The peak of the flu season could still be several weeks away, federal health officials cautioned Friday.

“We may be on track to break some recent records,” said Dr. Anne Schuchat, acting director of the Centers for Disease Control and Prevention. Nearly all states are still reporting widespread flu activity, with less severe reports only coming from Oregon and Hawaii.

“Flu is incredibly difficult to predict and we don’t know if we’ve hit the peak yet,” Schuchat said in a call with reporters. “We could still see several more weeks of increased activity.”

Health officials don’t directly count flu cases and deaths for the general population. They do track deaths among children, which climbed to a total of 63 for this season.

Another measure is the percentage of deaths attributed to flu or pneumonia, which often accompanies influenza. Last week, 1 in 10 of all deaths reported in the United States were caused by flu or pneumonia.

The rate of flu activity is similar to the rate in 2009, which was the last flu pandemic, “though that doesn’t mean we’re having a pandemic,” Schuchat said.

The strain of flu known as H3N2 remains the dominant form circulating in the United States. It’s a particularly severe strain that isn’t easily stopped by the current vaccine.

Two other strains are on the rise, however, and they generally cause milder symptoms. They’re also more likely to be blocked by the flu vaccine. So, Schuchat said, it’s still not too late to get vaccinated.

The CDC recommends antiviral medications, such as Tamiflu or the generic version called oseltamivir, for vulnerable populations hit by flu. Those groups include young children, pregnant women, the elderly and people with heart or lung disease.

There are spot shortages of the antiviral drugs, Schuchat said. People seeking them may need to call multiple pharmacies to fill their prescriptions.

The CDC has been working with insurers and pharmacies to alleviate those shortages and to make brand-name drugs available at a lower cost when generics aren’t available.

“I wish there were better news this week,” Schuchat said.

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In a rare show of congressional cooperation, Republican and Democratic leaders in the Senate announced a two-year budget deal Wednesday that would increase federal spending for defense as well as key domestic priorities, including many health programs.

Not in the deal, for which the path to the president’s desk remains unclear, is any bipartisan legislation aimed at shoring up the Affordable Care Act’s individual health insurance marketplaces. Senate Majority Leader Mitch McConnell, R-Ky., promised Sen. Susan Collins, R-Maine, a vote on health legislation in exchange for her vote for the GOP tax bill in December. So far, that vote hasn’t materialized.

The deal does appear to include almost every other health priority Democrats have been pushing the past several months, including two years of renewed funding for community health centers and a series of other health programs Congress failed to provide for before they technically expired last year.

“I believe we have reached a budget deal that neither side loves but both sides can be proud of,” said Senate Minority Leader Chuck Schumer, D-N.Y., on the Senate floor. “That’s compromise. That’s governing.”

McConnell said, “This bill represents a significant bipartisan step forward.”

Senate leaders are still negotiating details of the accord, including the size of a cut to the Prevention and Public Health Fund, which would help offset the costs of this legislation.

According to documents circulating on Capitol Hill, the deal includes $6 billion in funding for treatment of mental health issues and opioid addiction, $2 billion in extra funding for the National Institutes of Health, and an additional four-year extension of the Children’s Health Insurance Program, which builds on the six years approved by Congress last month.

In the Medicare program, the deal would accelerate the closing of the “doughnut hole” in Medicare drug coverage that requires seniors to pay thousands of dollars out-of-pocket before catastrophic coverage kicks in. It would also repeal the controversial Medicare Independent Payment Advisory Board, which is charged with holding down Medicare spending for the federal government if it exceeds a certain level.

Members have never been appointed to the IPAB, however, and its use hasn’t so far been triggered by Medicare spending. Both the closure of the doughnut hole and creation of the IPAB were part of the Affordable Care Act.

The agreement would also fund a host of more limited health programs — some of which are known as “extenders” because they often ride along with other, larger health or spending bills.

Those programs include more than $7 billion in funding for the nation’s federally funded community health centers. The clinics serve 27 million low-income people and saw their funding lapse last fall — a delay advocates say had already complicated budgeting and staffing decisions for many clinics.

And in a victory for the physical therapy industry and patient advocates, the accord would permanently repeal a limit on Medicare’s coverage of physical therapy, speech-language pathology and outpatient treatment. Previously, the program capped coverage after $2,010 worth of occupational therapy and another $2,010 for speech-language therapy and physical therapy combined. But Congress had long taken action to delay those caps or provide exemptions — meaning they had never actually taken effect.

According to an analysis by the nonpartisan Congressional Budget Office, permanently repealing the caps would cost about $6.47 billion over the next decade.

Lawmakers would also forestall cuts mandated by the ACA to reduce the payments made to what are called Disproportionate Share Hospitals, which serve high rates of low-income patients. Those cuts have been delayed continuously since the law’s 2010 passage.

