Updated Communicable Disease Reportable Conditions List – Effective June 14, 2019

To: Healthcare providers, facility administrators, and infection control staff at licensed healthcare facilities

From: Disease Control and Environmental Epidemiology Division, Colorado Department of Public Health and Environment. 

The Colorado Board of Health updates the Communicable Disease regulations (6 CCR 1009-1) and Environmental Health regulations (6 CCR 1009-1) periodically to reflect changes in public health priorities for disease surveillance. Reportable conditions may be added, removed or modified. The communicable disease regulations have been revised this year and additions and modifications became effective on June 14, 2019.

Major changes include:
– Addition of all Gram-negative bacteria resistant to colistin (minimum inhibitory concentration [MIC] of greater than or equal to 4 microgram per milliliter) statewide. 
– Addition of respiratory syncytial virus (RSV)-associated hospitalizations in the 5-county Denver metropolitan area (Adams, Arapahoe, Denver, Douglas and Jefferson counties). 
– Addition of Nontuberculous mycobacteria (NTM) in the 5-county Denver metropolitan area. 
– Reporting for Hepatitis C virus (HCV) was modified to include negative (nonreactive confirmatory assays) by laboratories. 
– Positive interferon gamma release assays (IGRAs) now reportable by laboratories that use electronic reporting (ELR).
– Carbapenem-resistant Acinetobacter baumannii (CRAB) has been expanded to statewide for all specimen sites and the reporting time frame is now 4 days. 
– Requirements for vancomycin-resistant Staphylococcus aureus (VRSA) were clarified to include vancomycin-intermediate Staphylococcus aureus (VISA).

Important reminder:
– Influenza-associated hospitalizations and pediatric influenza deaths should be reported year round. While CDPHE performs additional surveillance activities during October – May each year, individual cases of illness should be reported whenever they are detected and are in fact key to detecting unusual patterns in influenza illness.

A complete and updated list of reportable conditions with information on how to report can be accessed here: https://www.colorado.gov/pacific/cdphe/report-a-disease

The following updated documents may also be found at the above link:
– Specimen submission requirements for clinical laboratories 
– Laboratory guidance for selected reportable antimicrobial resistant organisms 
– FAQs for the Infection Preventionists for ELR

For further information:

For concerns or questions about disease reporting, please contact the CDPHE Integrated Disease Reporting Program (IDRP) staff at 303-692-2700 or email cdphe_idrp@state.co.us

Politically Driven Public Health Disinformation – the Latest Examples: Dread Infections, Porn Causing White Male Impotence

It used to be all about the money. We had previously noted deceptive public relations practices, including orchestrated stealth health policy advocacy campaigns, to sell health policies favoring big health care corporations.  Third party strategies used patient advocacy organizations and medical societies that had institutional conflicts of interest
due to their funding from companies selling health care products and
services, or the influence of conflicted leaders and board members. 
Some deceptive public relations campaigns were extreme enough to be
characterized as propaganda or disinformation.

Also, we had previously noted health care leaders often were unfamiliar with, unsympathetic to, or frankly hostile
to their organizations’ health care mission, and/or health care
professionals’ values. Again, most such examples seemed to be generated by leaders who put their
organization’s revenue, often in parallel with their own compensation
ahead of patients’ and the public’s health.

But now, it seems to be all about religous or political ideology.  We discuss examples of disinformation in the health care and public health spheres that seems driven not by people wanting to sell products and services to make money, but by political ideology.

Rumors of Immigrants with Deadly Infectious Diseases

In 2018, we discussed nonsense about migrants supposedly infected with smallpox (look here).  In 2019, there are rumors of other deadly diseases.

[influenza hospital, Camp Funston, Kansas, 1918, for the Spanish Flu epidemic] 

Drug-Resistant Tuberculosis

In April, 2019, Rollcall and the Arizona Republic traced the course of a rumor that Central American migrants seeking US asylum were carrying drug resistant tuberculosis.   According to Rollcall, tt may have been inspired thus:

The unfounded rumor of a public health crisis in Yuma [AZ] follows several viral and misleading stories in conservative media that families seeking asylum from Central America were bringing in dangerous infections.

