U.S. doctors should regularly screen all adults under 65 for anxiety, an influential health guidelines group proposed Tuesday.

It’s the first time the U.S. Preventive Services Task Force has recommended anxiety screening in primary care for adults without symptoms. The proposal is open for public comment until Oct. 17, but the group usually affirms its draft guidance.

The recommendations are based on a review that began before the COVID-19 pandemic, evaluating studies showing potential benefits and risks from screening. Given reports of a surge in mental health problems linked with pandemic isolation and stress, the guidance is “very timely," said Lori Pbert, a task force member and co-author. Pbert is a psychologist-researcher at the University of Massachusetts’ Chan Medical School.

The task force said evidence for benefits, including effective treatments, outweighs any risks, which include inaccurate screening results that could lead to unnecessary follow-up care.

Anxiety disorders are among the most common mental health complaints, affecting about 40% of U.S. women at some point in their lives and more than 1 in 4 men, Pbert noted.

Black people, those living in poverty, people who have lost partners and those who have other mental health issues are among adults who face higher risks for developing anxiety, which can manifest as panic attacks, phobias or feeling always on edge. Also, about 1 in 10 pregnant and postpartum women experience anxiety.

Common screening tools include brief questionnaires about symptoms such as fears and worries that interfere with usual activities. These can easily be given in a primary care setting, the task force said, although it didn’t specify how often patients should be screened.

“The most important thing to recognize is that a screening test alone is not sufficient to diagnose anxiety," Pbert said. The next step is a more thorough evaluation by a mental health professional, though Pbert acknowledged that finding mental health care can be difficult given shortages of specialists.

Megan Whalen, a 31-year-old marketing specialist who was diagnosed with anxiety in 2013, says regular doctors should screen for mental health issues as commonly as they do for physical problems.

“Health is health, whether the problem is visible or not," said Whalen, of Hoboken, New Jersey.

She has gotten help from medicine and talk therapy, but her symptoms worsened during the pandemic and she temporarily moved back home.

“The pandemic made me afraid to leave home, my anxiety telling me anywhere outside of my childhood house was unsafe," Whelan said. “I absolutely still struggle with feelings of dread and fear sometimes. It’s just a part of my life at this point, and I try to manage it as best as I can."

The task force said there isn’t enough solid research in older adults to recommend for or against anxiety screening in those aged 65 and up.

The group continues to recommend depression screening for adults and children, but said there isn’t enough evidence to evaluate potential benefits and harms of suicide screening in adults who show no worrisome symptoms.

In April, the group issued similar draft guidance for children and teens, recommending anxiety screening but stating that more research is needed on potential benefits and harms of suicide screening kids with no obvious signs.

Guidelines from the task force often determine insurance coverage, but anxiety is already on the radar of many primary care doctors. In 2020, a group affiliated with the American College of Obstetricians and Gynecologists recommended routine primary care anxiety screening for women and girls starting at age 13.

Melissa Lewis-Duarte, a wellness coach in Scottsdale, Arizona, says rhythmic breathing, meditation and making a daily list of three things for which she is grateful have all helped with her anxiety.

“Doctors say, ‘Make sure you’re sleeping, control your stress.’ Yeah, I get that," but not everyone knows how, said the 42-year-old mother of three. “It’s difficult to prioritize self-care, but that’s what’s necessary.”

BALTIMORE —

In a medical first, doctors transplanted a pig heart into a patient in a last-ditch effort to save his life and a Maryland hospital said Monday that he's doing well three days after the highly experimental surgery.

While it's too soon to know if the operation really will work, it marks a step in the decades-long quest to one day use animal organs for life-saving transplants. Doctors at the University of Maryland Medical Center say the transplant showed that a heart from a genetically modified animal can function in the human body without immediate rejection.

The patient, David Bennett, 57, knew there was no guarantee the experiment would work but he was dying, ineligible for a human heart transplant and had no other option, his son told The Associated Press.

"It was either die or do this transplant. I want to live. I know it's a shot in the dark, but it's my last choice," Bennett said a day before the surgery, according to a statement provided by the University of Maryland School of Medicine.

There's a huge shortage of human organs donated for transplant, driving scientists to try to figure out how to use animal organs instead. Last year, there were just over 3,800 heart transplants in the U.S., a record number, according to the United Network for Organ Sharing, which oversees the nation's transplant system.

