Tag: coronavirus

It’s been three years since the first Covid-19 case in the United States. What have we learned and what more do we need to understand? | CNN

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CNN
 — 

It’s been three years since the first Covid-19 case was diagnosed in the United States, on January 20, 2020. In the time since, nearly 1.1 million Americans have died from the coronavirus; the US has reported 102 million Covid cases, more than any other country, according to Johns Hopkins University. Both figures, many health officials believe, are likely to have been undercounted.

There have also been remarkable scientific achievements in our response to the pandemic, not least of which is the development of Covid-19 vaccines. But there are still many unanswered questions. To help with reflections on what we’ve learned and what more we need to understand, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician, public health expert and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

CNN: You’re a physician caring for patients, a public health researcher and professor. What are the key lessons you’ve learned from the last three years of Covid-19?

Dr. Leana Wen: There are three main lessons that come to mind. First, we have seen how much the global scientific community has come together and delivered some truly incredible achievements. Less than a year after Covid-19 was declared a pandemic, we had a vaccine developed, authorized and being distributed. The scientific community has rallied on many other aspects of the response to Covid-19, including to identify treatments and improve surveillance testing.

Many of the scientific developments will last beyond this pandemic and help with other aspects of our infectious disease response. For instance, the technology behind mRNA vaccines could be used to make vaccines for other diseases. The wastewater surveillance being used to identify and track Covid-19 may be helpful for detecting other viruses.

Second, Covid-19 has unmasked many existing crises and amplified them for the world to see. The coronavirus didn’t create health disparities — these long-predated the virus — but exacerbated existing ones.

There were also many faults with the public health infrastructure that, while long known to those of us in the field, have been exposed for all to see. Data systems are not integrated between public health agencies, for example, and city and county health departments are woefully underfunded given their many responsibilities. These stem from the fragmented health care system we have in the US, as well as the ongoing lack of investment in local public health agencies.

At the same time, Covid has also demonstrated how crucial public health is. There is a saying that “public health saved your life today, you just don’t know it.” I think there is much more recognition among many that public health is essential to preventing problems that can have a major impact on people’s health and well-being.

With that said, Covid-19 occurred during a time of deep division. Virtually every aspect of the pandemic has become politicized and polarized. So thirdly, there has been rampant misinformation and disinformation that’s made the response much more challenging. We are seeing the lasting effects, such as reduced uptake of routine childhood immunizations. I’m very concerned that public health itself has become politicized in a way that could harm our response to future pandemics.

CNN: You mentioned that we’ve learned a lot scientifically. What more do we need to understand about Covid-19?

Wen: At this point in the pandemic, a lot of people have moved on from Covid-19 and no longer think about it as a major factor in their everyday lives. However, there are millions of Americans vulnerable to severe illness who remain very concerned about the coronavirus. These are people who are immunocompromised, elderly or with multiple underlying illnesses. To me, the most important research questions pertain to these individuals.

There are some antiviral medications that are effective for Covid-19 treatment, such as Paxlovid. Some patients are not eligible for Paxlovid, though, and other options are becoming more limited. The US Food and Drug Administration has revoked their authorization for monoclonal antibodies that could treat Covid-19 infection, as they no longer appear to be effective against new circulating variants. Recently, the FDA has also said that the preventive antibody Evusheld may be ineffective against some variants, including the XBB.1.5 variant that’s currently dominant in the US.

It should be an urgent priority to focus on developing better treatments for those most vulnerable to severe disease from Covid-19. I also hope that there will be much more investment into finding better vaccines. The vaccines that we have are excellent at protecting against severe disease, which is most important. However, they are not very effective at preventing infection.

The ideal vaccine would be more effective at reducing infection, and target the virus broadly so that we are not always trying to anticipate what variant will develop next — and then scrambling to find a vaccine that works against that variant. There is research being undertaken into nasal vaccines and pan-coronavirus vaccines, for example. I hope these efforts will be expedited.

CNN: We are learning more about long Covid, but is this an area that needs more research?

Wen: Absolutely. We know that many people have lingering symptoms after a Covid-19 infection. According to a large study from Israel, most symptoms resolve within the first year after infection for people with mild illness. However, there are some who have lasting symptoms, like fatigue, headache, palpitations and shortness of breath, that are so debilitating they can no longer work.

There is a lot that we don’t yet know about long Covid. The most important is how to treat patients who have it. The physiological mechanisms behind what’s causing their lingering symptoms are also unclear, along with exactly how common they are.

There are long waits to get into specialized clinics that treat this condition at present, so a lot more education needs to be done for primary care physicians and other clinicians who will probably end up being the main health care providers for many people suffering from long Covid.

CNN: What do you anticipate will happen in this coming year around Covid-19?

Wen: Right now, China is undergoing a massive surge of cases. It’s the last major country to have enforced a strict zero-Covid policy, and now that policy has been reversed. Once China’s infection numbers stabilize, Covid-19 will probably become endemic there, as it has become in most other parts of the world.

There will, no doubt, be new variants that arise. We need to keep on top of them and monitor accordingly to see if they are more deadly and/or evade the effectiveness of existing vaccines. The key, as I said earlier, is to develop vaccines that can more broadly cover variants.

And we must again remember that, while many people have resumed pre-pandemic lives, others have not. In the next year of Covid-19, I believe that the focus needs to be much more specific to these individuals who need our help the most. We should target boosters and treatments to those most vulnerable, for example.

Finally, there should be a much greater effort to rebuild our public health infrastructure. This is long overdue. Doing so is critical not just for preparing for the next pandemic, but also for improving health and well-being for all Americans.

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The FDA Wants an Annual COVID Vaccine: What You Need to Know

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Jan. 24, 2023 – Is pivoting to an annual COVID-19 shot a smart move? The FDA, which proposed the change on Monday, says an annual shot vs. periodic boosters could simplify the process to ensure more people stay vaccinated and protected against severe COVID-19 infection. 

A national advisory committee plans to vote on the recommendation Thursday.

If accepted, the vaccine formula would be decided each June and Americans could start getting their annual COVID-19 shot in the fall, like your yearly flu shot.  

Keep in mind: Older Americans and those who are immunocompromised may need more than one dose of the annual COVID-19 shot.

Most Americans are not up to date with their COVID-19 boosters. Only 15% of Americans have gotten the latest booster dose, while a whopping nine out of 10 Americans age 12 or older finished their primary vaccine series. The FDA, in briefing documents for Thursday’s meeting, says problems with getting vaccines into people’s arms makes this a change worth considering. 

“Given these complexities, and the available data, a move to a single vaccine composition for primary and booster vaccinations should be considered,” the agency says.

A yearly COVID-19 vaccine could be simpler, but would it be as effective? WebMD asks health experts your most pressing questions about the proposal.

Pros and Cons of an Annual Shot

Having an annual COVID-19 shot, alongside the flu shot, could make it simpler for doctors and health care providers to share vaccination recommendations and reminders, according to Leana Wen, MD, a public health professor at George Washington University and former Baltimore health commissioner.

