The Wisconsin Department of Health Services said in a statement Friday that among those infected by salmonella are 42 people in Wisconsin, where the eggs are believed to have been sold.

“The eggs were distributed in Wisconsin, Illinois and Michigan through retail stores and food service distributors,” the department said. “The recall includes all egg types such as conventional cage-free, organic, and non-GMO, carton sizes, and expiration dates in containers labeled with ‘Milo’s Poultry Farms’ or ‘Tony’s Fresh Market.’”

The U.S. Centers for Disease Control and Prevention confirmed in a statement on its website that 65 people in nine states were infected by a strain of salmonella, with 24 hospitalizations and no deaths as of Friday. The states include Wisconsin, Illinois, Michigan, Minnesota, Iowa, Virginia, Colorado, Utah and California, the agency said.

One case has been reported in Colorado to date, according to the CDC.

The egg recall was undertaken by Milo’s Poultry Farms LLC of Bonduel, Wisconsin, the CDC said.

“Anyone who purchased the recalled eggs is advised to not eat them or cook with them and to throw them away. Restaurants should not sell or serve recalled eggs,” the Wisconsin health department said.

The department advised anyone who ate the eggs and is experiencing symptoms to contact a health care provider. Symptoms include diarrhea, abdominal pain, fever and vomiting lasting for several days, the statement said.

The U.S. Department of Agriculture in July announced new measures to limit salmonella in poultry products. The proposed directive included requiring poultry companies to keep salmonella levels under a certain threshold and test for the presence of six particularly sickening forms of the bacteria, three found in turkey and three in chicken.

Bacteria exceeding the proposed standard and identification of any of the strains would prevent poultry sales and leave the products subject to recall.

The CDC estimates salmonella causes 1.35 million infections annually, most through food, and about 420 deaths. The Agriculture Department estimates there are 125,000 infections from chicken and 43,000 from turkey each year.

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The Centers for Disease Control and Prevention’s forecasting center projected the number of people hospitalized for COVID-19, flu and RSV combined would be similar to what it was last year, or slightly lower, director Dr. Mandy Cohen said during a press briefing on Aug. 23.

But the projection could be off if the forecasters misjudged how many people will get vaccinated, she said. The CDC assumed vaccine uptake will be similar to last year, when fewer than half of adults got a flu shot and less than one-quarter got an updated COVID-19 vaccine.

“The power is in our hands,” she said.

Typically, flu season in Colorado takes off in November and peaks in late December or January, which usually overlaps partially with a period of increased infections from RSV and COVID-19. Other viruses that cause common colds also circulate more widely in the fall and winter, but those three are responsible for most hospitalizations and deaths from respiratory infections.

The Southern Hemisphere’s flu season, which comes while the United States is experiencing summer, has followed the normal pattern, said Jenna Guthmiller, an assistant professor of immunology and microbiology at the University of Colorado School of Medicine. While the respiratory season can be different in the Northern Hemisphere, the data points to a relatively ordinary year for flu, she said.

One possible exception to the normal pattern is that influenza B may make a late-season appearance, as it has since the pandemic, Guthmiller said.

A and B are the two major flu subtypes that infect humans. Traditionally, flu B primarily affected children, but now it seems to be making a broader range of people sick after influenza A’s seasonal peak, she said.

“We don’t really understand why,” Guthmiller said.

Dr. Michelle Barron, senior medical director of infection prevention and control at UCHealth, agreed that the flu season is likely to be relatively normal, but cautioned that significant numbers of people still get sick even in an ordinary year. About 20,000 to 25,000 Americans, mostly older adults and young children, die during a typical flu season, she said.

“Typical is good, in that it’s probably not going to overrun our (health care) resources,” she said.

Experts were less sure what to expect from COVID-19. Hospitalizations started rising in June, and have leveled out since mid-August. As of Tuesday, 146 people were in Colorado hospitals for the virus, which was higher than at the same point last year, but lower than in early September 2022.

If a significant number of people had the virus recently, that could mean the population has some immunity heading into the fall, when it typically spreads more widely, Barron said. But since the state and federal government are no longer tracking COVID-19 as closely, no one really knows how many people had a recent infection, she said.