But the source of the particular story, according to the Republic, was that:

Yuma County Sheriff Leon Wilmot said he was told about 12 tuberculosis cases at a San Luis detention center by federal authorities in a March 23 briefing. He shared that information with Lines and said he stands by it still. 

Here “Lines” referred to one Jonathan Lines, “a former chairman of the Arizona Republican Party,” according to Rollcall. He also is

a board member of the Arizona-Mexico Commission, a 501(c)4 advocacy organization chaired by Arizona Governor Doug Ducey with the aim of boosting bilateral trade, according to an aide.

So,

Lines … lead a delegation of Republican lawmakers along the border. The group also included Republican Reps. Duncan Hunter of California, Matt Gaetz of Florida, Sean Duffy of Wisconsin, Dusty Johnson of South Dakota and Pete Stauber of Minnesota.

Also on the trip was Dr John Joyce, a member of the US House of Representatives,

13th District [of Pennsylvania] Republican, a dermatologist by trade, [who] is a staunch supporter of President Donald Trump and has echoed his calls for a border wall.

Lines had “made unsubstantiated claims about tuberculosis in a video.”  Joyce posted the video made by Lines to a Facebook page, since taken down. He also made a

bogus claim that immigrants seeking refuge over the Arizona border brought drug-resistant strains of tuberculosis to the U.S.

Joyce made the false claim in a briefing with reporters during a congressional trip led by Arizona GOP Rep. Andy Biggs last week to the U.S.-Mexican border near Yuma, Ariz. The claim was then echoed in the national press.

‘My concern is what about the person who wasn’t coughing and wasn’t recognized as having tuberculosis, and they didn’t come here for treatment for their disease,’ Joyce said. ‘They could be released in a day and a half and be sitting at a restaurant (table) beside you.’

That was all ultimately debunked.

Local public health officials quickly shot down rumors of an outbreak, clarifying that there have been zero cases of multi-drug resistant tuberculosis in the county for the last six to seven years, and further, no present cases of tuberculosis in Yuma at all.

‘I can say, after confirming with the Yuma County Health District, there is no drug-resistant tuberculosis in Yuma County,’ Kevin Tunell, a Yuma County spokesman told the Arizona Republic. ‘Further, there are no cases of tuberculosis involving migrants in Yuma County at this time.’

Who knows, however, how much traction the original warnings about tuberculosis got, and whether those who believed them saw, or credited the attempts to debunk them?

Note here that this little disinformation campaign seem to have been politically motivated, an attempt to justify the Trump administration’s claims about the dangers of migrants at the border, and the need to build a wall.  It is particularly disturbing that the disinformation got picked up beyond the shadowy recesses of the web, to be propagated by political leaders into the main stream media.

Ebola Virus

We do not have such detailed information about he track of rumors of Ebola virus infected immigrants at the southern border.  However, the Associated Press did report in June, 2019,

Texas health officials said Tuesday there are no ‘suspected or confirmed cases’ of Ebola in the state as social media posts have falsely suggested in the wake of immigrants arriving from Africa, including Congo, where an outbreak in has surpassed 2,000 cases.

The false claims, ranging from there is an Ebola ‘outbreak’ in Texas to reports of a few confirmed cases, have been circulating since April. The erroneous claims are also spreading at a time when Border Patrol officials said last week there has been a ‘dramatic’ rise in the number of migrants arriving at the Texas border from African countries, although they remain a small fraction of the total number of migrants apprehended.

We do not have any suspected or confirmed cases of Ebola right now in Texas,’ said Lara Anton, spokeswoman for the Texas Department of State Health Services.

The U.S. Centers for Disease Control and Prevention is also unaware of any Ebola cases nationwide, spokesman Benjamin Haynes said.

Note that propaganda accusing hated others of being infected with dread diseases is an old part of the authoritarian playbook.  In particular, from the US Holocaust Museum, the second version of the Nazi propaganda film Der Ewige Jude (The Eternal Jew)

contained notorious antisemitic sequences. These scenes compared Jews to rats that carry contagion, flood the continent, and devour precious resources.

Disinformation about disease outbreaks may make it harder to fight real disease outbreaks.  An op-ed in the New York Times by Bruce Schneier, a fellow at the Harvard Kennedy School, warned

When the next pandemic strikes, we’ll be fighting it on two fronts. The first is the one you immediately think about: understanding the disease, researching a cure and inoculating the population. The second is new, and one you might not have thought much about: fighting the deluge of rumors, misinformation and flat-out lies that will appear on the internet.

