“It bothers me. They are being defiant,” Hase said. “And most of the people I see that walk in without a mask are just looking for a fight. They are asking you to ‘Just ask me. Just give me a reason to yell at you.’ I just stay away from them and keep on with my own life.”

Six and a half months after President Donald Trump declared the coronavirus emergency, COVID-19 has killed more than 207,000 Americans and infected 7.3 million, now including Trump himself and the first lady.

Scientists are warning of a larger wave of infection this winter. They agree the simplest, easiest way to fight that surge is to get most people to wear masks most of the time.

Yet the political fight over face coverings rages. It plays out on city streets, in suburban grocery stores, in rural sheriff’s offices and at the highest echelons of government — all the way to the presidential debate stage this week in Cleveland. There, most of Trump’s contingent refused to wear required masks, and one of them tested positive soon afterward. Only time will tell if they spread the infection, but their behavior is mirrored across the nation.

Hefty Price in Iowa

In April, Iowa health officials cut an agreement with Iowa University to do modeling on the impact of coronavirus. Among the data are estimates of future death rates and the projection that more than a thousand Iowans could be saved by adopting a universal mask policy.

Later that month, the researchers warned Republican Gov. Kim Reynolds not to ease restrictions aimed at curtailing the virus, saying a spike would result later in the year. They also recommended a strong policy on facial coverings, producing a report that said face shields would dramatically lower the virus’s toll.

Reynolds took none of that advice. She started easing restrictions in late April. She argued it was more important to reopen the state’s economy while encouraging people to be responsible and wear masks than to throw down a mandate she called unenforceable.

“I think the goal is to strongly encourage and recommend that people wear them,” she said in late August. “I believe that people are.”

Yet at that moment, Iowa was proving the university’s predictions true, suffering the highest infection rate in the nation. In late September, the state was one of only seven thatÌýÌýaveraging more than 890 new infections a day.

The governor’s intransigence on masks highlights a troubling problem. At a time when experts believe the nation needs to unite around a strategy to curb a potentially catastrophic winter, the cheapest, best option — masks — have become increasingly politicized. Even Republicans like Reynolds, who agree masks work, refuse to take the advice of their experts. They oppose mandates and favor an educational approach that many people actively resist.

Dissent Within the Trump Administration

The trouble starts at the top. The Trump administration’s leading medical advisers have testified repeatedly that masks were the country’s best tool to blunt a second wave that could be significantly deadlier than the initial spike.

Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, went as far to say face coverings were a more certain bet than a vaccine if everyone would wear them.

“If we did it for six, eight, 10, 12 weeks, we’d bring this pandemic under control,” Redfield said during a Sept. 16 hearing. “They are our best defense.”

Trump contradicted him before the day was done, and just a few daysÌýearlier, as the president and his coterie did in Cleveland,ÌýTrump modeled exactly the opposite behavior. At a campaign rally of thousands in Nevada, he cheered on the mostly maskless crowd. The next day, he held a massive mask-optional indoor rally at a warehouse in Henderson, Nevada, defying state restrictions. He advised the owner () that he’d protect the man if the state went after him.

“I’ll be with you all the way. Don’t worry about a thing,” Trump said.

But Trump’s actions and statements are worrisome for scientists and public health experts. They have watched in horror and frustration as the president’s dismissive attitude toward masks and COVID-19 itself has gone hand in hand with growing politicization of the public health response.

Meanwhile, the White House Coronavirus Task Force, led by Vice President Mike Pence, issued a “state report” on Montana on Sept. 20 that included the suggestion that the state “consider fines for violations of face mask mandates in high transmission areas.” At a press conference, Gov. Steve Bullock, a Democrat, said fining people would not be “the Montana way.” The state is, however, one of 34 with a mask mandate in place.

Indeed, the single-strongest predictor of whether or not a state will mandate strong mask policies bears little relationship to a state’s disease problem, according toÌýÌýby a team at the University of Washington.

After analyzing comprehensive data on mask policies, researchers led by Chris Adolph, a professor of political science and statistics, found that having a Republican governor would predict a 30-day delay in recommending mask policies. In a state that is also ideologically conservative, the delay would be closer to 40 days. A state’s death rate or infection rate had a much weaker influence.

“Because mask mandates are far less costly than business closures or stay-at-home orders, when we started to monitor these policies in April, we hoped their adoption would be universal,” Adolph said. “Instead, we found the same pattern: Republican governors resisted mandating masks even when public health conditions called for them.”

Adolph’s research suggests Trump is at least amplifying disdain for masks and, in fact, the phenomenon has been playing out across the country, most strikingly among some of Trump’s most ardent supporters — law enforcement and extremely conservative politicians.

Anti-Mask Sheriffs

In Washington state, Florida and even Democratic California, sheriffs made headlines by taking actions in opposition to local masking guidelines.

In Washington’s Snohomish County, where theÌýÌýin the United States, Sheriff Adam Fortney declared in an April Facebook post: “The impacts of COVID 19 no longer warrant the suspension of our constitutional rights.”

Democratic Gov. Jay Inslee ordered people to wear masks in public in late June, just as a summer-long rise of infections began. Lewis County Sheriff Rob Snaza responded by telling a cheering crowd outside a church, “Don’t be a sheep.” Klickitat County Sheriff Bob Songer on the radioÌýÌýover the order.