“COVID’s still my wild card,” she said.

Outpatient visits for COVID-19 went up over the summer, and Dr. Amy Duckro, an infectious disease specialist at Kaiser Permanente Colorado, said she wouldn’t be surprised if they continue increasing through the fall. RSV and flu typically come later, so she doesn’t know what to expect from them yet based on clinic visits. Colorado doesn’t start tracking flu and RSV until October.

“It’s really difficult to predict what any respiratory season will bring, so the best thing you can do is be prepared,” she said.

Guthmiller, with the CU School of Medicine, agreed that a continuation of the late-summer COVID-19 wave is more likely than a drop-off at this point. While predicting what the virus will do is never easy, it looks likely to peak around the end-of-year holidays, as it usually does, she said.

The CDC forecasted two possible scenarios: one where COVID-19 cases keep rising and peak in early fall, and another where the summer wave is peaking now, and a second wave follows in the winter. Right now, the second scenario looks more likely, but they likely would produce similar amounts of severe illness and death, said Beth Carlton, chair of environmental and occupational health at the Colorado School of Public Health.

“What we really care about now is peak hospital demand across the three viruses,” to ensure the health care system can care for everyone who needs a bed, she said. “And then it’s, how we prevent people from becoming acutely ill or dying, and that’s vaccination, vaccination, vaccination.”

None of the experts predict anywhere close to the level of hospitalizations and deaths in the first years of the pandemic, unless an evolutionary leap produced a radically different variant. Other possibilities that would cause trouble include extremely low vaccine uptake, or the avian influenza currently circulating in cows adapting to spread between people, Carlton said.

RSV also appears likely to have a more-normal year after two abnormal seasons. Infections with RSV spiked in 2022 when children who hadn’t had their first infection during the period of masking and social distancing got it, alongside younger kids who would have gotten it anyway during that time, said Dr. Kevin Messacar, an infectious disease specialist at Children’s Hospital Colorado. Infections also were higher than usual last year, but not as high as in 2022.

“In 2023, we started to see a slow return toward normal,” he said. “We’d expect this year is going to look like a more typical RSV year.”

Relatively new shots to prevent RSV could be a “game-changer” for infants, who are at the highest risk of severe disease, Messacar said. The shots debuted last year, but relatively few people got them because they arrived late in the season, he said.

Women who are between 32 and 36 weeks of pregnancy and will give birth during RSV season can get vaccinated and pass the antibodies to their babies prenatally, Messacar said. When that timing doesn’t work out, or if the baby was born prematurely and the antibodies didn’t have a chance to transfer, they can get a product of lab-made antibodies to protect them through their first RSV season, he said. Kids who are at high risk of severe illness can also get the antibody drug during their second RSV season.

The virus frequently hospitalizes babies, because their tiny airways become inflamed and they need oxygen, Messacar said. In healthy adults and older children, it typically causes colds.

RSV “tends to fill up our hospitals with children needing respiratory support… and sometimes hydration,” he said.

Overall, it appears that the viruses are settling back down after the pandemic’s peak and measures to fight COVID-19 threw off their normal cycles, UCHealth’s Barron said. But even before COVID-19, viruses and bacteria would sometimes behave in unexpected ways, so people working in infectious disease have to be prepared in case they end up facing a worse-than-expected season, she said.

“It’s kind of like horse racing,” she said. “Occasionally, the long shot shows up.”

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Anthem sells two general types of plans on the individual marketplace: those labeled Pathway, which include UCHealth hospitals and doctors, and Pathway Essentials, which don’t. The plan description on the Connect for Health Colorado website mistakenly listed UCHealth as in-network for both types of plans.

Vince Plymell, spokesman for the Colorado Division of Insurance, said the division discovered the mistake earlier this year and required Anthem to reprocess some claims it billed as out-of-network, resulting in about $67,000 in refunds to customers. Anthem could face a fine of up to $500,000, though the division is holding off on the penalty while it assesses if the company is allowing patients to go to UCHealth at in-network rates, he said.

Mistakes like that are rare, and this one triggered an open enrollment period from May to July for people who want to switch plans, said Nina Schwartz, senior director of policy and external affairs at Connect for Health Colorado.

