Journalist/developer. Interactive editor @frontlinepbs. Builder of @HomicideWatch. Sinophile for fun. Past: @WBUR, @NPR, @NewsHour.
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As Zika Season Nears, States Brace for an End to CDC Funding

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State programs that track Zika infections and Zika-related birth defects around the country are in jeopardy as public health officials have been told not to count on federal funds for those efforts after July.

In meetings at the Centers for Disease Control and Prevention in Atlanta last week, federal officials told state health departments that Zika funding initially envisioned to last five years will likely run out this summer instead, according to representatives of six states that attended the meetings. State health officials say this could harm their ability to prepare for an inevitable wave of new infections, or to provide services for babies already struggling with Zika-related birth-defects.

The potential loss of federal funding comes as health officials are bracing for this summer’s mosquito season, and as the dangers associated with the mosquito-borne disease are finally becoming clearer. After the disease erupted in Brazil in 2015, it was discovered that the otherwise mild virus caused neurological defects in developing fetuses. A CDC report released this month concluded that one in 10 pregnant women with Zika gave birth to a child with serious birth defects. Another CDC study found that a Zika infection increased the chances of delivering a baby with certain birth defects 20-fold.

Over the course of 2016, the virus spread to at least 58 countries and territories; outbreaks occurred in Puerto Rico, the U.S. Virgin Islands, American Samoa, Florida and Texas, and pregnant women infected with the disease during travel were identified in 44 states. Last year in the U.S., 77 Zika babies died in the womb, while 51 babies were born with Zika-related birth defects. Each of the surviving children will cost an estimated $10 million to care for during their lifetimes.

Money problems have troubled the public health response to Zika since last February, when the Obama administration asked Congress for an emergency infusion of $1.9 billion for the crisis. But the plan languished after Republicans inserted a provision blocking Planned Parenthood from receiving money from the bill and Democrats balked. Congress finally approved a $1.1 billion package in September after removing the Planned Parenthood language.

That money was divvied up between several federal agencies. Some of it funded vaccine research, some helped Puerto Rico with mosquito control and some was sent abroad for international response. Nearly $400 million was sent to CDC, and the bulk of that went to public health departments around the country.

But the money earmarked for the CDC was a one-time infusion and is now nearly spent, according to to state health officials who say they’ve been told by the agency to not count on new money for Zika. State labs, which ran 60,000 Zika tests in 2016, were told they should expect CDC support for mosquito-borne disease testing to return to pre-Zika levels.

That level of funding “is really small, and in most cases funds a half of an employee and no supplies,” said Kelly Wroblewski, director of infectious disease programs for the Association of Public Health Laboratories, who attended last week’s meetings.

CDC officials declined to comment on the meetings or any proposed funding cuts, noting that no budget has been finalized. But officials from several state health departments described the meetings. In some, they said, the funding news was delivered by PowerPoint.

Tracking Birth Defects

Among the programs potentially affected by cuts is one that aimed to track Zika-associated birth defects, educate women and doctors about them, and follow up with families of Zika babies after their birth. Before Zika emerged, only a handful of states actively tracked microcephaly — a condition in which improper brain development leads to an abnormally small head — and the other neurological conditions now associated with the disease. This paucity of data has made it difficult to parse which cases are triggered by Zika and which may be attributable to other causes.

To solve this problem, the CDC last year funneled money to states to create or bolster birth defect registries. The funding was structured as a five-year grant, predicated on future congressional appropriations. However, at last week’s meeting, CDC officials advised states to prepare for the grant to end in July — after just one year.

An early end to the grant would deal a major blow to many states’ efforts to track Zika’s impacts and help families affected by it.

Some states, like Pennsylvania, had never tracked birth defects until now. The $669,000 they received from the CDC allowed them to do so, said the state’s health secretary, Karen Murphy. Murphy hesitated to predict what will happen with the federal budget, but she acknowledged that without CDC funding, “we would have no way to track birth defects.”

Texas, which has the nation’s fourth highest number of confirmed Zika cases, has long tracked birth defects. But the size of the state made it a time-consuming process, said Texas Department of State Health Services spokesman Chris Van Deusen, who was briefed on the meetings. CDC funding helped Texas speed up the time it takes to register a birth defect from two years to three months. This, in turn, helped the state provide services to the families of Zika babies, Van Deusen said.

In California, federal funding expanded surveillance for Zika-related birth defects from 10 counties to 19. The state now tracks all counties infested with Aedes aegypti, the mosquito that primarily spreads Zika, as well as the five counties with the highest numbers of pregnant women with infections. In an emailed statement, a California Department of Public Health spokesman said department officials attended the meetings in Atlanta and were advised the surveillance funding may end this year. “Changes to the funding stream will directly affect surveillance efforts,” the statement said.

