long lacuna in confirming a permanent IHS director left the Native peoples particularly vulnerable—when the COVID-19 pandemic essentially worsened the existing problems they faced, such as diabetes mellitus and cancer. Life expectancy for Native people fell by more than 6 years between 2019 and 2021, to 65 years, compared with the US average of 76 years.

Without a full-time IHS leader, the National Council of Urban Indian Health said in a statement, tribal nations and other Native health care providers struggled to raise and address the issues they were facing amid the pandemic. “Since the resignation of Rear Admiral Weahkee, there have been countless requests from Indian Country calling on Congress and the Administration to nominate a new IHS director to address the growing health disparities experienced by AI/ANs.”

Tso laid out her priorities in her May testimony: creating a more unified health care system using the latest technology to develop centralized systems; improving accountability, transparency, and patient safety; addressing workforce needs and challenges, improving recruitment and retention.

Meeting her goals, she noted, would take “strong partnerships and communication with our Tribal partners…. Each tribe has unique needs, and those needs cannot be met if you do not understand them.”

Last year, President Joseph R. Biden asked Congress to significantly increase IHS funding, but his proposal was cut to $400 million. “For years, IHS has been funded at a rate that is far below its level of need, and the results of this historical neglect can be seen in the disparities in health outcomes for AI/AN people,” William Smith, Valdez Native Tribe, Chairman of the National Indian Health Board (NIHB), wrote to the Senate Committee on Indian Affairs, on the topic of the next IHS director. “Perhaps one of the greatest challenges facing the [Indian, tribal and urban] system is the chronic and severe underfunding and budgetary instability for health care and public health services infrastructure and delivery. Since its creation in 1955, IHS has been chronically underfunded, with annual appropriations never exceeding 50% of demonstrated need. This underfunding has contributed to substandard investment in health delivery systems, some of the worst health disparities among any US population and a severe lack of public health infrastructure and services for our people. At the start of the COVID-19 pandemic these vulnerabilities were starkly exposed and while Congress moved decisively to invest into Tribal health and public health, the new Director must work to maintain these one-time investments.”

Stacy Bohlen, NIHB chief executive, told The Oklahoman that tribal leaders will look to Tso to press Congress for more money and to secure mandatory full funding for IHS—in contrast with the current annual appropriations, where Congress includes IHS in much larger budget bills. “When those bills stall, so does the money tribal clinics need to pay employees and suppliers,” making it hard to recruit and retain employees. “In the Indian Health System,” Bohlen says, “we simply can’t afford that kind of vulnerability.”

Securing advance appropriations and, ultimately, full mandatory funding for IHS, Smith wrote in his letter to the Senate committee, “fulfills the commitment made to our people generations ago and breaks down the systemic healthcare funding inequities the federal government tolerates for Tribes.”

Tso emphasized her intent to “improve the physical, mental, social, and spiritual health and well-being of all American Indians and Alaskan Natives served by the Agency.” Tso “understands the healthcare needs that many first people of this country deal with,” President Nez said. “Her work ethic, value system and approach to problem solving demonstrates the resilience of Indigenous peoples and the commitment to combat the systemic inequities that impact tribal nations.”

We now know that the effects of COVID-19 don’t always end when the infection seems over. Long COVID—the postacute sequelae—can encompass a wide range of extrapulmonary organ dysfunctions. Most studies on COVID-19 have had follow-ups of 6 months or less with a narrow selection of neurologic outcomes, say Evan Xu, Yan Xie, PhD, and Ziyad Al-Aly, MD of the US Department of Veterans Affairs (VA) St. Louis Health Care System in Missouri. The 12-month study of 11,652,484 people published in Nature Medicine sounds an alert: Get ready to care for more patients with long-term, even chronic, neurologic disorders from migraine to stroke.

The researchers “leveraged the breadth and depth” of the VA’s national health care databases to build 3 groups: 154,068 people who survived the first 30 days of COVID-19; 5,638,795 VA users with no evidence of COVID-19 infection; and 5,859,621 VA users during 2017 (ie, prepandemic). Altogether, the groups corresponded to 14,064,985 person-years of follow-up.

The findings, which the researchers termed robust, revealed substantial risks and burdens beyond the first 30 days of COVID-19 infection, including “an array of neurologic disorders spanning several disease categories.”

Patients were at greater risk for stroke (both ischemic and hemorrhagic), cognition and memory disorders, peripheral nervous system disorders, episodic disorders like migraine and seizures, extrapyramidal and movement disorders, mental health disorders, musculoskeletal disorders, sensory disorders, Guillain-Barré syndrome, and encephalitis or encephalopathy.

The researchers estimated the hazard ratio of any neurological sequelae as 1.42. The risks were elevated even in people who did not require hospitalization during acute COVID-19 and increased according to the care setting of the acute phase of the disease from nonhospitalized to hospitalized and admitted to intensive care.

