Q&A: The Future of COVID-19

Senior writer Kara Grant co-authored this report.

March 15, 2023 – As we approach the third anniversary of the COVID-19 pandemic, experts and everyday Americans wonder if we are finally at the end of what has been a painful and exhausting ordeal that’s lasted 3 years. With vaccine and booster fatigue, COVID-19 cases leveling out, and a growing body of research that has helped us understand the virus more clearly, many are still asking: How concerned should I be?

 In February, the Biden administration announced that it was the end of the road for the COVID-19 emergency orders, which had been in place since January 2020. That came after a year still fraught with ups and downs, with the U.S. surpassing 1 million COVID-19 deaths and variants continuing to evolve.

 We asked experts their thoughts on the future of COVID-19 and how their perspectives have shifted over the years.

Where Are We Now With COVID-19?

While the Omicron variant is still lingering, we’re in a period of lower rates of COVID-19 transmission.

Vaccinations and boosters have helped. That, along with antiviral treatments and high rates of collective immunity, have kept COVID-19 at bay, but it’s important to remember that this virus isn’t going anywhere, says Ashwin Vasan, MD, the commissioner of the New York City Department of Health and Mental Hygiene.  

“The federal emergency will expire in May, and compared to where we’ve been, we’re not in an emergency today,” he says. “But we will have to use the tools and strategies to really manage whatever COVID-19 throws at us going forward – if it were to change or if it ends up being more of a seasonal virus, like other coronaviruses.”

One thing is for certain: Health care will never be the same, says Jennifer Gil, a registered nurse and a member of the American Nurses Association Board of Directors.

“While cases in our area are steadily declining, patients and health care workers continue to experience the long-lasting effects of the pandemic,” she says. “I witness it every day when I see the long-term impact it has had on patients, access to care, and health care workers’ mental and emotional well-being.”

Is This the End of the Pandemic? 

First, it’s important to understand the difference between a pandemic and an epidemic, Vasan says. An epidemic is the spreading of a disease that outpaces what would be expected within a certain time and location. A pandemic is an epidemic that spreads across various continents and regions of the world.

COVID-19 is a new virus, which makes things tricky. “Before 2020, our baseline was zero because COVID-19 didn’t exist,” says Vasan. “So, the question we can’t really answer from an epidemiologic standpoint is – ‘is it still a pandemic?’ Well, is it circulating beyond what’s to be expected? I think we’re going to have to figure out what those expectations are at baseline.”

Jim Versalovic, MD, pathologist-in-chief at Texas Children’s Hospital, deems this a “post-pandemic” period, since the virus isn’t impacting us as dramatically as it did in 2020 and 2021. This is thanks to the successful efforts “to diagnose, treat, and prevent COVID-19,” along with collective immunity after many being exposed and infected with the virus, he says.

Some experts believe that declaring the pandemic “over” is a long shot. Rather, it’s likely that we are changing to more of an endemic status, according to Natascha Tuznik, DO, an infectious disease specialist at the University of California, Davis. It’s best to view COVID-19 as a “permanently established infection” in both humans and animals, she says. So we should treat it like the seasonal flu and continue to be careful to update vaccinations. 

“Vaccine uptake, overall, is still insufficient,” says Tuznik, “It’s important to not let our guard down and believe the problem no longer exists.”

The impact the pandemic has had on communities of color, frontline workers, and the health care system more broadly is also not to be forgotten, says Gil. “While the number of COVID-19 cases is subsiding, the invisible impact of the pandemic will continue to emerge in the coming years,” she says. 

What Worries You Now About COVID-19? 

Complacency can be an issue with any viral infection, says Versalovic, and it’s critical to continue to treat COVID-19 with extreme caution. For example, the U.S. will always need to track COVID-19 trends.

“It has become one of our major respiratory viruses affecting mankind around the globe,” he says. “Certainly, in the medical profession, we’re going to have to do our best to communicate and emphasize to everyone that these viruses aren’t going to disappear, and we need to continue to be aware and vigilant.”

Don’t forget that people still die from this virus every day, says Tuznik. “COVID-19 has killed over 1 million Americans and over 6.8 million people globally,” she says. “While the rates of death have declined, they have not stopped.”

Vasan poses another critical question: “What pieces are in place to ensure that we have a strong health system prepared to respond to COVID-19 changes or if another epidemic or pandemic illness arrives?” 

Examples could include ensuring tests, vaccines, and treatments are deployed in a quick, strategic manner, and building a public health system that can make that happen, without failing to support health care workers, he says.

Challenges like staffing shortages and hazardous work conditions have resulted in mental health-related issues and burnout among health care workers, Gil says. Many have reported skyrocketing rates of PTSDanxietydepression, and stress. Some have chosen to leave the health care workforce entirely.

“Investing in our health care workforce by providing mental health and wellness resources is essential,” says Gil. “We must also equally address the underlying issues by enforcing safe staffing standards and investing in long-term solutions that aim to improve the work environment.”

Has the Pandemic Changed Your Relationship to Medicine? 

The COVID-19 crisis has altered the health care world, likely for posterity. For many, like Vasan, the last 3 years have been a shining example of how fragile our health care system is. 

“We continually spend on things that don’t deliver on health,” he says, referring specifically to the $4 trillion spent on health care, with only a small fraction of that dedicated to disease prevention efforts. “Had we spent more on prevention, fewer would have died from COVID. We need to have a reckoning in this country about whether we are willing not to design for health care and medicine, but to design for health.” 

And while COVID-19 certainly brought to light the major – and minor – flaws in the health care system, the knowledge we’ve learned along the way is a silver lining for many doctors. Versalovic says that the chaos and anxiety forced those in medicine to rapidly refine their approaches to diagnostics, from in-hospital testing to drive-thru and at-home testing. Along the way, he says, there has also been a renewed gratitude for treatments like monoclonal antibodies and the preventive powers of RNA vaccines. 

But for Tuznik, the pandemic has given her an entirely newfound appreciation for her career path. 

“The infectious diseases community really came together as a tour de force during the pandemic, and it was humbling to be a part of such a mass effort and collaboration,” she says. 

What Have the Last 3 Years Taught You?

COVID-19 has forced us all to learn new and often difficult lessons about ourselves, our relationships, and how we each fit into the world. 

It’s a line we’ve heard over and over again: These are unprecedented times. A large part of that has been the extreme politicization of science and the growing divisiveness across the country. But despite what feels like unyielding friction in the medical community and beyond, people were still able to come together and tackle the pandemic’s challenges. 

Vasan says that our ability to work together on life-saving treatments and prevention strategies is “a testament to human endeavor, ingenuity, collaboration, in the face of an existential threat.”

For nurses, the pandemic brought about pervasive burnout and fatigue. But that’s not the end of the story. 

“Personally, it has driven me to go back to school to gain the research and analytical skills necessary to develop evidence-based policies and programs that aim to improve health care delivery,” says Gil. “Now, more than ever, nurses are key stakeholders at the policy and decision-making table.”

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COVID at 3 Years: Where Are We Headed?

March 15, 2023 – Three years after COVID-19 rocked the world, the pandemic has evolved into a steady state of commonplace infections, less frequent hospitalization and death, and continued anxiety and isolation for older people and those with weakened immune systems.

After about 2½ years of requiring masks in health care settings,  the CDC lifted its recommendation for universal, mandatory masking in hospitals in September 2022.

Some statistics tell the story of how far we have come. COVID-19 weekly cases dropped to nearly 171,000 on March 8, a huge dip from the 5.6 million weekly cases reported in January 2022. COVID-19 deaths, which peaked in January 2021 at more than 23,000 a week, stood at 1,862 per week on March 8.

Where We Are Now

Since Omicron is so infectious, “we believe that most people have been infected with Omicron in the world,” says Christopher J.L. Murray, MD, a professor and chair of health metrics sciences at the University of Washington and director of the Institute for Health Metrics and Evaluation in Seattle. Sero-prevalence surveys — or the percentage of people in a population who have antibodies for an infectious disease, or the Omicron variant in this case — support this rationale, he says.