“It would be easier [for primary care doctors and other health care providers] to encourage our patients to get one set of annual shots, rather than to count the number of boosters or have two separate shots that people have to obtain,” she says.

“Employers, nursing homes, and other facilities could offer the two shots together, and a combined shot may even be possible in the future.”

Despite the greater convenience, not everyone is enthusiastic about the idea of an annual COVID shot. COVID-19 does not behave the same as the flu, says Eric Topol, MD, editor-in-chief of Medscape, WebMD’s sister site for health care professionals.

Trying to mimic flu vaccination and have a year of protection from a single COVID-19 immunization “is not based on science,” he says. 

Carlos del Rio, MD, of Emory University in Atlanta and president of the Infectious Diseases Society of America, agrees. 

“We would like to see something simple and similar like the flu. But I also think we need to have the science to guide us, and I think the science right now is not necessarily there. I’m looking forward to seeing what the advisory committee, VRBAC, debates on Thursday. Based on the information I’ve seen and the data we have, I’m not convinced that this is a strategy that is going to make sense,” he says. 

“One thing we’ve learned from this virus is that it throws curveballs frequently, and when we make a decision, something changes. So, I think we continue doing research, we follow the science, and we make decisions based on science and not what is most convenient.” 

COVID-19 Isn’t Seasonal Like the Flu

“Flu is very seasonal, and you can predict the months when it’s going to strike here,” Topol says. “And as everyone knows, COVID is a year-round problem.” He says it’s less about a particular season and more about times when people are more likely to gather indoors. 

So far, European officials are not considering an annual COVID-19 vaccination schedule, says Annelies Zinkernagel, MD, PhD, of the University of Zurich and president of the European Society of Clinical Microbiology and Infectious Diseases. 

Regarding seasonality, she says, “what we do know is that in closed rooms in the U.S. as well as in Europe, we can have more crowding. And if you’re more indoors or outdoors, that definitely makes a big difference.”

Which Variant(s) Would It Target?

To decide which variants an annual COVID-19 shot will attack, one possibility could be for the FDA to use the same process used for the flu vaccine, Wen says.

“At the beginning of flu season, it’s always an educated guess as to which influenza strains will be dominant,” she says.

“We cannot predict the future of which variants might develop for COVID, but the hope is that a booster would provide broad coverage against a wide array of possible variants.”

Topol agrees it’s difficult to predict. A future with “new viral variants, perhaps a whole new family beyond Omicron, is uncertain.”

Reading the FDA briefing document “to me was depressing, and it’s just basically a retread. There’s no aspiration for doing bold things,” Topol says. “I would much rather see an aggressive push for next-generation vaccines and nasal vaccines.”

To provide the longest protection, “the annual shot should target currently predominant circulating strains, without a long delay before booster administration,” says Jeffrey Townsend, PhD, a professor of biostatistics and ecology and evolutionary biology at Yale School of Public Health. 

“Just like the influenza vaccine, it may be that some years the shot is less useful, and some years the shot is more useful,” he says, depending on how the virus changes over time and which strain(s) the vaccine targets. “On average, yearly updated boosters should provide the protection predicted by our analysis.”

Townsend and colleagues published a prediction study on Jan. 5, in the Journal of Medical Virology. They look at both Moderna and Pfizer  vaccines and how much protection they would offer over 6 years based on people getting regular vaccinations every 6 months, every year, or for longer periods between shots. 

They report that annual boosting with the Moderna vaccine would provide 75% protection against infection and an annual Pfizer vaccine would provide 69% protection. These predictions take into account new variants emerging over time, Townsend says, based on behavior of other coronaviruses.

“These percentages of fending off infection may appear large in reference to the last 2 years of pandemic disease with the massive surges of infection that we experienced,” he says. “Keep in mind, we’re estimating the eventual, endemic risk going forward, not pandemic risk.”

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Flu, Covid-19 and RSV are all trending down for the first time in months | CNN

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CNN
 — 

A rough respiratory virus season in the US appears to be easing, as three major respiratory viruses that have battered the country for the past few months are finally all trending down at the same time.

A new dataset from the US Centers for Disease Control and Prevention shows that the number of emergency department visits for the three viruses combined – flu, Covid-19 and RSV – have dropped to the lowest they’ve been in three months. The decline is apparent across all age groups.

Measuring virus transmission levels can be challenging; health officials agree that Covid-19 cases are vastly undercounted, and surveillance systems used for flu and RSV capture a substantial, but incomplete picture.

But experts say that tracking emergency department visits can be a good indicator of how widespread – and severe – the respiratory virus season is.

“There’s the chief complaint. When you show up to the emergency room, you complain about something,” said Janet Hamilton, executive director at Council of State and Territorial Epidemiologists. “Being able to look at the proportion of individuals that seek care at an emergency department for these respiratory illness concerns is a really good measure of the respiratory disease season.”

In the week following Thanksgiving, emergency department visits for respiratory viruses topped 235,000 – matching rates from last January, according to the CDC data.

While the surge in emergency department visits early in the year was due almost entirely to Omicron, the most recent spike was much more varied. In the week ending December 3, about two-thirds of visits were for flu, about a quarter were for Covid-19 and about 10% were for RSV.

Grouping the impact of all respiratory viruses together in this way offers an important perspective.

“There’s a strong interest in thinking about respiratory diseases in a more holistic way,” Hamilton said. “Transmission is the same. And there are certain types of measures that are good protection against all respiratory diseases. So that could really help people understand that when we are in high circulation for respiratory diseases, there are steps that you can take – just in general.”

Now, Covid-19 again accounts for most emergency department visits but flu and RSV are still the reason behind about a third of visits – and they’re all trending down for the first time since the respiratory virus season started picking up in September.

More new data from the CDC shows that overall respiratory virus activity continues to decline across the country. Only four states, along with New York City and Washington, DC, had “high” levels of influenza-like illness. Nearly all states were in this category less than a month ago.

Whether that pattern will hold is still up in the air, as vaccination rates for flu and Covid-19 are lagging and respiratory viruses can be quite fickle. Also, while the level of respiratory virus activity is lower than it’s been, it’s still above baseline in most places and hospitals nationwide are still about 80% full.

RSV activity started to pick up in September, reaching a peak in mid-November when 5 out of every 100,000 people – and 13 times as many children younger than five – were hospitalized in a single week.

RSV particularly affects children, and sales for over-the-counter children’s pain- and fever-reducing medication were 65% higher in November than they were a year before, according to the Consumer Healthcare Products Association. While “the worst may be over,” demand is still elevated, CHPA spokesperson Logan Ramsey Tucker told CNN in an email – sales were up 30% year-over-year in December.

But this RSV season has been significantly more severe than recent years, according to CDC data. The weekly RSV hospitalization rate has dropped to about a fifth of what it was two months ago, but it is still higher than it’s been in previous seasons.