When patients go to an in-network provider, they pay an agreed-upon share of their care costs. If they go to an out-of-network provider, they can get stuck with a bill for the difference between the amount their insurer paid and their provider charged. Federal and state law prohibits such “surprise bills” in the case of emergencies, but not for scheduled care.

Dan Weaver, spokesman for UCHealth, said the system knew it wasn’t in-network with the Essentials plans, so the incorrect information had no effect on its operations. The system screens patients so they know if they’re going out-of-network for care, he said.

Anthem estimated about 20,000 people, out of roughly 1.5 million customers in Colorado, had purchased plans involved in the mix-up. It didn’t have information about how many had switched because of it. The company attributed the mistake to a computer error.

“The health of our members is our top priority and we worked quickly with Connect for Health Colorado and the Division of Insurance to correct this mistake,” spokeswoman Emily Snooks said in a statement.

Chris Citron, of Denver, said the news was confusing for her family. She manages an adult relative’s health insurance, and said she had chosen the plan specifically so her relative could stay with familiar doctors, who work at UCHealth.

“I was incredulous,” she said. “I thought that was bait-and-switch.”

The letter customers received said they could continue to see UCHealth doctors at in-network rates for the rest of the year if another provider had referred them to the health system. But Citron said it hasn’t worked out easily for her family so far. She called Anthem multiple times to verify that her relative’s appointment would be covered at in-network rates, but still got an out-of-network bill that she’s trying to sort out.

Ideally, she’d like to sign up with a new plan to keep UCHealth in-network for her relative next year, but isn’t sure if she’ll be able to find one. Most plans sold on the individual marketplace for Denver don’t include that health system.

“I’m really worried, because there are hardly any alternatives,” she said.

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The Centers for Disease Control and Prevention recommend that everyone 6 months and older get an annual flu shot and the newly approved and updated vaccines for COVID-19.

The guidance is more complicated for respiratory syncytial virus, with vaccination recommended for people over 75; those between 60 and 74 who have chronic conditions; and women between 32 and 36 weeks of pregnancy who will deliver during RSV season. Anyone who got the RSV shot last year doesn’t need another one, unless they became pregnant again and need to pass protection to a new baby.

People get the best immune response if they space out their flu and COVID-19 shots, but they need to consider if they will return to get another vaccine, or if they’re likely to forget or get busy, said Jenna Guthmiller, an assistant professor of immunology and microbiology at the University of Colorado School of Medicine. She didn’t specify how far to space them out.

The shots are safe to get together.

“If it’s convenient for you to get them all at the same time, just do it,” she said. “Some protection is better than no protection.”

Ideally, people would get their shots around late October, since the flu typically takes off in the state near the end of the year, Guthmiller said.

Not everyone agrees that waiting is the best plan.

While some people like to time their shots closer to the holidays, getting them early ensures people won’t get sick or pass the viruses to others during the early weeks of respiratory season, said Dr. Amy Duckro, an infectious disease specialist at Kaiser Permanente Colorado. She personally likes to get the flu and COVID-19 shots together, so as to only have side effects once a year.

“I’d recommend getting them as soon as you can. It does take some time for immunity to develop,” she said.

Given the high amount of COVID-19 circulating right now, the best thing is to get that shot as soon as possible, said Beth Carlton, chair of environmental and occupational health at the Colorado School of Public Health. For flu, people should get adequate protection as long as they get the shot before Halloween, she said.

Last year, flu shot uptake held steady, while the number of people getting COVID-19 vaccines dropped. Relatively few people got a new shot for RSV, which typically causes colds but can be deadly in infants and older people.

So far, uptake of the new flu and COVID-19 shots has been relatively strong, said Jessica Chenoweth, who oversees 17 CVS pharmacy locations along the Front Range. She isn’t sure what changed to revitalize people’s interest.

“It feels on-pace to what I’ve seen in previous years,” she said.

People who got a COVID-19 booster during the summer wave should wait two months before getting their next dose, though they could get the flu shot earlier if they want, Chenoweth said. Generally, though, she recommends getting all seasonal vaccines at once, to avoid forgetting one.