“Given the colossal scale of the pandemic,” the researchers say, governments and health systems should consider these findings when devising policy for continued management and developing plans for a postpandemic world. Some of the disorders they report on, they note, “are serious chronic conditions that will impact some people for a lifetime.” They point to 2 key findings: first, regardless of age, people with COVID-19 had a higher risk of all the neurologic outcomes examined, and second, the analyses suggest that the effects on risk were stronger in younger adults.

“The effects of these disorders on younger lives are profound and cannot be overstated,” the researchers say. Equally troubling, they note, is the stronger effect of COVID-19 on mental health, musculoskeletal, and episodic disorders in older adults, “highlighting their vulnerability” to these disorders following COVID-19 infection.

“It is imperative,” the researchers conclude, “that we recognize the enormous challenges posed by long COVID and all its downstream long-term consequences” and design capacity planning and clinical care pathways to address the needs of people who make it past the acute phase of COVID-19

We now know that the effects of COVID-19 don’t always end when the infection seems over. Long COVID—the postacute sequelae—can encompass a wide range of extrapulmonary organ dysfunctions. Most studies on COVID-19 have had follow-ups of 6 months or less with a narrow selection of neurologic outcomes, say Evan Xu, Yan Xie, PhD, and Ziyad Al-Aly, MD of the US Department of Veterans Affairs (VA) St. Louis Health Care System in Missouri. The 12-month study of 11,652,484 people published in Nature Medicine sounds an alert: Get ready to care for more patients with long-term, even chronic, neurologic disorders from migraine to stroke.

The researchers “leveraged the breadth and depth” of the VA’s national health care databases to build 3 groups: 154,068 people who survived the first 30 days of COVID-19; 5,638,795 VA users with no evidence of COVID-19 infection; and 5,859,621 VA users during 2017 (ie, prepandemic). Altogether, the groups corresponded to 14,064,985 person-years of follow-up.

The findings, which the researchers termed robust, revealed substantial risks and burdens beyond the first 30 days of COVID-19 infection, including “an array of neurologic disorders spanning several disease categories.”

Patients were at greater risk for stroke (both ischemic and hemorrhagic), cognition and memory disorders, peripheral nervous system disorders, episodic disorders like migraine and seizures, extrapyramidal and movement disorders, mental health disorders, musculoskeletal disorders, sensory disorders, Guillain-Barré syndrome, and encephalitis or encephalopathy.

The researchers estimated the hazard ratio of any neurological sequelae as 1.42. The risks were elevated even in people who did not require hospitalization during acute COVID-19 and increased according to the care setting of the acute phase of the disease from nonhospitalized to hospitalized and admitted to intensive care.

“Given the colossal scale of the pandemic,” the researchers say, governments and health systems should consider these findings when devising policy for continued management and developing plans for a postpandemic world. Some of the disorders they report on, they note, “are serious chronic conditions that will impact some people for a lifetime.” They point to 2 key findings: first, regardless of age, people with COVID-19 had a higher risk of all the neurologic outcomes examined, and second, the analyses suggest that the effects on risk were stronger in younger adults.

“The effects of these disorders on younger lives are profound and cannot be overstated,” the researchers say. Equally troubling, they note, is the stronger effect of COVID-19 on mental health, musculoskeletal, and episodic disorders in older adults, “highlighting their vulnerability” to these disorders following COVID-19 infection.

“It is imperative,” the researchers conclude, “that we recognize the enormous challenges posed by long COVID and all its downstream long-term consequences” and design capacity planning and clinical care pathways to address the needs of people who make it past the acute phase of COVID-19

We now know that the effects of COVID-19 don’t always end when the infection seems over. Long COVID—the postacute sequelae—can encompass a wide range of extrapulmonary organ dysfunctions. Most studies on COVID-19 have had follow-ups of 6 months or less with a narrow selection of neurologic outcomes, say Evan Xu, Yan Xie, PhD, and Ziyad Al-Aly, MD of the US Department of Veterans Affairs (VA) St. Louis Health Care System in Missouri. The 12-month study of 11,652,484 people published in Nature Medicine sounds an alert: Get ready to care for more patients with long-term, even chronic, neurologic disorders from migraine to stroke.

The researchers “leveraged the breadth and depth” of the VA’s national health care databases to build 3 groups: 154,068 people who survived the first 30 days of COVID-19; 5,638,795 VA users with no evidence of COVID-19 infection; and 5,859,621 VA users during 2017 (ie, prepandemic). Altogether, the groups corresponded to 14,064,985 person-years of follow-up.

The findings, which the researchers termed robust, revealed substantial risks and burdens beyond the first 30 days of COVID-19 infection, including “an array of neurologic disorders spanning several disease categories.”

