Coronavirus Updates October 2022

missy · Oct 2, 2022

Oops I did it again. Posted in the September thread yesterday but here we are in October. Time is flying by.

"

Is Covid getting less deadly?

Will future strains be less of a concern?

Are we likely to see a reduction in the mortality rate from Covid in future strains? And what is the likelihood of another disease becoming as globally destructive as Covid? Lisa, Australia
In much of the world Covid has receded into the background of daily life, giving the virus at least the veneer of having become less ferocious. But before we dive into the details of this question, it’s worth pointing out that while vaccines and an ever-increasing arsenal of treatments have vastly improved the prognosis of a Covid diagnosis since early 2020, many people still die from this virus every single day.
For example, a recent analysis by the Los Angeles Times found that Covid killed nine times more LA county residents than car crashes and five times more than the flu and pneumonia in the early part of 2022.
Now, on to the question at hand.
“I want to believe future strains will cause a milder form of Covid, especially given how many people now have infection- and/or vaccine-related immunity,” says Jessica Justman, an infectious-diseases specialist and epidemiologist at the Columbia University Irving Medical Center.
Many people already have a fair amount of protection against the virus should they encounter it. So far, new variants such as omicron have been more contagious but not more deadly.

Covid vaccines have helped greatly reduce deaths from the virus. Photographer: Hannah Beier/Bloomberg
“But,” says Justman, “it’s also possible that a new variant will arise that can evade existing immunity and cause a more deadly illness.”
An entirely new coronavirus could potentially emerge as well, just as Covid did back in 2019. Justman points out that scientists recently discovered a new coronavirus in bats — Khosta-2 — that is able to infect human cells and evade the current Covid vaccines in experiments.
Pandemics, of course, are not new to history. Neither are deadly viruses.
“In terms of infectious diseases, Covid is not the worst illness nature can deliver,” says Justman. Tuberculosis, for example, is far more deadly.
What was unique about Covid was how quickly and efficiently it spread. And mutations have helped it stick around, even as vaccines prevent severe cases of the virus.
But what Covid has proven over and over again is that predictions are not guarantees. The virus’s spillover from animals to humans was in many ways a chance event. Spillover events are rare. How Covid continues to evolve will also be largely up to chance.
“We all want to know what to expect but predicting the future is tricky,” says Justman. “In the meantime, we should continue to strengthen our public-health systems, take advantage of available vaccines and boosters, and prepare for another winter surge.” — Kristen V. Brown

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missy · Oct 3, 2022

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Good Riddance

Hong Kong has finally junked its controversial hotel quarantine system for travelers. From 6am last Monday, people could freely walk out of the airport -- albeit subject to multiple Covid tests -- for the first time in nearly three years.
Restrictions remain for now, with travelers not allowed to enter restaurants and other high-risk places for three days after they arrive. But that last hurdle to free travel also looks likely to be dumped before the end of the year.
The bigger question is whether the damage done to the city’s reputation and economic prospects can now be reversed.
Hong Kong’s shambolic handling of the hotel quarantine system -- and the pandemic overall -- has left a deep scar. It mandated quarantine stays as long as 21 days in the past, as strict as mainland China. Yet unlike Beijing, it didn’t control hotel supply or cap prices, leading to a chaotic capitalistic nightmare which left travelers stressed and often stranded.

Travelers in the departure hall at Hong Kong International Airport following the government's scrapping of its hotel quarantine regime. Photographer: Lam Yik/Bloomberg
It’s difficult to overstate the significance of travel quarantine in driving expatriates from the once-vibrant city. Its population has declined 1.6% while Singapore’s rose 3.4% in the year to June.
At the end of the day, it wasn’t really about hotels. It was the fact that living in a city known for being connected and at the economic forefront had become a literal experience of being trapped and isolated.
Hong Kong has its remaining advantages. Besides the mainland proximity and low-tax environment that businesses care about, its stunning natural vistas are a spiritual balm. The city’s winter is the nicest four months, weather-wise, that can be found in the region. And its hustling, self-reliant culture still imbues the air with a frenetic, anything-goes excitement.
For those like me that have stayed through the worst months, we no longer have an immediate reason to find a way to leave. But whether anyone else will come -- or return -- remains to be seen. — Rachel Chang

What we’re reading

Calling the pandemic “over” is like calling a fight “finished” because your opponent is punching you in the ribs instead of the face, the Atlantic reports.