In Florida, anti-mask resistance has been especially fierce. Again, sheriffs offered the most startling opposition. One, Marion County Sheriff Billy Woods, banned masks for his deputies and visitors to the sheriff’s department offices, though he later relented on visitors.

Even in solid-blue Los Angeles County, the sheriff’s officeÌýÌýby the county inspector general because deputies refused to wear masks, in violation of public health orders.

Surprisingly, officials there who support masks were disinclined to push tough enforcement.

“One of the things in all of this is we’re not going to enforce or fine our way out of this,” L.A.’s top public health official, Dr. Muntu Davis, told reporters recently.

Researchers disagree with Davis and Reynolds, not because education doesn’t work, but because it takes a long, sustained effort.

“Developing and deploying health education programs takes time, so in emergencies where rapid compliance is essential for reducing the spread of a novel pathogen, mandates are a critical element,” said Adolph.

Tickets in Tennessee

That’s the path officials took in Nashville, Tennessee, though initially officers opted for a more lenient approach than the mayor wanted. They had to be forced to write tickets with a potential fine of $50. The police still mostly have been giving warnings — thousands on any given weekend — but they’ve also written dozens of tickets and made some arrests.

City officials credit the crackdown with curbing COVID-19, even as it ran rampant in rural Tennessee counties where there are no mask mandates. In late September, Nashville’s Davidson County had 13.5 cases per 100,000 people, while more than three dozen less populous counties had “, with more than 25 cases per 100,000 people.

Amid the conflicting messages, including where enforcement has worked, not everyone is convinced that covering your nose and mouth is something that should rise to the level of police.

“I think they have better things to do than force anybody to wear a mask,” said Jennifer Johnson, an X-ray tech in downtown Nashville. “I think it should be at your own risk, but that’s just my opinion.”

Lawsuits Plus Weekly Protests in Florida

Plenty of conservative-leaning citizens and lawmakers agree with her, to the point of suing to block mandates.

In Hillsborough County, Florida, home to Tampa, county commissioners must vote each week to renew a state of emergency that requires masks to be worn in indoor public places.

Jason Kimball, a regular speaker at those meetings opposing the order, grew so angry he started a GoFundMe campaign for a lawsuit. He hit his $5,000 goal in 24 hours.

“You can only do so much as a commission legally, without violating the state constitution and the United States Constitution,” Kimball said at a recent meeting.

Rep. Anthony Sabatini, a state lawmaker who has filed 15 similar lawsuits on behalf of others all over the state, took the case. He claims mask ordinances are an overreach by government and a violation of Florida’s privacy clause.

“The government has never done this before,” Sabatini said. “It’s never told people that they have to wear masks everywhere they go all day long, and that’s basically what it’s come to.”

A judge dismissed Sabatini’s case in Hillsborough County and several of his other lawsuits have been denied.

Like Kimball and many other mask opponents, Sabatini insists masks don’t work, saying anyone can Google it to find out.

Scientists beg to differ, and are distressed political ideology has trumped real data and made it impossible for science to dictate the best responses.

“That’s certainly been a source of frustration for those of us who work in public health,” said Joe Cavanaugh, who runs the Department of Biostatistics at the University of Iowa’s College of Public Health and helped build the modeling distributed to Gov. Reynolds.

Watching Other Countries Succeed

Dr. Ali Mokdad, a former outbreak scientist at the CDC who works for the Institute for Health Metrics and Evaluation at the University of Washington’s School of Medicine, finds it especially painful to watch other countries deal with the pandemic better than the United States.

He traveled the globe to stop outbreaks, and now other countries are using the methods he and his former colleagues at the CDC taught them.

“Why aren’t people wearing a mask? For the first time in our history, of humankind, we have a measure that is really very cheap,” he said. “You can make it at home yourself from something old you have. It saves lives. It saves the economy.”

It is doubly frustrating — and alarming — because while mask adoption had been rising over the summer, it’s recently begun to slip. The shift caused IHME to adjust upward its model of how many people would get infected and die by Jan. 1 in the United States.

“This change in the last week is due mainly to the decline in masks and the increase in mobility,” Mokdad said.

The death rate estimate has since moderated — projected this week at 372,000.

One place where mask use has declined is Iowa, where Mokdad said only 28% of people say in surveys they are always likely to wear a mask when they go out.

Scientists at the University of Iowa had been using data similar to what IHME uses for its coronavirus models. The state won’t let the university make its modeling public, but when some of its data was online, the projection was that Iowa would see more than 1,000 deaths by the end of August if no additional safety steps were taken. As of Tuesday, theÌýÌýwas 1,328.

By IHME’s most recent similar estimates, more than 3,400 Iowans will die by Jan. 1. With a universal mask requirement, some 1,600 could be saved. Nationally, nearly 115,000 lives could be spared.

Winter Is Coming

Cavanaugh would welcome even a toothless mandate to spare some of those lives. “Just sending that message at the state level is, I think, an important step in emphasizing the importance of it,” said the University of Iowa researcher.

Sixteen states still do not have a mandate, all of them led by Republicans.

The especially frightening element to the anti-mask movement is that it can only worsen what scientists already warn is going to be a bad winter.

When it’s cold, the virus can survive longer on surfaces, and people are stuck indoors where it can become more concentrated in the aerosolized droplets people exhale.