Flu activity ramped up earlier than typical, but seems to have already reached a peak. Flu hospitalizations – about 6,000 new admissions last week – have dropped to a quarter of what they were at their peak a month and a half ago, and CDC estimates for total illnesses, hospitalizations and deaths from flu so far this season have stayed within the bounds of what can be expected. It appears the US has avoided the post-holiday spike that some experts cautioned against, but the flu is notoriously unpredictable and it’s not uncommon to see a second bump later in season.

The Covid-19 spike has not been as pronounced as flu, but hospitalizations did surpass levels from the summer. However, the rise in hospitalizations that started in November has started to tick down in recent weeks and CDC data shows that the share of the population living in a county with a “high” Covid-19 community level has dropped from 22% to about 6% over the past two weeks.

Still, the XBB.1.5 variant – which has key mutations that experts believe may be helping it to be more infectious – continues to gain ground in the US, causing about half of all infections last week. Vaccination rates continue to lag, with just 15% of the eligible population getting their updated booster and nearly one in five people remain completely unvaccinated.

Ensemble forecasts published by the CDC are hazy, predicting a “stable or uncertain trend” in Covid-19 hospitalizations and deaths over the next month.

And three years after the first Covid-19 case was confirmed in the US, the virus has not settled into a predictable pattern, according to Dr. Maria Van Kerkhove, the World Health Organization’s technical lead for the Covid-19 response.

“We didn’t need to have this level of death and devastation, but we’re dealing with it, and we are doing our best to minimize the impact going forward,” Van Kerkhove told the Conversations on Healthcare podcast this week.

Van Kerkhove says she does believe 2023 could be the year in which Covid-19 would no longer be deemed a public health emergency in the US and across the world, but more work needs to be done in order to make that happen and transitioning to longer-term respiratory disease management of the outbreak will take more time.

“We’re just not utilizing [vaccines] most effectively around the world. I mean 30% of the world still has not received a single vaccine,” she said. “In every country in the world, including in the US, we’re missing key demographics.”

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To go or not to go? Von der Leyen’s COVID committee dilemma

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There won’t be any severed horses’ heads but the European Commission president may soon receive an offer that she can’t refuse — at least without causing an institutional dust-up.

Last week, the coordinators of the European Parliament’s special committee on COVID-19 voted to invite Ursula von der Leyen to appear in front of the panel to answer their questions on vaccine procurement. 

It’s not a courtesy call. EU lawmakers want to shine a light on exactly what happened during those hectic months at the height of the pandemic in 2021, when the bloc was frantically searching for vaccine doses to protect its population from the coronavirus.

The committee’s chair, Belgian MEP Kathleen Van Brempt has said she wants full transparency on the “preliminary negotations” leading up to vaccine purchases — a reference to the Commission president’s unusual personal role in negotiating the EU’s biggest vaccine contract, signed with Pfizer and its partner BioNTech. An appearance would refocus attention on von der Leyen’s highly contentious undisclosed text messages with Pfizer’s chief executive.

It’s a topic von der Leyen has so far fiercely resisted opening up about — but the COVI committee invite could put the Commission president in a sticky situation.

All bark, no bite? 

On the face of it, von der Leyen could just say no. European Parliament committees don’t have many formal powers. They have no rights to compel witnesses to appear or to get them to tell the truth — and there’s no recourse if someone refuses to appear or lies in front of the committee.

Indeed, Pfizer’s Chief Executive Albert Bourla — with whom von der Leyen is reported to have conducted personal negotiations via text message — thumbed his nose at the committee more than once, and sent one of his employees instead.

Even when the Parliament does reel in a big name, the performance can be lackluster — like in the case of Facebook CEO Mark Zuckerberg who agreed to show up but then avoided answering most questions. That’s a far cry from how the U.S. Senate’s commerce and judiciary committees grilled the tech titan for hours. 

And the Commission president has already shown a penchant for being evasive when it comes the Pfizer negotiations, earning the Commission a verdict of maladministration from the European Ombudsman for its lack of transparency.

However, the fact that von der Leyen is an inter-institutional figure gives the Parliament more bite than with external guests — and may help tip the balance in the committee’s favour.

First, there’s precedent. While the Commission President usually appears in front of all MEPs at a plenary session such as in the annual State of the European Union speech, Commission presidents have appeared in front of committees in the past. Von der Leyen’s predecessor, Jean-Claude Juncker, for example, appeared in front of a special committee to answer uncomfortable questions over his role in making Luxembourg a tax haven. 

Secondly, the European Parliament is tasked with overseeing the EU’s budget. With billions of euros spent in the joint purchase of the vaccines, and part of those funds coming straight from the EU’s pockets, it’s hard to argue that there aren’t important financial considerations at play, and ones that the elected representatives of the EU should be allowed to scrutinize.

Then there’s Article 13 of the EU’s founding treaty, which calls for “mutual sincere cooperation” between the EU’s institutions. It’s a point that’s repeated in an inter-institutional agreement between the Parliament and the Commission, which states that the EU’s executive should also provide lawmakers with confidential information when it’s requested — like, for example, the contents of certain text messages.

The Commission has so far been tight-lipped. When asked last week about Ursula von der Leyen’s upcoming invite to the COVID-19 committee, a Commission spokesperson said “No such invitation has been received.”

Don’t shoot the messenger 

And, in fact, it’s now up to European Parliament president Roberta Metsola to decide whether the invite will ever reach von der Leyen’s hands. The request is on her desk and, per protocol, any invitation to appear must come from the president’s office.

Metsola, who belongs to the same political group as von der Leyen (the center-right European People’s Party), confirmed to POLITICO that she has received a letter from the COVI committee and “will look at it.” “I cannot pre-empt what my reply will be to that committee,” she said.

As long as proper form is followed, Metsola should “pass on the message,” said Emilio De Capitani, a former civil servant who for 14 years was secretary of the European Parliament’s civil liberties committee (LIBE).

“The question isn’t abusive,” said De Capitani.  

In theory, von der Leyen, who was elected to her role by the Parliament, relies on its mandate to stay there.

“There’s nothing strange about meeting with an organ of the Parliament,” the former Parliamentary official added. “Then it will be up to von der Leyen to ask whether the hearing is in public or, behind closed doors. She could also choose to address it in plenary.” 

For political operatives such as Metsola and von der Leyen, the optics of their actions are likely to play a major role in any decision. And this invite comes at the same time as the biggest scandal in the European Parliament’s history.

An assistant for one of the MEPs in the COVI committee said the drive for transparency produced by the unfolding “Qatargate” influence scandal gave extra force to the invite.

“It wouldn’t have had the same result without Qatargate,” said the assistant. “If she says no, it will only make the problem worse.” 

Not everyone agrees. Detractors say the Parliament has lost its moral standing. And that even if none of the MEPs in the COVID-19 committee are implicated, the institution is still weakened on the whole.

“I think this [Qatargate] will make it less likely for von der Leyen to cooperate with the Parliament,” said Camino Mortera-Martinez, head of the Brussels office at the think tank Centre for European Reform. She said the Commission president is riding high after weathering a pandemic, and now the war in Ukraine.