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missy · Oct 3, 2022

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California Bill Barring Docs From Telling COVID Lies Signed Into Law

— Law won't stop docs who spread misinfo on social media; only during direct patient care

by Cheryl Clark, Contributing Writer, MedPage Today October 1, 2022

A photo of California Governor Gavin Newsom

California Governor Gavin Newsom signed legislation on Friday that gives the state some ammunition against physicians who spread lies about COVID in the context of direct patient care, although it won't apply to those who spread such misinformation on social media.
It is said to be the first such law in the nation.
Such misinformation -- when it is "contradicted by contemporary scientific consensus contrary to the standard of care," and delivered with "malicious intent or an intent to mislead" -- now can be defined as "unprofessional conduct."

Violators would be subject to disciplinary actions from the Medical Board of California or the Osteopathic Medical Board of California, which combined license some 155,000 doctors.
In a statement issued on the last day for signing or vetoing this legislative session's bills, Newsom explained his belief that the new statute's language "is narrowly tailored to apply only to those egregious instances in which a licensee is acting with malicious intent or clearly deviating from the required standard of care while interacting directly with a patient under their care."
"To be clear," he continued, "this bill does not apply to any speech outside of discussions directly related to COVID-19 treatment within a direct physician-patient relationship."
Newsom acknowledged that he is "concerned about the chilling effect other potential laws may have on physicians and surgeons who need to be able to effectively talk to their patients about the risks and benefits of treatments for a disease that appeared in just the last few years."

"However, I am confident that discussing emerging ideas or treatments including the subsequent risks and benefits does not constitute misinformation or disinformation under this bill's criteria."
Newsom's signature on the bill, which was sponsored by the California Medical Association, came after much public controversy and opposition from some clinicians including former Baltimore health commissioner Leana Wen, MD, of George Washington University. In a widely referenced opinion piece in the Washington Post, Wen wrote that "while well-intentioned, this legislation will have a chilling effect on medical practice, with widespread repercussions that could paradoxically worsen patient care."
That's true especially with a virus like COVID, where knowledge about prevention and treatment continues to evolve, and physicians need to tailor broad public policy guidelines from the CDC to their individual patients, she wrote.
As an example, she wrote that while most doctors recommend that seniors should get the Omicron-specific booster right away, others might advise waiting until winter to better protect over the holidays, which is against federal guidelines.

"But is it really right for physicians to be threatened with suspension or revocation of their license for offering nuanced guidance on a complex issue that is hardly settled by existing science?" she wrote.
Needless Suffering and Death
Nick Sawyer, MD, an emergency physician in Sacramento and executive director of the group No License for Disinformation, acknowledged skepticism that the new law will result in any disciplinary action against physicians. The Medical Board of California has yet to exercise its authority to discipline doctors using the existing statute, he said -- a point he has raised with board officials multiple times.
Still, he had urged Newsom to sign it.
Looking at the Federation of State Medical Boards' (FSMB) legislative tracker, he recently counted 82 proposed bills in 31 states that he said are "effectively pro-COVID misinformation as there is no evidence that either ivermectin or hydroxychloroquine (aka 'early treatment') provide any benefits in the prevention or treatment of COVID-19.