"If this works, there will be an endless supply of these organs for patients who are suffering," said Dr. Muhammad Mohiuddin, scientific director of the university's animal-to-human transplant program.

But prior attempts at such transplants — or xenotransplantation — have failed, largely because patients' bodies rapidly rejected the animal organ. Notably, in 1984, Baby Fae, a dying infant, lived 21 days with a baboon heart.

The difference this time: The Maryland surgeons used a heart from a pig that had undergone gene-editing to remove a sugar in its cells that's responsible for that hyper-fast organ rejection.

"I think you can characterize it as a watershed event," Dr. David Klassen, UNOS' chief medical officer, said of the Maryland transplant.

Still, Klassen cautioned that it's only a first tentative step into exploring whether this time around, xenotransplantation might finally work.

The Food and Drug Administration, which oversees xenotransplantation experiments, allowed the surgery under what's called a "compassionate use" emergency authorization, available when a patient with a life-threatening condition has no other options.

Just last September, researchers in New York performed an experiment suggesting these kinds of pigs might offer promise for animal-to-human transplants. Doctors temporarily attached a pig's kidney to a deceased human body and watched it begin to work.

The Maryland transplant takes their experiment to the next level, said Dr. Robert Montgomery, who led that experiment at NYU Langone Health.

"This is a truly remarkable breakthrough," he said in a statement. "As a heart transplant recipient, myself with a genetic heart disorder, I am thrilled by this news and the hope it gives to my family and other patients who will eventually be saved by this breakthrough."

It will be crucial to share the data gathered from this transplant before opening the option to more patients, said Karen Maschke, a research scholar at the Hastings Center, who is helping develop ethics and policy recommendations for the first clinical trials under a grant from the National Institutes of Health.

"Rushing into animal-to-human transplants without this information would not be advisable," Maschke said.

The surgery last Friday took seven hours at the Baltimore hospital.

"He realizes the magnitude of what was done and he really realizes the importance of it," David Bennett Jr. said of his father. "He could not live, or he could last a day, or he could last a couple of days. I mean, we're in the unknown at this point."

__

AP Medical Writer Lauran Neergaard contributed.

CHICAGO — Nearly 200 million people are now fully vaccinated with more than 30 million having received a booster shot. With lower infection rates, mask mandates remain. Some are asking whether we’re nearing the end of the pandemic. The answer to that is complex.

While most would agree, the worst of the outbreak is over. Experts say it’s unlikely COVID-19 will ever completely disappear.

“If we vaccinated every single person, we could probably get rid of this thing, get it down to a dull roar. That's never going to happen,” said Dr. Robert Murphy, executive director of the Institute for Global Health at Northwestern University’s Feinberg School of Medicine.

That means that life beyond the pandemic won’t quite be the same as before it.

“For vaccinated individuals, they are a lot closer to being able to treat this pandemic like it's just an endemic problem that is going to come up every year and they just need to get their booster and be careful,” said Dr. Emily Landon, an infectious disease specialist at the University of Chicago Medicine. “For unvaccinated individuals, they're still at extremely high risk of very bad infection.”

According to the CDC right now, about 42% of the entire U.S. population is not fully vaccinated. More than 30 million people – about 15%— of those who are fully vaccinated have already gotten a booster.

But there are more tools in the toolbox: monoclonal antibodies, two promising antiviral drugs that have applied for emergency use authorization, and millions of children are now eligible for vaccination.

The current seven-day moving average of daily new cases dropped by 1.4% from the previous week to just over 70,000.

“I look at the bumps on the curve, the United States is going into the fifth wave right now,” said Murphy.

This winter, with less moisture in the air, concentrated indoor aerosols mean everyone in the northern hemisphere will be more vulnerable to infection.

“We're going to see a bump,” said Landon. “We're already seeing a bump in the northern part of the country. How big that bump is going to be is going to depend a lot based on your community and the outbreaks are going to be very localized.”

And while we could expect to see lower levels of transmission year-round, it's not likely to ever go out of season.

“It's not seasonal. Seasons may impact it, but we had a spike in August. That's crazy. It's all about behavior and the delta variant, and the virus has changed. It's much more contagious,” said Murphy.