“Vaccination was higher in the developed world but we see in the data that Omicron infected most individuals in low income countries,” says Murray. For now, he says, the pandemic has entered a “steady state.”

At New York University Langone Health System, clinical testing is all trending downward, and hospitalizations are low, says Michael S. Phillips, MD, an infectious disease doctor and chief epidemiologist at the health system. 

In New York City, there has been a shift from pandemic to “respiratory viral season/surge,” he says. 

The shift is also away from universal source control – where every patient encounter in the system involves masking, distancing, and more – to a focus on the most vulnerable patients “to ensure they’re well-protected,” Phillips says. 

Johns Hopkins Hospital in Baltimore has seen a “marked reduction” of the number of people coming to the intensive care unit because of COVID, says Brian Thomas Garibaldi, MD, a critical care doctor and director of the Johns Hopkins Biocontainment Unit.

“That is a testament to the amazing power of vaccines,” he says. 

The respiratory failures that marked many critical cases of COVID in 2020 and 2021 are much rarer now, a shift that Garibaldi calls “refreshing.”

“In the past 4 or 5 weeks, I’ve only seen a handful of COVID patients. In March and April of 2020, our entire intensive care unit – in fact, six intensive care units – were filled with COVID patients.”

Garibaldi sees his own risk differently now as well. 

“I am not now personally worried about getting COVID, getting seriously ill, and dying from it. But if I have an ICU shift coming up next week, I am worried about getting sick, potentially having to miss work, and put that burden on my colleagues. Everyone is really tired now,” says Garibaldi, who is also an associate professor of medicine and physiology in the Division of Pulmonary and Critical Care Medicine at Johns Hopkins University School of Medicine. 

What Keeps Experts Up at Night?

The potential for a stronger SARS-CoV-2 variant to emerge concerns some experts.  

A new Omicron  subvariant could emerge, or a new variant altogether could arise.  

One of the main concerns is not just a variant with a different name, but one that can escape current immune protections. If that happens, the new variant could infect people with immunity against Omicron. 

If we do return to a more severe variant than Omicron, Murray says, “then suddenly we’re in a very different position. 

Keeping an Eye on COVID-19, Other Viral Illnesses

We have better genomic surveillance for circulating strains of SARS-CoV-2 than earlier in the pandemic, Phillips says. More reliable, day-to-day data also helped recently with the respiratory syncytial virus (RSV) outbreak and for tracking flu cases.

 Wastewater surveillance as an early warning system for COVID-19 or other respiratory virus surges can be helpful, but more research is needed, Garibaldi says. And with more people testing at home, test positivity rates are likely an undercount. So, hospitalization rates for COVID and other respiratory illnesses remain one of the more reliable community-based measures, for now, at least. 

One caveat is that sometimes, it is unclear if COVID-19 is the main reason someone is admitted to the hospital vs. someone who comes in for another reason and happens to test positive upon admission. 

Phillips suggests that using more than one measure might be the best approach, especially to reduce the likelihood of bias associated with any single strategy. “You need to look at a whole variety of tests in order for us to get a good sense of how it’s affecting all communities,” he says. In addition, if a consensus emerges among different measures – wastewater surveillance, hospitalization and test positivity all trending up – “that’s clearly a sign that things are afoot and that we would need to modify our approach accordingly.”

Where We Could Be Heading

Murray predicts a steady pace of infection with “no big changes.” But waning immunity remains a concern. 

That means if you have not had a recent infection – in the last 6 to 10 months – you might want to think about getting a booster, Murray says “The most important thing for people, for themselves, for their families, is to really think about keeping their immunity up.” 

Phillips hopes the improved surveillance systems will help public health officials make more precise recommendations based on community levels of respiratory illness. 

When asked to predict what might happen with COVID moving forward, “I can’t tell you how many times I’ve been wrong answering that question,” Garibaldi says.

 Rather than making a prediction, he prefers to focus on hope. 

“We weathered the winter storm we worried about in terms of RSV, flu, and COVID at the same time. Some places were hit harder than others, especially with pediatric RSV cases, but we haven’t seen anywhere near the level we saw last year and before that,” he says. “So, I hope that continues.”

“We’ve come very far in just 3 years. When I think about where we were in March 2020 taking care of our first round of COVID patients in our first unit called a biocontainment unit,” Garibaldi says. 

Murray addresses whether the term “pandemic” still applies at this point. 

“In my mind, the pandemic is over,” he says, because we are no longer in an emergency response phase. But COVID in some form is likely to be around for a long time, if not forever.  

“So, it depends on how you define pandemic. If you mean an emergency response, I think we’re out of it. If you mean the formal definition you know of an infection that goes all over the place, then we’re going to be in it for a very long time.”

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‘Breakthrough’ Study: Diabetes Drug Helps Prevent Long COVID

March 9, 2023 – Metformin appears to play a role in preventing long COVID when taken early during a COVID-19 infection, according to a new preprint study from The Lancet. The preprint hasn’t yet been peer-reviewed or published in a journal.

In particular, metformin led to a 42% drop in long COVID among people who had a mild to moderate COVID-19 infection. 

“Long COVID affects millions of people, and preventing long COVID through a treatment like metformin could prevent significant disruptions in people’s lives,” says lead author Carolyn Bramante, MD, an assistant professor of internal medicine and pediatrics at the University of Minnesota.

Between January 2021 and February 2022, Bramante and colleagues tested three oral medications – metformin (typically used to treat type 2 diabetes), ivermectin (an antiparasitic), and fluvoxamine (an antidepressant) – in a clinical trial across the U.S. called COVID-OUT. The people being studied, investigators, care providers, and others involved in the study were blinded to the randomized treatments. The trial was decentralized, with no in-person contact with participants.

The researchers included patients who were ages 30-85 with overweight or obesity, had documentation of a confirmed COVID-19 infection, had fewer than 7 days of symptoms, had no known prior infection, and joined the study within 3 days of their positive test. The study included monthly follow-up for 300 days, and participants indicated whether they received a long COVID diagnosis from a medical doctor, which the researchers confirmed in medical records after participants gave consent.

The medications were pre-packaged into pill boxes for fast delivery to participants and to ensure they took the correct number of each type of pill. The packages were sent via same-day courier or overnight shipping.

The metformin doses were doled out over 14 days: with 500 milligrams on the first day, 500 milligrams twice a day for the next 4 days, and then 500 milligrams in the morning and 1,000 milligrams in the evening for the remaining 9 days.

Among the 1,323 people studied, 1,125 agreed to do long-term follow-up for long COVID, including 564 in the metformin group and 561 in the blinded placebo group. The average age was 45, and 56% were women, including 7% who were pregnant. 

The average time from the start of symptoms to starting medication was 5 days, and 47% began taking the drug within 4 days or less. About 55% had received the primary COVID-19 vaccination series, including 5.1% who received an initial booster, before enrolling in the study.

Overall, 8.4% of participants reported that a medical provider diagnosed them with long COVID. Of those who took metformin, 6.3% developed long COVID, compared to 10.6% among those who took the identical-matched placebo.

The risk reduction for metformin was 42% versus the placebo, which was consistent across subgroups, including vaccination status and different COVID-19 variants.

When metformin was started less than 4 days after COVID-19 symptoms started, the effect was potentially even greater, with a 64% reduction, as compared with a 36% reduction among those who started metformin after 4 or more days after symptoms.

Neither ivermectin nor fluvoxamine showed any benefits for preventing long COVID.

At the same time, the study authors caution that more research is needed. 

“The COVID-OUT trial does not indicate whether or not metformin would be effective at preventing long COVID if started at the time of emergency department visit or hospitalization for COVID-19, nor whether metformin would be effective as treatment in persons who already have long COVID,” they wrote. “With the burden of long COVID on society, confirmation is urgently needed in a trial that addresses our study’s limitations in order to translate these results into practice and policy.”

Several risk factors for long COVID emerged in the analysis. About 11.1% of the women had a long COVID diagnosis, as compared with 4.9% of the men. Also, those who had received at least the primary vaccine series had a lower risk of developing long COVID, at 6.6%, as compared with 10.5% among the unvaccinated. Only one of the 57 people who received a booster shot developed long COVID.