"In fact, there are multiple high-quality studies that show they do not" provide benefit, he said.
And many states have considered or passed bills that "restrict their state medical boards' authority to discipline doctors who advocate for or prescribe ivermectin or hydroxychloroquine for COVID," such as North Dakota, Tennessee, and Missouri, Sawyer wrote. And Tennessee has made ivermectin available without a prescription.
"The results of these misguided laws are needless suffering and death, as well as increased costs to federal healthcare programs because they provide false reassurance to people who then decline to get the COVID vaccines," he said. "We are pleased to see the California Legislature and Gov. Gavin Newsom continue to stand up for science, particularly in an era so overwhelmed with COVID-related conspiracy theories and outright lies from licensed doctors across the nation."
During debate over the bill in the California legislature and during medical board quarterly meetings, some mentioned the names of California physicians who spread false and misleading information through social media or public websites. That included Simone Gold, MD, a former Beverly Hills doctor who runs the organization America's Frontline Doctors, and who is now dually licensed in Florida.

Speakers lamented that the bill lacked language allowing discipline against clinicians who spread potentially harmful information on platforms such as Twitter or Facebook, on television, or in the U.S. Capitol on January 6.
The California licensing agency automatically placed Gold's license on "inactive status" during her prison sentence for trespassing into the Capitol and making a speech during the insurrection.
FSMB Warning
The FSMB, which represents medical and osteopathic licensing agencies across the country, last year issued a statement warning that, "Physicians who generate and spread COVID-19 vaccine misinformation or disinformation are risking disciplinary action by state medical boards, including the suspension or revocation of their medical license."
"Due to their specialized knowledge and training, licensed physicians possess a high degree of public trust and therefore have a powerful platform in society, whether they recognize it or not," the statement said.
In April, the FSMB issued guidance on regulatory policy for boards and licensees regarding the expectations they should have about "sharing truthful and transparent medical information."
https://www.fsmb.org/siteassets/adv...ee-report-misinformation-april-2022-final.pdf
"Inaccurate information spread by physicians can have pernicious influences on individuals with widespread negative impact, especially through the ubiquity of smartphones and other internet-connected devices on wrists, desktops and laptops reaching across thousands of miles to other individuals in an instant," the federation said.
Newsom closed his signing statement with, "COVID-19 treatment and care is rapidly evolving and this bill allows physicians to discuss both emerging and current treatments in a manner that is unique to each patient and their distinctive medical history."
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missy · Oct 3, 2022

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The latest
The Food and Drug Administration updated its guidance Monday on the use of the intramuscular injection Evusheld, which is given to immunocompromised patients as a way to prevent coronavirus infections. The agency wants doctors and other prescribers to be aware of data released that showed a 1,000-fold decrease in the efficacy of the treatment against the omicron subvariant BA.4.6. Which means the pre-exposure prophylaxis could provide minimal effectiveness against that variant.

“Certain SARS-CoV-2 viral variants may not be neutralized by monoclonal antibodies such as tixagevimab and cilgavimab, the components of Evusheld,” the FDA told The Washington Post in an email.

Evusheld is used to minimize the impact of coronavirus infections in certain high-risk adults and children 12 and older who are moderately or severely immunocompromised. It is given preemptively to patients who may not have an adequate response to the coronavirus vaccine or are unable to get the shot. It is not used as a post-infection treatment.

Because it's impossible for patients to know what variant of the coronavirus they have contracted, the FDA recommends “timely treatment” to decrease “your risk of hospitalization or death.”

The medication, manufactured by AstraZeneca, was authorized for emergency use in 2021.

According to the Centers for Disease Control and Prevention, BA.4.6 is currently the second-most common subvariant in the United States, accounting for 12.8 percent of infections.

A new study finds that the onset of diabetes increased after a coronavirus infection in children younger than 18.

Researchers at Case Western Reserve University School of Medicine studied the records of more than 1 million children with coronavirus infections and compared them with children with other respiratory infections. After six months, 0.043 percent of children with a coronavirus infection compared with 0.025 percent with other respiratory infections, such as the flu, were diagnosed with type 1 diabetes.

Diabetes cases in children are rising in the United States, but Rong Xu, one of the study's authors, said type 1 diabetes diagnoses overall are rare. She adds that scientists are still unsure how the virus affects children's pancreas and overall metabolic system long-term, which is why the study is a “good indicator that children need to be vaccinated against the virus.”