In Louisiana, which counts among the states most at risk of Zika due to its climate and mosquito population, federal funding has helped the state transition from a passive birth defect tracking system — in which birth defects are noted on birth certificates and voluntarily reported by doctors — to an active one, where health officials seek out information from birthing centers, said Dr. Frank Welch, medical director for community preparedness at the Louisiana Department of Health.

“You can imagine it’s much better reporting because it’s closer in time. People don’t have to remember back two or three years,” he said.

Losing funding, he said, could make them revert to a passive system, as well as jeopardize educational outreach for women and doctors, the distribution of Zika prevention kits and follow-up for pregnant women exposed to the virus. “What we heard last week was very disappointing, especially after all the work we’ve done to prepare for and to coordinate these grants,” he said.

The state hasn’t been officially informed of any final funding decisions, Welch said, and he remains hopeful the CDC will find a way to continue funding the grants. If not, he doubts the state could pick up the tab. “Louisiana is a very poor state,” he said. “Unfortunately there’s not a whole lot of extra money sitting around.”

Tracking Pregnant Women

Federal grants also established a second tracking system called the U.S. Zika Pregnancy Registry, which tests and tracks pregnant women in the U.S. who live in or have traveled to Zika-infected areas. To date, the testing has revealed evidence of a Zika infection in more than 5,000 pregnant women in the U.S. About two thirds of them are in Puerto Rico, where the disease erupted last year. If no more money is budgeted for it, the funding for the program will end next July. 

State labs will also soon be in a precarious position, Wroblewski said. Federal grants last year helped them get set up for Zika testing. But grantees were told in Atlanta not to expect new Zika-specific funding once their current money is spent. Instead, they should expect the same amount of money for testing mosquito-borne diseases that they received before the Zika outbreak.

Many previous health crises have been responded to with similar one-time bullets of funding, Wroblewski said. But unlike the 2014 Ebola outbreak or the 2009 swine flu epidemic, which came and went, Zika is likely to persist. Like its mosquito-borne cousins dengue and West Nile Virus, Zika may pop up every year.

“Zika is not something we can respond to this year and then move onto the next crisis,” she said. “It’s going to be something we pay attention to every mosquito season — and in travelers in the off season. We need more of a sustained response.”

It’s unclear whether the CDC will have much wiggle room in their budget in the coming year. The budget blueprint presented by President Donald Trump’s Office of Management and Budget in March proposed a 17.9 percent cut to the Department of Health and Human Services, which CDC falls under. The OMB did not return requests for comment.

Lori Freeman, executive director of the Association of Maternal and Child Health Programs, said she is in constant communication with federal and state health officials about how to plan for all potential fiscal scenarios. Funding is a perennial problem in public health, she said, and it distracts from efforts to keep the nation safe and healthy.

“In an ideal budget there would be funding built in for emergent infectious diseases. If you don’t use it, great, but just so we’re not constantly trying to figure out how to fund this surge capacity,” she said.

Chris Whelen, administrator of Hawaii’s state laboratory, said his lab, which has been handling Zika testing for his state as well as several U.S. territories, has enough remaining funding to continue that work through this year – as long as infections don’t spike and “there’s not much else going on.” Then he laughed.

“But there always is,” he said. “There’s always something going on. Usually multiple things going on. It’s a balancing act”

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chrisamico
2 days ago
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Boston, MA
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Survivorship Bias

5 Comments and 21 Shares
They say you can't argue with results, but what kind of defeatist attitude is that? If you stick with it, you can argue with ANYTHING.
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chrisamico
3 days ago
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Boston, MA
acdha
3 days ago
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Washington, DC
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5 public comments
FarrelBuch
2 days ago
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Survivorship bias is just the beginning. We humans love stories, particularly about just one person. Alas, only systematic review of ALL the data is the only hope of seeing effects that are not random chance and seeing how big those effects are.
Pittsburgh, PA, USA
CallMeWilliam
3 days ago
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Applies to actively managed funds too, of course.
dukeofwulf
3 days ago
Basically just another lottery.
elwillow
3 days ago
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Applies to jobs search too.
Ottawa, Ontario
alt_text_bot
3 days ago
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They say you can't argue with results, but what kind of defeatest attitude is that? If you stick with it, you can argue with ANYTHING.
Covarr
3 days ago
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I'd rather see speeches about how it's okay not to be a massive success. "Statistically, kids, some of you won't ever make it significantly above the poverty line. But you'll keep going, and raise a family, and when you look back on your life in the end, you'll realize that at least you were a more likable person than Justin Bieber.
Moses Lake, WA
sfrazer
3 days ago
Such a low bar, and most of reddit will still fail to meet it.

How Google Crushed One Small Publisher

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Here’s an interesting article in The Outline about how Google basically destroyed a small web publisher by stealing the information it created and using it for Google.

