ABCDE HEALTH SCIENCE tuesday, september 7, 2010 & ,p THE GREEN LANTERN
Is telecommuting really less polluting? Maybe. But you have to calculate heating, cooling and connecting your home office. E3
94.6 quadrillionThe number of BTUs Americans used in 2009, a 4.6 percent drop from 2008. Science News, E3 HOSPICE Not a death panel
In some cases, health-care overhaul offers better end-of-life options. Insuring Your Health, E5
URBAN JUNGLE Empty nesters
Having raised four clutches of offspring, house sparrows are getting out of the family
business and forming flocks. E6
Walter Reed’s ‘human challenge’ is a key weapon against the global killer malaria
back Fighting by Eric Niiler Special to The Washington Post J
esse Bolton is a pretty buff guy. He’s in the Navy, and a few mosquitoes don’t scare him much. But he has seen what the bite of a malaria- carrying insect can do. One of his squadmates picked it up in Africa a few years ago.
That’s why Bolton was sitting in a suite at the Residence Inn in Bethesda in June, getting ready to give a blood sample. As part of a scientific experi- ment, Bolton had allowed himself to be bitten by a pretty buff mosquito. “These mosquitoes were huge,” said Bolton, 27, a medical technician at the National Naval Medical Center in Bethesda. “Probably with legs that were the size of a quarter.” Now, 10 days after the bite, he was sweaty, tired and registering a 102-degree fever, signs that a ma- laria parasite was doing a number on his blood- stream.
Bolton was one of a dozen volunteers being mon- itored by doctors and nurses from the Walter Reed Army Institute of Research. The entire sixth floor of the hotel had been rented and turned into a care
unit, laboratory and doc- tor’s office. For two weeks, professionals drew blood and checked on the parasite’s progress. Each time blood was drawn, the volunteers got a crisp $100 bill; once any of them exhibited symptoms, they were quickly treated with malaria medication. They will be monitored for the next six months to be sure the disease doesn’t recur. For the past 17 years, Walter Reed’s “human challenge model,” in which volunteers get bitten by malaria-carrying mosquitoes, has been a crit-
malaria continued on E4 THE WASHINGTON POST VIKTOR KOEN FOR When is a hospital patient not an inpatient?
system says so. For those in need, that can be expensive.
by Susan Jaffe Kaiser Health News
After Ann Callan, 85, fell and broke four ribs, she spent six days at Holy Cross Hospital in Silver Spring. Doctors and nurses examined her daily and gave her medications and oxygen to help her breathe. But when she was discharged in early January, her family got a surprise: Medicare would not pay for her follow-up nursing home care, because she did not have the prerequisite three days of in- patient care. “Where was she?” asks her husband,
Paul Callan, 85, a retired U.S. Army colo- nel. “I was with her all the time. I knew she was a patient there.” But Holy Cross had admitted her only for observation. Observation services in- clude short-term treatment and tests to help doctors decide if the patient should
KIM ROSEN FOR THE WASHINGTON POST When Medicare’s scoring
be admitted for inpatient treatment. Medicare’s guidance says it should take no more than 24 to 48 hours to make this determination. Yet some hospitals keep patients under
observation for days, and that decision can have severe consequences. Medicare considers observation services outpa- tient care, which requires beneficiaries to cover a bigger share of drug costs and other expenses than they would when re- ceiving inpatient care.And unless pa- tients spend at least three consecutive days as an inpatient, Medicare will not cover follow-up nursing home expenses after discharge. The Callans owe $10,597.60 to Renais- sance Gardens, the Silver Spring nursing home where Ann Callan spent three weeks. “I’m going to fight this,” Paul Callan
says. “I don’t care how long it takes, be- cause I don’t think it’s right.” The Callans have since retained an at-
torney to pursue the matter, and hospital officials would not discuss details of the case “in anticipation of possible legal ac-
inpatient continued on E6
Pandemic over, flu gets back to normal
Millions will get ill and thousands will die, but vaccine should be plentiful
by Lena H. Sun
Remember the lines last winter for hard-to-find flu shots, the closed schools and the craziness about an H1N1 pan- demic? Health officials say all those are things of the past: The pandemic is offi- cially over, there’s plenty of vaccine available already, and this year, one shot will deal with most of the different flus expected this winter. Health officials say this year’s flu sea-
son is expected to return to normal now that the H1N1 pandemic has ended. In the Washington area, there will be some school-based clinics to vaccinate chil- dren, but there won’t be the mass clinics and long lines that characterized last year’s flu season, local and state health officials said. The mass clinics were part of the un- precedented global response to the first flu pandemic in more than 40 years. The World Health Organization declared an end to the pandemic last month, based on indications that the H1N1 flu was transitioning to a more seasonal virus. Unlike last year, when there was one vac- cine for H1N1 flu and another for sea- sonal flu, this year’s vaccine is a “three- in-one” that includes protection against H1N1 as well as two other strains. Because flu viruses change from year
to year, vaccinations received last year won’t protect you this year. For the first time, federal officials are recommending that everyone older than 6 months get vaccinated. It takes about two weeks for antibodies to develop and provide pro- tection, so it’s worth getting the shot as soon as it’s available. “This is the first time they have recommended it for [es- sentially] the entire population,” said Frances Phillips, Maryland’s deputy sec- retary for public health. “Everybody is at risk. Everybody should get one.” And unlike last year, officials expect
that there will be enough vaccine and that most people will be returning to their traditional methods of getting it: from doctors and retailers. Some sourc- es, such as Safeway pharmacies, health- care providers and MinuteClinic loca- tions in CVS stores, say they already have the new vaccine, in advance of the November-to-May period when, accord- ing to the Centers for Disease Control and Prevention, most influenza occurs. In an average flu season in the United
States, the CDC estimates that 5 to 20 percent of the population will be sick- ened; that would be 15 million to 62 mil- lion people. More than 200,000 people are hospitalized from flu-related compli- cations each year, and tens of thousands die from flu-related causes. Most affect- ed people feel lousy for a few days, with symptoms including fever, chills and muscle aches. Others, including infants, the elderly, pregnant women and people
flu continued on E5 E DM VA
MARVIN JOSEPH/THE WASHINGTON POST
Some locations already have the new vaccine, a three-in-one formulation.
Tuning up your immune system. AnyBODY, E2
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