Science
California Health and Human Services chief Dr. Mark Ghaly to step down
![California Health and Human Services chief Dr. Mark Ghaly to step down California Health and Human Services chief Dr. Mark Ghaly to step down](https://ca-times.brightspotcdn.com/dims4/default/09f93f9/2147483647/strip/true/crop/4928x2587+0+346/resize/1200x630!/quality/75/?url=https%3A%2F%2Fcalifornia-times-brightspot.s3.amazonaws.com%2F5c%2F68%2F3a9f2ebf4d0d883a7e08743b24c6%2Fap20280768589085.jpg)
Dr. Mark Ghaly is stepping down as head of the California Health and Human Services Agency after an eventful tenure that included the eruption of the COVID-19 pandemic, Gov. Gavin Newsom announced Friday.
Newsom called Ghaly “a driving force for transformative changes to make healthcare more affordable and accessible,” whose leadership during the pandemic “saved countless lives and set the stage for our state’s strong recovery.” The governor’s office also credited Ghaly with reimagining Medi-Cal, the California Medicaid program; overhauling the state behavioral health system; and launching efforts to make crucial medications more affordable, among other initiatives.
Ghaly was appointed in 2019 to lead the state agency, which oversees a slew of California departments and offices that handle public health, mental health, assistance to people with developmental disabilities and a range of other health and social services.
Ghaly will stay at the agency through the end of the month. Newsom is appointing California Department of Social Services Director Kim Johnson to replace Ghaly in October. The Times talked to Ghaly this week about his tenure.
This conversation has been edited for length and clarity.
What were the three biggest challenges you faced at Health and Human Services, and what are the three biggest challenges facing your successor?
One of the big ones was navigating, under the governor’s leadership, this state through our COVID response — that obviously is a huge one. The second one, I think, is really addressing a comprehensive overhaul of our safety net …. And then the third piece has been, how do we make sure that for all Californians, we’re making progress to keep these basic necessities affordable, like healthcare … ?
The successor will certainly need to continue implementing the really thoughtful policy agenda that has stitched together … this real tapestry of programs and services that, when implemented successfully, I think really changed the arc of the lives of a lot of Californians, in particular the most vulnerable.
The focus on the principles of equity … I have no doubt that will continue to be a focal point. And then just on the last point, there’s a lot of pundits and detractors on the affordability agenda: Can we make thoughtful policy decisions and implement them to make things more affordable for Californians?
Having started a year before the pandemic, if you knew then what you know now, is there anything that you would do differently, in terms of the COVID response in California?
If you had told me that we had to successfully navigate California — the largest state in the nation — with one of the lowest end death rates from the disease, with a very thoughtful path to economic recovery, and while achieving that, build up and grow the California Health and Human Services Agency’s investment by nearly 50% over these six years, I would have said, ‘Sign me up for that job any day of the week. What a privilege.’
But of course, there are things that happened during the pandemic, that as it goes on and you think through it, you hope you may do something different in the future. And I would say No. 1 on the list for me … is how we supported young people with learning and school.
You’ll remember early on, the question about how to handle … schools as places where people become infected and go home and infect other vulnerable people — we were learning more about this sneaky airborne virus that mutated as it went along. And we made decisions in this state to have kids stay home, [to] really lean into virtual distance learning, and it stuck much longer than I think people had hoped …. And the governor put together a number of programs that supported their education in all sorts of forms.
But I think knowing what we know now about both the virus, the length of the pandemic — some of that information would have been helpful in those early days, weeks, months, around how we supported kids in schools.
During your time at the agency, we’ve seen some major changes in how California handles severe mental illness: the opening of CARE Court and Senate Bill 43, which broadened the definition of grave disability for involuntary treatment …. Do you think it is bringing about the change that was hoped for?
When I say the full transformation of the safety net, I can think of no better issue, single issue to focus on than behavioral health. Under Gov. Newsom’s leadership, we have changed from a focus on mental health to behavioral health, to include the very real need to focus on addiction and substance use disorders, its connection to things like housing instability and homelessness, its connection to incarceration.