Some experts say no matter the transmission rates, masks will need to remain in use in certain situations indefinitely.

“The time when we're going to be able to stop wearing masks when people stop worrying about them as some sort of punishment and stop making them into something bigger than they are,” said Landon.

And while some believe we could be turning the corner, just how long this pandemic will last is uncertain.

“Some of the pandemics have lasted five or 10 years,” said Murphy. “We don't know how long this one is going to last. Usually, they just kind of mysteriously disappeared.”

Unfortunately, Dr. Murphy says that may be wishful thinking.

DENVER, Colo. — People rely on hospitals to help them when they need medical attention. Some of those hospitals are the very reason some of the best doctors get into the medical profession.

That is the case for Dr. Woosik Chung, who is the director of Spine Surgery at Presbyterian St. Luke's Medical Center in Denver, Colorado.

One of the newest spaces within their facility is the smartOR. It's where Dr. Chung does all of his spinal surgeries.

He's the brains behind incorporating some of the newest technologies within this space. However, he didn’t get to where he is by accident.

“Growing up with a dad that was a surgeon and a mom that was an OR nurse, you know, you kind of take it for granted, unfortunately," Dr. Chung said.

His story starts when he was about three years old and it was a celebratory holiday in South Korea.

“I remember I was playing with my friends. I believe we were playing hide-and-seek. I remember hiding behind a tractor and I remember the engine cover was open or it wasn’t there, and there was the propeller spinning and the fan belt around that propeller. I remember I was sitting on my tricycle and I was hiding and nobody could come and find me and I got bored and I saw the propeller moving around and I thought I could stop it," Dr. Chung said.

He severed both of his hands. Both were a clean cut.

“The next thing I remember— my dad is holding me and compressing my arms and I heard my mom say, 'I found them,' and she was referring to my limbs," Dr. Chung said.

They lived right near the hospital. His father had to step in as many doctors weren't working because it was a holiday.

“Luckily, thanks to my parents, my dad and the powers that be, I healed up and I was able to start using my hands again and I think it took me a long time to understand the significance of that," Dr. Chung said.

What could have turned into a tragic story, instead, was the beginning of a remarkable career.

“I was curious about the OR, I was curious about what my dad did because I knew that he had done my hand surgery and so I think it made me want to go to his hospital more when we were living in Malawi and check out what he was doing," Dr. Chung said. “He was as busy as ever so the only times I really saw him were if I visited him at the hospital and then I’d run around with him as he was making his rounds and then I’d kind of look in as he was operating outside of the OR.”

Those times of exploration, combined with his curiosity, gave him purpose to join the medical field.

“Wow, this is pretty unique and it’s an opportunity that doesn’t come by that often and so maybe the best thing to do is to try and use my hands to help somebody else," Dr. Chung said.

That’s exactly what he does now. Day-in and day-out, using his own hands, to change others' lives at this hospital. His outcome, is not the norm. Limb reattachment is far from a guarantee.

“I would still say it’s a rarity. And I would say this only happens in unique circumstances. And I think In my case, thank goodness I was a young kid, thank goodness the injury itself is what we call a clean cut, and thank goodness my father was able to take care of me so quickly right after the injury," Dr. Chung said.

People would never know Dr. Chung's story by looking at him but knowing it, makes people appreciate him as the doctor and surgeon he is.

“Get to know your doctor. Get to know your nurse. Get to know the people that want to take care of you because we want to be able to take care of you, we want to help," Dr. Chung said. “Helping others, and do whatever you can, even if all the odds are against you, and as long as you look at that goal and you work towards it as hard as you can, well sometimes amazing things can happen.”

Over half of people with chronic depression who attempted to stop their antidepressant medication relapsed into depression by the end of a year, compared to those who did not stop medicating, according to a randomized, double-blinded clinical trial released Wednesday.

The research, published in the New England Journal of Medicine, found that "quality-of-life measures and symptoms of depression, anxiety, and medication withdrawal were generally worse in patients who discontinued their antidepressant therapy."

Interestingly, the study did find a small percentage of people were able to successfully stop their antidepressant without having another depressive episode.

"Some people can stop their medication without relapse, although at present, we cannot identify who those people are," said coauthor Gemma Lewis, a professor of psychiatric epidemiology at University College London.