“The European Parliament in theory could force von der Leyen to appear by threatening to dismiss her — but how can they do that in the current climate?”

This article was updated Friday morning to include comment from Roberta Metsola.

Eddy Wax contributed reporting.



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Can ‘Radical Rest’ Help With Long COVID Symptoms?

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Jan. 18, 2023 – On March 18, 2020, Megan Fitzgerald was lying on the floor of her Philadelphia home after COVID-19 hit her like a ton of bricks. She had a fever, severe digestive issues, and she couldn’t stand on her own. Yet there she was, splayed out in the bathroom, trying both to respond to work emails and entertain her 3-year-old son, who was attempting to entice her by passing his toys through the door. 

She and her husband, both medical researchers, were working from home early in the pandemic with no child care for their toddler. Her husband had a grant application due, so it was all-hands-on-deck for the couple, even when she got sick. 

“My husband would help me up and down stairs because I couldn’t stand,” Fitzgerald says.

So, she put a mask on and tried to take care of her son, telling him, “Mommy’s sleeping on the floor again.” She regrets pushing so hard, having since discovered there may have been consequences. She often wonders: If she’d rested more during that time, would she have prevented the years of decline and disability that followed? 

There’s growing evidence that overexertion and not getting enough rest in that acute phase of COVID-19 infection can make longer-term symptoms worse. 

“The concept that I would be too sick to work was very alien to me,” Fitzgerald says. “It didn’t occur to me that an illness and acute virus could be long-term debilitating.” 

Her story is common among long COVID-19 patients, not just for those who get severely ill but also those who only have moderate symptoms. It’s why many medical experts and researchers who specialize in long COVID rehabilitation recommend what’s known as radical rest – a term popularized by journalist and long COVID advocate Fiona Lowenstein – right after infection as well as a way of coping with the debilitating fatigue and crashes of energy that many have in the weeks, months, and years after getting sick.

These sustained periods of rest and “pacing” – a strategy for moderating and balancing activity– have long been promoted by people with post-viral illnesses such as myalgic encephalomyelitis, or chronic fatigue syndrome (ME/CFS), which share many symptoms with long COVID.

That’s why researchers and health care providers who have spent years trying to help patients with ME/CFS and, more recently, long COVID, recommend they rest as much as possible for at least 2 weeks after viral infection to help their immune systems. They also advise spreading out activities to avoid post-exertional malaise (PEM), a phenomenon where even minor physical or mental effort can trigger a flare-up of symptoms, including severe fatigue, headaches, and brain fog.

An international study, done with the help of the U.S. Patient-Led Research Collaborative and published in The Lancet in 2021, found that out of nearly 1,800 long COVID patients who tried pacing, more than 40% said it helped them manage symptoms.

Burden on Women and Mothers

In another survey published last year, British researchers asked 2,550 long COVID patients about their symptoms and found that not getting enough rest in the first 2 weeks of illness, along with other things like lower income, younger age, and being female, were associated with more severe long COVID symptoms.

It’s also not lost on many investigators and patients that COVID’s prolonged symptoms disproportionately affect women – many of whom don’t have disability benefits or a choice about whether they can afford to rest after getting sick. 

“I don’t think it’s a coincidence, particularly in America, that women of reproductive age have been hit the hardest with long COVID,” says Fitzgerald. “We work outside the home, and we do a tremendous amount of unpaid labor in the home as well.”

How Does Lack of Rest Affect People With COVID?

Experts are still trying to understand the many symptoms and mechanisms behind long COVID. But until the science is settled, both rest and pacing are two of the most solid pieces of advice they can offer, says David Putrino, PhD, a neuroscientist and physical therapist who has worked with thousands of long COVID patients at Mount Sinai Hospital in New York. “These things are currently the best defense we have against uncontrolled disease progression,” he says.

There are many recommended guides for rest and pacing for those living with long COVID, but ultimately, patients need to carefully develop their own personal strategies that work for them, says Putrino. He calls for research to better understand what’s going wrong with each patient and why they may respond differently to similar strategies. 

There are several theories on how long COVID infection triggers fatigue. One is that inflammatory molecules called cytokines, which are higher in long COVID patients, may injure the mitochondria that fuel the body’s cells, making them less able to use oxygen. 

“When a virus infects your body, it starts to hijack your mitochondria and steal energy from your own cells,” says Putrino. Attempts to exercise through that can significantly increase the energy demands on the body, which damages the mitochondria, and also creates waste products from burning that fuel, kind of like exhaust fumes, he explains. It drives oxidative stress, which can damage the body.

“The more we look objectively, the more we see physiological changes that are associated with long COVID,” he says. “There is a clear organic pathobiology that is causing the fatigue and post-exertional malaise.”

To better understand what’s going on with infection associated with complex chronic illnesses such as long COVID and ME/CFS, Putrino’s lab is looking at things like mitochondrial dysfunction and blood biomarkers such as microclots. 

He also points to research by pulmonologist David Systrom, MD, director of the Advanced Cardiopulmonary Exercise Testing Program at Brigham and Women’s Hospital and Harvard Medical School. Systrom has done invasive exercise testing experiments that show that people with long COVID have a different physiology than people who have had COVID and recovered. His studies suggest that the problem doesn’t lie with the functioning of the heart or lungs, but with blood vessels that aren’t getting enough blood and oxygen to the heart, brain, and muscles.

Why these blood vessel problems occur is not yet known, but one study led by Systrom’s colleague, neurologist Peter Novak, MD, PhD, suggests that the small nerve fibers in people with long COVID are missing or damaged. As a result, the fibers fail to properly squeeze the big veins (in the legs and belly, for instance) that lead to the heart and brain, causing symptoms such as fatigue, PEM, and brain fog. Systrom has seen similar evidence of dysfunctional or missing nerves in people with other chronic illnesses such as ME/CFS, fibromyalgia, and postural orthostatic tachycardia syndrome (POTS).

“It’s been incredibly rewarding to help patients understand what ails them and it’s not in their head and it’s not simple detraining or deconditioning,” says Systrom, referring to misguided advice from some doctors who tell patients to simply exercise their way out of persistent fatigue. 

These findings are also helping to shape specialized rehab for long COVID at places like Mount Sinai and Brigham and Women’s hospitals, whose programs also include things like increasing fluids and electrolytes, wearing compression clothing, and making diet changes. And while different types of exercise therapies have long been shown to do serious damage to people with ME/CFS symptoms, both Putrino and Systrom say that skilled rehabilitation can still involve small amounts of exercise when cautiously prescribed and paired with rest to avoid pushing patients to the point of crashing. In some cases, the exercise can be paired with medication.

In a small clinical trial published in November, Systrom and his research team found that patients with ME/CFS and long COVID were able to increase their exercise threshold with the help of a POTS drug, Mestinon, known generically as pyridostigmine, taken off label.