Limited programs are also affected. The deal would fund for five years the Maternal, Infant and Early Childhood Home Visiting Program, a program that helps guide low-income, at-risk mothers in parenting. It served about 160,000 families in fiscal year 2016.

“We are relieved that there is a deal for a 5-year reauthorization of MIECHV,” says Lori Freeman, CEO of advocacy group the Association of Maternal & Child Health Programs, in an emailed statement. “States, home visitors and families have been in limbo for the past several months, and this news will bring the stability they need to continue this successful program.”

And the budget deal funds programs that encourage doctors to practice in medically underserved areas, providing just under $500 million over the next two years for the National Health Service Corps and another $363 million over two years to the Teaching Health Center Graduate Medical Education program, which places medical residents in Community Health Centers.

Kaiser Health News correspondent Emmarie Huetteman contributed to this report.

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More than three months after President Trump declared the nation’s opioid crisis a public health emergency, activists and healthcare providers say they’re still waiting for some other action.

The Trump administration quietly renewed the declaration recently. But it’s given no signs it’s developing a comprehensive strategy to address an epidemic that claims more than 115 lives every day. The President now says to combat opioids he’s focused on enforcement, not treatment.

Trump spent just over a minute of his 80-minute State of the Union address talking about opioids. In a speech this week in Cincinnati, he had a few more comments. The opioid epidemic, he said, “has never been worse. People form blue ribbon committees. They do everything they can. And frankly, I have a different take on it. My take is you have to get really, really tough, really mean with the drug pushers and the drug dealers.”

The President’s mention of “blue ribbon committees” sounds like a slam on one he convened last year, chaired by former New Jersey Governor Chris Christie — the President’s Commission on Combating Drug Addiction and the Opioid Crisis. The commission issued more than 50 recommendations. The administration has so far followed up on just a few of those recommendations.

Some officials and care providers who work on the frontlines of the opioid crisis, however, are scathing about what they see as a lack of action from the White House. Former Congressman Patrick Kennedy, who served on the White House opioid commission, says he’s “incredulous” that, after declaring a public health emergency in October, the President still hasn’t requested any money from Congress to combat the epidemic.

“I mean this is just a mental health crisis of the first order,” Kennedy says, “and this administration has done nothing.”

Here’s what the administration has done so far:

• President Trump declared a public health emergency in October to deal with the opioid epidemic. The declaration brought no new money to fund the federal response.
• In November, President Trump announced he’s donating his third-quarter salary — about $100,000 — to help the Department of Health and Human Services fight opioids.
• The Centers for Medicare and Medicaid Services announced a policy change in November that allows states to apply for waivers allowing them to use Medicaid to pay for residential drug treatment at facilities that have more than 16 beds. Some states are already taking advantage of that policy change.
• President Trump signed the INTERDICT Act in January giving federal agents additional tools for detecting fentanyl and other synthetic opioids at the border.
• Also this month, Attorney General Jeff Sessions announced an operation using medical data to crack down on pharmacies and doctors that dispense suspicious amounts of opioids.

Here are things critics point out the administration hasn’t done:

• There is still no head of the Office of National Drug Control Policy. In October, Trump’s nominee to the position, Rep. Tom Marino, R-Pa., withdrew his name after reports linked him with a bill that limited the DEA’s ability to investigate abuses by opioid manufacturers and distributors.
• President Trump still hasn’t nominated anyone to head the Drug Enforcement Agency.
• The administration hasn’t asked Congress for any new funding to address the opioid epidemic.

Roughly 64,000 people died from drug overdoses in 2016, and data from the CDC indicates deaths are rising. Kennedy says what’s needed is a coordinated federal response similar to the one in the mid-1990s — when the U.S. spent $24 billion a year to address the HIV/AIDS crisis.

“We’re talking about a major league crisis and they’re taking credit for little things, while the whole country is burning down,” Kennedy says.

Instead of a big boost in funding, the Trump administration is focused, in many cases, on cutting spending.

In the 2018 budget, the President recommended cutting the Office of National Drug Control Policy budget by 95 percent, and may do so again this year.

“It’s very hard to make sense of,” says Keith Humphreys, a professor of psychiatry at Stanford and former policy adviser to the drug czar’s office in the Obama administration. “I mean, it’s like closing a fire station in the middle of a wildfire.”

A law signed by President Obama that designated a billion dollars to help states combat opioids runs out of money this year. Humphreys has seen no sign President Trump intends to ask Congress to renew that funding.

“The 2018 budget had a $400 million cut to the Substance Abuse and Mental Health Services Administration which is the lead agency that funds treatment in the United States,” Humphreys says. “So, the administration’s impulse seems to be not to spend more — in fact to spend less.”

The White House is preparing to act on one of the recommendations of its opioid commission—that it launch a campaign to educate the public, especially young people, on the dangers of opioids. The campaign is being developed not by the Office of National Drug Control Policy, but by a team in the White House led by Kellyanne Conway.

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