Some people who got the COVID-19 vaccine for free last year will have to pay out of pocket this fall. The Bridge Access program, which paid for COVID-19 vaccines for uninsured people, ended this year, but the CDC said it would allocate $62 million for state and local health departments to buy vaccines they can give out for free.

Chenoweth said the shot costs about $200 if an uninsured person pays cash. Nearly all insurance plans cover them.

The flu and COVID-19 vaccines change each year, to try to match the dominant variants. RSV doesn’t evolve as quickly, so the vaccine is the same one that rolled out last year.

For the first time in a decade, the flu vaccine will include three strains, rather than four. The influenza B Yamagata strain hasn’t shown up in testing since March 2020, and flu manufacturers dropped it from the vaccine this year. Unlike influenza A strains, flu B only circulates in people, so when respiratory virus transmission plummeted early in the pandemic, the Yamagata strain apparently couldn’t survive, said Guthmiller, the CU researcher.

“There’s a strong belief that it’s gone extinct,” she said.

The updated Pfizer and Moderna COVID-19 vaccines teach the body to make the spike protein from the KP.2 variant of the virus, which is a cousin of the currently dominant KP.3.1.1. When the body sees the spike, it develops antibodies against it, reducing the risk a person will get sick if they encounter the actual virus. The disembodied spike proteins produced after vaccination can’t give anyone the virus, though some people feel tired or achy because of their immune response.

The updated Novavax shot, which injects the spike protein directly, is based on the JN.1 variant, which dominated last winter.

In addition to getting vaccinated, people can protect themselves and others by staying home if they feel sick, washing their hands frequently, practicing general healthy habits and wearing masks in crowded spaces if they feel comfortable doing that, Duckro said.

“We certainly wouldn’t want to rely on vaccines entirely,” she said.

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DAKAR, Senegal (AP) — The Africa Center for Disease Control and Prevention and the World Health Organization launched on Friday a continent-wide response plan to the outbreak of mpox, three weeks after WHO declared outbreaks in 12 African countries a global emergency.

The estimated budget for the six-month plan is almost $600 million, with 55% allocated to the response to mpox in 14 affected nations and boosting readiness in 15 others, Africa CDC director-general Dr. Jean Kaseya told reporters on Friday. The other 45% is directed towards operational and technical support through partners. The organization didn’t give an indication of who would be funding it.

The plan focuses on surveillance, laboratory testing and community engagement, Kaseya said, underscoring the fact that vaccines aren’t enough to fight the spreading outbreak.

The organization said that since the start of 2024, there have been 5,549 confirmed mpox cases across the continent, with 643 associated deaths, representing a sharp escalation in both infections and fatalities compared to previous years. The cases in Congo constituted 91% of the total number. Most mpox infections in Congo and Burundi, the second most affected country, are in children under age 15.

The plan comes a day after the first batch of mpox vaccines arrived in the capital of Congo, the center of the outbreak. The 100,000 doses of the JYNNEOS vaccine, manufactured by the Danish company Bavarian Nordic, have been donated by the European Union through HERA, the bloc’s agency for health emergencies. Another 100,000 are expected to be delivered on Saturday, Congolese authorities said.

“These vaccines are vital in safeguarding our health workers and vulnerable populations, and in curbing the spread of mpox,” Kaseya said Thursday.

The 200,000 doses are just a fraction of the 3 million that doses authorities have said are needed to end the mpox outbreaks in Congo, the epicenter of the global health emergency. The European Union countries pledged to donate more than 500,000 others, but the timeline for their delivery remained unclear.

Emmanuel Lampaert, a representative of Doctors Without Borders in Congo, said that vaccination was an additional tool. Basic health measures were still crucial to combat the outbreak, and there were challenges with that in many parts of Congo.

Congo issued an emergency approval of the vaccine, which has already been used in Europe and the United States in adults, but it remained unclear on Friday when the vaccination campaign would begin. For the moment, the rollout would be reserved for adults, Kaseya said, with priority targeted groups being those who have been in close contact with infected people and sex workers.

The European Medicines Agency is examining additional data to be able to administer it to children ranging in age from 12 to 17, which could happen at the end of the month, HERA Director-General Laurent Muschel said.