Notably, pregnant and lactating people were included in this study, which is important given that pregnant people face higher risks for poor COVID-19 outcomes and are excluded from most non-obstetric clinical trials, the study authors wrote. In this study, they were randomized to metformin or placebo but not ivermectin or fluvoxamine due to limited research about the safety of those drugs during pregnancy and lactation.

The results are now under journal review but show consistent findings from other recent studies. Also, in August 2022, the authors published results from COVID-OUT that showed metformin led to a 42% reduction in hospital visits, emergency department visits, and deaths related to severe COVID-19.

“Given the lack of side effects and cost for a 2-week course, I think these data support use of metformin now,” says Eric Topol, MD, founder and director of the Scripps Research Translational Institute and editor-in-chief of Medscape, WebMD’s sister site for health care professionals. 

Topol, who wasn’t involved with this study, has been a leading voice on COVID-19 research throughout the pandemic. He noted the need for more studies, including a factorial design trial to test metformin and Paxlovid, which has shown promise in preventing long COVID. Topol also wrote about the preprint in Ground Truths, his online newsletter.

“As I’ve written in the past, I don’t use the term ‘breakthrough’ lightly,” he wrote. “But to see such a pronounced benefit in the current randomized trial of metformin, in the context of it being so safe and low cost, I’d give it a breakthrough categorization.”

Another way to put it, Topol wrote, is that based on this study, he himself would take metformin if he became infected with COVID-19. 

Jeremy Faust, MD, an emergency medicine doctor at Brigham and Women’s Hospital in Boston, also wrote about the study in his newsletter, Inside Medicine. He noted that the 42% reduction in long COVID means that 23 COVID-19 patients need to be treated with metformin to prevent one long COVID diagnosis, which is an “important reduction.”

“Bottom line: If a person who meets criteria for obesity or overweight status were to ask me if they should take metformin (for 2 weeks) starting as soon as they learn they have COVID-19, I would say yes in many if not most cases, based on this new data,” he wrote. “This is starting to look like a real win.”

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Long COVID Takes Toll on Already Stretched Health Care Workforce

March 6, 2023 — The impact of long COVID – and its sometimes-disabling symptoms that can persist for more than a year — has worsened health care’s already severe workforce shortage. 

Hospitals have turned to training programs, traveling nurses, and emergency room staffing services. While the shortage of clinical workers continues, support workers are also in short supply, with no end in sight.

“Our clinical staff is the front line, but behind them, several layers of people do jobs that allow them to do their jobs,” says Joanne Conroy, MD, president of Dartmouth-Hitchcock Medical Center, a 400-bed hospital in New Hampshire. “Lab and radiology and support people and IT and facilities and housekeeping … the list goes on and on.” 

Long COVID is contributing to the U.S. labor shortage overall, according to research. But with no test for the condition and a wide range of symptoms and severity – and with some workers attributing their symptoms to something else — it’s difficult to get a clear picture of the impacts on the health care system.

Emerging research suggests long COVID is hitting the health care system particularly hard.

 The system has lost 20% of its workforce over the course of the pandemic, with hospital understaffing at hospitals resulting in burnout and fatigue among frontline medical professionals, according to the U.S. Bureau of Labor Statistics.

Other research spotlights the significant impacts on health care workers:

  • In New York, nearly 20% of long COVID patients are still out of work after a year, with high numbers among health care workers, according to a new study of workers compensation claims.  
  • A new study in the American Journal of Infection Control reports nurses in intensive care units and non-clinical workers are especially vulnerable. About 2% of nurses have not returned work after developing COVID-19, according to a 2022 survey by the National Nursing Association, which represents unionized workers.  
  • In the United Kingdom, long COVID symptoms impact the lives of 1.5 million people, according to the Office of National Statistics, which is monitoring the impact of COVID. Nearly 20% report their ability to engage in day-to-day activities had been “limited a lot,” according to data from February.

While long COVID brain fog, fatigue, and other symptoms can sometimes last just a few weeks or months, a percentage of those who develop the condition – on or off the job – go on to have chronic, long-lasting, disabling symptoms that may linger for years. 

Several recent research studies suggest the impacts of long COVID on health care workers, who interact more closely with COVID patients than others on the job, are greater than other occupations and are likely to have a continuing impact.

About 25% of those filing COVID-related workers compensation claims for lost time at work are health care workers, according to a study from the National Council on Compensation Insurance. That was more than any other industry. At the same time,  the study – which included data from nine states – found that worker compensation claims for acute COVID cases dropped from 11% in 2020 to 4% in 2021.  

Last year, Katie Bach wrote a study for the Brookings Institution on the impact of long COVID on the labor market. She said in an email that she still thinks it’s a problem for the health care workforce and the workforce in general. 

“It is clear that we have a persistent group of long COVID patients who aren’t getting better,” she says.

Hospitals Forced to Adapt

Dartmouth-Hitchcock Medical Center is the largest health system — and one of the largest employers — in New Hampshire with 400 beds and 1,000 employees at the flagship hospital and affiliate. Human resource staff here have been tracking COVID-19 infections among employees.

The hospital is treating fewer COVID cases, down from a high of about 500 a month to between 100 and 200 cases month. But at the same time, they are seeing an increase in staff are who calling in sick with a range of COVID-like symptoms or consulting with the occupational medicine department, says Aimee M. Claiborne, the head of human resources for the Dartmouth Health system. 

“Some of that might be due to long COVID; some if it might be due to flu or RSV or other viruses,” she says. “We are definitely looking at things like absenteeism and what people are calling in for.”

They are also looking at “presenteeism” – where workers show up when they are not feeling well and they are not as productive, she says. 

Those who return to work can access the company’s existing disability programs to get accommodations – allowing people with low energy or fatigue or another disability to, for example, work shorter shifts or from home. Dartmouth-Hitchcock is also building more remote work into its system after trying the approach during the height of the pandemic, Claiborne says. 

Ultimately, some workers will not be able to return to work. Those who were infected on the job can also seek workers’ compensation, but coverage varies from employer to employer and state to state. 

On the other side of the country, Annette Gillaspie, a nurse in a small Oregon hospital, says she caught COVID – like many other health care workers – early in the pandemic before vaccines were available and protective measure were in place. 

She says she still hasn’t fully recovered 3 years later – she still has a cough as well as POTS (postural orthostatic tachycardia syndrome), a common post-COVID-19 condition of the automatic nervous system that can cause dizziness and fatigue when a sitting person stands up.

But she’s back at work and the hospital has made accommodations for her, like a parking space closer to the building. 

She remembers being exposed — she forgot to put on protective glasses. A few days later she was in bed with COVID. She says she never quite recovered. Gillaspie says she sees a lot of other people at work who seem to have some long COVID symptoms. 

“Some of them know it’s COVID related,” she says. “They’re doing just like I do — pushing through.”

They do it because they love their work, she says. 

Shortages Span the Country

Millions of people are living in what the federal government calls “health practitioner shortage areas” without enough dental, primary, and mental health practitioners. At hospitals, vacancies for nurses and respiratory therapists went up 30% between 2019 and 2020, according to an American Hospital Association (AHA) survey

Hospitals will need to hire to 124,000 doctors and at least 200,000 nurses per year to meet increased demand and to replace retiring nurses, according to the AHA. 

When the pandemic hit, hospitals had to bring expensive traveling nurses in to deal with the shortages driven by wave after wave of COVID surges. But as the AHA notes, the staffing shortfalls in health care existed before the pandemic.

The federal government, states, and health care systems have programs to address the shortage. Some hospitals train their own staff, while others may be looking at expanding the “scope of care” for existing providers, like physician assistants. Still others are looking to support existing staff who may be suffering from burnout and fatigue – and now, long COVID.

Long COVID numbers  — like the condition itself — are hard to measure and ever-changing. Between 10% and 11% of those who have had COVID have long COVID, according to the Household Pulse Survey, an ongoing Census Bureau data project.

A doctor in the U.K. recently wrote that she and others initially carried on working, believing they could push through symptoms. 