He speculated,

Misinformation can affect society’s ability to deal with a pandemic at many different levels. Right now, Ebola relief efforts in the Democratic Republic of Congo are being stymied by mistrust of health workers and government officials.

It doesn’t take much to imagine how this can lead to disaster. Jay Walker, curator of the Tedmed conferences, laid out some of the possibilities in a 2016 essay: people overwhelming and even looting pharmacies trying to get some drug that is irrelevant or nonexistent, people needlessly fleeing cities and leaving them paralyzed, health workers not showing up for work, truck drivers and other essential people being afraid to enter infected areas, official sites like CDC.gov being hacked and discredited. This kind of thing can magnify the health effects of a pandemic many times over, and in extreme cases could lead to a total societal collapse.

Pornography as a Plot to Render White Males Impotent

Sometimes you cannot make this stuff up.  We have discussed, most recently in April, 2019, here, how many US state legislators have been promulgating resolutions condemning pornography as a major public health hazard, despite the lack of clear evidence to justify this belief.  They seem to have put more emphasis on this supposed threat than on much more evidence-based public health hazards.

[Porn has been around for a long time in the US: Times Square, 1973]

We had speculated that this peculiar focus was based on sectarian religious beliefs about the evils of pornography.

Note that since April, another state legislature has gotten on board.  In May, 2019, the Arizona Republic reported,

Republican senators on Monday adopted a measure declaring pornography a public-health crisis and urging the state to ‘systemically prevent exposure and addiction.

The resolution — approved by the House in February — deems the ‘societal damage of pornography…beyond the capability of the individual to address alone.’

It argues that porn can lead to human trafficking, sexual abuse, infidelity, low self-esteem and eating disorders, among other issues.

The Republican supporters of this measure did not cite any epidemiological evidence about the dnagers of porn. Their Democratic opponents suggested that the state should focus on better substantiated public health threats, such as the measles outbreak, rising suicide rates, and the opioid epidemic.

Instead, per a Republican backer of the measure:

‘Billions of dollars worldwide are being made upon this industry that is poisoning the minds of our citizens,’ [Sen Sylvia] Allen said, calling porn ‘the root problem for many of the other problems that we’re experiencing.’ She said it contributes to sexual activity at young ages, sexually transmitted diseases and unplanned pregnancies.

‘It has morphed into something … horrible,’ she said.

Although perhaps her remarks had a religious tone, religious justification for her non-evidence-based beliefs was not apparent.

In June, 2019, the New York Times reported that the sudden emphasis on the evils of pornography may have come from not just religious fundamentalist beliefs, but political extremism from the deepest internet.  The article opened with this chilling example,

Buried in the anti-Semitic manifesto of the 19-year-old man who recently opened fire in a synagogue near San Diego is a sentence in which he blames Jews for ‘causing many to fall into sin with their role in peddling pornography.’

To enlarge on this example,

some of the suspects in racist attacks and their supporters have invoked the societal ills caused by pornography in manifestos or online forums.

White nationalists, misogynistic clubs and online forums have also drawn a connection between pornography and anti-Semitism. Many of the adherents appear to be young men who blame the prevalence of pornography online for their own struggles and what they perceive as society’s decline.

‘Any right-leaning dude on the internet in 2019 is at least aware of the phenomenon,’ said Daniel Harper, a podcaster who tracks white nationalism online.

For example, a forum on Reddit is a support group of sorts for 440,000 members who take breaks from masturbation and porn for what they believe to be mental, physical and sexual-health reasons. The Proud Boys, a self-professed ‘western chauvinist’ group, encouraged a similar message.

These dark beliefs turn out to be nothing new, but perhaps are having more influence in the current era in which political extremists now seen to be welcomed into the mainstream.

The theory that Jews are trying to control the West by using porn to render white Christian men impotent has deep roots. Among its exponents are several elder statesmen of the current white nationalist movement, such as David Duke, who, in a 2016 Twitter feud posted: ‘Jews dominate porn — why are ‘Christians’ ok with that?’