Children have a much lower coronavirus death rate, but scientists continuously discover new and long-term health implications. “It's too early to tell if these changes are temporary or persistent over a longer period,” Xu said.

On Monday, Norwegian Cruise Line announced it would drop its coronavirus rules, which include testing and mask-wearing.

Our bodies changed during the pandemic. The Post's daily podcast, “Post Reports” discussed those changes on a recent episode.

“

missy · Oct 4, 2022

Around 3.2 Million Americans Received Updated COVID Boosters Last Week: CDC

By Reuters Staff
September 30, 2022

(Reuters) — Around 3.2 million people in the United States received updated COVID-19 booster shots over the past week, the Centers for Disease Control and Prevention said on Thursday.
The CDC said a total of 7.6 million Americans had received the shot as of Sept. 28, the first four weeks the booster has been available. This is up from the 4.4. million people who received the shot as of Sept. 21.
The 7.6 million figure represents only 3.5% of the 215.5 million people in the United States aged 12 or older who are eligible to receive the shots because they have completed their primary vaccination series.
The shots are being administered at a slower pace than last year, when the United States initially authorized COVID boosters just for older and immunocompromised people. Around 12 million people received their third shot in the first four weeks of that vaccination campaign.

As of last week, the U.S. government had sent out over 25 million of the updated booster shots, mostly from Pfizer/BioNTech, as production of Moderna's shot continues to ramp up.

The U.S. Food and Drug Administration authorized Pfizer and Moderna's Omicron-tailored shots last month, in preparation for the country's ongoing fall revaccination campaign.
The CDC tally includes booster shots from both Pfizer/BioNtech and Moderna.
While the Pfizer/BioNTech updated COVID-19 booster is approved for those aged 12 and above, Moderna's shot is approved for individuals aged 18 and above.

The Omicron-tailored shots aim to tackle the BA.5 and BA.4 subvariants, which make up a significant majority of the currently circulating variants in the United States, according to government data.
(Editing by Alistair Bell)

missy · Oct 4, 2022

As Australia Calls End to COVID Emergency Response, Doctors Warn of Risk to Public

By Renju Jose and Lewis Jackson
September 30, 2022

SYDNEY (Reuters) — Australia will end the mandatory five-day home quarantine for COVID-infected people on Oct. 14, Prime Minister Anthony Albanese said on Friday, even as some doctors warned the move would put the public at risk.
The decision to let COVID-infected Australians decide whether they need to isolate or not removes one of country's last remaining restrictions from the pandemic era, and comes about a month after the quarantine period was cut to five days from seven.
"We want a policy that promotes resilience and capacity-building and reduces a reliance on government intervention," Albanese told reporters after a meeting of the national cabinet.
The pandemic leave payments for casual workers will also stop when isolation rules end, as Albanese said "it isn't sustainable for government to pay people's wages forever."

A champion of COVID-suppression strategy, Australia shifted away from its fortress-style controls and began living with the virus from early this year through a staggered easing of curbs amid higher vaccination rates.
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"The crucial point is that the emergency response phase is probably finished at this point in the pandemic," Chief Medical Officer Paul Kelly said. "This virus will be around for many years but it's time to consider ... different ways of dealing with it."
But Australian doctors warned that ending the mandatory quarantine rules puts the public at risk.
Professor Brendan Crabb, a microbiologist and chief executive of the Burnet Institute, told ABC: "It's disappointing, pretty dark day actually. You know, it's illogical and uninformed, for me I find it distressing."

Australian Medical Association President, Steve Robson, concurred.
"I think people who are pushing for the isolation periods to be cut are not scientifically literate," Robson told ABC television ahead of the government decision.
Australia, one of the most heavily vaccinated countries against COVID-19, has given two doses to 96.5% of those older than 16, although just under 72% have had the booster shot.
People admitted to hospitals from the virus and the number of infected have been trending lower after a major Omicron outbreak during the winter. The country's tally of about 10.2 million infections and 15,153 deaths is lower than many developed economies.