“As a doctor, the system I worked in and the martyr complex instilled by medical culture enabled that view. In medicine, being ill, being human, and looking after ourselves is still too often seen as a kind of failure or weakness,” she wrote anonymously in February in the journal BMJ.

Jeffrey Siegelman, MD, a doctor at Emory University Medical Center in the Atlanta, also wrote a journal article about his experiences with long COVID in 2020 in JAMA. More than 2 years later, he still has long COVID. 

He was out of work for 5 months, returned to practice part-time, and was exempt from night work – “a big ask,” he says, for an emergency department doctor. 

In general,  he feels like the hospital “bent over backwards” to help him get back to work. He is just about to return to work full-time with accommodations.

“I’ve been really lucky in this job,” Siegelman says. “That’s not what most patients with long COVID deal with.”

He led a support group for hospital employees who had long COVID – including clerks, techs, nurses, and doctors. Many people were trying to push through their symptoms to do their jobs, he says. A couple of people who ran through their disability coverage were dismissed.

He acknowledges that as a doctor, he had better disability coverage than others. But with no diagnostic test to confirm long COVID, he’s not exempt from self-doubt and stigma. 

Siegelman was one of the doctors who questioned the physiological basis for ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), a condition that mirrors long COVID and commonly appears in those who have lingering symptoms of an infection. He doesn’t anymore. 

Researchers are beginning to link ME/CFS and other long-term problems to COVID and other infections, and research is underway to better understand what is known as post-infection illnesses. 

Hospitals are dealing with so much, Siegelman says, that he understands if there’s a hesitancy to acknowledge that people are working at a reduced capacity. 

“It’s important for managers in hospitals to talk about this with their employees and allow people to acknowledge if they are taking more time than expected to recover from an illness,” he says. 

In medicine, he says, you are expected to show up for work unless you are on a gurney yourself. Now, people are much more open to calling in if they have a fever – a good development, he says.

And while he prepared to return to work, symptoms linger. 

“I can’t taste still,” he says. “That’s a pretty constant reminder that there is something real going on here.” 

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Celebrities may have helped shape anti-vaccine opinions during Covid-19 pandemic, study finds | CNN



CNN
 — 

Covid-19 vaccines are known to be safe and effective, and they’re available for free, but many Americans in the US refuse to get them – and a recent study suggests that celebrities may share some of the blame for people’s mistrust.

Celebrities have long tried to positively influence public health, studies show, but during the Covid-19 pandemic, they also seemed to have a large influence on spreading misinformation.

Decades ago, in the 1950s, people could see stars like Elvis Presley, Dick Van Dyke and Ella Fitzgerald in TV ads that encouraged polio vaccination. This celebrity influence boosted the country’s general vaccination efforts, and vaccination nearly eliminated the deadly disease.

In 2021, US officials used celebrities in TV ads to encourage more people to get vaccinated against Covid-19. Big names like lifestyle guru Martha Stewart, singer Charlie Puth and even Senate Minority Leader Mitchell McConnell showed up in spots that had billions of ad impressions.

The world isn’t restricted to only three TV networks any more, so celebrities like actress Hilary Duff, actor Dwayne “The Rock” Johnson, singer Dolly Parton and even Big Bird also used their enormous presence on Instagram and Twitter to promote a pro Covid-19 vaccine message.

But social media also became a vehicle for celebrities to cast doubt about the safety and effectiveness of the vaccine and even to spread disinformation about Covid.

Their negative messages seemed to find an audience.

For their study, published in the journal BMJ Health & Care Informatics, researchers examined nearly 13 million tweets between January 2020 and March 2022 about Covid-19 and vaccines. They designed a natural language model to determine the sentiment of each tweet and compared them with tweets that also mentioned people in the public eye.

The stars they picked to analyze included people who had shared skepticism about the vaccines, who had Covid-related tweets that were identified as misinformation or who retweeted misinformation about Covid.

They included rapper Nicki Minaj, football player Aaron Rodgers, tennis player Novak Djokovic, singer Eric Clapton, Sen. Rand Paul, former President Donald Trump, Sen. Ted Cruz, Florida Gov. Ron DeSantis, TV host Tucker Carlson and commentator Joe Rogan.

The researchers found 45,255 tweets from 34,407 unique authors talking about Covid-19 vaccine-related issues. Those tweets generated a total of 16.32 million likes. The tweets from these influencers, overall, were more negative about the vaccine than positive, the study found. These tweets were specifically more related to antivaccine controversy, rather than news about vaccine development, the study said.

The highest number of negative comments was associated with Rodgers and Minaj. Clapton had “very few” positive tweets, the study said, and that may have had an influence, but he also caught flak for it from the public.

The most-liked tweet that mentioned Clapton and the vaccine said, “Strongly disagree with [EC] … take on Covid and the vaccine and disgusted by his previous white supremacist comments. But if you reference the death of his son to criticize him, you are an ignorant scumbag.”

Trump and Cruz were found to have the most substantial impact within this group, with combined likes totaling more than 122,000.

They too came in for criticism on the topic, with many users wondering whether these politicians were qualified to have opinions about the vaccines. The study said the most-liked tweet mentioning Cruz was, “I called Ted Cruz’s office asking to make an appointment to talk with the Senator about my blood pressure. They told me that the Senator was not qualified to give medical advice and that I should call my doctor. So I asked them to stop advising about vaccines.”

The most-liked tweet associated with Rogan was an antivaxx statement: “I love how the same people who don’t want us to listen to Joe Rogan, Aaron Rodgers about the covid vaccine, want us to listen to Big Bird & Elmo.”

Posts shared by news anchors and politicians seemed to have the most influence in terms of the most tweets and retweets, the study found.

“Our findings suggest that the presence of consistent patterns of emotional content co-occurring with messaging shared by those persons in the public eye that we’ve mentioned, influenced public opinion and largely stimulated online public discourse, for the at least over the course of the first two years of the Covid pandemic,” said study co-author Brianna White, a research coordinator in the Population Health Intelligence lab at the University of Tennessee Health Science Center – Oak Ridge National Laboratory Center for Biomedical Informatics.

“We also argue that obviously as the risk of severe negative health outcomes increase with the failure to comply with health protective behavior recommendations, that our findings suggest that polarized messages from societal elite may downplay those severe negative health outcome risks.”

The study doesn’t get into exactly why celebrity tweets would have such an impact on people’s attitudes about the vaccine. Dr. Ellen Selkie, who has conducted research on influence at the intersection of social media, celebrity and public health outcomes, said celebrities are influential because they attract a lot of attention.

“I think part of the influence that media have on behavior has to do with the amount of exposure. Just in general, the volume of content that is focused on a specific topic or on a specific sort of interpretation of that topic – in this case misinformation – the repeated exposure to any given thing is going to increase the likelihood that it’s going to have an effect,” said Selkie, who was not involved in the new research. She is an adolescent health pediatrician and researcher with UW Health Kids and an assistant professor of pediatrics at the University of Wisconsin School of Medicine and Public Health.

Just as people listen to a friend’s thoughts, they’ll listen to a celebrity whom they tend to like or identify with because they trust their opinion.

“With fandoms, in terms of the relationship between musical artists and actors and their fans, there is this sort of mutual love that fans and artists have for each other, which sort of can approximate that sense that they’re looking out for each other,” Selkie said.

She said she would be interested to see research on the influence of celebrities who tweeted positive messages about the Covid-19 vaccine.

The authors of the study hope public health leaders will use the findings right away.

“We argue this threat to population health should create a sense of urgency and warrants public health response to identify, develop and implement innovative mitigation strategies,” the study says.

Exposure to large amounts of this misinformation can have a lasting impact and work against the public’s best interest when it comes to their health.

“As populations grow to trust the influential nature of celebrity activity on social platforms, followers are disarmed and open to persuasion when faced with false information, creating opportunities for dissemination and rapid spread of misinformation and disinformation,” the study says.