During the 2018 race to fill Paul D. Ryan’s Wisconsin congressional seat, long shot candidate Paul Nehlen, a self-avowed ‘pro-white’ advocate, was suspended from Twitter for circulating a video titled ‘The Jewish Role in the Porn Industry.’ He has since made other racist comments and been suspended again.

There are also hints that the extemism of white supremicist politics on this topic may not be entirely divorced from the more open condemnation of pornography by some fundamentalist religious groups.

Michael German, a former F.B.I. agent who is now a fellow at the Brennan Center for Justice at New York University, said the anti-porn rhetoric was baked into the culture of the violent white supremacist groups he investigated in the 1990s.

‘In any sort of fundamentalist culture, there is a desire to control sexuality, and this one’s no different,’ he said.

Discussion

There have always been snake oil salemen and quck health care practitioners.  Some years ago, proponents of evidence-based medicine (EBM) were dreaming of a world in which honest discussion based on critical thought about the best available evidence from clinical research would lead to a health care revolution.  Early on, though EBM  faced difficulties from deceptive marketing and manipulation and suppression of medical research in service of promotion of drugs, devices, and other medical goods and services.

Now EBM seems under seige by a new wave of propaganda and disinformation, not so much to sell products, but to further religious or political ideologies (for other examples, look here) , or national interests of hostile countries (look here). The health care dysfunction we now see will seem like nothing compared to the dark sort of dysfunction that could be generated by health care and public health based on sectarian beliefs, extreme political ideologies, and the interests of hostile foreign powers. The time for complacency and excuses is past.  Any health care professional who cares about our national future must get on the information barricades and fight for science and the truth in health care.   

ALR IDR Committee Meeting

To: ALR providers

From: HFEMSD

The ALR IDR Committee will meet on 6/27/19 at 10 a.m. at the Department. The public is welcome to observe or listen to the committee discussion by calling 1.712.770.8066 and entering conference code 727084. Information on the location of the meeting will be available at the security desk in building A. 

Elaine Sabyan

Free Training Opportunities

To: Nursing Home NHA’s, DON’s and other stakeholders

From: Jo Tansey, Section Manager Nursing Facilities

Attached are flyer’s announcing free training presented/sponsored by Telligen. Really looks like great information. Each flyer gives information on the training description and registration details. 

MDS coding flyer 

Positive care flyer

Pressure ulcer flyer 

Staff reliability flyer

Reminder – Assisted Living Advisory Committee meeting on Thursday, June 27, 2019

To: Assisted Living Residence Providers and Stakeholders 

From: Dee Reda, Community Services Section Manager

The next Assisted Living Advisory Committee meeting is on Thursday, June 27, 2019 from 1:30 p.m. – 3:30 p.m. in Building A, Sabin/Cleere Room.

For meeting agendas, handouts, etc. please go to https://drive.google.com/drive/folders/0ByqZDBabyNVSR3pNejg2X2J0V2c?usp=sharing%20. Click on the folder labeled “2019 Meetings” and find the corresponding meeting date. We recommend that you return to this site on the day of the meeting to check for additional or revised meeting materials. 

To participate via Web using Zoom Meetings: 
Join from PC, Mac, Linux, iOS or Android: https://zoom.us/j/675245553 

Meeting ID: 675 245 553

Step #1: Go to https://zoom.us/j/675245553 
The Zoom meeting screen will appear entitled “Assisted Living Advisory Committee”
Step #2: For sound, choose Phone Call or Computer Audio.
Step #3: You will now be in the Virtual Meeting Room.

If you have never attended a Zoom meeting before:
Get a quick overview: https://support.zoom.us/hc/en-us/articles/204772869-Zoom-Rooms-User-Guide 

To participate by telephone:
Step #1: Dial (for higher quality, dial a number based on your current location): US: +1 669 900 6833+ or 1 408 638 0968 or +1 646 876 9923
Step #2: When prompted, enter the Meeting ID: 675 245 553
Step #3: You will be on hold until a few moments before the meeting.

If you have any questions, please contact Michelle Topkoff at michelle.m.topkoff@state.co.us or call 303-692-2848 at least a business day in advance of the meeting. 