“We’ve seen it in our data. We’ve seen it in other countries,” Mokdad said. “It’s very strong, and it’s going to happen in the U.S., unfortunately.”

Back in Florida, Nils Hase will keep wearing his mask.

“I’ve always believed in the science behind it,” Hase said. “It’s a virus and we need to be aware of what’s going on. People who don’t, they’re just idiots.”

This story is from a reporting partnership that includes Health News Florida, KPCC, Nashville Public Radio, KHN and NPR.Ìý

This <a target="_blank" href="/public-health/mask-wearing-enforcement-not-so-simple/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Children registering for school in Florida this year were asked to reveal some history about their mental health.

The new requirement is part of a law rushed through the state legislature after the FebruaryÌýÌýin Parkland, Fla.

°¿²ÔÌýÌýfor new students, the state’s school districts now must ask whether a child has ever been referred for mental health services.

“If you do say, ‘Yes, my child has seen a counselor or a therapist or a psychologist,’ what does the school then do with that?” asked Laura Goodhue, who has a 9-year-old son on the autism spectrum and a 10-year-old son who has seen a psychologist. “I think that was my biggest flag. And I actually shared the story with a couple of mom friends of mine and said, ‘Can you believe this is actually a thing?'”

Goodhue said she worries that if her children’s mental health history becomes part of their school records, itÌý.

“If my child was on the playground and something happened,” she said, “they might think, ‘This child has seen mental health services. This must mean something’ — more than it really means.”

The question was largely overlooked until parents started filling out school registration forms this summer. It was one sentence in aÌýÌýthat contained such controversial measures as increasing the minimum age to buy a gun and arming school employees.

Parents express concern that the information could fall into the wrong hands and may follow children throughout their education, saidÌý, executive director of the Florida chapter of the National Alliance on Mental Illness.

“In a perfect world, getting treatment for mental health challenges would be no different than getting medical treatment for a skin rash or a bad cold or a broken leg,” LaPolt said. “But that’s not the world we live in right now. There is stigma around mental illness and getting treatment for it.”

School districts say counselors will use the information to help Florida students get the services they need.

Some districts will share the information only with psychologists and administrators. Others say they will provide access to teachers and front-office staff as well.

School counselors say they understand the stigma surrounding mental illness. Some say the way the law was written doesn’t help. The mental health question was grouped with requirements to report arrests or expulsions.

“I can certainly understand parents having a reaction when they see those questions, sort of, asked back to back, saidÌý, manager of psychological services for Pinellas County Schools.

But in order to help students, Cowley said, school officials must first determine who needs mental health services.

“The process we’re trying to develop and everything we’re trying to do is just with an eye toward reducing stigma, increasing awareness and getting students access to more care,” Cowley said.

The requirement has school districts worried about more than just stigma. The state left implementation of the provision up to local districts.

At a meeting in Tampa, Fla., Hillsborough County School Board memberÌý raised the issue of patient privacy and a federal law that protects it, known asÌý.

“I could foresee some lawsuits around this,” Griffin said.

Still, counselors say more parents may support the law once they start to see children getting the counseling they need.

°Õ³ó±ðÌýÌýnearly $70 million to increase access to mental health services in schools. National experts say the money is long overdue.

Florida has historically been among the worst states in terms of providing money for mental health care, saidÌý, senior policy adviser for the National Alliance on Mental Health.

“We know that the symptoms of mental health conditions and serious mental illnesses in particular tend to surface during the teen years and early 20s,” Honberg said. “And that’s a time when we should be putting the most resources into interventions.”

In Broward County, where Parkland is located, the district is using part of theÌýÌý— many of them counselors, psychologists and social workers.

Their ability to reach students in need could depend on whether parents feel comfortable checking “yes” on a registration form.

This story is part of a partnership that includes , and Kaiser Health News.

This <a target="_blank" href="/mental-health/parents-are-leery-of-schools-requiring-mental-health-disclosures-by-students/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

[UPDATED March 8]

A billÌýÌýWednesday has received huge attention because of a controversial provision that would allow some teachers to have guns in schools. But the measure, now headed to the governor’s desk, would also designate an influx of cash for mental health services.

The state has seen three mass shootings in 20 months — at the Pulse nightclub in Orlando, the Fort Lauderdale airport and at Marjory Stoneman Douglas High School in Parkland. And the need for increased mental health funding has come up twice before — with no cash forthcoming.

In today’s dollars, Florida is spending 40 percent less on mental health than it did in 2000, according toÌý, interim president of the Florida Council for Community Mental Health.

“That means there are fewer providers or fewer sources that the individuals can access,” she said. And that lack of resources, she and other mental health care providers say, undercuts the ability to catch mental illness early and treat it.

Since 2000, the state has increased funding for mental health services by $218 million. But that hasn’t kept up with inflation and the 4.5 million people who have moved to Florida since then, Brown-Woofter said.

The shooting in Parkland shifted the focus of many people in Florida and nationally to mental health. President Donald Trump and other leaders were quick to label the 19-year-old man who killed 17 people at his former high school mentally ill.

Republican Gov. Rick Scott called for $500 million for school safety, including giving young people more counseling and crisis management.

“Florida is never going to be the same — and we’ve got to make sure Florida is never the same,” Scott said duringÌýa recent appearance in Tampa. “We’ve got to make sure we have common-sense solutions to make sure every parent knows that their child is safe.”