When I came into this job, in my actual interview with the governor before I was appointed, we talked about how much we wanted to change the trajectory of people with serious mental health and behavioral health conditions, because in so many ways, the often ending place for individuals was jail, incarceration, prison ….
[With CARE Court] our goal was not just to get people in the line, but to get people in the front of the service line that so often are left outside to decompensate … until they do something that gets them arrested, and then suddenly we start to wrap around some of the care that they need, but often in the worst environment possible.
I do think the governor’s many programs that focus on behavioral health … when you take a step back and look at it all together, it’s essentially giving Californians and local government tools that they never had to be able to dream differently and put together a program that, I think, really gives us a credible shot to catch people much earlier in their trajectories with the challenges of behavioral health conditions, rather than what we so frequently do ….
I think we’re going to see these programs really pay off as they become more deeply seated [and] we work through some of the obvious operational challenges.
California has been expanding Medi-Cal, its Medicaid program, to cover many more people, but there’s been concern from healthcare providers that it doesn’t pay them adequately, which results in a shortage of providers willing to accept Medi-Cal patients. How should California fix that problem?
A: I often tell the governor, ‘Look, there’s four basic things when you talk about health services. You think about benefits, you think about access, you think about quality, you think about eligibility.’ And I think the governor has addressed all of those areas ….
We made pretty big investments in some of what I’ll call the bread-and-butter rates in Medicaid, bringing them either to 100% or close to 100% of what Medicare pays in this part of the country. Because of some budget challenges, we had to back off some other planned investments for this coming year, but as that budget starts to hopefully turn around … I know those will be an ongoing place of focus.
Mind you, Medicaid has a lot of different ways for providers and plans to receive payment …. I think as you look at that in totality, the opportunities to recruit providers to take care of the Medicaid population is stronger than it was when Gov. Newsom took office six years ago.
That all said, this has to be an ongoing sort of balance and conversation about how we continue to support this program, because one in three Californians now depend on Medicaid. So many kids — more than 33%, closer to 50% of kids — are dependent on Medicaid. When you have that vital a safety net program, we must continue to keep our eye on all four of those elements: quality, access, eligibility and benefits.
Earlier this year, the Office of Health Care Affordability announced a target of 3% annual growth in healthcare spending, to be phased in over time. How do you anticipate that healthcare providers will reach that target, given the kinds of pressures that have ramped up costs in the past — things like labor costs and inflation?
I think it’s going to require some real movement away from our traditional views on how you operate healthcare. We’re going to really have to make some decisions about moving more things upstream — promoting prioritizing things like preventative care and primary care, helping support other access points for people where access is challenging, and frankly speaking, really looking at some of the benefits of each of the different entities in the whole healthcare delivery system ….
We don’t expect everyone in California to always be there. There will be some conditions that legitimately push the markets in a different direction.
But as a whole, if we don’t chase a target that is both aggressive and achievable, that affordability problem that so many Californians face won’t just not get better — it is likely to get worse.
Reporters who cover the Capitol have raised concerns about interviews like this becoming rare. I know for me, personally, it’s been unusual to get anyone from the Department of Public Health on the phone. Why aren’t these departments routinely speaking directly to the media, instead of sending written statements?
Frankly, it is less about a lack of interest in speaking directly to the media — often, the interviews allow directors and leaders to very clearly convey nuance and important points.
My experience has been, so often the questions that reporters want answers to have some ability to be answered very clearly in a written form. And so we’ve used that frequently — not to sort of hide behind something or avoid the live interview — but because it seems and has been adequate in many of those conversations or requests.
One of the things I know you’ve been working on lately is this state plan on services for Californians with developmental disabilities. In California, these services have long been coordinated through a system of nonprofits called regional centers, which contract with the state. Do you believe that system is working for Californians and their families, and if not, what do you think needs to change?
One of the most important themes that got amplified during COVID was this notion of building trust through transparency …. And in my time and experience, I have heard loud and clear [from consumers and their families] that this system is not as transparent as it can be or that it should be, and I agree with that.