Meeting information

At the Colorado Department of Public Health and Environment, we work hard to protect and promote your health and the environment. If you’re planning a visit to our campus and want to ride your bike here, we won’t take a second look at your helmet head, and if the bus you’re taking is running a little late, we won’t worry. We want you to be your healthiest you, and we appreciate your efforts to reduce pollution.
If you’re coming to our campus: Our campus is located at 4300 Cherry Creek Drive South, Denver, 80246.
If you’re riding your bike: Our campus is located just south of the Cherry Creek bike trail. Bicycle parking is available at multiple locations on the main campus. Covered bicycle parking also is available at several locations, as well as on the ground floor of the parking structure on Birch Street, which is just east of the main campus 
If you’re riding the bus: RTD’s Trip Planner is a great way to find the fastest route.
If you’re driving: Visitor parking is conveniently located in front of all of our buildings. Please check in with security in Building A so you can get a visitor badge.
You might also want to know:
We care about your health, so our campus is tobacco-free.
We are located just east of Glendale’s City Set, where there are several restaurants.
Lactation Rooms are available on the first floors of buildings A and B. 

Chapter 7 Assisted Living Regulation Updates and Resources:

Updates on the Chapter 7 Assisted Living Regulations can be found on the Assisted Living News & Resources web page at http://67.231.102.44/HFEMSD/ALR/index.html.

It is our hope that this resource will provide you with up-to-date and relevant tools, training, and information, as we move forward with implementing the new regulations under 6CCR 1011-1, Chapter 7 Assisted Living Regulations. Current features of the newsletter include on “What’s New”, “Important Dates,” “Training,” “Blog,” “FAQs”, “Help” and “Advisory Committee”. Our goal is to provide you with a clear understanding of the new portions of the regulation as well as training to help you comply. 

US Does Not Guarantee Healthcare To Diabetics Until Kidney Failure

If you are a diabetic in the United States, you will pay
more for your insulin than anywhere else in the world and you are much less likely
to have insurance pay for your required care. Presently, if a diabetic lacks
private insurance, the U.S. government does not guarantee any medical care for
that person until he or she is in end-stage renal failure, which means on kidney
dialysis.  This provision is thanks to a 1963
act of Congress authorizing Medicare inclusion for those in end-stage kidney failure. If
an individual is on Medicaid, which is for low-income folks, healthcare is
provided. But working-class people without insurance are left out in the cold, unable to afford private insurance and struggling to buy their insulin.
The Trump Administration is suing the federal agency charged with
administering the Patient Protection and Affordable Care Act known as Obamacare,
which is one of the few methods that people can obtain affordable health
insurance. In the United States only 52% of employers provide any kind of
medical insurance or workplace benefits. Consequently 48% of the working
population lacks access to affordable healthcare. In addition, if the Trump
Administration gets its way it will rollback protections for people with
pre-existing conditions and they will be unable, in many cases, to obtain any
medical insurance. Keeping with current trends the Trump Administration and
Senate leader, McConnell are intent to take the nation back to the fifties, not
1950, but 1850.

The US does not guarantee any access to primary healthcare
for people with chronic diseases, like Type 1 Diabetes and in fact, many cannot
afford to pay for their insulin, and some have died. This needs to stop.

  1.  Firstly, as a nation we need to start providing primary care to prevent kidney
    failure for diabetics and others. Providing care earlier will reduce problems
    and costs later. 
  2. Secondly, we need to reduce the manipulations of the
    pharmaceutical industry to continually up-sell scant changes in patent formulations which restrict access to affordable generic drugs.
  3. Thirdly, the Food and Drug Administration
    should represent the people of the United States and quit viewing
    pharmaceutical companies as its customers. A regulatory agency must maintain a
    separate authority from those it is policing. 
  4. Fourthly, let’s restore the
    application of quality science in health policy decision-making. 
  5. Finally, establishing a national healthcare policy, like
    Medicare-for-all would alleviate a number of these challenges, by providing a
    baseline of care, establishing one government authority to negotiate for pricing
    for health products and services, and lowering administrative costs.

 

To that end, I am once-again riding the Russell Ride from
Bremerton, Washington to Napa, California to promote the research Benaroya
Research Institute is doing to cure Type 1 Diabetes, an auto-immune disease
which took my brother at age 42. I will be speaking with people along the coast
and listening to their stories about their diabetic challenges. This year, my son,
Nathan will be riding with me. Join us for the Russell Ride by following me on Twitter
or on the fundraising site below.