“We don’t have all the answers,” Muschel told reporters on Friday. “We learn by doing. We are going to adapt the strategy depending on the impact of the vaccination campaign.”

The combination of drugs targets two brain proteins critical in neuroinflammation, which is involved in brain aging and Alzheimer’s, according to a study published in July in the Journal of Neuroinflammation featuring CSU researchers.

Results from the study show this medicine could become “a game-changing tool” against Alzheimer’s, researchers said.

“There are no effective treatments right now,” said Devin Wahl, a CSU postdoctoral fellow, who co-authored the study. “We have treatments that can manage symptoms, but we don’t have any that can stop the disease. We want to try to identify novel treatments that may be effective to slow, or even reduce, the effects of Alzheimer’s disease.”

This cocktail of medicines could also improve memory in aging adults, the study found, and, potentially, reverse cognitive decline.

The research came out of a partnership between CSU faculty member Tom LaRocca’s Healthspan Biology Lab and Colorado-based biotech company Sachi Bio.

“This is a novel and effective treatment to improve memory in mice,” said Prashant Nagpal, who co-founded Sachi Bio with his wife, Anushree Chatterjee. “A very important finding that we saw in this study is that you can reverse some cognitive decline. We are hoping to take this to human clinical trials next year.”

The mice behavioral tests measured memory and grip strength because grip strength and muscle function are closely linked to brain function, researchers said.

“If we can target what comes before Alzheimer’s disease, which is what this drug is meant to do, that will give people more treatment options, especially earlier in life,” Wahl said.

By next year or 2026, Nagpal hopes there will be a more conclusive data set including human trials.

“We’ve all been touched by seeing older parents and family members just being a shadow of themselves,” Nagpal said. “It’s just heartbreaking. It may seem like just a glimmer of hope, but can you latch onto it and just, you know, go for it?”

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The Centers for Disease Control and Prevention made grants to Colorado, Arizona, New Mexico and Utah for “biomonitoring,” which refers to testing blood or other bodily fluids for chemical contamination. The grants will allow them to test the amount of lead and other heavy metals in rural residents’ blood, while testing for per- and polyfluoroalkyl (PFAS) will focus on firefighters and other people in jobs where they frequently use the chemicals.

The four states previously worked together to quantify their residents’ exposure to pesticides, herbicides and other chemicals.

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At the same time, parents whose children attend Dupont Elementary School are organizing to fight the construction of five additional storage tanks at the Magellan Pipeline Company’s terminal at 8160 Krameria St., which is across the street from the school in the Dupont neighborhood.

The additional tanks would increase the amount of volatile organic compounds, benzene and other hazardous chemicals emitted into the air.

And Cultivando, a nonprofit that focuses on community health and clean air in Commerce City and north Denver, is joining Adams 14 officials at 10 a.m. Saturday to rally resistance during an event at Adams City High School.

About 40 people gathered last week at the elementary school to learn about Magellan’s expansion plans, their environmental impact on the neighborhood and how parents and nearby residents might push back against the new storage tanks.

Parents and neighbors are concerned about how increased pollutants would impact people’s health, especially school children who play outside, and about more truck traffic in the neighborhood — another pollution source.

“Let’s do it! Vamos!” one father shouted as Wednesday night’s meeting concluded.

Magellan applied in the fall of 2023 to build the five additional gasoline storage tanks at the site. Twenty already are there, and those tanks store fuel delivered via a pipeline that is then trucked around Colorado to fuel vehicles. The company wants to expand, in part, to store reformulated gasoline, which is a special blend required from June to September along the Front Range to reduce ozone pollution.

But people in the neighborhood, including the school principal and residents who live next to the storage facility, were unaware of the project until The Denver Post reported on it in July.

School officials, environmental activists and neighbors are furious about the lack of communication from the company or from the Colorado Department of Public Health and Environment’s Air Pollution Control Division, which has the authority to approve, amend or deny the expansion application.

In their application to build the new tanks, Magellan officials wrote that they would notify the neighborhood of the plans by posting signs on the front gate. When Guadalupe Solis, Cultivando’s environmental justice programs director, mentioned the signs at the Wednesday meeting and asked the crowd whether anyone had seen them, multiple people scoffed and laughed.