So part of the work of this new strategic plan … is recognizing that Gov. Newsom did something unprecedented. He took a rate study from before he came into office and implemented it …. We’re on a trajectory to fully implement that soon [Ghaly is referring to increases in rates paid to regional center vendors that provide services to people with disabilities] …. To say it plainly, we — given the level of investment — should become a lot more of a system that’s able to say “yes” to consumers, rather than “no” or delay.
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Science
How parents and caregivers can evaluate the research on MERT and other potential treatments
![How parents and caregivers can evaluate the research on MERT and other potential treatments How parents and caregivers can evaluate the research on MERT and other potential treatments](https://ca-times.brightspotcdn.com/dims4/default/a206319/2147483647/strip/true/crop/6122x3214+0+434/resize/1200x630!/quality/75/?url=https%3A%2F%2Fcalifornia-times-brightspot.s3.amazonaws.com%2F32%2Fc9%2Fa86d2f274822bd2785c3025a31ce%2F1375080-me-wave-neuro-brain-treatment-jlc-1127-53273.jpg)
Wave and licensees also highlight a 2022 paper by a technician at a licensee clinic in Australia who is also a doctoral candidate at Australia’s University of the Sunshine Coast.
It looks at data from 28 patients at two MERT clinics in Australia whose brains showed “significant improvement” in their individual alpha frequency waves after treatment.
Although some previous research has found correlations between atypical alpha wave frequency and autism diagnoses, six scientists told The Times that there isn’t yet enough evidence to understand how changes in alpha waves affect autistic traits, or any scientific consensus on whether “improvement” in this pattern of brain activity has any meaningful effect on autistic behaviors.
The report is a retrospective chart review, which examines existing data from patients’ medical records and is often used to identify interesting outcomes worthy of further study.
By design it does not include a control group, which is what allows researchers to identify whether any changes they see are related to the variable they are studying. Its authors noted in the paper that findings are preliminary and require further study.
“Because this was not a controlled trial or study, [the cause of the changes] could have been anything including placebo effect, any additional therapies the children were receiving, etc.,” said Lindsay Oberman, director of the Neurostimulation Research Program at the National Institute of Mental Health.
Medical research follows a hierarchy of evidence. At the bottom are anecdotes and observations: valid points of information that alone aren’t enough to draw broad conclusions from.
Above that are observational studies that collect and analyze preexisting data in a systematic way. And at the top are randomized controlled trials, which are designed to eliminate as much bias as possible from the experiment and ensure that the thing being studied is responsible for any changes observed.
“Families need to know that there is this gold standard for studies — to make sure that something works to help people with autism, it needs to have what’s called a randomized controlled trial,” said Alycia Halladay, chief science officer at the Autism Science Foundation.
Science
Officials confirm H5N1 bird flu outbreaks in three California dairy farms
![Officials confirm H5N1 bird flu outbreaks in three California dairy farms Officials confirm H5N1 bird flu outbreaks in three California dairy farms](https://ca-times.brightspotcdn.com/dims4/default/c7a99b5/2147483647/strip/true/crop/6476x3400+0+459/resize/1200x630!/quality/75/?url=https%3A%2F%2Fcalifornia-times-brightspot.s3.amazonaws.com%2Fee%2Fbe%2F6386a1ec4e869216afdced3ffdd9%2Fla-photos-1staff-534244-me-0501-cattle-auction-11-cmc.jpg)
Federal officials have confirmed that three California dairy herds have suffered outbreaks of H5N1 bird flu, due most likely to the transportation of cattle and not exposure to diseased birds.
Health officials announced last week that they suspected cows at three Central Valley dairies had contracted the illness, and were awaiting testing for confirmation. On Tuesday, officials said those tests revealed that the strain of virus that infected California herds was nearly identical to that found in Colorado dairy herds — suggesting the infections were the result of interstate transfer of cattle.