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Cancer screenings could be back to normal after millions missed during Covid-19 pandemic | CNN



CNN
 — 

Millions of people across the United States missed routine cancer screenings during the second year of the Covid-19 pandemic, with the prevalence of screening for breast, cervical and prostate cancers in the previous year falling anywhere from 6% to 15% between 2019 and 2021, according to a new study from the American Cancer Society.

“We were thinking there would be a rebound in late 2020,” said Dr. William Dahut, chief scientific officer of the American Cancer Society. “We were surprised to see the continued increase in the number of folks not getting their screenings.”

But more recently, it appears that people are starting to return to routine screenings at rates seen before the pandemic, separate research suggests.

Rates of screening for breast, cervical and colon cancers may have returned to normal, according to more recent data published last week in the journal Epic Research, which is owned by the health care software company Epic.

“As screening rates returned to normal from the drop we previously reported, rates of cancer diagnosis returned to normal as well,” Dr. Chris Alban, a clinical informaticist at Epic Research, wrote in an email.

“We haven’t seen evidence that the screenings missed during the pandemic resulted in worsened patient outcomes, though we plan to monitor this trend to see whether it holds over time,” he said. “The recommended intervals between screenings for a given cancer can be several years, so evidence of advanced cancers can take a long time to appear.”

Due to the declines in cancer screenings as well as barriers to accessing treatment in the early days of the pandemic, not only did physicians nationwide worry that screening and treatment delays led to patients arriving at their offices with advanced cancer, some anecdotally reported seeing upticks in advanced cancers at the time.

The prevalence of screening for breast, cervical and prostate cancers did not return to pre-pandemic levels in 2021, the second year of the Covid-19 pandemic, according to the American Cancer Society’s new study, published Thursday in the Journal of Clinical Oncology.

The study included data on more than 60,000 adults in the United States who were eligible for screening for breast, cervical, prostate and colorectal cancers between 2019 and 2021. The data came from the US Centers for Disease Control and Prevention’s National Health Interview Survey.

The researchers found that between 2019 and 2021, the overall prevalence of eligible adults who completed screening in the previous year fell 6% for breast cancer, 15% for cervical cancer and 10% for prostate cancer. That means there were about 1 million fewer people who got screened for breast cancer, 4.4 million fewer screened for cervical cancer and about 700,000 fewer screened for prostate cancer.

“These declines have significant public health implications as they are expected to lead to more advanced stage cancer diagnosis in the future,” the researchers wrote.

The prevalence of screening for colorectal cancer was unchanged, the researchers found.

The growing popularity of at-home colon cancer screening tests probably offset any decline in colorectal cancer screenings, they wrote.

The researchers also found some racial differences, as the Asian community had the largest declines in breast, cervical and prostate cancer screenings.

“These findings are especially concerning as cancer is the leading cause of death in both Asian American men and women,” wrote the researchers, all from the American Cancer Society.

Dahut said that anyone who missed a routine cancer screening during the early days of the pandemic should catch up now.

“Even in the best of times, the number of folks who are screened is far too low,” he said. “Go ahead and follow the guidelines, get screened when appropriate, and the outcomes will be better.”

The Epic Research study involved data on 373,574 cancer diagnoses entered in patients’ charts in the US between January 2018 and December 2022.

The data came from 190 health care organizations that use software from Epic for their electronic health records. Together, these organizations represent 1,123 hospitals and more than 22,500 clinics, and they agreed to contribute to the de-identified data set, meaning no individual patient can be identified within the data.

The data showed a clear decrease in cancer cases early in the pandemic, which correlates with a decline in screening, but screening rates appeared to return to normal last year, as did cancer detection rates. The data also did not appear to show a significant rise in new diagnoses of advanced cancers through the end of last year.

It’s “good news” that the data demonstrate a return to pre-Covid rates of cancer screening, Dr. Arif Kamal, the American Cancer Society’s chief patient officer – who was not involved in the Epic Research study – wrote in an email. He called the new data intriguing but emphasized that more time is needed to determine whether or when rates of advanced cancers may increase due to missed screenings. It could take years.

“Conclusions regarding whether advanced cancer rates have increased due to missed screenings are a bit premature to reach. This is because cancer takes years to develop, and the resulting effect of missed cancers cannot be known after only a few years,” Kamal said.

“We remain hopeful that as cancer screening rates have returned to baseline, that the two years of missed screenings will not have a long-lasting effect on cancer incident or mortality,” he said. “But more time will tell.”

The data from Epic Research’s study is encouraging, as it suggests that more advanced cancers are not being seen, Dr. David Cohn, chief medical officer for the Ohio State University Comprehensive Cancer Center, wrote in an email.

“Whether this holds up over the next few years is yet to be seen,” he added.

Cohn, a practicing gynecologic oncologist who was not involved in either new study, said that he is “always concerned” about a decrease in screening rates and the resulting impact on later cancer diagnoses.

Yet “these data suggest that folks are getting back to the core business of screening,” he said, “such that these data will hopefully hold up over the next few years without seeing an increase in later diagnoses.”

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First on CNN: HHS secretary sends letter to state governors on what’s to come when Covid-19 public health emergency ends | CNN



CNN
 — 

Plans are moving forward at the US Department of Health and Human Services to prepare for the end of the nation’s Covid-19 public health emergency declaration in May.

On Thursday, HHS Secretary Xavier Becerra sent a letter and fact sheet to state governors detailing what exactly the end of the emergency declaration will mean for jurisdictions and their residents.

“Addressing COVID-19 remains a significant public health priority for the Administration, and over the next few months, we will transition our COVID-19 policies, as well as the current flexibilities enabled by the COVID-19 emergency declarations, into improving standards of care for patients. We will work closely with partners including state, local, Tribal, and territorial agencies, industry, and advocates, to ensure an orderly transition,” Becerra wrote in a draft of the letter obtained by CNN.

“In the coming days, the Centers for Medicare & Medicaid Services (CMS) will also provide additional information, including about the waivers many states and health systems have adopted and how they will be impacted by the end of the COVID-19 PHE,” he wrote. “I will share that resource with your team when available.”

Declaring a public health emergency in the United States means that certain actions, access to funds, grants, waivers and data – among other steps – can happen more quickly in response to the crisis for the duration of the emergency. A declaration lasts 90 days – unless HHS ends it – and may be renewed.

On January 30, the White House announced its intention to end the Covid-19 national and public health emergencies on May 11, signaling that the administration considers the nation to have moved out of the emergency response phase.

Becerra had agreed to give governors a 60-day notice to prepare for the end of the emergency. Thursday’s letter was sent 90 days ahead of the emergency’s planned end.

“We are having ongoing conversations about what else we need to do in the next 90 days to ensure a smooth transition. I can tell you that every one of our agencies has been working hard on this plan,” an HHS official told CNN. “We’re going to have a series of additional materials that will go out, as well as a series of conversations over the coming days and weeks.”

The end of the public health emergency will affect some Medicare and state Medicaid flexibilities provided for the duration of the emergency. This includes waivers like the requirement for a three-day hospital stay before Medicare will cover care at a skilled nursing facility.

“We’ve been working closely with the governors on the public health emergency. This is a combination of both federal flexibilities that we allow, and the states are often the ones who are using those flexibilities,” the HHS official said.

“Just about every aspect of the pandemic response, I would say, has been in partnership with our state partners. And so, I think they have been, frankly for months now, the ones that we have been going to and the ones that we publicly committed to notifying in advance of changes to the public health emergency declaration.”

But the emergency’s end will not impact the authorizations of Covid-19 devices, including tests, vaccines and treatments that have been authorized for emergency use by the US Food and Drug Administration.

During the Covid-19 pandemic, the FDA has issued about 15 times as many emergency use authorizations as it did for all other previous public health emergencies, Commissioner Dr. Robert Califf said Wednesday in a joint hearing of the House Oversight and Investigations and Health subcommittees.

“Today, we’ve issued EUAs or provided traditional marketing authorizations to over 2,800 medical devices for Covid-19, which is 15 times more EUAs than all other previous emergencies combined,” Califf said. He added that the effects of the end of the emergency declaration will be “modest” because the “EUAs are independent of the public health emergency, so we can keep them going as long as we need to.”

