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Good morning! Welcome back to The Health 202, where we have Christmas cookies on the mind. Send your favorite recipes and baking tips and tricks to [email protected] 

Today’s edition: The White House is restarting its free at-home coronavirus testing program. Federal regulators are looking to crack down on Medicare Advantage advertising schemes. But first …

Russian troops damaged or destroyed health infrastructure in Ukraine’s recently recaptured villages

Ukrainian President Volodymyr Zelensky and first lady Olena Zelenska are calling on the international community to pledge new funds to help the country survive the winter, with the top priorities being restoring access to care and replenishing emergency medical supplies in recently recaptured territories. 

Zelenska gave the example of a hospital destroyed in the southeastern city of Izyum at a speech at an international donor conference hosted earlier this week in Paris. When Russian troops fled in September, she said they also looted the facility of its remaining working medical equipment and supplies. 

  • “They took everything that was of any value. Even sockets, wiring and toilets were removed,” she said. “This is what their invasion is, this is what the Russian army is.” 

The conference comes as relief workers rush to deliver drugs, medical supplies and primary care services to people in regions like Kherson and Kharkiv following Russia’s recent retreat from key areas in the east and south.

The World Health Organization has verified 715 attacks on health-care facilities and providers since Russia invaded the country at the end of February. There have been at least 630 attacks on health facilities and more than 170 of them affected medical supplies. Approximately 100 people have died because of the attacks, and 129 have been injured. 

Most losses were recorded in the east and south, according to Jarno Habicht, WHO’s representative in Ukraine and head of WHO’s Ukraine Country Office. 

Regaining ground and restoring care

Russian troops damaged or destroyed the health infrastructure in nearly all of the recently recaptured villages, forcing health providers to flee the area, according to Christopher Stokes, the emergency coordinator in Ukraine for Doctors Without Borders. 

As a result, thousands of Ukrainians have been without access to primary care, psychological treatment, gynecological services, critical drugs and medical supplies since March, he added. “A lady died because she was quite old and needed her hypertension medication and felt sick, but we just couldn’t evacuate her and no one was there to help her,” Stokes told The Health 202. 

Organizers involved in relief efforts said they’ve shifted their focus from evacuating residents in southern and eastern parts of the country to restarting services in some of those areas. But they’re struggling to confront a number of barriers:

  • Recently recaptured areas are still experiencing active hostilities, including shelling and land mines. 
  • There’s an extreme shortage of medical personnel, with many providers reluctant to return to their homes and jobs on the front lines. 
  • Repeated attacks on Ukraine’s energy infrastructure have caused rolling blackouts across the country, casting villages in darkness and leaving many without heat and running water. 

“It’s been a compounding effect,” Stokes said. “People are living in appalling hygienic conditions, so they can’t wash and it’s too cold so their wounds get infected. … Then they go to hospitals that are themselves only half-functioning. The closer you get to the front lines and the recaptured areas, the worse it is.”

Doctors Without Borders/Médecins Sans Frontières Ukraine:

Surviving winter…and beyond

Basic rebuilding is already underway in some previously occupied regions, according to Conor Savoy, a senior fellow working for the Center for Strategic and International Studies’s Ukraine Economic Reconstruction Commission. Those efforts are critical to restoring access to care and sustaining the country’s health system in the long term as Ukrainians return.

But there are significant challenges. Multiple waves of Russian airstrikes on Ukraine’s critical energy infrastructure have hit the country’s health system particularly hard: nonessential procedures have been suspended, patient records are unavailable because of internet outages and providers are delivering emergency services using headlamps in darkened operating rooms

Hospitals in large cities have been prioritized to receive diesel generators, new medical equipment and supplies. But that has left primary care centers, emergency clinics and struggling health systems on the front lines to operate with limited resources in freezing temperatures, per Halyna Skipalska, Ukraine country director for HealthRight International.

The country’s health ministry estimates it will need approximately 5,700 generators,  along with critical medical supplies and drugs, to support all of the nation’s health-care facilities throughout the winter. 

That’s where Zelensky’s latest plea for aid comes in. The Paris conference generated more than $1 billion to help Ukraine survive the harsh winter and make basic repairs to its vital electric, food, water and health-care systems, Reuters reports. 

But in the long term, the country’s monumental needs will persist. Restoring the health infrastructure destroyed by Russia alone will cost at least $1 billion, according to Deputy Minister of Health Oleksiy Yaremenko.

“We need to be very smart about the way we support Ukraine that combines budget support, humanitarian aid and funding for recovery and development, especially in these areas that are newly accessible,” Habicht said. 