The B3.13 genetic sequence found in the infected cows was clearly the result of “anthropogenic movement; essentially zero chance it was an independent spill from wild birds into these dairies,” said Bryan Richards, the Emerging Disease Coordinator at the U.S. Geological Survey’s National Wildlife Health Center. “So, if anyone is trying to blame wild birds: Nope!”
In a statement from the California Department of Food and Agriculture, officials said there were no confirmed human cases of H5N1 bird flu in the state, and neither the U.S. Centers for Disease Control and Prevention nor state officials see this development as a significant public health threat; the risk to humans is considered low.
“The primary concern is for dairy workers who come into close contact with infected dairy cows,” said officials in the statement. Four cases of human infection from dairy have been reported in other states, including Texas, Colorado and Michigan.
Officials also said the state’s supply of milk and dairy foods is not affected. Contaminated milk is not permitted to be sold and pasteurization inactivates the virus, “so there is no cause for concern for consumers from” pasteurized milk or dairy items.
“We have been preparing for this eventuality since earlier this year when [hightly pathogenic avian influenza] detections were confirmed at dairy farms in other states,” said CDFA Secretary Karen Ross. “Our extensive experience with HPAI in poultry has given us ample preparation and expertise to address this incident, with workers’ health and public health as our top priorities.”
Hoping to stop or slow the spread of the virus, the U.S. Department of Agriculture in April limited the movement of some interstate cattle transfers, mandating that lactating dairy cattle get tested for bird flu before any transfer, and that livestock owners report any positive cases before moving the animals across state lines.
Large-scale cattle movement is standard practice among U.S. dairy farms, and many send days-old calves away to be raised at farms that specialize in rearing calves. Once the calves are grown, the females are generally sent back to the dairy where they were raised — or to another dairy — while males are sent to feeding lots, veal farms or straight to slaughter.
In 2022, research from a team out of Texas Tech University showed that 1 in 10 dairy-born calves were raised off-site at these “calf ranches.” That rose to almost 5 in 10 when researchers looked at farms that had more than 500 lactating cows.
The researchers noted that these operations are often located hundreds, if not thousands, of miles from the dairy farms where the animals were born. “It is not uncommon to see operations feeding over 20,000 pre-weaned calves in the Central Great Plains and West regions,” wrote the authors.
This large-scale transfer of cattle is one of many biosecurity weak spots that observers and critics of the dairy industry say is contributing to the spread of the disease.
According to a USDA map, 197 herds have been affected in 14 states since March, when the virus was first reported in U.S. dairy cattle.
In an interview from July, Maurice Pitesky — an associate professor with a research focus on poultry health and food-safety epidemiology at UC Davis — noted that the dairy industry “is uniquely susceptible to the potential for disease transmission from a single dairy” in part because of these cattle transfers.
Commercial poultry farms, which have been contending with avian flu for decades, have the advantage of being closed systems in that most farms have physical barriers such as fences and walls that keep wildlife, including waterfowl, away from the commercial birds. In contrast, dairies are open to the outside environment and in many cases — such as the flushing of dairy stalls with lagoon water — purposely introduce potentially infected water (from dairy lagoons where waterfowl roost) into their facilities.
“When you go on to a poultry facility, you have to fill out paperwork that says you haven’t touched any other birds for 48-72 hours, because they’re so concerned about disease transmission,” he said, underscoring the biosecurity of these operations.
Surveillance of the virus is also complicated by the fact that H5N1 infected cows show only subtle signs of infection — lethargy, decreased milk production, etc. Poultry, on the other hand, die.
Without mandating on-site testing, or milk-pool testing — in which farmers test samples of the milk they’ve pooled from their cows — it’s hard to know where the virus is.
For now, California dairy farmers are working to keep an eye on their cows for signs of illness. And according to Michael Payne, a researcher and outreach coordinator at the Western Institute for Food Safety and Security at UC Davis, state and local health officials are working to understand and perhaps limit the movement of the disease.
Payne said the state has quarantined the three herds where infections have been confirmed. And all animal movement on or off those farms now requires permits.