As is the case of many people with long COVID, Fitzgerald’s recovery has had ups and downs. She now has more help with child care and a research job with the disability-friendly Patient-Led Research Collaborative. While she hasn’t gotten into a long COVID rehab group, she’s been teaching herself pacing and breathwork. In fact, the only therapeutic referral she got from her doctor was for cognitive behavioral therapy, which has been helpful for the toll the condition has taken emotionally. “But it doesn’t help any of the physical symptoms,” Fitzgerald says.

She’s not the only one who finds that a problem.

“We need to continue to call out people who are trying to psychologize the illness as opposed to understanding the physiology that is leading to these symptoms,” says Putrino. “We need to make sure that patients actually get care as opposed to gaslighting.”



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Study shows convalescent plasma works for immune-compromised Covid-19 patients, but it can be hard to find | CNN

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CNN
 — 

Convalescent plasma – a once-celebrated treatment for Covid-19 that has largely fallen out of favor – does work well for people who are immune-compromised, according to a study published Thursday.

The report in the journal JAMA Network Open analyzed the results of nine studies and found that immune-compromised Covid-19 patients were 37% less likely to die if they got convalescent plasma, an antibody-rich blood product from people who’d recovered from the virus.

Although it’s legal to use convalescent plasma to treat Covid patients who are immune-compromised, as inpatients or outpatients, government guidelines are neutral about whether the treatment works, so some hospitals offer it but others do not.

“Our concern is that many patients who need [convalescent plasma] are not getting it,” said Dr. Arturo Casadevall, an infectious disease expert at Johns Hopkins University and a co-author of the new study. “This is really important because these people can be treated, and they could have better outcomes with this material if we can just get the word out.”

He said it’s to everyone’s advantage to treat immune-compromised patients quickly.

Immune-compromised people sometimes have “smoldering Covid” for months because they lack the antibodies to fight it off, which gives the virus plenty of opportunities to mutate in the person’s body.

“These immune-compromised patients are essentially variant factories,” said Dr. Michael Joyner, an anesthesiologist at the Mayo Clinic and another study co-author. “And you do not want a bunch of people running around out there making weird variants.”

There are about 7 million immune-compromised people in the US, and treating them if they contract Covid-19 has proved challenging.

Many of them can’t take the antiviral drug Paxlovid because it interferes with other medicines they take.

Monoclonal antibodies, once popular for prevention and treatment for this group, aren’t used anymore because coronavirus variants have changed over time. One of the advantages of convalescent plasma is that as long as it’s been donated recently, there’s a high likelihood it will have antibodies to currently circulating variants, according to advocates for the treatment.

But the National Institutes of Health’s Covid-19 treatment guidelines say there’s not enough evidence to recommend either for or against the use of convalescent plasma in people with compromised immune systems.

Three times last year – in May, August and December – Casadevall, Joyner and dozens of other doctors from Harvard, Stanford, Mayo, Columbia and other academic medical centers wrote emails to scientists at the National Institutes of Health, sending them research materials and urging them to revise the guidelines. They say they have not received a response.

Joyner said he’s “frustrated” with the NIH’s “bureaucratic rope-a-dope,” calling the agency’s guidelines a “wet blanket” that discourages doctors from trying convalescent plasma on these people.

Some patient advocates say they’re angry.

“This lack of response to the researchers is infuriating,” said Janet Handal, co-founder of the Transplant Recipient and Immunocompromised Patient Advocacy Group.

Several large randomized clinical trials on the general population, including one in India and one in the UK, have found that convalescent plasma did not reduce Covid-19 deaths or prevent severe illness, and the treatment is no longer authorized in the US for people who have healthy immune systems.

The nine studies analyzed in the new report are much smaller and looked only at immune-compromised patients.

Dr. Peter Horby, a professor at the University of Oxford and the co-principal investigator of the large UK study, said that a large randomized clinical trial should be done on immune-compromised patients before clinical practice guidelines for this group are changed.

He said that support for convalescent plasma to treat Covid-19 has been based on “an emotional feeling that something had to be done.”

“We’ve seen time and again that people’s beliefs and emotions about what works can be wildly wrong, and so the best thing to do is to evaluate these things properly in trials,” he said.

At the beginning of the pandemic, there was great enthusiasm for convalescent plasma as Covid-19 survivors sought to save lives, donating antibodies against the virus to people who were sometimes at death’s door.

In August 2020, the US Food and Drug Administration granted emergency use authorization for the treatment, but some questioned whether it was politically motivated and whether the data really showed that it worked.

Then, the large clinical trials suggested convalescent plasma didn’t work.

“We didn’t see a benefit,” said Horby, director of Oxford’s Pandemic Sciences Institute.

But there was one exception.

Horby said his study did find “some evidence of some benefit” in Covid-19 patients who had not developed antibodies against the virus. This would most likely include immune-compromised patients because their faulty immune systems don’t always generate antibodies the way they should, even after infection.

When this group of patients received convalescent plasma, Horby said, they had a slightly shortened hospital stay and a slightly lower risk of ending up on a ventilator compared with similar patients who did not receive convalescent plasma.

Joyner and Casadevall, the Mayo and Hopkins doctors, point to that finding – and a similar one in a large trial in Australia, Canada, the UK and the US, as well as results of smaller studies – as an indication that convalescent plasma is worth trying in immune-compromised patients.

Immune-compromised patients who catch Covid-19 can get convalescent plasma relatively easily if they’re patients at Hopkins, Mayo or several other medical centers.

But many other people might have a difficult time accessing it.

It took Bernadette Kay of Manhattan Beach, California, months to get it, and she had to be “relentless” and call in the help of several “angels” in New York, Maryland, Minnesota and California to finally make it work.

Kay, 64, who has a compromised immune system because of a drug she takes for rheumatoid arthritis, got Covid-19 in July. She took two monoclonal antibodies, as well as remdesivir and Paxlovid – twice. But she still tested positive on and off for months and had fatigue, congestion and headaches.

“I felt like half a person,” she said. “I was not an able-bodied person. I was disabled because of lack of energy. It feels dark – a heavy feeling in your forehead and your face.”

Kay said she saw several doctors and none of them suggested convalescent plasma. That’s where her first angel came in: her daughter, who had signed her up for the Transplant Recipient and Immunocompromised Patient Advocacy Group.

That group, as well as the CLL Society, an advocacy organization for cancer patients, have been helping immune-compromised people when they get infected with Covid-19, connecting them with experts and offering guidance on how to arrange to have the plasma ordered.

Kay says Handal, the co-founder of the immune-compromised patients’ group, was her second angel, because she pointed her to angels No. 3 and 4: Joyner, the Mayo doctor, and Dr. Shmuel Shoham, an infectious disease expert at Hopkins.

Joyner and Shoham pointed Kay to her fifth angel: Chaim Lebovits, a businessman, leader in the New York’s Hasidic Jewish community and co-founder of the Covid Plasma Initiative.

