How to manage your mental health in the holiday season

By Dr. Gopalkumar Rakesh

Assistant professor of psychiatry, University of Kentucky

For many, the holiday season is not always the most wonderful time of year. With work and school deadlines quickly approaching, holiday shopping expenses piling up, and back-to-back large social gatherings, this time of year can eventually take a toll on one’s mental wellness.

According to the National Alliance on Mental Illness, a study showed that 64% of people with mental illness report holidays make their conditions worse. In a separate study conducted by the American Psychological Association, 38% of people surveyed said their stress increased during the holiday season.

Photo by Tommaso79, Getty Images / iStock Plus

Increased stress can cause symptoms of physical illness, depression, loneliness and more. If you or a loved one are experiencing increased stress this year’s holiday season, here are some tips to help make your season a bit jollier.

Manage your time: Remember that your priorities still matter, and procrastination is not your friend. Putting off important projects can cause unwanted stress. Be sure to prepare ahead of time if you have important deadlines approaching to ensure that you do your best. Try making a schedule of when you will work on your projects and do your holiday prep to make sure your schedule is balanced, productive and not rushed.

Set boundaries: Communicate your limits as early as possible to friends and family so that everyone is on the same page. It is okay to say no to social obligations that may be too stressful. Choosing to set boundaries surrounding stressful conversations on topics that may be contentious in a family setting may also be advised.

Take care of yourself: The holiday season is not only about spoiling those you love but making yourself a priority as well. Fight seasonal depression by staying on top of your sleep and exercise schedule. If you can, work near a window throughout the day to get as much sunlight as possible. Even adding bright holiday lighting throughout your work or engaging with mindfulness apps on your smartphone can help boost your mood.

Seek support: Check in with a local support group or friends who understand what you may be going through. Surrounding yourself with people who feel similar can help combat feelings of loneliness.

If you or someone you know needs additional support, reach out to your therapist if you have one, talk to a mental-health professional or contact your primary-care physician.

Additionally, if you or a loved one are experiencing a suicidal crisis or mental distress, call or text 988 to reach the Suicide and Crisis Lifeline (formerly the National Suicide Prevention Lifeline) to access free and confidential support 24/7.

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Rep. Guthrie, in line to head health panel, says priorities include Medicare oversight, Covid-19 origins and price transparency

U.S. Rep. Brett Guthrie, R-2nd District (C-SPAN screenshot)

U.S. Rep. Brett Guthrie of Bowling Green discussed several health issues that Republicans will focus on when they take over the House during an interview with Caitlin Owens of Axios, including price transparency, investigations into the origin of Covid-19 and oversight of the Medicare drug-negotiation provision in the Inflation Reduction Act. 

Guthrie, a Republican who represents the Second District, is in line to lead the health subcommittee of the House Energy and Commerce Committee when the new Congress convenes next month. 

Asked about the evolution of the GOP's health agenda since the days when the party wanted to "repeal and replace" the Affordable Care Act of 2010, Guthrie said there are still things that need to be done with the ACA, noting that the Inflation Reduction Act recently "took $288 billion out of Medicare . . . and put it into subsidies for the Affordable Care Act." 

Actually, $288 billion was not literally removed from Medicare to pay for the ACA subsidies that were increased as part of the Inflation Reduction Act. Instead, the Congressional Budget Office estimated that provisions in the Act to lower prescription-drug costs in Medicare and reduce drug spending by the federal government would reduce the federal budget by $288 billion over 10 years.

Asked about this, Guthrie's office explained in an e-mail that under budget reconciliation rules, new spending cannot be added to the deficit without it being offset. The cost of the enhanced ACA subsidies was only $33 billion, but his office said, "Rep. Guthrie was making the argument, given the score and the reconciliation rules, that these savings from Medicare are being used to offset other parts of the Inflation Reduction Act, including ACA subsidies."

Guthrie's office said he introduced an amendment to the Act to not allow the savings from Medicare to be used to "pay for or offset any program, activity or expenditure that is not with respect to the Medicare program under such title," but the amendment was not considered. 

In the Dec. 7 Axios interview, Guthrie said of the ACA, "It's not sustainable.  . . . Prices keep going up, we subsidize it and it's pricing people out of the marketplace, which still needs to be addressed."