The emergency is slated to end May 11. “What happens on May 12? On May 12, you can still walk into a pharmacy and get your bivalent vaccine,” Dr. Ashish Jha, the White House’s coronavirus response coordinator, wrote on Twitter last week.

He said that at some point, probably in the summer or early fall, the Biden administration will transition from federal distribution of Covid-19 vaccines and treatments to purchases through the regular health care system – but that’s not happening quite yet.

Overall, there are additional Medicaid waivers and other flexibilities that states and territories have received under the public health emergency. Some of those will be terminated. But state Medicaid programs will have to continue covering Covid-19 testing, treatments, and vaccinations without cost-sharing through September 30, 2024.

The end of the public health emergency declaration means Medicare beneficiaries will face out-of-pocket costs for over-the-counter home Covid-19 tests and treatment. However, people with Medicare will continue to have no cost for medically necessary lab-conducted Covid-19 tests ordered by their health care providers.

Covid-19 vaccinations will continue to be covered at no cost for all Medicare beneficiaries.

Those with private insurance could face charges for lab tests, even if they are ordered by a provider, according to the Kaiser Family Foundation. Vaccinations will continue to be free for those with private insurance who go to in-network providers, but going to an out-of-network providers could incur charges once federal supplies run out.

And the privately insured will not be able to get free at-home tests from pharmacies and retailers anymore unless their insurers choose to cover them.

Americans with private insurance have not been charged for monoclonal antibody treatment since they were prepaid by the federal government, though patients may be charged for the office visit or administration of the treatment, according to Kaiser. But that is not tied to the public health emergency, and the free treatments will be available until the federal supply is exhausted. The government has already run out of some of the treatments so those with private insurance may already be picking up some of the cost.

The uninsured had been able to access no-cost testing, treatments and vaccines through a different pandemic relief program. However, the federal funding ran out in the spring of 2022, making it more difficult for those without coverage to obtain free services.

Also, the “ability of health care providers to safely dispense controlled substances via telemedicine without an in-person interaction is affected; however, there will be rulemaking that will propose to extend these flexibilities,” according to the letter’s fact sheet.

One of the most meaningful pandemic enhancements for states is no longer tied to the public health emergency. Congress severed the connection in December as part of its fiscal year 2023 government funding package, which state Medicaid officials had urged lawmakers to do.

States will now be able to start processing Medicaid redeterminations and disenrolling residents who no longer qualify, starting April 1. They have 14 months to review the eligibility of their beneficiaries.

As part of a Covid-19 relief package passed in March 2020, states were barred from kicking people off Medicaid during the public health emergency in exchange for additional federal matching funds. Medicaid enrollment has skyrocketed to a record 91 million people since then.

A total of roughly 15 million people could be dropped from Medicaid when the continuous enrollment requirement ends, according to an analysis the Department of Health and Human Services released in August. About 8.2 million folks would no longer qualify, but 6.8 million people would be terminated even though they are still eligible, the department estimated.

Many who are disenrolled from Medicaid, however, could qualify for other coverage.



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The virus threat is easing, but US hospitals are still as full as ever | CNN



CNN
 — 

At Massachusetts General Hospital in downtown Boston, the hallways of the emergency department are lined with dozens of patients waiting to get a room upstairs.

“Imagine spending days and nights in the hallway under fluorescent lights in the ER next to a trauma bay while [patients] have heart failure, kidney failure or pneumonia,” said Dr. Melissa Mattison, a physician and chief of hospital medicine at Mass General, which is a founding member of Mass General Brigham.

“Everybody’s doing their best, but where do they go to the bathroom? How do they take a shower if they want to clean up? How do they eat? There’s no privacy. It’s just, it’s awful. It’s absolutely awful.”

As of Friday, about 87% of all available hospital beds in the state are in use, and capacity strains have eased little despite a dramatic decrease in the number of people being treated for respiratory illness.

“Every day, our emergency room has a backlog of anywhere between 25 and 100 patients waiting for a bed upstairs. So if today, that number was 25, and two weeks ago, it was 100 – yes, that’s better, but there’s still a long line,” Mattison said. “Maybe the patients aren’t piled like sardines in the ER as much when you only have 35 patients waiting compared to 75. But it’s still not great.”

The winter triple threat of flu, Covid-19 and RSV is easing across the United States, and as in Massachusetts, most states are now reporting low or minimal levels of respiratory illness activity overall.

Nationwide, emergency department visits for the respiratory viruses are a third of what they were a month ago, federal data shows. Flu hospitalizations are nearly as low as they’ve been all season, since October. Hospitalizations for Covid-19 – the last of the three viruses to trend down – have been falling for the past few weeks, and just 4% of hospital beds nationwide are being used by Covid-19 patients.

That’s a dramatic shift from January 2022, when Covid-19 patients were filling most hospital beds amid the early Omicron surge. But hospitals are still about as full as they’ve ever been during the pandemic – at least three-quarters of available beds across the country were in use for all of 2022 – and that doesn’t seem likely to change any time soon.

Hospitals were facing capacity and resource challenges long before the pandemic hit, experts say, in large part because the people who are being admitted are sicker than they were before.

“It’s been a continuing trend over the last decade or so that there’s been this greater acuity of patients inside the hospitals,” said Nancy Foster, vice president for quality and patient safety with the American Hospital Association. “So what you see is this incredibly sick group of people inside of hospitals. If you’re a doctor or nurse or respiratory therapist or pharmacist or any other health professional working inside the hospital, that means it’s always a difficult puzzle you’re trying to solve to help that patient out.”

At Mass General, an emergency department boarder program – which outlines plans for how to cover patients who were waiting for a bed – was well-established years before the pandemic hit, Mattison said.

Hospitals started to report capacity data to the federal government in 2020 under a pandemic requirement, so there’s no federal data to compare to pre-pandemic years.

But Mattison was quick to say her hospital is 99% full now, like it was in 2019 and years before the pandemic. Still, she says, “how long is that waiting list, and who’s on that waiting list? That’s something that’s not reflected in that metric.”

By and large, the mix of patients in hospitals is similar to what it was pre-pandemic, said Aaron Wesolowski, vice president of policy research, analytics and strategy at the American Hospital Association.

As the share of Covid-19 patients drops, it’s perhaps “a breath less stressful” for health care providers who felt frustrated by the lack of tools available to help people as they so desperately wanted to in the early days of the pandemic, Foster said.

In fact, for most categories of care – with infectious disease as a noticeable exception – the number of people seen in inpatient and emergency department settings in 2022 was lower than it was in 2019, Wesolowski said, citing data from Strata, a health care data analytics firm.

A mix of complicating factors were exacerbated during the pandemic, experts say, straining resources more than ever.

“Length of stay is longer because people are needing more acute care. Because of work force pressures, there are not as many people who can be treated in an inpatient setting all at once,” Wesolowski said. “So both things, I think, can be true.”

Samuel Scarpino, director of AI and life sciences at Northeastern University, says it’s a “perfect storm” of issues: Covid-19 and the ongoing infection control measures that hospitals have to keep in place, a backlog of other patients with a delayed need for acute care, and work force burnout three years into a pandemic.

The biggest risk factor in the equation is still Covid-19, he says, not because a new variant will necessarily cause more hospitalizations but because the unpredictability is forcing hospitals to leave more beds open as a buffer just in case.

“The biggest risk is almost certainly the uncertainty associated with what’s coming,” said Scarpino, who was previously vice president at the Rockefeller Foundation’s Pandemic Prevention Institute.

Foster, of the American Hospital Association, says the pandemic emergency declaration has granted a number of flexibilities – such as telehealth – that have helped more patients have options for care that are outside of hospitals.

The federal government has continuously renewed the emergency declaration since January 2020, but it is likely to come to an end in May.

Without it, Foster says, hospitals would probably be even more full than they already are – particularly as alternative options for care outside of the hospital may become more limited again.

“Part of the reason we have the kind of inpatient hospital capacity that we have right now is that we do have a number of flexibilities that were granted to hospitals by [the Centers for Medicare and Medicaid Services] and other federal agencies and the states during Covid that are being used for a wide variety of patients,” she said. “If those were to disappear overnight, we would be struggling to care for the current level of patients.”