Lebovits reached out to a hospital and blood bank near Kay that could procure the plasma once a doctor ordered it. Kay then reached out to six local doctors, most of them infectious disease experts, inquiring about convalescent plasma, but she didn’t make any progress.

“I think they thought it was quack medicine,” she said.

By this time, it was November, four months after she initially tested positive for Covid. She sought out a seventh doctor, sending him information from plasma experts, including a slide presentation by Joyner and Casdevall. She said that doctor, after conferring with someone at the blood bank that Libovits had suggested, agreed to order the plasma.

That’s where her sixth angel came in: Robert Simpson, vice president for hospital services at the San Diego Blood Bank, who arranged to have the blood flown in from Stanford University Medical Center.

“Robert watched the flight on Flight Tracker and had a courier waiting to bring it to the hospital,” Kay said, adding that she calls her angels collectively her “circle of love.”

Two to three weeks after her infusion, she began to feel better. She tested negative on January 4 and has continued to feel well and test negative since then.

“My energy level is back to normal. I don’t feel like half a person,” she said.

She said she’ll never know for sure exactly what spurred her recovery, but “I think it was plasma that made the difference, because in six months, nothing else made a difference.”

Kay, who works in health care, said most other people wouldn’t have known how to navigate the system like she did or might have given up in frustration.

“With the help of Janet [Handal] and her team of scientists, I’ve been able to get where I am today,” she said. “But it was not easy. This was driven by my bullheaded advocacy, because that’s who I am. I think I’m a total anomaly. No one has the persistence that I have.”

Joyner said that while he and his colleagues wait for a response from their emails to the NIH, they’ve formed the National Covid-19 Convalescent Plasma Project, and they have a phone meeting every Thursday night to discuss their progress.

“We’ve encountered many roadblocks,” said Dr. Liise-anne Pirofski, chief of the Division of Infectious Diseases at the Albert Einstein College of Medicine. “It’s just not viewed as part of the Covid-19 treatment armamentarium, and it should be.”

Pirofski, Joyner and Casadevall say they receive no financial benefit from convalescent plasma. They think one reason convalescent plasma isn’t more widely used is that there isn’t a pharmaceutical company spending money to advocate for it.

Handal, who runs the Facebook group for people who are immune-compromised, said that after she sent several emails to the NIH, agency scientists wrote back, inviting her and other leaders of her group to a meeting next week.

She plans to tell them that they need to review their Covid-19 plasma guidelines and fund more research on the coronavirus and the immune-compromised, as they have few treatment options and so often isolate at home with their families to avoid the virus.

“It is unconscionable that the NIH has let stand for months its guideline on Covid convalescent plasma, which says there is not enough information to make a recommendation, while we who are immune-compromised see our treatments dwindle,” she said. “The NIH needs to speak to the clinician researchers who are experts, prioritize the immune-compromised and fund the research needed to keep us safe.”

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Should you attend that New Year’s Eve party? Our medical analyst weighs in | CNN

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CNN
 — 

At the end of 2020 and 2021, many people greeted the start of the coming year hunkered down due to the risk of Covid-19. But now, New Year’s Eve events and celebrations are back in a big way. A lot of people have plans to attend social functions, whether they are crowded festivities with thousands or house parties with a few relatives and friends.

These gatherings are occurring as the United States is in the midst of a triple threat — a confluence of respiratory syncytial virus or RSV, influenza and Covid-19. All three viral infections are spread from person to person, and gatherings involving many people can increase transmission at a time when hospital capacity nationwide is at near-record levels: More than 70% of inpatient beds are in use across the country, according to the US Department of Health and Human Services.

What should you consider in deciding whether to attend New Year’s Eve parties? How can you gauge the risk of specific events? Are there individuals who may want to take more precautions, and which mitigation measures can reduce risk if they go? If you find out later that an attendee was ill, when should you test afterward to make sure you are in the clear? And what happens if you develop symptoms after an event?

To guide you through these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician, public health expert and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also the author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

CNN: What should people consider in deciding whether to attend New Year’s Eve parties?

Dr. Leana Wen: People should start by considering three factors. First, what is your risk and the risk of your household from severe outcomes due to respiratory viruses? If everyone is generally healthy and you have already resumed other aspects of pre-pandemic activities, it might be reasonable to do the same for New Year’s get-togethers. But if someone is elderly or severely immunocompromised, you may wish to take additional precautions.

Second, what’s the importance of these events to you, compared with the importance of avoiding infection? Virtually every in-person interaction has some level of risk. That doesn’t mean everyone should avoid in-person activities permanently, but if you do attend a higher-risk event, know that you have a chance of getting a respiratory infection from it. Whether you go depends on how you weigh the importance of that event versus your desire to not get sick.

Third, is there a specific timing issue for which you really don’t want to get sick heading into the new year? For example, someone who has an operation scheduled the week after New Year’s may wish to be extra careful, so they don’t get an infection and then have to postpone their surgery. Someone else may have an important work event or school exam, and the desire to avoid any infection before that occasion could outweigh the desire to participate in New Year’s Eve celebrations. These are all things to consider and will vary depending on individual preference.

CNN: How can people gauge the risk of different New Year’s Eve events?

Wen: The risk depends on the type of event and what kind of mitigation measures are put into place, if any.

The more people, the higher the risk. A small gathering of, say, 10 close friends means that you could potentially contract respiratory viruses from one of these 10. Especially if these friends have been fairly cautious themselves, chances are low that none of these 10 are infected coming into the party. Compare that with a large party of 1,000 people. In this case, chances are much higher that someone at that party is infectious.

An outdoor event will be lower risk than an indoor event. Indoor events where everyone is spaced out, and where there is good ventilation, will be safer than ones where people are crowded close together.

In addition to space and ventilation, another mitigation measure that can make a difference is testing. If the event requires same-day rapid Covid-19 tests, that reduces risk. And it helps if the organizers emphasize that people who are symptomatic should not attend.

CNN: What are some things people can do to reduce their risk if they do go to an event?

Wen: Flu, RSV and a lot of other respiratory infections are spread through droplets. Washing your hands well and often can reduce your risk. Bring hand sanitizer with you in case it’s not readily available and use it frequently, especially after shaking hands and touching commonly used surfaces like shared serving utensils.

You could also stand near windows and try to stay away from crowds, especially if people are gathering in areas that aren’t well-ventilated.

Covid-19 is airborne in addition to being transmitted through droplets. Studies have shown that masks reduce the risk of Covid-19 transmission. Some venues may require masks, but even if they don’t, if you are someone who is very concerned about Covid-19, you could wear a high-quality N95 or equivalent mask during the event.

If you find out a partygoer at an event you attended had Covid-19, take a test five days after the gathering, Wen advised.

CNN: If you find out that someone at an event had Covid-19, when should you test afterward to make sure you are in the clear?

Wen: If you are asymptomatic, you should test at least five days after the event. If you test earlier than that, the test result might be negative, and you could still have contracted Covid-19, even if the virus in your body hasn’t replicated enough for the test to detect it yet. To be certain, I’d test five days after and then again two days after that.