It’s not a total morality play. The site researched and published estimates of celebrities’ net worths. The site was also basically built on getting traffic from people searching for that information on Google. Still it’s a good example of Google’s often Borg-like nature. In some ways, Google uses monopoly power to maximize profits and destroy both competitors – like all monopolies do. But Google also has a certain kind of myopia, pursuing its own vision of what’s best for users, with little recognition of the fact that that vision usually coincides with Google’s profitability, destroys anyone in its way and not infrequently does things that are either unethical or perhaps even against the law. That doesn’t always matter since Google has a good enough and big enough legal department to – in many cases – simply change the law or drive legal rulings that accomplish the same.

You may have noticed that in recent years, in addition to giving you search results, Google often simply gives you the answer at the top of the page. So what was the score of the football game or how long do you cook an egg? Google will often now just cut to the chase and give you the quick answer on its own.

This story about the celebrity net worth publisher is about those quick answers. Google went to the guy who ran the celebrity wealth site and asked if they could scrape his site for the topline wealth numbers for those quick answers at the top of the page. Since a fair amount of research had gone into getting those estimates and since giving google the answers would basically remove any reason for visiting his site, the owner said no.

Then Google took the data anyway. In many instances, they didn’t even credit his site.

Also in the article is the fact that the AI and algorithms Google uses aren’t quite up to the challenge. So not infrequently they publish phony information.

This may sound like I’m hostile to Google. But that’s not really true. Without its core search function, the Internet as it exists today wouldn’t really exist, not in the same way as we experience it. More generally, I’m no more hostile to Google than I am to the weather. It’s simply there, regardless of what I think of it. And on balance, I’m glad it is. I need air. Weather is better than no weather.

Like most digital publishers, TPM has what amounts to an extensive partnership with Google, though most of it is programmatic. We use the Google ad serving software. We use its ad exchange, which drives a significant amount of our revenue. We use it for traffic statistics, search, email. It really is kind of like The Borg. If you removed all Google/Borg implants, it’s not clear we could survive without them (though we did before they existed.)

But it’s a simple fact that Google is a big, big, big part of the early 21st century monopoly capitalism story. A huge amount of Google’s value is derived from siphoning value from the creative work or productivity of others and making that into profit for Google. To a degree this is in the nature of most disintermediation and a lot of capitalism. One woman’s siphoning value is another’s creating value. It’s complicated. The key though is that Google enforces its actions with an almost unprecedented monopoly power. I’m not sure I know the solution to that. We may even be better off on balance. But we should recognize that it is a fact.

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chrisamico
5 days ago
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WATCH: How the U.S. Became the World Leader in Solitary Confinement

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Around 80,000 prisoners across America are being held in solitary confinement — many of them for months or years at a time.

Critics call the prolonged use of solitary confinement torture, pointing to research on its heavy mental toll.

But when solitary was first introduced in America in the late 18th century, it wasn’t intended to be a punishment. In fact, solitary was first put into practice at U.S. prisons by a pacifist spiritual community called the Quakers, as part of an experiment to improve prison conditions and rehabilitate inmates.

“There was a belief that you could put a prisoner in his own solitary cell, freed from the evil influences of modern society, and if you put them in that cell, they would become like a penitent monk, free to come close to God and to their own inner being, and they would naturally heal, heal from the evils of the outside society,” Stuart Grassian, a clinical psychiatrist who has studied the long-term impact of isolation in prison, says in Last Days of Solitary, a new FRONTLINE documentary premiering Tues., April 18.

Explore how that “noble experiment” became an “absolute catastrophe,” in Grassian’s words, in the above excerpt — which unspools the 200-year history of solitary confinement in the U.S.

Though the U.S. remains the world leader in the use of long-term solitary confinement, in recent years, more than 30 states have begun to experiment with reforms aimed at reducing its use — a trend whose risks and rewards are explored up-close in Last Days of Solitary.

Filmed inside Maine State Prison’s solitary confinement ward by Dan Edge and Lauren Mucciolo over the past three years, Last Days of Solitary traces the prison’s experiment to scale back its use of solitary, and follows the experiences of five men who have spent considerable time in isolation — one of whom goes on to murder another inmate after being released back into the prison’s general population.

Gripping, immersive, and raw, the film also delves into the latest research on the psychological impact of long-term isolation, and what effects offenders carry with them back into the community.

“It leaves a scar on you that you won’t forget, and you can’t heal it no matter how good you are,” one inmate tells FRONTLINE of his time in solitary.

Last Days of Solitary premieres Tues., April 18 at 9 p.m. EST/8 p.m. CST on PBS stations (check local listings) and online.

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chrisamico
6 days ago
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Multiple graphics, multiple possible insights

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One of my favorite mantras about visualization is that a single chart, graph, or map is unlikely to show everything you need to know about a story. It's through the combination of several adjacent graphics that compelling insights often arise.