Guthrie said another priority for his subcommittee will be oversight of the implementation of the provisions in the Inflation Reduction Act that authorize Medicare to negotiate prices with drug manufacturers.

He said that the worst thing that can happen in the negotiations is that they will reduce innovation by drug makers, noting that one company has already announced it will not do a third-phase study of a new drug because of concerns about pricing going forward.

"We want more innovation, not less," Guthrie said. "And I'm afraid that's where we're going." 

The CBO estimates that the drug pricing and negotiation provisions in the Act "will have a very modest impact on the number of new drugs coming to market in the U.S. over the next 30 years; 13 fewer out of 1,300 or a reduction of 1%," reports the Kaiser Family Foundation.

Guthrie said Republicans will also focus on price transparency, calling it a bipartisan issue that has not yet been resolved. The Trump administration required hospitals to disclose the rates they privately negotiate with insurers and also provide online, searchable rates for 300 common services. 

"I think we need to make sure that information is out there," Guthrie said. "We need to expose if the price is right, then that's what the price is, but my guess is there seems to be a lot of steps in the supply chain of health care and we're not sure of the value of every step." 

Guthrie also said it will be important to investigate where Covid-19 originated as a way to prepare for future pandemics. "The purpose is to lead to legislation or information that we need to move forward," he said. "One of my biggest concerns as we look at what's moving forward is bringing trust back into our institutions. . . . We need to know that the groups that are supposed to put forth science are putting forth science in the public sphere so the policy makers can make decisions in the public and have confidence." 

As an example, he pointed to White House medical adviser Dr. Anthony Fauci's early dismissal of the idea that the virus came from a lab in China, even though "We now know that it probably did come from there." That is a matter of opinion, and the stated view of most experts is that the virus originated naturally.

Guthrie is co-chair of the Republican Healthy Future Task Force, which has put together a list of proposals that seeks to improve health-care choices for workers and small business owners, promotes innovation and transparency and lowers costs and increases options through competition. 

Inside Health Policy, reporting on its own interview with Guthrie, says that "If tapped as chair, he would focus on medical-product innovation, price transparency and health-agency oversight, including looking into FDA’s use of emergency use authorizations to ascertain lessons for future pandemics and the agency’s response to the infant-formula shortage to improve its handling of ongoing drug-supply issues."

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Two studies, one of seniors and the other of all ages, show Covid bivalent booster shots very effective at preventing severe disease

Katelyn Jetelina, right, interviews the CDC's Dr. Ruth Link-Gelles about boosters.

By Katelyn Jetelina

Your Local Epidemiologist

We got an early holiday present. One of the last puzzle pieces about the fall Covid-19 boosters was released today: data on the effectiveness against severe disease. We have nine lab studies and one real-world study showing the fall boosters provide:

• Greater protection against infection and transmission, by boosting our first line of defense—neutralizing antibodies. (See my previous updates here.)
• Broader protection, or the ability to create antibodies that “see” more virus parts and “attach” more strongly compared to the antibodies we have right now. (See my previous updates on this here.)
• Longer protection against infection and severe disease, even just by a few months. We are still at the mercy of time for this, but have promising data from the Beta bivalent vaccine clinical trials.

Until now, we didn’t know whether they provided additional protection against severe disease and hospitalization. We now have three real world analyses, and things are looking good.

The CDC released studies answering the same question from two different perspectives. The first study , in 22 large hospitals in 18 states, found that among patients 65 and older with no Covid-19 vaccination, effectiveness of the fall booster against hospitalization was 84%; among who had received mRNA vaccines, effectiveness was 73%.

The second study, at nine hospitals in 11 states, looked at emergency room and urgent care visits (a proxy for more severe disease) for patients of all ages. It found that among people with no vaccination, effectiveness of the fall booster against emergency room or urgent-care visits was 56%. Among the vaccinated, effectiveness was less with more recent vaccination (reflecting the fact that vaccine protection wanes over time). If someone got their last mRNA shot two to four months ago, effectiveness was 31%. If the last dose was more than a year ago, effectiveness was 50%.

Dr. Ruth Link-Gelles, program lead of Covid-19 vaccine effectiveness at the CDC, told me, "These vaccines provide pretty substantial additional protection, especially if it's been a long time since you got you last monovalent dose." But we still don't know how long protection will last, so studies will continue.