CNN: What if you saw other people on New Year’s — if you were exposed on New Year’s Eve, could you infect people the day after?

Wen: The incubation period for Covid-19 is at least two days. Even if you did contract Covid-19 on New Year’s Eve, you wouldn’t have enough virus in your system to infect other people the day after. By the next day, two days after exposure, it’s possible.

CNN: What happens if you develop symptoms after an event?

Wen: If you develop symptoms, you should test for Covid-19, and then, if you test positive and you are eligible for Paxlovid, speak with your health care provider about taking the antiviral treatment. Inform the event organizer right away so that they can alert others.

Viral symptoms are not just due to Covid-19, of course. If you are someone who is particularly vulnerable, you should call your health care provider, who can test you for influenza and prescribe the antiviral Tamiflu. Children and other vulnerable people should get tested for RSV, too.

Otherwise, the advice is the same as pre-pandemic: Refrain from going to public places while symptomatic. Use standard measures to treat viral syndromes — such as fluids, rest, fever-reducing medicines and other symptom-based treatment.

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Here’s what the Federal Reserve’s half-point rate hike means for you

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The Federal Reserve raised its target federal funds rate by 0.5 percentage points at the end of its two-day meeting Wednesday in a continued effort to cool inflation.

Although this marks a more typical hike compared to the super-size 0.75 percentage point moves at each of the last four meetings, the central bank is far from finished, according to Greg McBride, chief financial analyst at Bankrate.com.

“The months ahead will see the Fed raising interest rates at a more customary pace,” McBride said.

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The latest move is only one part of a rate-hiking cycle, which aims to bring down inflation without tipping the economy into a recession, as some feared would have happened already.

“I thought we would be in the midst of a recession at this point, and we’re not,” said Laura Veldkamp, a professor of finance and economics at Columbia University Business School.

“Every single time since World War II the Federal Reserve has acted to reduce inflation, unemployment has shot up, and we are not seeing that this time, and that’s what stands out,” she said. “I couldn’t really imagine a better scenario.”

Still, the combination of higher rates and inflation has hit household budgets particularly hard.

What the federal funds rate means for you

The federal funds rate, which is set by the central bank, is the interest rate at which banks borrow and lend to one another overnight. Whether directly or indirectly, higher Fed rates influence borrowing costs for consumers and, to a lesser extent, the rates they earn on savings accounts.

For now, this leaves many Americans in a bind as inflation and higher prices cause more people to lean on credit just when interest rates rise at the fastest pace in decades.

With more economic uncertainty ahead, consumers should be taking specific steps to stabilize their finances — including paying down debt, especially costly credit card and other variable rate debt, and increasing savings, McBride advised.

Pay down high-rate debt

Since most credit cards have a variable interest rate, there’s a direct connection to the Fed’s benchmark, so short-term borrowing rates are already heading higher.

Credit card annual percentage rates are now over 19%, on average, up from 16.3% at the beginning of the year, according to Bankrate.

The cost of existing credit card debt has already increased by at least $22.9 billion due to the Fed’s rate hikes, and it will rise by an additional $3.2 billion with this latest increase, according to a recent analysis by WalletHub.

If you’re carrying a balance, “grab one of the zero-percent or low-rate balance transfer offers,” McBride advised. Cards offering 15, 18 and even 21 months with no interest on transferred balances are still widely available, he said.

“This gives you a tailwind to get the debt paid off and shields you from the effect of additional rate hikes still to come.”

Otherwise, try consolidating and paying off high-interest credit cards with a lower interest home equity loan or personal loan.

Consumers with an adjustable-rate mortgage or home equity lines of credit may also want to switch to a fixed rate. 

How to know if we are in a recession

Because longer-term 15-year and 30-year mortgage rates are fixed and tied to Treasury yields and the broader economy, those homeowners won’t be immediately impacted by a rate hike.

However, the average interest rate for a 30-year fixed-rate mortgage is around 6.33% this week — up more than 3 full percentage points from 3.11% a year ago.

“These relatively high rates, combined with persistently high home prices, mean that buying a home is still a challenge for many,” said Jacob Channel, senior economic analyst at LendingTree.

The increase in mortgage rates since the start of 2022 has the same impact on affordability as a 32% increase in home prices, according to McBride’s analysis. “If you had been approved for a $300,000 mortgage in the beginning of the year, that’s the equivalent of less than $204,500 today.”

Anyone planning to finance a new car will also shell out more in the months ahead. Even though auto loans are fixed, payments are similarly getting bigger because interest rates are rising.

The average monthly payment jumped above $700 in November compared to $657 earlier in the year, despite the average amount financed and average loan term lengths staying more or less the same, according to data from Edmunds.

“Just as the industry is starting to see inventory levels get to a better place so that shoppers can actually find the vehicles they’re looking for, interest rates have risen to the point where more consumers are facing monthly payments that they likely cannot afford,” said Ivan Drury, Edmunds’ director of insights. 

Federal student loan rates are also fixed, so most borrowers won’t be impacted immediately by a rate hike. However, 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 Fed raises rates, borrowers will likely pay more in interest, although how much more will vary by the benchmark.

That makes this a particularly good time to identify the loans you have outstanding and see if refinancing makes sense.

Shop for higher savings rates

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 were near rock bottom during most of the Covid pandemic, are currently up to 0.24%, on average.

Thanks, in part, to lower overhead expenses, the average online savings account rate is closer to 4%, much higher than the average rate from a traditional, brick-and-mortar bank.

“The good news is savers are seeing the best returns in 14 years, if they are shopping around,” McBride said.

Top-yielding certificates of deposit, which pay between 4% and 5%, are even better than a high-yield savings account.

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

What’s coming next for interest rates

Consumers should prepare for even higher interest rates in the coming months.

Even though the Fed has already raised rates seven times this year, more hikes are on the horizon as the central bank slowly reins in inflation.

Recent data show that these moves are starting to take affect, including a better-than-expected consumer prices report for November. However, inflation remains well above the Fed’s 2% target.

“They will still be raising interest rates now and into 2023,” McBride said. “The ultimate stopping point is unknown, as is how long rates will stay at that eventual destination.”

Subscribe to CNBC on YouTube.

Correction: A previous version of this story misstated the extent of previous rate hikes.

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Home delivery of medications can help improve access, especially when time is tight | CNN

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CNN
 — 

Covid-19 hospitalizations are on the rise in the United States, with more than 34,000 new admissions last week, but millions of vaccines and doses of antiviral treatments that could help prevent severe outcomes from the virus remain unused.

Research has found that many who could benefit most from the Covid-19 medication Paxlovid – including the elderly and Black and Hispanic people, groups that have disproportionately had the most severe illness – are less likely to take it.

As the supply of Paxlovid has grown, efforts have been made to improve timely, equitable access to the treatment.

“The driving distance to the nearest site or the geographic accessibility of the places where Paxlovid is being offered doesn’t seem to be the primary driver of why these populations are not getting the treatments they need,” said Dr. Rohan Khazanchi, a resident at Harvard Medical School and health equity consultant for the New York City health department.