“There are no lactating cows leaving those herds right now,” he said, adding that “any younger stock that need to go, or animals that need to go to slaughter, or dead animals that need to be moved … all of that is being permitted through the creation of a pretty extensive biosecurity program that is being overseen and developed with California CDFA employees, veterinarians, veterinary medical officers.”
He said he’s been on the phone for days fielding calls from producers and helping them follow best practices as they watch for signs of infection.
The location of the herds has not been divulged. The federal government provides county data on infected poultry, but only statewide figures for dairy.
“We do not tend to share that because sometimes there are only one or two dairies in a certain county, and due to privacy concerns, we tend to refer folks to the state,” said Will Clement, a spokesman for the USDA. “If the state department of ag wants to share that information, that is their purview. But we don’t want to out anybody, if you will, in any specific region,” he said.
A spokesman for the state department of agriculture said his agency is not naming specific counties.
Science
The new COVID vaccine is here. Why these are the best times to get immunized
![The new COVID vaccine is here. Why these are the best times to get immunized The new COVID vaccine is here. Why these are the best times to get immunized](https://ca-times.brightspotcdn.com/dims4/default/1159eed/2147483647/strip/true/crop/7369x3869+0+623/resize/1200x630!/quality/75/?url=https%3A%2F%2Fcalifornia-times-brightspot.s3.amazonaws.com%2F84%2Fa0%2F4bce7b184d2484138d90bf641cb6%2F1473216-me-0828-covid-vaccines-cmh-08.jpg)
With the new COVID-19 vaccinations for the 2024–25 season arriving in California and across the nation, an important question arises: When is the best time to get the shot?
The U.S. Centers for Disease Control and Prevention says September and October are generally the best times for most people to get the COVID immunization.
But which month is better for your particular situation? Should you rush to get the shot now, considering the high levels of COVID circulating in California? Or should you wait till closer to Halloween in hopes that doing so will extend more robust protection against infection through Christmas and into the New Year?
And what about people who got infected recently or got the old immunization formula a couple of months ago?
Providers in California began administering COVID-19 immunizations using the latest formulation this week. Appointments are available at CVS, Walgreens, Rite Aid, Ralphs, Vons, Albertsons, Pavilions and Safeway stores. Kaiser Permanente expects to begin making vaccines available by mid-September and possibly earlier in some locations. Sutter Health is also aiming for a mid-September rollout.
The CDC recommends that everyone 6 months old and older get the updated COVID-19 vaccination, which was authorized for distribution by the U.S. Food and Drug Administration last week.
Here are some factors to consider:
The case for October
The head of the CDC suggested that the most important decision is not when to get the vaccination, but just getting it.
“The important part is getting it done,” CDC Director Mandy Cohen said at a briefing. “If September, from a calendar perspective, works better for folks, great. October gets you closer to the winter season. But the important part is getting it done.”
Dr. Peter Chin-Hong, a UC San Francisco infectious disease expert, makes the case for an October dose.
Getting the COVID-19 vaccine now or in October will offer good protection against severe disease for at least a year, he said. But the best protection against infection is roughly six to eight weeks after getting vaccinated — although that window can be wider if the vaccine is a close match to circulating subvariants, Chin-Hong said.
“To me, the sweet spot is always October,” he said, as it’s closer to the peak of the late fall and winter respiratory virus season, as well as major holidays like Thanksgiving, Christmas and New Year’s. Based on wastewater data during the last two winters, COVID peaked in California and nationally either the last week of December or the first week of January.
The case for September
But Dr. Elizabeth Hudson, regional chief of infectious diseases for Kaiser Permanente Southern California, suggested that people get the vaccine as soon as they can.
“The way that COVID is looking now — with just the sheer volume of cases — this is not a year that you want to wait,” Hudson said. “As soon as you are able to get the vaccine, you should get it.”
COVID-19 continues to circulate at a very high level nationally and in California. Depending on the region, health officials are “potentially seeing some indication of a plateauing of the summer increase in COVID-19,” said Dr. Demetre Daskalakis, who heads the CDC’s National Center for Immunization and Respiratory Diseases. Still, “we’re not out of the woods yet,” he added. Trends won’t be clear until there are a few weeks of sustained declines, and that hasn’t happened yet.