Bottom line: The fall boosters work. There is now evidence fall boosters broaden protection, help against infection, protect against severe disease, and (we think and hope) provide longer protection. There is one major problem though: more than 150 million people are eligible for a fall booster in the U.S. and have yet to get one.

Link-Gelles blamed that on Covid fatigue and people seeing fewer hospitalizations and deaths from the disease, but she said now is good time to get boosted because of holiday gatherings, especially with grandparents, who are more vulnerable. She said 28 million Americans over 65 have not gotten a booster.

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How to not pick up pounds during the holidays, and how to eat in general: Consume more in the morning, less in the evening

By Michael Crupain, Michael Crozien and Ted Spiker
National Geographic

Heading into the winter holidays, 'tis the time for eating — and plenty of it. But food can affect your body differently throughout the day, so let’s take a closer look at that internal timepiece.

Understanding your biological clock is the key to shifting your body to optimal function. The biological clock is your body’s automated energy conservation system, influencing behavior on a cellular level from sunset to sunset.

Some people live in opposition to their bodies’ natural instincts — and this is an important example of how food plays a role in the rhythm of life. About 15 million workers in the United States have shift jobs; they work nights and sleep during the day. Studies examining the health of these populations find that they have increased rates of both sleep issues and obesity. People who work the night shift tend to gain more weight than people with normal nine-to-five schedules.

Although we don’t completely understand the cause, the main suspect behind the disturbances in the health and metabolism of shift workers is that they are fighting their natural circadian rhythms — and their body’s instinctual notions of when to eat.

Our body clock and our food clock have a natural tension point: We crave food at night, but we function better when we eat earlier. Research has shown that in the absence of normal light and time cues, people are naturally the hungriest around the time that would correspond to 8 p.m. and least hungry at the time that would correspond to 8 a.m.

That basic instinct was an advantage in the early days of human existence, but in modern times it may be hurting us. One of the body’s most important hormones for dealing with food is insulin, which regulates the amount of glucose in the blood.

The body’s secretion of and response to insulin follows a circadian rhythm. Studies suggest that sensitivity to insulin is highest during active phases (when we are awake) and most insulin resistant during their typical sleeping hours. Mealtime has a big effect on what happens to your blood-sugar levels; if you eat the same meal in the morning and at night, your blood sugar will increase more in the evening than in the morning.

Fat cells also appear the most insulin sensitive early in the day, with a peak at noon; they are about 50 percent more sensitive midday than they are at midnight. This means that your body is primed to eat at certain times. In fact, eating at the “wrong” time can throw off everything. One study found that those who ate lunch earlier lost more weight than those who ate later. A related study found that those who ate later burned less energy.

Research has shown that our body’s natural rhythm is to want food later, even though it has a negative effect on our overall health. Why are our body’s food cravings out of sync with our circadian rhythm? During periods when we didn’t know when our next meals would come, the human body may have evolved the need for a food-storage mechanism. In that era, humans didn’t live long enough to experience the harms of late-night eating—and in any case, the body only cared about surviving the next day, not the next decade.

Today, we no longer need that extensive storage ability because food is plentiful. We have to consciously override our ancient instincts and make smart choices about when to eat—and that means more in the morning, less later on.

This excerpt is adapted from What to Eat When: A Strategic Plan to Improve Your Health and Life Through Food, originally published by National Geographic Partners, LLC, on December 31, 2018. Copyright © 2019 Michael F. Roizen and Michael Crupain. Compilation copyright © 2021 National Geographic Partners, LLC. All rights reserved.

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Federal audits reveal widespread overcharges, other errors in Medicare Advantage plans; Humana and United stand out

Illustration by Eric Harkleroad, Kaiser Health News, from federal Medicare data

By Fred Schulte and Holly K. Hacker
Kaiser Health News

Recently released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans, with some plans overbilling the government more than $1,000 per patient a year on average.

Summaries of the 90 audits, which examined billings from 2011 through 2013 and are the most recent reviews completed, were obtained exclusively by Kaiser Health News through a three-year Freedom of Information Act lawsuit, which was settled in late September.

A review of the audits reveals that health insurers that issue Medicare Advantage plans have repeatedly tried to sidestep regulations requiring them to document medical conditions the government paid them to treat.

UnitedHealthcare and Louisville-based Humana, the two biggest Advantage insurers, accounted for 26 of the 90 contract audits over the three years.