"I think we can be very cheered by the findings," said coauthor Dr. Tony Kendrick, a professor of primary care at the University of Southampton in the United Kingdom.

"This is really good evidence to support a patient's own decisions — in discussion with their doctor or other prescriber — about whether they should continue antidepressants or not," Kendrick said. "Both courses of action are reasonable."

Antidepressants for life?

When people slip into depression for the first time, current practice is to continue antidepressants between four to nine months after remission of their depression, said Dr. Jonathan Alpert, chair of the American Psychiatric Association's Council on Research, who was not involved in the study.

Remission is defined as a two-month period with no signs of major depression such as sadness and a reduced interest or pleasure in life.

"In my own practice, if the patient has a first episode of depression, and particularly if it was triggered by a life event — death of a loved one, failed business — then I try my best to get patients into remission (and) then I treat for a minimum of six months after they achieve remission," said Dr. Jeffrey Jackson, a professor at the Medical College of Wisconsin, who studies depression.

"If they stay in remission for those six months, then we can consider slowly tapering off the antidepressants — with the person carefully monitoring their own depressive symptoms," Jackson added. Jackson, who was not involved in the study, wrote an accompanying editorial published in NEJM.

Unfortunately, the danger of another bout of depression later in life is high, said Alpert, who is also the chair of psychiatry at Montefiore Health System in the Bronx.

"If one has had one episode of depression, the chances of a second episode sometime during one's lifetime is 50%," he said. "If somebody has already had two depressions, the chances of a third are even higher — over 75% of people who have had two or more depressions will have another."

Science has long known that people with recurrent depression have the most difficulty coming off antidepressants and the most likelihood of relapse when they do, Alpert added.

"For patients who have had three or more depressive episodes, I generally plan to treat them for life," Jackson said.

Addressing out-of-date research

Much of the research done on long-term effectiveness of antidepressants is old and limited, so the study was designed to fill that gap in knowledge, the study authors said.

"Many people are taking long-term antidepressants, and the evidence to advise them whether to continue maintenance or discontinue is poor," Lewis said.

The study recruited 478 people from 150 primary care practices in the U.K. Each person had experienced at least two depressive episodes or had been on antidepressant medication for two years or more. All felt well enough to stop taking their medication.

"This is the largest study that's been done in a real-world primary care setting," said Alpert.

"That's important because most patients with depression are managed by their primary care provider," Jackson said. "Most primary care providers only refer to psychiatrists if the patients are suicidal, homicidal, psychotic, bipolar or not responding to therapy."

Only people taking maintenance dosages of four antidepressants were included in the study: citalopram (Celexa), fluoxetine (Prozac), sertraline (Zoloft), and mirtazapine (Remeron). Other popular antidepressants, such as escitalopram (Lexapro), were not included due to the greater likelihood of severe withdrawal symptoms, the authors said.

All medications and the lactose placebo in the study were packaged identically in unmarked bottles so that both patients and researchers were blinded to the contents.

Half of the group was given reduced dosages of their antidepressant over a two-month period; by the beginning of the third month, all were taking placebo. The other half of the group continued to take their normal dose of antidepressant.

At the end of 52 weeks of follow-up, 56% of the people who had been weaned off their antidepressant had relapsed into depression, compared to 39% of the people who continued their medications.

"The patients who stopped their antidepressants experienced a relapse sooner than the patients who stayed on their antidepressants," Lewis said.

Symptoms of depression and anxiety were higher in the group who discontinued their medications as well, she added. But could those have been withdrawal symptoms instead?

"It's not always that easy to tell," Kendrick said. "If somebody's starting to get anxious, if they're starting to have sleep disturbances or are starting to feel low. Is that depression coming back? Or is it withdrawal symptoms?"

Regardless of the source of the symptoms, a number of people exited the trial even though they did not know if they were on medication or placebo.

"It was clear that they voted with their feet," Alpert said. "When they weren't doing as well, they were more likely to drop out of the trial and more likely to resume medications."

Long-term use

The study results did provide some insight into the benefits of long-term use of antidepressants, Kendrick said.

"It's reassuring to know that antidepressants people are taking long term do seem to be benefiting them, and this is not something that they're taking unnecessarily," he said.