The mental health provision is attached to theÌýÌýgun legislation. It raises the age of most firearm purchases to 21, institutes a mandatory three-day waiting period for all firearm purchases and bans the sale ofÌý, devices that can be attached to a weapon to enable it to fire more quickly.

These provisions are not popular with many in Florida’s legislature, where conservatives have opposed any restrictions on gun ownership in the past. On the Democratic side of the aisle, there was opposition to the provision allowing guns in schools (and Scott, too, opposes that).

But many people on both sides of the gun issue favor the bill’s mental health provisions, whichÌýwould allocate nearly $90 million more for mental health resources, including $69 million for schools.

Right now, there is roughly one school psychologist for every 2,000 students in Florida. The National Association of School Psychologists suggests there should be four times as many.

Ìýis a psychiatrist at All Children’s Hospital in St. Petersburg. The renewed interest and funding is a good start, he said, but “it alone is not going to prevent the next episode of mass violence.”

Though lawmakers have stressed that early detection of mental illness is key to keeping another school shooting from happening, Cavitt said there are other contributing factors, such as drug and alcohol use and gun availability. More research is needed, he said, to tease out the true mix of causes.

Brown-Woofter said she does think legislators are directing some money in the right place in this budget: funding to put more counselors in schools and to offer more training to help school employees identify mental illness.

“We are really pleased to see the attention and the awareness of mental health services now in the budget,” she said.

Survivors of the shootings also may need ongoing treatment, she said, and more counselors in schools could help students and parents get through situations like this — including families and schools that weren’t directly affected.

Hayes DuJardin, 15, worries that the same thing could happen at his school in Lakewood Ranch, south of Tampa.

“Parkland versus my school — they are very similar in the way they are set up,” he said. “So, everyone was asking, ‘How are we preventing this from happening here?'”

In the days after the shooting, officials across Florida chased down dozens of threats. Hayes said he was so disturbed by one online threat he came across that he brought it to the attention of his mom, Michelle DuJardin. It had a picture of a teen holding a gun with the words “Get ready for round two, Florida.”

“It’s terrifying when an incident like this happens,” Michelle DuJardin said. “You can’t help but be angry — scared.”

This story is part of a partnership that includes Health News Florida, and Kaiser Health News.

This <a target="_blank" href="/mental-health/mental-health-funding-tied-to-floridas-controversial-gun-legislation/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

When a hepatitis C treatment called Harvoni was released in 2014, Dr. Ronald Cirillo knew it was a big deal.

“It’s the reason that dragged me out of retirement!” he said.

Cirillo specialized in treating hepatitis C for more than 30 years in Stamford, Conn., before retiring to Bradenton, Fla. During his time in Connecticut, the onlyÌýÌýfor hepatitis C had terrible side effects and didn’t work well. It cured the viral infection less than half the time. But the newer drugs, Harvoni and Sovaldi, cure almost everybody, with few adverse reactions.

“In my lifetime, I’ve seen it change from a horrible treatment to a manageable treatment,” Cirillo says.

His mission is finding the patients.

“The disease is out there,” he said. “My job is to get the disease in here, so we can follow them and treat them.”

Last year, Cirillo joined theÌýÌýfree clinicÌýin Bradenton, about an hour south of Tampa. The clinic primarily serves uninsured Floridians who fall into what many call aÌýÌýin states like Florida that chose not to expand Medicaid. These are people who make less than about $12,000 a year.

Cirillo is trying to test every high-risk patient he encounters. On a recent weekday in the clinic, his assistant pricked a patient’s finger, and squeezed blood onto the end of a small plastic tube.

“And this little measuring tool goes into the blood and solution mix there,” Cirillo said. “We are going to time it — 20 minutes and that’s it. That’s the test.”

Nearly 30,000 people in Florida were found to have hepatitis C in 2016. It’s likely that many more are infected, because the virus can lie dormant for decades.

Cirillo spearheaded a partnership with Harvoni’s maker, Gilead Sciences, and that partnership has provided treatment to about 100 patients.

“We treat people without any insurance, that have no hope,” Cirillo said.”If you qualify to be a patient here, you’ll get tested.”

A 57-year-old patient named Patricia discovered she had hepatitis C a few months ago during a trip to the clinic. NPR and Kaiser Health News are not using her last name because the virus is sometimes associated with illegal IV drug use. It can also spread via sex. Patricia said she’s not sure how she got it.

“So, just because of my age, I guess, they went ahead and tested me for it and it blew my mind that I actually had hep C,” she said. “And the levels ended up being relatively high.”

The virus had started to scar and inflame her liver. But she lacked insurance and a job; the $94,000 Harvoni treatment would have been out of reach if she hadn’t had financial help from the drugmaker.

“I would never have been able to afford that treatment,” she said. “Never.”

Staff at the clinic help patients fill out the complicated application from Gilead. Only patients who don’t have insurance, have been drug-free for at least six months and who meet income requirements are eligible.

Patricia was able to get the treatment — one pill a day for 12 weeks — and will be tested again in three months to determine whether she is free of hepatitis C.

“Had they not discovered it and gotten me onto the program — really, who knows?” she said.

This story was produced with theÌýÌýandÌý.