Eight audits of United plans found overpayments, while seven others found the government had underpaid. Humana's 11 audits with overpayments included plans in Florida and Puerto Rico that CMS had audited twice in three years.

The Florida Humana plan also was the target of an unrelated audit in 2021 by the Department of Health and Human Services inspector general. That audit, which covered billings in 2015, concluded Humana improperly collected nearly $200 million by overstating how sick some patients in its Medicare Advantage plans were. Officials have yet to recoup any of that money, either.

In an email, Humana spokesperson Jahna Lindsay-Jones called the audit findings "preliminary" and noted they were based on a sampling of 2015 claims.

"While we continue to have substantive concerns with how CMS audits are conducted, Humana remains committed to working closely with regulators to improve the Medicare Advantage program in ways that increase seniors' access to high-quality, lower cost care," Lindsay-Jones wrote.

Medicare Advantage is an alternative to original Medicare and is primarily run by major insurance companies. As it has gained popularity among seniors, CMS has fought to keep its audit procedures, and the mounting losses to the government, largely under wraps. That approach has frustrated both the industry, which has blasted the audit process as "fatally flawed" and hopes to torpedo it, and Medicare advocates, who worry some insurers are getting away with ripping off the government.

Insurers can have some claims excluded from the audit by claiming hardship, such as the closure of clinics where the services were rendered. Hardship requests and other documents obtained by KHN in the lawsuit shed light on the secretive audit process.

Reacting to the audit findings, Iowa Sen. Chuck Grassley called for “aggressive oversight” to recoup overcharges. Grassley is the top Republican on the Senate Finance Committee, which oversees health insurance. He said, “CMS must aggressively use every tool at its disposal to ensure that it’s efficiently identifying Medicare Advantage fraud and working with the Justice Department to prosecute and recover improper payments.”

How Medicare Advantage works

Medicare reimburses Medicare Advantage plans using a complex formula called a risk score that computes higher rates for sicker patients and lower ones for healthier people. But federal officials rarely demand documentation to verify patients' conditions. Only about 5% of Advantage plans are audited each year.

When auditors came calling, the previously hidden CMS records show, they often found little or no support for diagnoses submitted by the Advantage plans, such as chronic obstructive pulmonary disease, diabetes, or vascular disease. Though auditors look at the records of a relatively small sample of patients, they can extrapolate the error rate to the broad population of patients in the Medicare Advantage health plan and calculate millions of dollars in overpayments.

Overall, CMS auditors flagged diagnostic billing codes — which show what patients were treated for — as invalid more than 8,600 times. The audits covered records for 18,090 patients over three years.

In many cases, auditors found that the medical credentials of the health-care provider who made the diagnosis were unclear, the records provided were unacceptable, or the record lacked a signature as required. Other files bore the wrong patient’s name or were missing altogether.

The rates of billing codes rejected by auditors varied widely across the 90 audits. Seven health plans had fewer than 10% of their codes flagged, but the rate of invalid codes topped 80% at a defunct New York HMO.

One Medicare Advantage health plan submitted 57 hardship requests, more than any other insurer, though CMS approved only six. In three cases, the health plans said the records were destroyed in floods. Another cited a warehouse fire, and two said the records couldn’t be turned over because a doctor had been convicted for his role in illegally distributing millions of oxycodone pills through his network of pain clinics.

Other Medicare Advantage health plans said they had no luck retrieving medical records from doctors who had moved, retired, or died — and in some cases been arrested or lost their licenses for misconduct.

CMS found most excuses wanting, telling health plans that it granted exceptions only in “truly extraordinary circumstances.” CMS said it receives about 100 of these requests for each year it audits and approves about 20% of them.

Dara Corrigan, a CMS deputy administrator, said that as a “general matter,” its Medicare Advantage audits “are not designed to detect fraud, nor are they intended to identify all improper diagnosis submissions.”

Protecting Taxpayers

The costs to taxpayers from improper payments have mushroomed over the past decade as more seniors pick Medicare Advantage plans. CMS has estimated the total overpayments to health plans in the 2011-13 audits at $650 million, but how much it will eventually claw back remains unclear.

Payment errors continue to be a drain on the program. CMS has estimated net overpayments to Medicare Advantage plans triggered by unconfirmed medical diagnoses in 2022 at $11.4 billion.