Transportation is one significant barrier to health care access for many people, experts say, but creating equitable outcomes will involve a much more comprehensive approach.

In response to the White House’s call for pharmacies to help make this winter a healthier one for Americans, Walgreens launched a program Thursday in partnership with DoorDash and Uber Health that offers free home delivery of Paxlovid for those with a prescription. The initiative is meant to increase access to Covid-19 treatment, particularly for those in socially vulnerable or medically underserved communities.

Millions of Americans get prescriptions through the mail, a service that research has shown is used more frequently among seniors, adults with poor health and others who are also at high risk of severe outcomes for Covid-19.

But Paxlovid is most effective when taken within five days of symptoms starting, making timely treatment a critical piece of the puzzle and traditional mail-order delivery too slow.

Walgreens also plans to expand the service to include HIV treatment – in line with the Biden administration’s goals to accelerate efforts to end the HIV/AIDS epidemic in the US.

As with Paxlovid, early uptake is key with HIV treatment. And people who miss doses of HIV treatment risk developing drug resistance, making it crucial that they stick with the prescription.

“There are places across the patient journey that would divert a patient from being able to get treated and back to feeling better. But that’s where our teams have been working on really understanding that patient journey and then offering and identifying solutions to help address that,” said Rina Shah, vice president of pharmacy strategy at Walgreens.

Rite Aid adopted a prescription delivery program during the Covid-19 pandemic through a partnership with ScriptDrop. Service fees are currently waived for all eligible prescriptions, which excludes controlled substances and refrigerated medications but includes Paxlovid.

CVS also has one- or two-day delivery in most locations and on-demand delivery at some, which is provided free to people enrolled in the membership program.

In March, the Biden administration launched a federal Test-to-Treat initiative that streamlined access to Paxlovid for people who had Covid-19, with testing and prescribing all happening in one visit. In May, the program was broadened to specifically reach more vulnerable communities.

Khazanchi was author of a study published last month that found that Black and Hispanic people were more likely to live closer to Test-to-Treat sites than White people. But despite the physical proximity, these groups were less likely to get outpatient Covid-19 therapeutics – even though they’re at elevated risk of infection and severe disease.

Even if someone has a car or another way to get to the doctor’s office, pharmacy or other Test-to-Treat location, they’re often challenged by the time required to make that trip, said Dr. Rachel Werner, executive director of the University of Pennsylvania’s Leonard Davis Institute of Health Economics.

“It’s a combination of things that prevent access to care,” said Werner, whose research has focused on health equity. “Often, people have to take time off of work to do that, and they don’t always have paid sick leave. Everyone’s lives are complicated, and sometimes it’s hard to balance competing priorities.”

According to a report from health analytics company IQVIA, 9% of all new prescriptions in 2019 were “abandoned” at pharmacies, representing a gap in physician-recommended care that was not received by the patient. But home delivery programs that have expanded throughout the Covid-19 pandemic may help.

“I think it may be important to think about other medications or conditions where the time to treatment really matters. And those may be the ones that I think would be ripe for this kind of home-based delivery system,” Werner said. “These are urgent things that people might otherwise show up to an urgent clinic or ER for and instead could just get a medication.”

With the expansion of things like telehealth and options for home care, experts say, the Covid-19 pandemic helped widen the picture of what health care can look like.

“For far too long, we’ve been bound by the idea that health care is something that occurs within the four walls of a hospital or clinic,” Werner said. “What the Covid pandemic really did, which is important, is it made people realize that health care should be accessible where and when people need it, and it doesn’t have to be delivered in the physical structure of a health care setting.”

Experts say that while it’s critical to break down barriers in terms of access to medication, it’s important to also address the issue of trust.

In the research about accessibility to Test-to-Treat sites, Khazanchi and his co-authors suggested that programs should leverage trusted community stakeholders like local health-care providers for in-person outreach and other “low-tech, high-touch” methods to ensure equitable use.

Dr. Kedar Mate, president and CEO of the Institute for Healthcare Improvement and assistant professor at Weill Cornell Medical College, thinks about it in terms of supply and demand.

“Getting treatments to people who need them is principally an issue around access and ensuring that the supply goes to where the people are,” he said. “There’s a different problem, though, on the demand side. Are patients willing or interested to get tested and then get treated if they are found to be positive? That has everything to do with a totally different set of challenges which have to do with trust, information, disinformation, misinformation and belief in the health system overall.”

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Anti-lockdown protests intensify in China as COVID cases hit record high

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Angry crowds took to the streets in Shanghai in the early hours of November 27.
| Photo Credit: AFP

Rare public protests opposing China’s stringent Covid lockdowns intensified in the country, while coronavirus cases continue to rise sharply with close to 40,000 infections reported on Sunday.

Chinese social media and Twitter have many videos of public protests, including a mass demonstration in Shanghai where people in a rare display of anger shouted slogans against the ruling Communist Party of China (CPC) and President Xi Jinping.

Many protesters were reportedly being arrested.

There are also videos of protests from various university campuses where students came out in the open to oppose the lockdowns.

On Saturday, the government stepped back from enforcing lockdowns in Urumqi, the provincial capital of Xinjiang, where 10 people were killed and nine others injured on Thursday in a fire at an apartment block which was under COVID lockdown.

During the weekend, Urumqi witnessed a huge demonstration in which many Han Chinese nationals took part along with Uygur Muslims.

Urumqi authorities on Saturday said the city would lift coronavirus restrictions “in phases” after footage surfaced online showing rare protests against a three-month lockdown, Hong Kong-based South China Morning Post reported on Sunday.

The footage of protests, which was later censored, showed hundreds of residents in a public square outside a government office, chanting slogans “serve the people” and “end the lockdown”, and singing the national anthem.

Other clips showed scuffles between residents and people in hazmat suits in the street.

In Beijing, people from several compounds, under lockdowns for days, also staged protests, leading to officials withdrawing the curbs.

Meanwhile, the National Health Commission on Sunday said 39,501 coronavirus cases, including 35,858 asymptomatic cases, were reported in the country by the end of Saturday as mass COVID tests were carried out across China to identify new clusters of infection.

It is for the fourth consecutive day that China reported an increase in cases, the highest since it recorded a sharp spike in cases in top cities like Shanghai in April.

The capital Beijing has been reporting a sharp escalation of cases, which on Sunday climbed to over 4,700, amid growing protests and unease in the city over lockdowns of dozens of apartment buildings.

As of Sunday, the city has 9,694 cumulative confirmed cases.

The State Council’s Joint Prevention and Control Mechanism, meanwhile, has reiterated its commitment to cracking down on COVID-19 control malpractices and urged localities to rectify improper implementation of the guidelines.

The mechanism said that some local governments have been found to either roll out overt measures such as ordering widespread lockdowns or take a lax attitude toward the disease, and both tendencies are wrong, state-run China Daily reported on Sunday.



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