This <a target="_blank" href="/public-health/from-retirement-to-the-front-lines-of-hepatitis-c-treatment/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

“It bothers me. They are being defiant,” Hase said. “And most of the people I see that walk in without a mask are just looking for a fight. They are asking you to ‘Just ask me. Just give me a reason to yell at you.’ I just stay away from them and keep on with my own life.”

Six and a half months after President Donald Trump declared the coronavirus emergency, COVID-19 has killed more than 207,000 Americans and infected 7.3 million, now including Trump himself and the first lady.

Scientists are warning of a larger wave of infection this winter. They agree the simplest, easiest way to fight that surge is to get most people to wear masks most of the time.

Yet the political fight over face coverings rages. It plays out on city streets, in suburban grocery stores, in rural sheriff’s offices and at the highest echelons of government — all the way to the presidential debate stage this week in Cleveland. There, most of Trump’s contingent refused to wear required masks, and one of them tested positive soon afterward. Only time will tell if they spread the infection, but their behavior is mirrored across the nation.

Hefty Price in Iowa

In April, Iowa health officials cut an agreement with Iowa University to do modeling on the impact of coronavirus. Among the data are estimates of future death rates and the projection that more than a thousand Iowans could be saved by adopting a universal mask policy.

Later that month, the researchers warned Republican Gov. Kim Reynolds not to ease restrictions aimed at curtailing the virus, saying a spike would result later in the year. They also recommended a strong policy on facial coverings, producing a report that said face shields would dramatically lower the virus’s toll.

Reynolds took none of that advice. She started easing restrictions in late April. She argued it was more important to reopen the state’s economy while encouraging people to be responsible and wear masks than to throw down a mandate she called unenforceable.

“I think the goal is to strongly encourage and recommend that people wear them,” she said in late August. “I believe that people are.”

Yet at that moment, Iowa was proving the university’s predictions true, suffering the highest infection rate in the nation. In late September, the state was one of only seven thatÌýÌýaveraging more than 890 new infections a day.

The governor’s intransigence on masks highlights a troubling problem. At a time when experts believe the nation needs to unite around a strategy to curb a potentially catastrophic winter, the cheapest, best option — masks — have become increasingly politicized. Even Republicans like Reynolds, who agree masks work, refuse to take the advice of their experts. They oppose mandates and favor an educational approach that many people actively resist.

Dissent Within the Trump Administration

The trouble starts at the top. The Trump administration’s leading medical advisers have testified repeatedly that masks were the country’s best tool to blunt a second wave that could be significantly deadlier than the initial spike.

Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, went as far to say face coverings were a more certain bet than a vaccine if everyone would wear them.

“If we did it for six, eight, 10, 12 weeks, we’d bring this pandemic under control,” Redfield said during a Sept. 16 hearing. “They are our best defense.”

Trump contradicted him before the day was done, and just a few daysÌýearlier, as the president and his coterie did in Cleveland,ÌýTrump modeled exactly the opposite behavior. At a campaign rally of thousands in Nevada, he cheered on the mostly maskless crowd. The next day, he held a massive mask-optional indoor rally at a warehouse in Henderson, Nevada, defying state restrictions. He advised the owner () that he’d protect the man if the state went after him.

“I’ll be with you all the way. Don’t worry about a thing,” Trump said.

But Trump’s actions and statements are worrisome for scientists and public health experts. They have watched in horror and frustration as the president’s dismissive attitude toward masks and COVID-19 itself has gone hand in hand with growing politicization of the public health response.

Meanwhile, the White House Coronavirus Task Force, led by Vice President Mike Pence, issued a “state report” on Montana on Sept. 20 that included the suggestion that the state “consider fines for violations of face mask mandates in high transmission areas.” At a press conference, Gov. Steve Bullock, a Democrat, said fining people would not be “the Montana way.” The state is, however, one of 34 with a mask mandate in place.

Indeed, the single-strongest predictor of whether or not a state will mandate strong mask policies bears little relationship to a state’s disease problem, according toÌýÌýby a team at the University of Washington.

After analyzing comprehensive data on mask policies, researchers led by Chris Adolph, a professor of political science and statistics, found that having a Republican governor would predict a 30-day delay in recommending mask policies. In a state that is also ideologically conservative, the delay would be closer to 40 days. A state’s death rate or infection rate had a much weaker influence.

“Because mask mandates are far less costly than business closures or stay-at-home orders, when we started to monitor these policies in April, we hoped their adoption would be universal,” Adolph said. “Instead, we found the same pattern: Republican governors resisted mandating masks even when public health conditions called for them.”

Adolph’s research suggests Trump is at least amplifying disdain for masks and, in fact, the phenomenon has been playing out across the country, most strikingly among some of Trump’s most ardent supporters — law enforcement and extremely conservative politicians.

Anti-Mask Sheriffs

In Washington state, Florida and even Democratic California, sheriffs made headlines by taking actions in opposition to local masking guidelines.

In Washington’s Snohomish County, where theÌýÌýin the United States, Sheriff Adam Fortney declared in an April Facebook post: “The impacts of COVID 19 no longer warrant the suspension of our constitutional rights.”

Democratic Gov. Jay Inslee ordered people to wear masks in public in late June, just as a summer-long rise of infections began. Lewis County Sheriff Rob Snaza responded by telling a cheering crowd outside a church, “Don’t be a sheep.” Klickitat County Sheriff Bob Songer on the radioÌýÌýover the order.