Patients were at greater risk for stroke (both ischemic and hemorrhagic), cognition and memory disorders, peripheral nervous system disorders, episodic disorders like migraine and seizures, extrapyramidal and movement disorders, mental health disorders, musculoskeletal disorders, sensory disorders, Guillain-Barré syndrome, and encephalitis or encephalopathy.

The researchers estimated the hazard ratio of any neurological sequelae as 1.42. The risks were elevated even in people who did not require hospitalization during acute COVID-19 and increased according to the care setting of the acute phase of the disease from nonhospitalized to hospitalized and admitted to intensive care.

“Given the colossal scale of the pandemic,” the researchers say, governments and health systems should consider these findings when devising policy for continued management and developing plans for a postpandemic world. Some of the disorders they report on, they note, “are serious chronic conditions that will impact some people for a lifetime.” They point to 2 key findings: first, regardless of age, people with COVID-19 had a higher risk of all the neurologic outcomes examined, and second, the analyses suggest that the effects on risk were stronger in younger adults.

“The effects of these disorders on younger lives are profound and cannot be overstated,” the researchers say. Equally troubling, they note, is the stronger effect of COVID-19 on mental health, musculoskeletal, and episodic disorders in older adults, “highlighting their vulnerability” to these disorders following COVID-19 infection.

“It is imperative,” the researchers conclude, “that we recognize the enormous challenges posed by long COVID and all its downstream long-term consequences” and design capacity planning and clinical care pathways to address the needs of people who make it past the acute phase of COVID-19

The US Department of Veterans Affairs (VA) has submitted an interim final rule amending its medical regulations to remove the exclusion on abortion counseling and establish exceptions to the exclusion on abortions.

With this rule, the VA will now offer veterans abortion counseling and abortions—specifically, when the life or health of the pregnant veteran would be endangered if the pregnancy were carried to term, or in cases of rape or incest. Beneficiaries enrolled in CHAMPVA will have the same access to care.

“As abortion bans come into force across the country,” the interim final rule indicates, “veterans in many states are no longer assured access to abortion services in their communities, even when those services are needed… Unless VA removes its existing prohibitions on abortion-related care and makes clear that needed abortion-related care is authorized, these veterans will face serious threats to their life and health.”

“This is a patient safety decision,” said Denis McDonough, Secretary of Veterans Affairs. “Pregnant veterans and VA beneficiaries deserve to have access to world-class reproductive care when they need it most. That’s what our nation owes them, and that’s what we at VA will deliver.”

The rule is the VA’s latest response to the June 24, 2022, Dobbs v Jackson Women’s Health Organization Supreme Court decision, which overruled Roe v Wade and Planned Parenthood of Southeastern Pennsylvania v Casey. “After Dobbs,” according to the rule summary, “certain States have begun to enforce existing abortion bans and restrictions on care, and are proposing and enacting new ones, creating urgent risks to the lives and health of pregnant veterans and CHAMPVA beneficiaries in these states.” The VA is “acting to help to ensure that, irrespective of what laws or policies States may impose” veterans will be able to receive needed care.

Restricting access to abortion care has well-documented adverse health consequences, including a higher risk of loss of future fertility, significant morbidity, or death. Veterans are also at greater risk of experiencing pregnancy-related complications due to increased rates of chronic health conditions. “We came to this decision after listening to VA health care providers and veterans across the country, who sounded the alarm that abortion restrictions are creating a medical emergency for those we serve,” said Under Secretary for Health Shereef Elnahal, MD, MBA. “Offering this care will save veterans’ health and lives, and there is nothing more important than that.”

Services will be authorized immediately after the interim final rule is published. VA is taking steps to guarantee abortion-related care anywhere in the country. VA employees, when working within the scope of their federal employment, may provide authorized services regardless of state restrictions.

The determination of whether the “life and health of the pregnant veteran would be endangered if the pregnancy were carried to term” will be made on a case-by-case basis after “careful consultation” between VA health care professionals and their patients, the VA says. In cases of rape or incest, self-reporting from a veteran or VA beneficiary will constitute sufficient evidence that an act of rape or incest occurred.

The interim final rule will be available for public comment for 30 days after it is published.

The US Department of Veterans Affairs (VA) has submitted an interim final rule amending its medical regulations to remove the exclusion on abortion counseling and establish exceptions to the exclusion on abortions.

With this rule, the VA will now offer veterans abortion counseling and abortions—specifically, when the life or health of the pregnant veteran would be endangered if the pregnancy were carried to term, or in cases of rape or incest. Beneficiaries enrolled in CHAMPVA will have the same access to care.