“This isn’t a partisan issue,” said Sen. Sherrod Brown (D-Ohio). “I’ve requested a plan from CMS as to how they plan to recoup these taxpayer-funded overpayments and prevent future overbilling.”

Leslie Gordon, acting director of health care for the Government Accountability Office, the auditing arm of Congress, said CMS needs to speed up the audit and appeals process to get quicker results.

“That is money that should be recovered,” Gordon told Kaiser Health News.

As Medicare Advantage faces mounting criticism from government watchdogs and in Congress, the industry has tried to rally seniors to its side while disputing audit findings and research that asserts the program costs taxpayers more than it should.

America's Health Insurance Plans, an insurance industry lobby, criticized Kaiser’s reporting on the newly released audits as “misleading,” while the pro-industry group Better Medicare Alliance said the audits were “in some cases, more than a decade old.”

Jeff De Los Reyes, a senior vice president at the GHG Advisors health-care consulting group, said he believes the health plans have improved their documentation in recent years. But, he said, “Coding is never 100% perfect and there will be errors despite the best of intentions.”

Rep. Katie Porter, a Democrat from Southern California and a critic of Medicare Advantage, countered: “When big insurance bills taxpayers for care it never intends to deliver, it is stealing our tax dollars.”

Kaiser Health News is a national newsroom that produces in-depth journalism about health issues. Together with policy pnalysis and polling, KHN is one of the three major operating programs of the Kaiser Family Foundation, an endowed nonprofit organization providing information on health issues to the nation.

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58% of Kentucky adults say the pandemic is over for them, and resistance among the unvaccinated to getting a shot is increasing

By Melissa Patrick
Kentucky Health News

Four in seven Kentucky adults (57%) think the pandemic is over in the state and more than 80% say concerns about Covid-19 will not keep them from attending or hosting gatherings during the holiday season, according to a Foundation for a Healthy Kentucky poll taken from Oct. 29 to Dec. 4. 

"Kentuckians are, I think as a general matter, determined that this pandemic is over," Ben Chandler, president and CEO of the foundation, said Tuesday. "They're going to behave like it for the most part during the holidays."

Chandler that's appropriate, if people are up-to-date on their Covid-19 and flu vaccinations, keeping their hands washed and staying home when they are sick. But the poll found that resistance among unvaccinated Kentuckians to getting vaccinated to protect them from the disease continues to increase.

Foundation for a Healthy Kentucky graph; click on it to enlarge.

The poll found that 59% of Kentucky adults said it is "not likely at all" that Covid-19 will prevent them from attending or hosting a small gathering with friends and family this holiday season and 22% said it is "not too likely" that Covid-19 will impact this decision. Only 4.4% said it is "very likely" and 12.5% said it is "somewhat likely" that Covid-19 will affect their decision to gather with others over the holidays. 

Being vaccinated didn't seem to matter when making the decision to attend or host a small holiday gathering, as 73% of those who were vaccinated with at least one booster, 86% of those who were  vaccinated with no boosters and 91% of those who were not vaccinated said they were either not likely at all or not too likely to let Covid-19 impact their decision to attend or host a small holiday gathering

Further, the poll found that more men (69%) than women (50.2%) said they were not likely at all to let Covid-19 prevent them attending or hosting a small holiday gathering.

Hanukkah begins Sunday, Dec. 18; Christmas is Sunday, Dec. 25, and Kwanzaa starts Dec. 26.

The poll was the latest edition of the Vaccines in Kentucky Poll, which the foundation has sponsored four times since February 2021.When asked if they thought the pandemic was over in Kentucky, 41.5% of the respondents said it was. That was an increase over the summer, when 31.7% said it was. 

The share of Kentucky adults who said the pandemic was not over decreased to 56.6% in the latest poll, down from 65.4% in the summer. 

And when asked if the pandemic was over as it pertains to their own lives, 58.1% of the respondents said it was, up from 53.3% in the summer poll. This rate was highest among Kentucky adults who were not vaccinated (80.1%), followed by those vaccinated but not boosted ( 61%) and those vaccinated with at least one booster (42.2%).  

Foundation for a Healthy Kentucky graph; click on it to enlarge.

The poll also found that nearly three-quarters of vaccinated Kentuckians (73%) were either "very likely" or "somewhat likely" to get an annual Covid-19 booster if that were recommended like annual flu shots are.