In Florida, anti-mask resistance has been especially fierce. Again, sheriffs offered the most startling opposition. One, Marion County Sheriff Billy Woods, banned masks for his deputies and visitors to the sheriff’s department offices, though he later relented on visitors.

Even in solid-blue Los Angeles County, the sheriff’s officeÌýÌýby the county inspector general because deputies refused to wear masks, in violation of public health orders.

Surprisingly, officials there who support masks were disinclined to push tough enforcement.

“One of the things in all of this is we’re not going to enforce or fine our way out of this,” L.A.’s top public health official, Dr. Muntu Davis, told reporters recently.

Researchers disagree with Davis and Reynolds, not because education doesn’t work, but because it takes a long, sustained effort.

“Developing and deploying health education programs takes time, so in emergencies where rapid compliance is essential for reducing the spread of a novel pathogen, mandates are a critical element,” said Adolph.

Tickets in Tennessee

That’s the path officials took in Nashville, Tennessee, though initially officers opted for a more lenient approach than the mayor wanted. They had to be forced to write tickets with a potential fine of $50. The police still mostly have been giving warnings — thousands on any given weekend — but they’ve also written dozens of tickets and made some arrests.

City officials credit the crackdown with curbing COVID-19, even as it ran rampant in rural Tennessee counties where there are no mask mandates. In late September, Nashville’s Davidson County had 13.5 cases per 100,000 people, while more than three dozen less populous counties had “, with more than 25 cases per 100,000 people.

Amid the conflicting messages, including where enforcement has worked, not everyone is convinced that covering your nose and mouth is something that should rise to the level of police.

“I think they have better things to do than force anybody to wear a mask,” said Jennifer Johnson, an X-ray tech in downtown Nashville. “I think it should be at your own risk, but that’s just my opinion.”

Lawsuits Plus Weekly Protests in Florida

Plenty of conservative-leaning citizens and lawmakers agree with her, to the point of suing to block mandates.

In Hillsborough County, Florida, home to Tampa, county commissioners must vote each week to renew a state of emergency that requires masks to be worn in indoor public places.

Jason Kimball, a regular speaker at those meetings opposing the order, grew so angry he started a GoFundMe campaign for a lawsuit. He hit his $5,000 goal in 24 hours.

“You can only do so much as a commission legally, without violating the state constitution and the United States Constitution,” Kimball said at a recent meeting.

Rep. Anthony Sabatini, a state lawmaker who has filed 15 similar lawsuits on behalf of others all over the state, took the case. He claims mask ordinances are an overreach by government and a violation of Florida’s privacy clause.

“The government has never done this before,” Sabatini said. “It’s never told people that they have to wear masks everywhere they go all day long, and that’s basically what it’s come to.”

A judge dismissed Sabatini’s case in Hillsborough County and several of his other lawsuits have been denied.

Like Kimball and many other mask opponents, Sabatini insists masks don’t work, saying anyone can Google it to find out.

Scientists beg to differ, and are distressed political ideology has trumped real data and made it impossible for science to dictate the best responses.

“That’s certainly been a source of frustration for those of us who work in public health,” said Joe Cavanaugh, who runs the Department of Biostatistics at the University of Iowa’s College of Public Health and helped build the modeling distributed to Gov. Reynolds.

Watching Other Countries Succeed

Dr. Ali Mokdad, a former outbreak scientist at the CDC who works for the Institute for Health Metrics and Evaluation at the University of Washington’s School of Medicine, finds it especially painful to watch other countries deal with the pandemic better than the United States.

He traveled the globe to stop outbreaks, and now other countries are using the methods he and his former colleagues at the CDC taught them.

“Why aren’t people wearing a mask? For the first time in our history, of humankind, we have a measure that is really very cheap,” he said. “You can make it at home yourself from something old you have. It saves lives. It saves the economy.”

It is doubly frustrating — and alarming — because while mask adoption had been rising over the summer, it’s recently begun to slip. The shift caused IHME to adjust upward its model of how many people would get infected and die by Jan. 1 in the United States.

“This change in the last week is due mainly to the decline in masks and the increase in mobility,” Mokdad said.

The death rate estimate has since moderated — projected this week at 372,000.

One place where mask use has declined is Iowa, where Mokdad said only 28% of people say in surveys they are always likely to wear a mask when they go out.

Scientists at the University of Iowa had been using data similar to what IHME uses for its coronavirus models. The state won’t let the university make its modeling public, but when some of its data was online, the projection was that Iowa would see more than 1,000 deaths by the end of August if no additional safety steps were taken. As of Tuesday, theÌýÌýwas 1,328.

By IHME’s most recent similar estimates, more than 3,400 Iowans will die by Jan. 1. With a universal mask requirement, some 1,600 could be saved. Nationally, nearly 115,000 lives could be spared.

Winter Is Coming

Cavanaugh would welcome even a toothless mandate to spare some of those lives. “Just sending that message at the state level is, I think, an important step in emphasizing the importance of it,” said the University of Iowa researcher.

Sixteen states still do not have a mandate, all of them led by Republicans.

The especially frightening element to the anti-mask movement is that it can only worsen what scientists already warn is going to be a bad winter.

When it’s cold, the virus can survive longer on surfaces, and people are stuck indoors where it can become more concentrated in the aerosolized droplets people exhale.