NPR Visuals's latest project, “Maps Show A Dramatic Rise In Health Insurance Coverage Under ACA,” is a simple and lovely example of that principle: the choropleth map reveals geographic patterns; the histogram above it displays the decrease in the number of counties with high percentages of uninsured people.

The interactive visualization is followed by a story, some static graphs, and small multiple array of maps. They also are worth your attention.

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chrisamico
8 days ago
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The American economy isn’t actually becoming more concentrated

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Opportunity is clustering, but people and growth aren’t.

Donald Trump’s election win, many speculated, must be due to geographic inequality and the increasing concentration of economic activity in a handful of big coastal cities. It was tough to escape the woeful tales of small-town and Rust Belt voters in the final months of 2016.

But as Jed Kolko, chief economist at Indeed.com, pointed out last September, the economy isn’t actually becoming more concentrated. Something much more insidious is happening. Economic opportunity is becoming more concentrated, but Americans’ ability to move to take advantage of that opportunity is declining. Consequently, the rising average incomes in big coastal cities are being offset by those cities’ declining share of the population.

Economic concentration is flat even as inequality rises

Kolko’s analysis shows that America’s metropolitan areas are becoming more unequal, with per capita income rising faster in a small number of already affluent metro areas. This accords with the basic intuition that the growth sectors of the American economy — high tech, finance, biomedical devices — are largely concentrated in a few large coastal areas, while the plethora of manufacturing centers that dotted much of the country decades ago have declined.

What’s interesting, however, is that this has not led aggregate economic activity to be more concentrated in those affluent cities.

How can New York get richer without growing its share of the overall national economy? The answer is that these same affluent metro areas contain a shrinking share of the country’s overall population. When Detroit was at the cutting edge of high-tech innovation, the city was also a boomtown. Between 1920 and 1940, Wayne County grew from 1.1 million people to just over 2 million. Santa Clara County, in the epicenter of Silicon Valley, has grown at a much slower pace — adding a bit under 300,000 people between 1990 and 2010. Brooklyn has added a similar number of people in the past 20 years, but the borough’s recent growth still leaves its population below the 1940 level.

The growth of Rust Belt industries was fueled by massive influxes of people — the Great Migration of African Americans from the South, most famously — who flocked to new factory towns in search of better-paying jobs. Today, instead of heading to the metro areas that offer the highest wages, Americans are generally moving to places like Atlanta, Dallas, and Nashville, where economic opportunities are mediocre at best.

Nobody goes there anymore; it’s too crowded

The reason for this is not too mysterious.

The price of a house — especially one in a neighborhood that’s considered to have good public schools — in the suburbs of Boston, Washington, or San Francisco is prohibitive. Young people of all kinds move to the central cities of the great coastal metropolises despite the rent squeezing, making do with roommates and cramped apartments. But middle-class grown-ups face vicious trade-offs between space, commuting time, and money.

If you happen to earn a good living with specialized skills in a locally dominant industry, the math generally works out. New York bankers and Silicon Valley engineers pay exorbitant housing costs but make commensurate salaries.

A mere dental hygienist, high school math teacher, chef, hairstylist, or physical therapist would also earn a higher average wage in the Seattle area than in the Sunbelt. But in most cases, the difference isn’t enough to compensate for the higher cost of living. The result is that Americans as a whole are “moving to stagnation,” voluntarily accepting lower pay in lower-productivity places in order to avoid the bite of housing costs.

We could fix this with more concentration

The problem in a literal sense is that high-wage coastal cities are adjacent to oceans and thus have fewer dimensions of freedom in which to sprawl without creating untenable commuting conditions.

America does, however, possess the technological capacity to construct large numbers of dwellings on relatively small parcels of land. It happens to be the case that across most of the land in America’s suburbs — and even in America’s central cities — it is illegal to construct the attached rowhouses and small-scale duplex and triplex apartments that historically provided the bulk of America’s cheap housing stock. And where rowhouse neighborhoods exist and have become inordinately expensive, it is almost universally illegal to knock them down and replace them with large apartment buildings.

Former industrial spaces are sometimes converted to residential use, but in the overall context of extremely constrained supply, those new units are invariably high-end luxury housing, and lead many local residents to make the false inference that new construction causes high housing prices.

America also possesses the technological capacity to build the new rail lines, bus lanes, and congestion pricing systems that would make it possible for more people to commute through a given space.

We have largely chosen, however, not to deploy any of these state-of-the-art housing or transportation technologies, preferring to rely on detached single-family homes and unpriced car commuting. That naturally leads the population to migrate to sprawl-friendly geography despite relatively low pay. But if the situation turned around and we allowed more people to move to the most affluent areas, we would find that even as geographic concentration increased, opportunity and prosperity would be more widespread.

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chrisamico
9 days ago
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