“That’s what we thought. That’s why we are here,” Solis said. “They are doing this because we are people of color. We are immigrants, and they are sure we are not going to say anything, that we are going to be silent.”

Annelle Morrow, a spokeswoman for ONEOK, Magellan’s parent company, said the Dupont terminal expansion was in the works when the two companies merged in September 2023.

“Whether the proposed project is ultimately approved or denied, ONEOK intends to be a good neighbor to the school and surrounding community for years to come,” she said. “We have already reached out to the school district, and it is our genuine hope that — over time — we can demonstrate ONEOK’s commitment to engaging meaningfully with the communities in which we operate.”

Determining the environmental impacts

As part of its permit application, Magellan was required to submit an environmental justice impact analysis, to determine whether the work would take place in a disproportionately impacted community.

That analysis determined nearly 45% of the residents in the neighborhood surrounding the terminal qualify as low income, 79% are people of color, 31% are burdened by the cost of housing and 12% speak limited English. The environmental impact on the surrounding community is supposed to be taken into consideration by state regulators when they review the permit application.

The parents, school board and neighbors have an uphill battle.

Magellan filed for a construction permit, which doesn’t require the same level of scrutiny as other permits, and the Air Pollution Control Division already has given it preliminary approval.

Michael Ogletree, the division director, said his staff’s work is defined by the law and they must follow it when making decisions on permit applications.

“We must approve permits that comply with the law,” he said.

In the wake of the complaints over the permit’s secrecy, the Air Pollution Control Division extended the public comment period to 60 days, instead of the usual 30.

Ogletree also said the state health department plans to install air monitors near the school to detect emissions. He told The Post that plan was in the works before the newspaper published its July 22 story about the project, but people at the school and neighborhood residents said they had not heard about air monitors until they started complaining about the expansion project.

When asked about that discrepancy, a division spokeswoman, Leah Schleifer, sent an email to The Post saying Ogletree meant monitors were in place “in the area of the school district,” and he directed his staff to explore the possibility of adding monitors near the school.

Ogletree said his agency will listen to community feedback and offer support.

To that end, the health department is planning a community listening session from 6 to 8 p.m. Sept. 17 at Eagle Pointe Recreation Center in Commerce City. Schleifer said attendees must register in advance at bit.ly/APCDPublicSession. If not enough people sign up, the meeting will be moved to online-only, she said. She also noted that the meeting was not about any specific permit application.

“This is not fair”

Joe Salazar, chief legal counsel for Adams 14, said “the cake has been baked,” but he still believes there is a chance organized opposition could halt the permit. The school board voted unanimously last month to allow Salazar to fight the project on behalf of the district. He said it was unusual for a school board to take that step.

The Center for Biological Diversity will join the parents’ group, Cultivando and the school district in resisting the project, Salazar said.

“We’re up against it right now and we’re going to have to fight really hard to get the Air Pollution Control Division to change their minds,” he said.

Parents who attended last week’s meeting were worried about their children playing outside, but Dupont Elementary Principal Amanda Waller said she hoped to allow outdoor playtime as long as she feels it is safe.

“I pray we are not going to have to go that far,” Waller said. “It’s not fair to our kids.”

Waller broke down in tears as she talked about the gasoline storage expansion, saying she had been caught off guard when she learned about it. She also called it “a big deal” for the school.

“I just want you to know that I love and care for this community so much that this is really painful to me and I’m going to do everything I can to encourage all of us to join together because it’s about the kids,” she said. “This is not fair. This doesn’t happen in Cherry Creek.”

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The state is one of three piloting new incentives, and will receive $7.9 million by the end of 2027 to offer matching funds for money spent on fruits and vegetables purchased with money from the Supplemental Nutrition Assistance Program.

The other states that will receive funding from the U.S. Department of Agriculture to try out the Produce Bonus program are Washington and Louisiana.

Recipients can receive up to $20 in matching funds per transaction, for a maximum of $60 per month. The match is available for money spent on fresh or frozen fruits and vegetables, provided they don’t contain added fat, salt or sugar. At farmers markets, recipients can also get matching funds for funds spent on dried beans, fruits and vegetables, provided they don’t have those three added ingredients.