“We’ve seen it in our data. We’ve seen it in other countries,” Mokdad said. “It’s very strong, and it’s going to happen in the U.S., unfortunately.”

Back in Florida, Nils Hase will keep wearing his mask.

“I’ve always believed in the science behind it,” Hase said. “It’s a virus and we need to be aware of what’s going on. People who don’t, they’re just idiots.”

This story is from a reporting partnership that includes Health News Florida, KPCC, Nashville Public Radio, KHN and NPR.Ìý

This <a target="_blank" href="/public-health/mask-wearing-enforcement-not-so-simple/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Children registering for school in Florida this year were asked to reveal some history about their mental health.

The new requirement is part of a law rushed through the state legislature after the FebruaryÌýÌýin Parkland, Fla.

°¿²ÔÌýÌýfor new students, the state’s school districts now must ask whether a child has ever been referred for mental health services.

“If you do say, ‘Yes, my child has seen a counselor or a therapist or a psychologist,’ what does the school then do with that?” asked Laura Goodhue, who has a 9-year-old son on the autism spectrum and a 10-year-old son who has seen a psychologist. “I think that was my biggest flag. And I actually shared the story with a couple of mom friends of mine and said, ‘Can you believe this is actually a thing?'”

Goodhue said she worries that if her children’s mental health history becomes part of their school records, itÌý.

“If my child was on the playground and something happened,” she said, “they might think, ‘This child has seen mental health services. This must mean something’ — more than it really means.”

The question was largely overlooked until parents started filling out school registration forms this summer. It was one sentence in aÌýÌýthat contained such controversial measures as increasing the minimum age to buy a gun and arming school employees.

Parents express concern that the information could fall into the wrong hands and may follow children throughout their education, saidÌý, executive director of the Florida chapter of the National Alliance on Mental Illness.

“In a perfect world, getting treatment for mental health challenges would be no different than getting medical treatment for a skin rash or a bad cold or a broken leg,” LaPolt said. “But that’s not the world we live in right now. There is stigma around mental illness and getting treatment for it.”

School districts say counselors will use the information to help Florida students get the services they need.

Some districts will share the information only with psychologists and administrators. Others say they will provide access to teachers and front-office staff as well.

School counselors say they understand the stigma surrounding mental illness. Some say the way the law was written doesn’t help. The mental health question was grouped with requirements to report arrests or expulsions.

“I can certainly understand parents having a reaction when they see those questions, sort of, asked back to back, saidÌý, manager of psychological services for Pinellas County Schools.

But in order to help students, Cowley said, school officials must first determine who needs mental health services.

“The process we’re trying to develop and everything we’re trying to do is just with an eye toward reducing stigma, increasing awareness and getting students access to more care,” Cowley said.

The requirement has school districts worried about more than just stigma. The state left implementation of the provision up to local districts.

At a meeting in Tampa, Fla., Hillsborough County School Board memberÌý raised the issue of patient privacy and a federal law that protects it, known asÌý.

“I could foresee some lawsuits around this,” Griffin said.

Still, counselors say more parents may support the law once they start to see children getting the counseling they need.

°Õ³ó±ðÌýÌýnearly $70 million to increase access to mental health services in schools. National experts say the money is long overdue.

Florida has historically been among the worst states in terms of providing money for mental health care, saidÌý, senior policy adviser for the National Alliance on Mental Health.

“We know that the symptoms of mental health conditions and serious mental illnesses in particular tend to surface during the teen years and early 20s,” Honberg said. “And that’s a time when we should be putting the most resources into interventions.”

In Broward County, where Parkland is located, the district is using part of theÌýÌý— many of them counselors, psychologists and social workers.

Their ability to reach students in need could depend on whether parents feel comfortable checking “yes” on a registration form.

This story is part of a partnership that includes , and Kaiser Health News.

This <a target="_blank" href="/mental-health/parents-are-leery-of-schools-requiring-mental-health-disclosures-by-students/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

[UPDATED March 8]

A billÌýÌýWednesday has received huge attention because of a controversial provision that would allow some teachers to have guns in schools. But the measure, now headed to the governor’s desk, would also designate an influx of cash for mental health services.

The state has seen three mass shootings in 20 months — at the Pulse nightclub in Orlando, the Fort Lauderdale airport and at Marjory Stoneman Douglas High School in Parkland. And the need for increased mental health funding has come up twice before — with no cash forthcoming.

In today’s dollars, Florida is spending 40 percent less on mental health than it did in 2000, according toÌý, interim president of the Florida Council for Community Mental Health.

“That means there are fewer providers or fewer sources that the individuals can access,” she said. And that lack of resources, she and other mental health care providers say, undercuts the ability to catch mental illness early and treat it.

Since 2000, the state has increased funding for mental health services by $218 million. But that hasn’t kept up with inflation and the 4.5 million people who have moved to Florida since then, Brown-Woofter said.

The shooting in Parkland shifted the focus of many people in Florida and nationally to mental health. President Donald Trump and other leaders were quick to label the 19-year-old man who killed 17 people at his former high school mentally ill.

Republican Gov. Rick Scott called for $500 million for school safety, including giving young people more counseling and crisis management.

“Florida is never going to be the same — and we’ve got to make sure Florida is never the same,” Scott said duringÌýa recent appearance in Tampa. “We’ve got to make sure we have common-sense solutions to make sure every parent knows that their child is safe.”