Not only is the hyperinfectious KP.3.1.1 subvariant gaining dominance nationwide, doctors also are closely watching a new upstart subvariant, XEC, that has been getting attention in Europe.
Dr. Peter Marks, the FDA’s vaccine chief, said in an Aug. 23 briefing that he has scheduled his vaccine appointment.
“Getting vaccinated now probably gives you the maximum amount of protection that you can get against what’s currently circulating, and that will last for several months, at least,” he said.
What about seniors and immunocompromised people?
Chin-Hong said there are certain people he would urge to get the COVID-19 vaccination as soon as possible. That includes those who are older or immunocompromised and haven’t been vaccinated in more than a year. Those groups are at highest risk for being hospitalized with COVID, Chin-Hong said.
“I would love them to get protected,” he said.
Dr. Eric Topol, director of the Scripps Research Translational Institute in San Diego, offered some questions people should ask themselves to determine whether they should get vaccinated now versus in October.
“How long has it been since you had a booster? If it’s been more than six months, you know your immunity has waned,” Topol said. “How is your risk? Are you older — greater than 65? Are you immunocompromised? Are you somebody with a lot of comorbidities? You might want to just go now [if so], because you’re vulnerable.”
“For people at risk, I don’t think it’s a good idea to delay,” Topol said.
Another question: Are you getting vaccinated to reduce your chance of long COVID? “Because the studies in totality suggest up to a 50% reduction of long COVID” following vaccination, he said. “In fact, that’s people in their 30s and 40s that are at the highest risk for long COVID after a mild infection, and a lot of people tend to forget that issue.”
Another consideration is whether you are about to go on a trip or planning an unmissable event or experience.
“Right now, if they want to prevent infection, it’s a good time to get something because it’s so closely matched to what’s going around,” Chin-Hong said of the new vaccine.
But if you’re doing lower-risk activities and would rather save your time of enhanced protection against infection for the fall and winter holidays, some doctors say it’s reasonable to wait until October to get vaccinated
Already, it appears that XEC, the new subvariant detected in Europe, may be a contender for a late autumn and winter COVID wave, Topol said.
“Waiting a couple extra months so you’re closer to whatever the next wave/wavelet is like, that’s a reasonable plan,” Topol said. But protecting against infection is less important than protecting against severe illness, which the vaccine is very good at doing.
Topol said he’s getting his COVID-19 vaccination Friday, in part because he’s going on a cross-country trip and he’ll be indoors with crowds and unable to avoid exposure to the virus, he said.
Masking remains important to avoid infection, but there are some situations where people may not be able to wear a mask all the time.
Overall, though, there isn’t any one simple answer as to whether September or October is better for timing your COVID vaccination. “It’s really up to the person,” Topol said.
What about people who had COVID-19 recently?
After infection, people may consider waiting three months to get the latest COVID vaccination, according to the CDC. In terms of when to start counting the three-month period, Hudson said a good rule of thumb would be from when your symptoms began or, if asymptomatic, when you were diagnosed.
Part of that reason, the CDC says, is that “the risk of getting COVID-19 is less likely in the weeks to months following a SARS-CoV-2 infection,” using the formal name of the virus that causes COVID.
Besides potentially being able to benefit from some natural immunity, “there are also some studies that show that waiting for a few months after you’ve had COVID to get your COVID vaccine may increase your overall level of protection,” Hudson said.
But this advice applies only to people who are at lower risk for COVID and its complications, Hudson added.
For those at higher risk — such as seniors 65 and older and those who are immunocompromised — or anyone in frequent contact with people at higher risk, “they should get their vaccine as soon as they’re feeling better,” she said.
What about people who got the old vaccine this summer?
A number of people who weren’t up to date on their vaccinations may have gotten the old vaccine formula — originally released in September 2023 — over the summer. Those people should wait two months before getting the newer shot, Hudson said.
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