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Here’s what the Federal Reserve’s 25 basis point interest rate hike means for your money

The Federal Reserve raised the target federal funds rate for the eighth time in a row on Wednesday, in its continued effort to tame persistent inflation.

At its latest meeting, the central bank approved a more modest 0.25 percentage point increase after recent signs that inflationary pressures have started to cool.

“The easing of inflation pressures is evident, but this doesn’t mean the Federal Reserve’s job is done,” said Greg McBride, chief financial analyst at Bankrate.com. “There is still a long way to go to get to 2% inflation.”

What the federal funds rate means to you

The federal funds rate, which is set by the U.S. central bank, is the interest rate at which banks borrow and lend to one another overnight. Although that’s not the rate consumers pay, the Fed’s moves do affect the borrowing and saving rates consumers see every day.

This rate hike will correspond with a rise in the prime rate and immediately send financing costs higher for many forms of consumer borrowing — putting more pressure on households already under financial strain.

“Inflation has shredded household budgets and, in many cases, households have had to lean against credit cards to bridge the gap,” McBride said.

On the flip side, “with rates still rising and inflation now declining, it is the best of both worlds for savers,” he added.

How higher interest rates can affect your money

1. Your credit card rate will rise

Since most credit cards have a variable rate, there’s a direct connection to the Fed’s benchmark. As the federal funds rate rises, the prime rate does, as well, and your credit card rate follows suit within one or two billing cycles.

“Credit card interest rates are already as high as they’ve been in decades,” said Matt Schulz, chief credit analyst at LendingTree. “While the Fed is taking its foot off the gas a bit when it comes to raising rates, credit card APRs almost certainly will keep climbing for at least the next few months, so it is important that cardholders continue to focus on knocking down their debt.”

Credit card annual percentage rates are now near 20%, on average, up from 16.3% a year ago, according to Bankrate. At the same time, more cardholders carry debt from month to month while paying sky-high interest charges — “that’s a bad combination,” McBride said.

At more than 19%, if you made minimum payments toward the average credit card balance — which is $5,474, according to TransUnion — it would take you almost 17 years to pay off the debt and cost you more than $7,528 in interest, Bankrate calculated.

Altogether, this rate hike will cost credit card users at least an additional $1.6 billion in interest charges in 2023, according to a separate analysis by WalletHub.

“A 0% balance transfer credit card remains one of the best weapons Americans have in the battle against credit card debt,” Schulz advised.

Otherwise, consumers should consolidate and pay off high-interest credit cards with a lower-interest personal loan, he said. “The rates on new personal loan offers have climbed recently as well, but if you have good credit, you may be able to find options that feature lower rates that what you currently have on your credit card.”

2. Mortgage rates will stay higher

Rates on 15-year and 30-year mortgages are fixed and tied to Treasury yields and the economy. As economic growth has slowed, these rates have started to come down but are still at a 10-year high, according to Jacob Channel, senior economist at LendingTree.

The average interest rate for a 30-year fixed-rate mortgage is now around 6.4% — up almost 3 full percentage points from 3.55% a year ago.

“Relatively high rates, combined with persistently high home prices, mean that buying a home is still a challenge for many,” Channel said.

This rate hike has increased the cost of new mortgages by around 10 basis points, which translates to roughly $9,360 over the lifetime of a 30-year loan, assuming the average home loan of $401,300, WalletHub found. A basis point is equal to 0.01 of a percentage point.

“We’re still a ways away from the housing market being truly affordable, even if it has recently become a bit less expensive,” Channel said.

Other home loans are more closely tied to the Fed’s actions. Adjustable-rate mortgages, or ARMs, and home equity lines of credit, or HELOCs, are pegged to the prime rate. Most ARMs adjust once a year, but a HELOC adjusts right away. Already, the average rate for a HELOC is up to 7.65% from 4.11% a year ago.

More from Personal Finance:
64% of Americans are living paycheck to paycheck
What is a ‘rolling recession’ and how does it impact you?
Almost half of Americans think we’re already in a recession

3. Auto loans will get more expensive

Even though auto loans are fixed, payments are getting bigger because the price for all cars is rising along with the interest rates on new loans, so if you are planning to buy a car, you’ll shell out more in the months ahead.

The average interest rate on a five-year new car loan is currently 6.18%, up from 3.96% last year.

The Fed’s latest move could push up the average interest rate even higher, although consumers with higher credit scores may be able to secure better loan terms or look to some used car models for better deals.

Paying an annual percentage rate of 6% instead of 4% would cost consumers $2,672 more in interest over the course of a $40,000, 72-month car loan, according to data from Edmunds.

“The ever-increasing costs of financing remain a challenge,” said Ivan Drury, Edmunds’ director of insights.

4. Some student loans will get pricier

Federal student loan rates are also fixed, so most borrowers won’t be affected immediately. But if you are about to borrow money for college, the interest rate on federal student loans taken out for the 2022-23 academic year already rose to 4.99%, up from 3.73% last year and any loans disbursed after July 1 will likely be even higher.

If you have a private loan, those loans may be fixed or have a variable rate tied to the Libor, prime or T-bill rates, which means that as the central bank raises rates, borrowers will likely pay more in interest, although how much more will vary by the benchmark.

Currently, average private student loan fixed rates can range from just under 4% to almost 15%, according to Bankrate. As with auto loans, they also vary widely based on your credit score.

For now, anyone with existing federal education debt will benefit from rates at 0% until the payment pause ends, which the Education Department expects to happen sometime this year.

What savers should know about higher interest rates

The good news is that interest rates on savings accounts are finally higher after the recent run of rate hikes.

While the Fed has no direct influence on deposit rates, they tend to be correlated to changes in the target federal funds rate, and the savings account rates at some of the largest retail banks, which have been near rock bottom during most of the Covid pandemic, are currently up to 0.33%, on average.

Also, thanks, in part, to lower overhead expenses, top-yielding online savings account rates are as high as 4.35%, much higher than the average rate from a traditional, brick-and-mortar bank.

Rates on one-year certificates of deposit at online banks are even higher, now around 4.75%, according to DepositAccounts.com.

As the Fed continues its rate-hiking cycle, these yields will continue to rise, as well. However, you have to shop around to take advantage of them, according to Yiming Ma, an assistant finance professor at Columbia University Business School.

“If you haven’t already, it’s really important to benefit from the high interest environment by getting a higher return,” she said.

Still, because the inflation rate is now higher than all of these rates, any money in savings loses purchasing power over time. 

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FDA vaccine advisers vote to harmonize Covid-19 vaccines in the United States | CNN



CNN
 — 

A panel of independent experts that advises the US Food and Drug Administration on its vaccine decisions voted unanimously Thursday to update all Covid-19 vaccines so they contain the same ingredients as the two-strain shots that are now used as booster doses.

The vote means young children and others who haven’t been vaccinated may soon be eligible to receive two-strain vaccines that more closely match the circulating viruses as their primary series.

The FDA must sign off on the committee’s recommendation, which it is likely to do, before it goes into effect.

Currently, the US offers two types of Covid-19 vaccines. The first shots people get – also called the primary series – contain a single set of instructions that teach the immune system to fight off the original version of the virus, which emerged in 2019.

This index strain is no longer circulating. It was overrun months ago by an ever-evolving parade of new variants.

Last year, in consultation with its advisers, the FDA decided that it was time to update the vaccines. These two-strain, or bivalent, shots contain two sets of instructions; one set reminds the immune system about the original version of the coronavirus, and the second set teaches the immune system to recognize and fight off Omicron’s BA.4 and BA.5 subvariants, which emerged in the US last year.

People who have had their primary series – nearly 70% of all Americans – were advised to get the new two-strain booster late last year in an effort to upgrade their protection against the latest variants.

The advisory committee heard testimony and data suggesting that the complexity of having two types of Covid-19 vaccines and schedules for different age groups may be one of the reasons for low vaccine uptake in the US.