The mental health provision is attached to theÌýÌýgun legislation. It raises the age of most firearm purchases to 21, institutes a mandatory three-day waiting period for all firearm purchases and bans the sale ofÌý, devices that can be attached to a weapon to enable it to fire more quickly.

These provisions are not popular with many in Florida’s legislature, where conservatives have opposed any restrictions on gun ownership in the past. On the Democratic side of the aisle, there was opposition to the provision allowing guns in schools (and Scott, too, opposes that).

But many people on both sides of the gun issue favor the bill’s mental health provisions, whichÌýwould allocate nearly $90 million more for mental health resources, including $69 million for schools.

Right now, there is roughly one school psychologist for every 2,000 students in Florida. The National Association of School Psychologists suggests there should be four times as many.

Ìýis a psychiatrist at All Children’s Hospital in St. Petersburg. The renewed interest and funding is a good start, he said, but “it alone is not going to prevent the next episode of mass violence.”

Though lawmakers have stressed that early detection of mental illness is key to keeping another school shooting from happening, Cavitt said there are other contributing factors, such as drug and alcohol use and gun availability. More research is needed, he said, to tease out the true mix of causes.

Brown-Woofter said she does think legislators are directing some money in the right place in this budget: funding to put more counselors in schools and to offer more training to help school employees identify mental illness.

“We are really pleased to see the attention and the awareness of mental health services now in the budget,” she said.

Survivors of the shootings also may need ongoing treatment, she said, and more counselors in schools could help students and parents get through situations like this — including families and schools that weren’t directly affected.

Hayes DuJardin, 15, worries that the same thing could happen at his school in Lakewood Ranch, south of Tampa.

“Parkland versus my school — they are very similar in the way they are set up,” he said. “So, everyone was asking, ‘How are we preventing this from happening here?'”

In the days after the shooting, officials across Florida chased down dozens of threats. Hayes said he was so disturbed by one online threat he came across that he brought it to the attention of his mom, Michelle DuJardin. It had a picture of a teen holding a gun with the words “Get ready for round two, Florida.”

“It’s terrifying when an incident like this happens,” Michelle DuJardin said. “You can’t help but be angry — scared.”

This story is part of a partnership that includes Health News Florida, and Kaiser Health News.

This <a target="_blank" href="/mental-health/mental-health-funding-tied-to-floridas-controversial-gun-legislation/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

When a hepatitis C treatment called Harvoni was released in 2014, Dr. Ronald Cirillo knew it was a big deal.

“It’s the reason that dragged me out of retirement!” he said.

Cirillo specialized in treating hepatitis C for more than 30 years in Stamford, Conn., before retiring to Bradenton, Fla. During his time in Connecticut, the onlyÌýÌýfor hepatitis C had terrible side effects and didn’t work well. It cured the viral infection less than half the time. But the newer drugs, Harvoni and Sovaldi, cure almost everybody, with few adverse reactions.

“In my lifetime, I’ve seen it change from a horrible treatment to a manageable treatment,” Cirillo says.

His mission is finding the patients.

“The disease is out there,” he said. “My job is to get the disease in here, so we can follow them and treat them.”

Last year, Cirillo joined theÌýÌýfree clinicÌýin Bradenton, about an hour south of Tampa. The clinic primarily serves uninsured Floridians who fall into what many call aÌýÌýin states like Florida that chose not to expand Medicaid. These are people who make less than about $12,000 a year.

Cirillo is trying to test every high-risk patient he encounters. On a recent weekday in the clinic, his assistant pricked a patient’s finger, and squeezed blood onto the end of a small plastic tube.

“And this little measuring tool goes into the blood and solution mix there,” Cirillo said. “We are going to time it — 20 minutes and that’s it. That’s the test.”

Nearly 30,000 people in Florida were found to have hepatitis C in 2016. It’s likely that many more are infected, because the virus can lie dormant for decades.

Cirillo spearheaded a partnership with Harvoni’s maker, Gilead Sciences, and that partnership has provided treatment to about 100 patients.

“We treat people without any insurance, that have no hope,” Cirillo said.”If you qualify to be a patient here, you’ll get tested.”

A 57-year-old patient named Patricia discovered she had hepatitis C a few months ago during a trip to the clinic. NPR and Kaiser Health News are not using her last name because the virus is sometimes associated with illegal IV drug use. It can also spread via sex. Patricia said she’s not sure how she got it.

“So, just because of my age, I guess, they went ahead and tested me for it and it blew my mind that I actually had hep C,” she said. “And the levels ended up being relatively high.”

The virus had started to scar and inflame her liver. But she lacked insurance and a job; the $94,000 Harvoni treatment would have been out of reach if she hadn’t had financial help from the drugmaker.

“I would never have been able to afford that treatment,” she said. “Never.”

Staff at the clinic help patients fill out the complicated application from Gilead. Only patients who don’t have insurance, have been drug-free for at least six months and who meet income requirements are eligible.

Patricia was able to get the treatment — one pill a day for 12 weeks — and will be tested again in three months to determine whether she is free of hepatitis C.

“Had they not discovered it and gotten me onto the program — really, who knows?” she said.

This story was produced with theÌýÌýandÌý.

This <a target="_blank" href="/public-health/from-retirement-to-the-front-lines-of-hepatitis-c-treatment/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">