There are side effects to many medications, such as weight gain and sexual dysfunction, "so we try to choose antidepressants and adjust the dose for a given person that they tolerate the best and have the fewest side effects," Alpert said.

"However, to the very best we know, there are no long-term consequences, such as increased risk of cancer, stroke, heart disease or liver problems by virtue of being on antidepressants," he added.

If you do decide to taper, do it slowly and add psychological therapy, which studies have shown "can help prevent the risk of relapse," Kendrick added.

"The latest guidelines are suggesting that you should take some weeks to come off antidepressants," he said. "If you're getting withdrawal symptoms and finding it difficult, you might need to take months to come off them."

What else can be done?

Antidepressants are, of course, not the only treatment for depression. There are many things people can do to improve their depressive symptoms while on medication or reduce the likelihood of a relapse once weaned off an antidepressant, Alpert said.

Physical activity is key. "It looks like even relatively moderate amounts of activity, like a brisk walk several times a week, can help in the treatment of depression and also help in relapse prevention," he said.

Social connections are important, too. Making an effort not to be isolated, by reaching out to others for social support, makes a difference, as do activities that are meaningful and rewarding, Alpert said.

"Community activities, volunteer activities, seem to be important in helping with depression," he said. "When people are pursuing goals that are meaningful to them, that's also helpful."

Evidence-based psychotherapy works. "People who opt to taper off their medications have a greater chance at staying well if they're pursuing certain forms of psychotherapy that have been shown in studies to be effective," Alpert said.

Cognitive behavioral therapy, or CBT, has been widely studied and considered to be comparable in effectiveness to antidepressants for depression. It's often used in conjunction with medication for people whose symptoms do not improve on antidepressants alone.

The therapy focuses on a person's thought process, attempting to interrupt false or negative thoughts about oneself and others that can lead to a depressive mood. Instead, people are encouraged to substitute healthier, more positive thoughts, which can improve self-image and behavior.

"It's not quite like lying on the couch and free associating," Alpert said. "There's specifics like homework assignments and skills that people acquire."

Acceptance and commitment therapy, or ACT, uses a similar approach, Alpert said, with more of a focus on accepting negative thoughts and discarding them.

"Rather than changing your thoughts, you accept the idea that they're just thoughts, they're not the same as reality, and they are not who I am," Alpert explained. "Realizing that thoughts like 'I'm not good enough' and so on are just thoughts, and learning how to push those thoughts away."

Interpersonal psychotherapy or IPT, focuses on changes in one's life that has to do with interpersonal relationships, Alpert said.

"Interpersonal therapy has to do a lot with relationships like losses or transitions in one's role with others ... and then working on those, like how can you go ahead with a life worth living and adapt to or will make the best of those transitions," he said.

Therapists will often tell patients about the different approaches, as one may be a "better match to where they are in their lives and the things that they're dealing with," he added. "There are many things that people can do in addition to medications."

A mother is back home in Texas after a long battle with COVID-19 in an Oklahoma City intensive care unit.

Devisha Long credits her nurses for getting her home. But, she said, it has been a long journey.

She was flown by helicopter from Dallas to OKC. She was placed in a medically-induced coma at Integris Baptist Medical Center and was in this condition for nearly a month. She became a mother during her hospital stay.

“I surprised them. Oh, man, they were so excited,” she said. “You know, everybody was happy.”

Long survived COVID-19 thanks to the innovative extracorporeal membrane oxygenation treatment. This week, she finally returned home to her family in Dallas. Her nurses watched the tender moment while huddled around an iPhone.

“It was freaking awesome! I got chills. I cried, and I don’t cry. It was a breath of fresh air,” the nurses said.

Their former patient hugged her sweet daughters for the first time in months.

While Long was in a coma, Nurse Manager Rebecca Mitchell said she was very sick and was pregnant.

“And then they had to do an emergency C-section before she came to us,” Mitchell said.

“When I finally woke up, the only way I knew I wasn't pregnant is because one of the nurses from the other hospital had made a collage of the baby, and I seen him line up on the wall, and I looked and I was like, That's my baby,” Long said.

She eventually woke up from her coma, holding her baby girl.

“When I first held her and I was like, I can't believe, you know, this is you,” she said.