Ukraine first lady Olena Zelenska:

New this a.m.: More free coronavirus tests are coming to your doorstep

That’s a key part of the Biden administration’s plan to combat covid-19 this winter, which the White House released this morning. The effort includes allowing Americans to again order four free at-home coronavirus tests starting today (which Politico first reported), encouraging hospitals to offer vaccinations before discharging patients and letting more nursing home staff administer vaccines to residents. 

Of note: Those ideas largely build on past actions, rather than represent a strategy shift. The plan comes amid an uptick in cases after Thanksgiving, which is expected to continue during the holiday season. 

CMS pushes to crack down on Medicare Advantage advertising

The Medicare agency is proposing to tighten marketing standards for those selling private Medicare Advantage plans to older Americans. 

The details: If finalized, the proposed rule would ban any television commercials that don’t mention a specific plan name, as well as ads that use confusing words, images or logos. It would also prohibit sales presentations that come directly after educational events. 

The draft rule also includes policies to boost access to behavioral health services in Medicare Advantage networks, streamline the prior authorization process and improve drug affordability in Medicare Prescription Drug Benefit plans. 

Why it matters: Seniors shopping for coverage have criticized Medicare Advantage plans for their use of misleading and potentially deceptive marketing tactics, which, in some cases, allegedly lure seniors into signing up for plans that may not cover their drugs or doctors. Lawmakers on Capitol Hill have also scrutinized the sales techniques. Senate Finance Committee Chairman Sen. Ron Wyden (D-Ore.) released a report last month showing that complaints are on the rise in at least nine states. 

Meanwhile … CMS says it’s responding after a subcontractor was hit in a ransomware attack

The agency said that up to 254,000 of the Medicare program’s 64 million beneficiaries may have been impacted in an October breach at subcontractor Healthcare Management Solutions. CMS says people whose personal information “may have been put at risk as a result of the breach” will get updated Medicare cards, new Medicare numbers and credit-monitoring services, Aaron Schaffer, The Cybersecurity 202’s researcher, tells us.

In a sample letter posted on its website, CMS wrote that as more information became available after the breach, the agency determined with “high confidence” that the incident potentially included a breach of personally identifiable information and protected health information for some people with Medicare coverage. HMS didn’t immediately respond to a request for comment.

 Rep. Jan Schakowsky (D-Ill.):

For new National Cancer Institute director, work turns personal

In October, Monica Bertagnolli became the 16th director of the National Cancer Institute. And then, just before Thanksgiving, her life took an unexpected turn: The 63-year-old surgical oncologist was diagnosed with early-stage breast cancer, our colleague Laurie McGinley writes. 

At her first town hall with employees yesterday, Bertagnolli explained that she has the most common type of breast cancer for someone her age — hormone receptor-positive, HER2-negative. The cancer is considered treatable and has a very favorable prognosis, with a high survival rate.

She is still awaiting additional tests to determine her treatment plan, which will probably include surgery and some kind of drug therapy. She’s being treated by doctors at Dana-Farber Brigham Cancer Center in Boston, where she was chief of surgical oncology for a decade.

Bertagnolli alluded to, but didn’t dwell on, the poignancy of being diagnosed with the disease just as she takes the helm of the nation’s biggest cancer-fighting enterprise. She outlined her vision for the future of NCI — saying she wants to boost its number of research grants, streamline clinical trials and remove barriers in access for patients to participate in them — and made clear that while she will have to slow down from her rapid pace for a while, she expects the change to be temporary.

NCI Director Monica Bertagnolli: 

  • Health care spending by households increased 6.1 percent last year after growing just 1.2 percent in 2020 due largely to more out-of-pocket spending. However, overall U.S. health-care spending growth slowed last year as federal spending on the covid-19 pandemic declined, rising 2.7 percent in 2021, compared with a 10.3 percent boost in 2020, according to CMS.
  • The death of prominent American soccer journalist Grant Wahl last week was caused by the sudden rupture of an aortic aneurysm, according to his wife, Céline Gounder, an infectious-disease specialist and Kaiser Health News editor-at-large, The Post’s Cindy Boren and Ben Strauss report. 
  • A Veterans Affairs nurse working in Texas sued the department over its new policy offering abortion services in certain cases and related counseling to veterans, claiming that it violates her religious beliefs, CNN reports. 

Five down in Apt. 307: Mass fentanyl deaths test a Colorado prosecutor (By Sari Horwitz, Meryl Kornfield, Nick Miroff and Steven Rich l The Washington Post)

Death Sentence: An 8-part investigation into prisons’ refusal to treat hepatitis C (By Nicholas Florko l Stat)

Long covid can be deadly, CDC study finds (By Frances Stead Sellers l The Washington Post)

States Challenge Biden to Lower Drug Prices by Allowing Imports From Canada (By Phil Galewitz | Kaiser Health News)

Thanks for reading! See y’all tomorrow.

By Percy