The groups of vaccinated Kentuckians most resistant to getting an annual Covid-19 booster in the future were those who live in suburban counties (37%) and those between the ages of 30 and 45 (39.5%), either saying they were either "not too likely" or "not likely at all" to receive an annual booster. 

In rural and urban counties, about 75% of Kentucky adults in these areas said they would be very or somewhat likely to get a booster if recommended.

Foundation for a Healthy Kentucky graph; click on it to enlarge.

Since the first Vaccines in Kentucky Poll was taken in February 2021, an increasing share of Kentucky adults have said that getting vaccinated is a personal choice, rather than part of everyone's responsibility to protect the health of others. That view rose to 65% in the latest poll, marginally more than the 63% found this summer. In February 2021, shortly after vaccines became available, polling showed a nearly even split on the question. (Each number in the statewide sample has an error margin of plus or minus 3.4 percentage points.)

The belief that vaccination is a personal choice is greatest among rural Kentuckians, with 72% of them saying they agree with that statement and 27% of them saying getting vaccinated is everyone's responsibility to protect the health of others. In suburbs, the numbers were 66% and 32%, respectively; in cities, they were 57.5% and 41.8%. 

The latest poll also found that the number of unvaccinated people in Kentucky who said they will "definitely not get the vaccine" has increased to 75.2% in the latest poll, up from 63.5% in the summer. 

The poll, which was funded by the foundation, was conducted by the University of Cincinnati's Institute for Policy Research. It surveyed a random sample of 855 Kentucky adults via landline and cell phones.

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New cases of the flu outnumber new cases of the coronavirus in Kentucky, but deaths from Covid-19 went back up last week

Centers for Disease Control and Prevention map, adapted by Kentucky Health News

By Melissa Patrick and Al Cross
Kentucky Health News

Newly confirmed cases of influenza are outpacing new cases of the coronavirus in Kentucky, and the state is among the national leaders in new flu cases. Meanwhile, though, deaths from Covid-19 are going up.

The Centers for Disease Control and Prevention has Kentucky, 10 other states and the District of Columbia in the “very high” category of flu-like illnesses. That's based on reports for the week ending Dec. 3, when Kentucky had at least 7,192 new cases. The previous figure was 6,398. The CDC says "at least" because unlike Covid-19, flu cases do not have to be reported to health authorities.

In the week ended Sunday, Dec. 11, the state Department for Public Health reported 5,214 new coronavirus cases, an average of nearly 745 per day. That's 9% lower than the week before, when the state was averaging 821 new cases per day. Of last week's cases, 14.5% were in people 18 and younger.

The state attributed 51 more deaths to Covid-19, up from 28 the week before and higher than a month of weekly reports before that, which showed an average of 45 deaths per week. Kentucky's pandemic death toll totals 17,580. 

The flu has killed at least 29 Kentuckians this season. The Lexington-Fayette County Health Department reported Dec. 7 that six were in its jurisdiction. “The flu is hitting hard in Lexington,” spokesman Kevin Hall said in an email. “There are already more total lab-reported cases in the first 9 weeks this season than in the previous three years combined.”

The state's weekly Covid-19 report shows that the share of Kentuckians testing positive for the coronavirus was 8.63%, up just a bit from 8.14% the week before. The figures do not include at-home tests. 

All said, it appears that when it comes to cases and positivity rates, Covid-19 Kentucky remains on a the rough plateau seen for about three months.. 

Covid-19 hospitalizations barely increased last week, after taking a big jump in the last one, and the number of severely ill patients went down. Hospitals reported 388 patients with Covid-19 Monday morning, an increase of five over the prior Monday; 45 were were in intensive care, down 14; and 19 were in need of mechanical ventilation, down 10. 

The weekly new-case incidence rate was 15.82 cases per 100,000 residents, down from 16.29 the week before. The top 10 counties were Bath, 38.9 cases per 100,000;  Powell, 33.5; Washington, 33.1; Leslie, 30.4; Calloway, 30; Hart, 29.3; Simpson, 27.7; Metcalfe, 27; Montgomery, 26.9; and Union, 26.8.

The New York Times ranks Kentucky's coronavirus incidence rate 20th among states, even with a 16% drop in cases in the last two weeks. 

Nationwide, the Times reports, "Conditions are worsening across the country, with reported cases and hospitalizations up more than 25 percent in the past two weeks and test positivity rates rising quickly."

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