For the nurse team at Integris, they’ve been running nonstop, experiencing tragedy treating COVID-19 patients.

“It truly has been a hellacious year. I've seen more death. This just this past year than I have in the 10 years I've been a nurse,” Mitchell said.

But this brief moment offered a change from the sad realities of the COVID-19 pandemic.

“We all cried. I think we all teared up, because just that those are those moments that you, you need to kind of help rebuild to remind you why we do what we do,” she said.

They remember why they continue their work.

“Thank you for your positivity, thank you for encouraging me. You really helped me to remain strong,” Long said. “Even in the dark times of me being alone, y'all really did an amazing job and I just want to tell you how to continue to do the same because you're touching lives and making a difference."

Long is still recovering from COVID-19, going to appointments in Dallas. As for her newborn, she’s at a Dallas hospital until she can come home.

CHICAGO — Thousands of fully vaccinated people have contracted the coronavirus, but experts say these breakthrough cases are rare.

“The total number of individuals who are vaccine breakthroughs is pretty low compared to the number of cases that are out there,” said Dr. Emily Landon, an infectious disease specialist at the University of Chicago Medicine.

But according to Dr. Landon, that risk can easily go up and have far-reaching impacts beyond the person infected.

“The more contact and close contact you have with people who are unvaccinated, the more likely you are to have a breakthrough infection,” said Landon.

As of July 19^, the CDC documented nearly 6,000 cases of fully vaccinated people who were hospitalized or died from COVID-19, and 74% of them were 65 or older.

But the agency acknowledges those numbers are under-counted.

In Massachusetts, for example, where 63% of the residents are fully vaccinated, 5,000 breakthrough cases have been reported with 80 deaths.

“Every time someone gets COVID, whether they're vaccinated or not, it gives the virus an opportunity to spread to someone else or to mutate inside their body,” said Dr. Landon.

It’s why vaccination rates matter.

More than 160 million people in the U.S. have already been fully vaccinated, but that’s less than 50% of the total population.

“The more people that are vaccinated, the fewer cases of COVID we're going to see in general and the fewer variants we're going to see emerge,” said Dr. Landon.

And with the more contagious delta variant twice as transmissible, experts warn the more the virus can circulate among the unvaccinated, the more likely the chance of breakthrough cases and potentially vaccine-resistant mutations, which could lead to more spread.

“Any individual who is symptomatic, whether they've been vaccinated or not, should consider themselves to be contagious.”

In the end, experts like Dr. Landon say vaccination is key. But being fully vaccinated doesn’t mean someone is fully protected.

“For people who aren't willing to follow the science, it turns out it might be better for all of us to just wear a mask so that we know that everybody's protected," Dr. Landon said.

Federal regulators have approved the first new drug for Alzheimer’s disease in nearly 20 years, leaving patients waiting to see how insurers will handle the pricey new treatment.

Health care experts expect broad coverage of the drug, which was approved Monday. But what that means for patients will vary widely depending on their insurance plan. In some cases, that could mean coming up with several thousand dollars to pay for what the insurer didn’t cover.

And there's no guarantee that every case will be covered.

Here’s what you need to know:

WHAT WAS APPROVED?

The Food and Drug Administration said it granted approval to a drug from Biogen based on clinical research results that seemed “reasonably likely” to benefit Alzheimer’s patients.

It’s the only drug that U.S. regulators have said can likely treat the underlying disease, rather than just manage symptoms. The new drug, which Biogen developed with Japan’s Eisai Co., did not reverse mental decline. It slowed it in one study.

The FDA’s decision came despite the conclusion of its advisory committee that there wasn’t enough evidence that the drug slowed the brain-destroying disease.

WHAT DOES IT DO?

It aims to help clear harmful clumps of a protein called beta-amyloid from the brain. The medication will be marketed as Aduhelm and is to be given as an infusion every four weeks.

WHAT WILL IT COST?

Biogen said the drug would cost approximately $56,000 for a typical year’s worth of treatment, and it said the price would not be raised for four years.

HOW WILL INSURERS COVER IT?

They will likely request some documentation first that the patient needs the drug. Many plans will require doctors to submit records and other paperwork justifying the treatment before they agree to cover it.

Insurers also will likely require pre-approval for brain scans needed to determine that the patient is a candidate for treatment, said Lance Grady of Avalere Health consultants.