Coloradans who receive food assistance already have some incentives to buy produce, such as Double Up Food Bucks, which are paper coupons they receive when buying fruits and vegetables.

Produce Bonus funds automatically appear on people’s earned benefit transfer cards, so they don’t have to remember paper coupons, said Abby McClelland, director of the food and energy assistance division at the Colorado Department of Human Services.

People can spend their Produce Bonus funds on any foods that SNAP covers, unlike the Double Up funds, which are only good for fruits and vegetables, she said.

Because the cards don’t differentiate funding for produce from other food, states aren’t able to limit how recipients can spend the bonus money, a USDA spokeswoman said.

So far, the only participating Denver location is a single farmers market, and the other locations are concentrated in the upper portion of the Interstate 25 corridor, between Loveland and Wellington. See cdhs.colorado.gov/snap-produce-bonus for a full list.

The department is working to get more retailers involved, though some may have to upgrade their software or card readers to process the rebate funds, McClelland said. They are focusing on locally owned businesses in areas with low access to food and low average incomes, with no immediate plans to bring in chain grocery stores, she said.

“We’re trying to be strategic,” she said.

While the USDA ultimately will decide if the program succeeded, McClelland said she hopes it can increase food assistance recipients’ produce consumption and overall purchasing power, while giving a boost to businesses in underserved areas.

“I think this is a step forward,” she said.

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Chicagoan Sheila Hogan, one of 140,000 people registered in the state to use medical cannabis, believes in its powers. She uses mild gummies at bedtime to relieve debilitating pain from spinal stenosis, which has allowed her to get back to gardening and pickleball.

“I could not even believe it,” she said. “It was remarkable. I was able to get a lot more active.”

Despite support for legalization, and increasing use of marijuana nationwide, a recent Gallup poll showed slim majorities say it negatively affects both society and most people who use it — but is still less harmful than tobacco and alcohol.

The evolving perceptions of cannabis come as major changes are afoot in the regulation of the drug.

The Biden administration has proposed reclassifying pot as less-dangerous, making it legal with a prescription. Democratic presidential candidate Kamala Harris has called for decriminalization, while Republican candidate Donald Trump, who legalized hemp, has said he is open to decriminalization, and that legalization should be up to the states.

At the state level, more jurisdictions continue to legalize weed. Ohio became the most recent state to do so, effective this year. Residents of Florida and North and South Dakota will vote on the issue Nov. 5. So far, 24 states — with a majority of the nation’s population — have legalized marijuana for adults, and most states allow some level of medical use.

So with the nation at a potential tipping point in its treatment of cannabis, what have we learned from legalization, and what does the latest research show about its effects?

Public health effects

First, the sky has not fallen in those states that legalized. A report by the Cato Institute in 2021 concluded that the effects, both pro and con, were fairly limited.

Advocates have suggested that legalization reduces crime, improves public health and stimulates the economy. Critics argued that legalization spurs marijuana and other drug use, increases crime, harms public health and hurts kids in school.

But many of these claims, Cato reported, were overstated and sometimes baseless.

While adult use of marijuana is at record highs nationally, use among teens has not risen appreciably in states that have legalized it, surveys have found. In Illinois, the legal age to purchase marijuana is 21.

As far as crime goes, homicides and other violent crimes increased significantly in Illinois since recreational legalization in 2020, before decreasing substantially recently. That was part of a nationwide trend that criminologists say was influenced by many factors, including civil unrest and the COVID pandemic. In a prior study, the Cato report found no substantial increase or decrease in violent crime through 2018 in states that legalized.

Traffic fatality rates also surged in Illinois in 2020 and 2021, before falling in 2022, again part of a nationwide trend fueled by the pandemic. A 2022 study found a 6% increase in injury crashes and a 4% increase in fatal crash rates in states after legalization.

Ingestion of edibles by toddlers and overdoses by adults also have increased in Illinois since legalization, but remain far fewer and less harmful than overdoses of other substances.

One significant economic effect has been that legal weed has generated substantial tax revenues — about $1 billion since 2020 for Illinois.