Currently, only about two-thirds of Americans have had the full primary series of shots. Only 15% of the population has gotten an updated bivalent booster.

Data presented to the committee shows that Covid-19 hospitalizations have been rising for children under the age of 2 over the past year, as Omicron and its many subvariants have circulated. Only 5% of this age group, which is eligible for Covid-19 vaccination at 6 months of age, has been fully vaccinated. Ninety percent of children under the age of 4 are still unvaccinated.

“The most concerning data point that I saw this whole day was that extremely low vaccination coverage in 6 months to 2 years of age and also 2 years to 4 years of age,” said Dr. Amanda Cohn, director of the US Centers for Disease Control and Prevention’s Division of Birth Defects and Infant Disorders. “We have to do much, much better.”

Cohn says that having a single vaccine against Covid-19 in the US for both primary and booster doses would go a long way toward making the process less complicated and would help get more children vaccinated.

Others feel that convenience is important but also stressed that data supported the switch.

“This isn’t only a convenience thing, to increase the number of people who are vaccinated, which I agree with my colleagues is extremely important for all the evidence that was related, but I also think moving towards the strains that are circulating is very important, so I would also say the science supports this move,” said Dr. Hayley Gans, a pediatric infectious disease specialist at Stanford University.

Many others on the committee were similarly satisfied after seeing new data on the vaccine effectiveness of the bivalent boosters, which are cutting the risk of getting sick, being hospitalized or dying from a Covid-19 infection.

“I’m totally convinced that the bivalent vaccine is beneficial as a primary series and as a booster series. Furthermore, the updated vaccine safety data are really encouraging so far,” said Dr. David Kim, director of the the US Department of Health and Human Services’ National Vaccine Program, in public discussion after the vote.

Thursday’s vote is part of a larger plan by the FDA to simplify and improve the way Covid-19 vaccines are given in the US.

The agency has proposed a plan to convene its vaccine advisers – called the Vaccines and Related Biological Products Advisory Committee, or VRBPAC – each year in May or June to assess whether the instructions in the Covid-19 vaccines should be changed to more closely match circulating strains of the virus.

The time frame was chosen to give manufacturers about three months to redesign their shots and get new doses to pharmacies in time for fall.

“The object, of course – before anyone says anything – is not to chase variants. None of us think that’s realistic,” said Jerry Weir, director of the Division of Viral Products in the FDA’s Office of Vaccines Research and Review.

“But I think our experience so far, with the bivalent vaccines that we have, does indicate that we can continue to make improvements to the vaccine, and that would be the goal of these meetings,” Weir said.

In discussions after the vote, committee members were supportive of this plan but pointed out many of the things we still don’t understand about Covid-19 and vaccination that are likely to complicate the task of updating the vaccines.

For example, we now seem to have Covid-19 surges in the summer as well as the winter, noted Dr. Michael Nelson, an allergist and immunologist at the University of Virginia. Are the surges related? And if so, is fall the best time to being a vaccination campaign?

The CDC’s Dr. Jefferson Jones said that with only three years of experience with the virus, it’s really too early to understand its seasonality.

Other important questions related to the durability of the mRNA vaccines and whether other platforms might offer longer protection.

“We can’t keep doing what we’re doing,” said Dr. Bruce Gellin, chief of global public health strategy at the Rockefeller Foundation. “It’s been articulated in every one of these meetings despite how good these vaccines are. We need better vaccines.”

The committee also encouraged both government and industry scientists to provide a fuller picture of how vaccination and infection affect immunity.

One of the main ways researchers measure the effectiveness of the vaccines is by looking at how much they increase front-line defenders called neutralizing antibodies.

Neutralizing antibodies are like firefighters that rush to the scene of an infection to contain it and put it out. They’re great in a crisis, but they tend to diminish in numbers over time if they’re not needed. Other components of the immune system like B-cells and T-cells hang on to the memory of a virus and stand ready to respond if the body encounters it again.

Scientists don’t understand much about how well Covid-19 vaccination boosts these responses and how long that protection lasts.

Another puzzle will be how to pick the strains that are in the vaccines.

The process of selecting strains for influenza vaccines is a global effort that relies on surveillance data from other countries. This works because influenza strains tend to become dominant and sweep around the world. But Covid-19 strains haven’t worked in quite the same way. Some that have driven large waves in other countries have barely made it into the US variant mix.

“Going forward, it is still challenging. Variants don’t sweep across the world quite as uniform, like they seem to with influenza,” the FDA’s Weir said. “But our primary responsibility is what’s best for the US market, and that’s where our focus will be.”

Eventually, the FDA hopes that Americans would be able to get an updated Covid-19 shot once a year, the same way they do for the flu. People who are unlikely to have an adequate response to a single dose of the vaccine – such as the elderly or those with a weakened immune system – may need more doses, as would people who are getting Covid-19 vaccines for the first time.

At Thursday’s meeting, the advisory committee also heard more about a safety signal flagged by a government surveillance system called the Vaccine Safety Datalink.

The CDC and the FDA reported January 13 that this system, which relies on health records from a network of large hospital systems in the US, had detected a potential safety issue with Pfizer’s bivalent boosters.

In this database, people 65 and older who got a Pfizer bivalent booster were slightly more likely to have a stroke caused by a blood clot within three weeks of their vaccination than people who had gotten a bivalent booster but were 22 to 42 days after their shot.

After a thorough review of other vaccine safety data in the US and in other countries that use Pfizer bivalent boosters, the agencies concluded that the stroke risk was probably a statistical fluke and said no changes to vaccination schedules were recommended.

At Thursday’s meeting, Dr. Nicola Klein, a senior research scientist with Kaiser Permanente of Northern California, explained how they found the signal.

The researchers compared people who’d gotten a vaccine within the past three weeks against people who were 22 to 42 days away from their shots because this helps eliminate bias in the data.

When they looked to see how many people had strokes around the time of their vaccination, they found an imbalance in the data.

Of 550,000 people over 65 who’d received a Pfizer bivalent booster, 130 had a stroke caused by a blood clot within three weeks of vaccination, compared with 92 people in the group farther out from their shots.

The researchers spotted the signal the week of November 27, and it continued for about seven weeks. The signal has diminished over time, falling from an almost two-fold risk in November to a 47% risk in early January, Klein said. In the past few days, it hasn’t been showing up at all.

Klein said they didn’t see the signal in any of the other age groups or with the group that got Moderna boosters. They also didn’t see a difference when they compared Pfizer-boosted seniors with those who were eligible for a bivalent booster but hadn’t gotten one.

Further analyses have suggested that the signal might be happening not because people who are within three weeks of a Pfizer booster are having more strokes, but because people who are within 22 to 42 days of their Pfizer boosters are actually having fewer strokes.

Overall, Klein said, they were seeing fewer strokes than expected in this population over that period of time, suggesting a statistical fluke.

Another interesting thing that popped out of this data, however, was a possible association between strokes and high-dose flu vaccination. Seniors who got both shots on the same day and were within three weeks of those shots had twice the rate of stroke compared with those who were 22 to 42 days away from their shots.

What’s more, Klein said, the researchers didn’t see the same association between stroke and time since vaccination in people who didn’t get their flu vaccine on the same day.

The total number of strokes in the population of people who got flu shots and Covid-19 boosters on the same day is small, however, which makes the association a shaky one.

“I don’t think that the evidence are sufficient to conclude that there’s an association there,” said Dr. Tom Shimabukuro, director of the CDC’s Immunization Safety Office.

Nonetheless, Richard Forshee, deputy director of the FDA’s Office of Biostatistics and Pharmacovigilance, said the FDA is planning to look at these safety questions further using data collected by Medicare.

The FDA confirmed that the agency is taking a closer look.

“The purpose of the study is 1) to evaluate the preliminary ischemic stroke signal reported by CDC using an independent data set and more robust epidemiological methods; and 2) to evaluate whether there is an elevated risk of ischemic stroke with the COVID-19 bivalent vaccine if it is given on the same day as a high-dose or adjuvanted seasonal influenza vaccine,” a spokesperson said in a statement.

The FDA did not give a time frame for when these studies might have results.

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