And this is the healthpolicymaven signing off encouraging
you not to sign blanket medical releases, but specify that for which you
consent and what you decline. And do consider making a contribution to the site, I hope to obtain 100 contributions this year.

Tuberculosis for Health Care Workers in Canon City, Colorado

To: Medical Directors, Directors of Nursing and Local Public Health Agencies

From: Colorado Department of Public Health and Environment

SPACE STILL AVAILABLE!!!

The Colorado Department of Public Health and Environment is partnering with the Freemont County Public Health Department to host a full day training on Tuberculosis (TB). This free training will enable you and your team to feel comfortable managing TB by providing information and skill building activities on the following topics:

– Introduction to TB 
– Diagnosis and Treatment for TB infection and disease
– TB case management 
– TB contact investigation

We invite nurses and other interested personnel who provide health services to patients with or at risk for tuberculosis in Colorado to attend the TB for Health Care Workers training on July 24th from 8:00 am – 5:00 pm at the Fremont County Department of Public Health & Environment. Address: 201 N 6th street, Canon City, Colorado 81212.

For more details and registration, go to: www.train.org/colorado/home and search for course #1071602

Registration cost is FREE
Space is very limited so please register early. 

For more information please contact Tavia Mirassou-Wolf at 303-692-2638 or Tavia.mirassou-wolf@state.co.us with any questions. 

Fremont County Flier

Tuberculosis for Health Care Workers in Fort Morgan

To: Health care personnel who provide services for those with or at risk for tuberculosis infection and disease 

From: Colorado Department of Public Health and Environment

SPACE STILL AVAILABLE!!!

The Colorado Department of Public Health and Environment is partnering with the Northwest Colorado Public Health Department to host a 2-day training on Tuberculosis (TB). This free training will enable you and your team to feel comfortable managing TB by providing information and skill building activities on the following topics:

– Introduction to TB 
– Ruling out active TB disease
– Treatment and case management for TB infection

We invite doctors, nurses and other interested personnel who provide health services to patients with or at risk for tuberculosis in Colorado to attend the TB for Health Care Workers training on July 11th from 10:00 am – 2:00 pm at Salud Family Health Centers, 729 E Railroad Ave, Fort Morgan, CO 80701. As an additional plus, lunch will be served!

For more details and registration, go to: www.train.org/colorado/home and search for course #1071602

Registration cost is FREE
Space is very limited so please register early. 

For more information please contact Tavia Mirassou-Wolf at 303-692-2638 or Tavia.mirassou-wolf@state.co.us with any questions. 

For additional training opportunities, please visit the calendar on our website: https://www.colorado.gov/pacific/cdphe/tb

Fort Morgan Flier

Tuberculosis for Health Care Workers Colorado Springs

Health care personnel who provide services for those with or at risk for tuberculosis infection and disease 

Colorado Department of Public Health and Environment

SPACE STILL AVAILABLE!!!

The Colorado Department of Public Health and Environment is partnering with the El Paso County Public Health Department to host a 2-day training on Tuberculosis (TB). This free training will enable you and your team to feel comfortable managing TB by providing information and skill building activities on the following topics:

– Introduction to TB 
– Diagnosis and treatment for TB infection and disease
– TB case management 
– TB contact investigation
– Interviewing skills

We invite nurses and other interested personnel who provide health services to patients with or at risk for tuberculosis in Colorado to attend the TB for Health Care Workers training on August 22nd (8:00am-5:00pm) & August 23rd (8:00am-1:00pm) at the El Paso County Health Department. Address: 1675 Garden of the Gods Rd #2044, Colorado Springs, CO 80907. Please note, day one is applicable for all health care providers while day two is geared towards public health professionals. You may register for only day one, if applicable.

For more details and registration, go to: www.train.org/colorado/home and search for course #1080090

Registration cost is FREE
Space is very limited so please register early. 

For more information please contact Tavia Mirassou-Wolf at 303-692-2638 or Tavia.mirassou-wolf@state.co.us with any questions. 

For additional training opportunities, please visit the calendar on our website: https://www.colorado.gov/pacific/cdphe/tb 

El Paso County Flier