After administrative expenses, 25% of that money goes to community reinvestment; 20% for substance abuse prevention and mental health treatment; 8% to local governments for law enforcement; and 45% to the state budget. Illinois has awarded $244 million for community programs from weed tax revenue.

Effects on individuals

Despite widespread claims about the effectiveness of using pot to treat a host of medical conditions, the evidence is limited.

After a comprehensive review of medical uses last year, Health and Human Services found support for the use of marijuana for three conditions: anorexia related to a medical condition; nausea and vomiting; and pain, especially nerve pain.

Those findings match with prior Food and Drug Administration approval of synthetically derived THC, known as dronabinol, for the treatment of nausea, vomiting and anorexia. The agency also has approved pure CBD, under the brand name Epidiolex, to treat a rare form of severe epilepsy.

But marijuana showed mixed or inconclusive effectiveness for anxiety, inflammatory bowel disease, and post-traumatic stress disorder.

Anxiety disorder is a good example of divided views of cannabis. Though it’s one of the most common reasons people use the drug, the Illinois Medical Cannabis Advisory Board recently failed to recommend it as a qualifying condition on a tie vote.

Board member and family nurse practitioner Katie Sullivan said that with guidance, high doses of CBD, a nonpsychoactive component of pot, with low amounts of THC — the part of pot that gets users high — can help some people with anxiety.

But a study of 12,000 patients showed it’s not very helpful for many and can cause shrinkage in parts of the brain, neurologist Amarish Dave cautioned.

“There’s real risk,” he said. “There are studies to suggest it can make it worse for a significant portion of people.”

With people in Illinois able to buy cannabis for any reason, they may be using it for anxiety without any medical guidance. Board members agreed that Illinois needs better education of doctors and the public on the medical use of cannabis.

One of the advantages of marijuana is that it doesn’t have some of the side effects of opioids, such as constipation, or of causing fatal overdose. Many people use low doses occasionally without incident.

But modern commercial marijuana is much more potent than street weed of the past. It can have mild to moderate adverse effects, such as causing anxiety or, in rare cases, psychotic episodes.

More alarming, a National Institute on Drug Abuse study found that young men with cannabis dependence were at a significantly increased risk of developing schizophrenia.

And smoking or vaping can damage the lungs. One study showed that cannabis use was tied to increased risk of severe COVID-19.

The most popular nonpsychoactive component of cannabis, CBD, is generally well-tolerated by users, without the anxiety or other side effects of THC. It has been shown to help people with certain severe forms of epilepsy, though in high doses it could cause anemia, flatulence and sleepiness.

One small study at the University of Colorado suggested CBD was associated improvements in cognition and emotional issues associated with Parkinson’s disease. Other studies have suggested potential benefits for ulcerative colitis, opioid withdrawal and sleep, but doctors say much more research is needed to prove widespread health claims.

Rescheduling

Last year, at the request of President Joe Biden, the U.S. Department of Health and Human Services and National Institute on Drug Abuse recommended rescheduling marijuana from Schedule 1 (the highest) to Schedule 3 on a scale of 5 that rates controlled substances by their dangers and medical effectiveness.

Currently, at the federal level, marijuana is classified as having no medical use and high risk for abuse and addiction — somehow more so than even fentanyl or methamphetamine, which, unlike marijuana, kill thousands of people every year.

Instead, pot would be categorized as having a moderate to low likelihood of dependence and would be legal for medical use with a prescription. It would allow increased research and would let marijuana businesses take federal business tax deductions, making it easier to make money. Consumers would likely see little direct effect, since state law would still control where and how pot is legal.

At the local level, one aspect of the Illinois medical program upsets both patients and doctors.

Cannabis patients in the state still are restricted to getting their medical products without tax at the 55 original designated medical dispensaries. Some of those companies, which have a captive market, have lobbied to keep it that way.

Dr. Leslie Mendoza Temple, a member of the state cannabis advisory board, said the state should allow patients to get their medicine at any recreational dispensary.

“The consistency of supply for our medical patients has always been an issue,” she said. “It reduces compliance and confidence in the program. Our medical patients who built this program are being edged out by market forces.”

rmccoppin@chicagotribune.com