He noted that some plans also may want to see the results of a scan before they decide to cover the next infusion, which could delay treatment.

IS COVERAGE GUARANTEED?

Medicare is widely expected to cover the treatment. Insurers that offer private or commercial coverage also will pay for care that doctors deem medically necessary.

That may not mean every case, though. If the treatment is proposed for a patient with advanced Alzheimer’s, and research shows the drug isn’t effective in that population, then the insurer may not pay for it.

“That happens all the time with drugs,” said Robert Laszewski, a health care consultant and former insurance executive. “Just because the FDA says its safe doesn’t mean it’s appropriate for everybody.”

WHAT WILL PATIENTS PAY?

That’s impossible to say broadly.

It can depend on the person’s coverage and their out-of-pocket maximum, which is a plan’s limit for how much a patient pays in a year for in-network care before insurance picks up the rest of the bill.

Some patients who are already receiving a lot of care may not wind up with a huge added expense from the drug before they hit that limit.

Patients who have a supplemental plan for their Medicare coverage also may wind up with few out-of-pocket costs for the drug.

Patients with Medicare Advantage coverage, which is run by private insurers, or individual health insurance could pay several thousand dollars before they hit their plan’s annual limit, depending on the plan.

“That could be very burdensome for someone, especially if a person is looking at this cost every single year, and they don’t have an option to get a better health plan,” said Stacie Dusetzina, an associate professor at Vanderbilt University and drug pricing expert. “It can add up.”

ARE THE DRUGMAKERS HELPING?

Cambridge, Massachusetts-based Biogen plans to begin shipping millions of doses within two weeks.

The company says it will help patients figure out their options for financial assistance and find providers and care infusion sites. The drugmaker also is offering programs to help reduce the out-of-pocket cost for some patients with commercial coverage.

But people with Medicare and Medicare Advantage coverage cannot get drugmaker discounts like that. Health care researchers say most of the people who will need this drug will have some form of Medicare coverage.

___

Follow Tom Murphy on Twitter: @thpmurphy

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

CHICAGO, Ill. – Shortages of ventilators and personal protective equipment mean many healthcare providers are going into battle unarmed. It’s sparked a heated debate behind closed doors about balancing efforts to save patients versus exposing doctors and nurses to the virus.

Who lives? Who dies? Who gets priority to a ventilator? All complex questions health providers are being confronted with.

“We've never had this situation before. This is unprecedented,” said Craig Klugman a professor of bioethics at DePaul University in Chicago.

Bioethicists say widespread infection, protective equipment and ventilator shortages are creating unique ethical dilemmas for healthcare workers.

“We will start to care for the person who is at risk of dying first,” explained Dr. Ricardo Gonzalez-Fisher, a surgical oncologist who teaches healthcare ethics at Metropolitan State University of Denver. “But if we have more people than resources that we have to. Try to save those that are savable.”

“The obligation for a healthcare provider to treat the patient doesn't necessarily have a limit,” said Klugman.

In Spain, some 13,000 medical workers have been infected. In Italy, more than 60 workers have died since the outbreak began.

“It's not just their life. They can assume this risk for themselves,” said Klugman. “If they don’t have the right equipment, they also have the risk of infecting other patients, other healthcare providers. Their family.”

Some health systems around the country are reportedly discussing unilateral do-not-resuscitate policies. It’s something that was debated during the Ebola outbreak in 2015.

Determining who gets treatment and who does not is something Klugman says is taken very seriously.

“We think about it very carefully and with great deliberation.”

In Italy, that meant denying some care to the elderly in favor of the young.

Klugman says in Illinois, a pandemic flu plan created a decade ago includes care procedures built around ethical frameworks and algorithms that help decide who should for example, get a ventilator.

“We have to consider things like what is our most important value. So, the value that we're considering is maximizing the number of years of life that we can save,” said Klugman.

Ultimately, a balance must be struck.

“You have to make sure that the benefit of the patient overrides the harm or the risk that you're getting in,” said Dr. Gonzalez-Fisher.

Otherwise, bioethicists say there may not be enough first responders to treat the infected.

“When you call 9-1-1 because your loved one can't breathe, there will be nobody coming. That's the worst-case scenario,” said Klugman.