“As abortion bans come into force across the country,” the interim final rule indicates, “veterans in many states are no longer assured access to abortion services in their communities, even when those services are needed… Unless VA removes its existing prohibitions on abortion-related care and makes clear that needed abortion-related care is authorized, these veterans will face serious threats to their life and health.”

“This is a patient safety decision,” said Denis McDonough, Secretary of Veterans Affairs. “Pregnant veterans and VA beneficiaries deserve to have access to world-class reproductive care when they need it most. That’s what our nation owes them, and that’s what we at VA will deliver.”

The rule is the VA’s latest response to the June 24, 2022, Dobbs v Jackson Women’s Health Organization Supreme Court decision, which overruled Roe v Wade and Planned Parenthood of Southeastern Pennsylvania v Casey. “After Dobbs,” according to the rule summary, “certain States have begun to enforce existing abortion bans and restrictions on care, and are proposing and enacting new ones, creating urgent risks to the lives and health of pregnant veterans and CHAMPVA beneficiaries in these states.” The VA is “acting to help to ensure that, irrespective of what laws or policies States may impose” veterans will be able to receive needed care.

Restricting access to abortion care has well-documented adverse health consequences, including a higher risk of loss of future fertility, significant morbidity, or death. Veterans are also at greater risk of experiencing pregnancy-related complications due to increased rates of chronic health conditions. “We came to this decision after listening to VA health care providers and veterans across the country, who sounded the alarm that abortion restrictions are creating a medical emergency for those we serve,” said Under Secretary for Health Shereef Elnahal, MD, MBA. “Offering this care will save veterans’ health and lives, and there is nothing more important than that.”

Services will be authorized immediately after the interim final rule is published. VA is taking steps to guarantee abortion-related care anywhere in the country. VA employees, when working within the scope of their federal employment, may provide authorized services regardless of state restrictions.

The determination of whether the “life and health of the pregnant veteran would be endangered if the pregnancy were carried to term” will be made on a case-by-case basis after “careful consultation” between VA health care professionals and their patients, the VA says. In cases of rape or incest, self-reporting from a veteran or VA beneficiary will constitute sufficient evidence that an act of rape or incest occurred.

The interim final rule will be available for public comment for 30 days after it is published.

The US Department of Veterans Affairs (VA) has submitted an interim final rule amending its medical regulations to remove the exclusion on abortion counseling and establish exceptions to the exclusion on abortions.

With this rule, the VA will now offer veterans abortion counseling and abortions—specifically, when the life or health of the pregnant veteran would be endangered if the pregnancy were carried to term, or in cases of rape or incest. Beneficiaries enrolled in CHAMPVA will have the same access to care.

“As abortion bans come into force across the country,” the interim final rule indicates, “veterans in many states are no longer assured access to abortion services in their communities, even when those services are needed… Unless VA removes its existing prohibitions on abortion-related care and makes clear that needed abortion-related care is authorized, these veterans will face serious threats to their life and health.”

“This is a patient safety decision,” said Denis McDonough, Secretary of Veterans Affairs. “Pregnant veterans and VA beneficiaries deserve to have access to world-class reproductive care when they need it most. That’s what our nation owes them, and that’s what we at VA will deliver.”

The rule is the VA’s latest response to the June 24, 2022, Dobbs v Jackson Women’s Health Organization Supreme Court decision, which overruled Roe v Wade and Planned Parenthood of Southeastern Pennsylvania v Casey. “After Dobbs,” according to the rule summary, “certain States have begun to enforce existing abortion bans and restrictions on care, and are proposing and enacting new ones, creating urgent risks to the lives and health of pregnant veterans and CHAMPVA beneficiaries in these states.” The VA is “acting to help to ensure that, irrespective of what laws or policies States may impose” veterans will be able to receive needed care.

Restricting access to abortion care has well-documented adverse health consequences, including a higher risk of loss of future fertility, significant morbidity, or death. Veterans are also at greater risk of experiencing pregnancy-related complications due to increased rates of chronic health conditions. “We came to this decision after listening to VA health care providers and veterans across the country, who sounded the alarm that abortion restrictions are creating a medical emergency for those we serve,” said Under Secretary for Health Shereef Elnahal, MD, MBA. “Offering this care will save veterans’ health and lives, and there is nothing more important than that.”

Services will be authorized immediately after the interim final rule is published. VA is taking steps to guarantee abortion-related care anywhere in the country. VA employees, when working within the scope of their federal employment, may provide authorized services regardless of state restrictions.

The determination of whether the “life and health of the pregnant veteran would be endangered if the pregnancy were carried to term” will be made on a case-by-case basis after “careful consultation” between VA health care professionals and their patients, the VA says. In cases of rape or incest, self-reporting from a veteran or VA beneficiary will constitute sufficient evidence that an act of rape or incest occurred.

The interim final rule will be available for public comment for 30 days after it is published.