(Reporting by Renju Jose and Lewis Jackson; Editing by Jacqueline Wong & Shri Navaratnam)

Asscherhalo_lover · Oct 4, 2022

I got my bivalent booster and flu shot today!

missy · Oct 5, 2022

COVID State of Affairs: Oct 5

Katelyn Jetelina
Oct 5

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Here we go again. The start of a new wave. Eyes are on Western Europe, as hospitalizations are uniformly increasing. As we’ve seen throughout the pandemic, some are hospitalized “with COVID19,” but it’s important to note that the Germany’s numbers are reported purely as “for COVID19.” In other words, not only are infections increasing, but so is severe disease.

Figure by Jean Fisch
Interestingly, no new subvariant is driving this wave, as the majority of cases are still the “old” BA.5 subvariant. This means changing weather, waning immunity, and/or changing behaviors are the culprit. This theory is only solidified when we see patterns are not changing in neighboring country Israel, for example, whose weather hasn’t started changing yet.

Figure by Jean Fisch
This is concerning because subvariants are brewing. They only make up a small percentage of cases for now, but they are gaining ground; historically, we feel their impact when they make up ~30-50% of cases. These subvariants will eventually add fuel to the fire.

Currently, we have a “subvariant soup” on the horizon—a mix of many different Omicrons trying to dominate the space. Below is a figure of the Omicron subvariants we are closely tracking. Each subvariant has ~10% growth advantage over BA.5, meaning it has the ability to create a wave, but not a tsunami. (As a comparison, Alpha had a growth advantage of 7%/day; the first Omicron BA.1 had a growth advantage of 25%/day).

Convergent evolution in Omicron subvariants. X-axis represents the number of spike mutations. Figure by Mark Johnson
It’s a very busy figure, but there are three specific things to notice:

Convergent evolution. Subvariants with similar mutations are popping up independently across the globe. CA.1 popped up in one place with a R346X mutation, while BQ.1.1 popped up in a different spot with the same mutation. This pattern has been the hallmark of COVID-19, so this isn’t necessarily surprising. What is noteworthy is where these mutations are happening—a spot that helps Omicron continue to partially escape immunity.
Notice BQ.1.1 (in red above). This is a direct descendant of BA.5. While it has the most spike mutations, we picked the BA.5 formula for U.S. fall boosters. Our boosters will work best if this subvariant dominates in the future. For now, BQ.1.1 is winning the race in Europe, so this may have a good chance of taking over in the U.S. We may get lucky.
This is what we know. More than 90% of testing and sequencing has been stopped across the globe. This means we are largely flying blind and there may be a surprise in the mix we are unaware of just yet.
United States

Given the U.S. has mirrored European trends throughout the pandemic, a wave in the U.S. is likely coming.

Source: Pandem-ic
On a national level, SARS-CoV-2 wastewater has been decreasing the past two weeks, but that deceleration has started to level off. If we zoom in to specific jurisdictions, like Boston, there are concerning signals with sudden increases in viral wastewater levels. Wastewater will continue to be a huge asset moving forward as an early indicator of transmission in communities.

Wastewater COVID-19 Tracking | Massachusetts Water Resources Authority
We really don’t know what reported case and testing numbers mean these days, but for what it’s worth national test positivity rate has also plateaued. In the first two years of the pandemic, this metric was a consistent early indicator of what was to come.

(CDC)
If we combine five of the top new subvariant leaders in the U.S. (referred to as “Pentagon”), it’s clear that case acceleration is brewing below the surface. Given the current growth, we will likely see an impact on national metrics in mid-November.

(Source: JP Weiland)
The height of a U.S. wave is partially dependent on the number of people who get a fall booster. Unfortunately, it looks like the majority of Americans will be going into the winter ill-prepared. A new Kaiser Family Foundation survey found 40% of Americans are unsure if the booster is recommended for them, including about half of fully vaccinated rural residents (54%), Hispanic adults (51%), and those without a college degree (49%). There is clearly a failure of communication and outreach. This must be a priority as vaccines continue to protect against death, severe disease, transmission, cases, and long COVID-19. So far only 7.6 million Americans have received their fall booster.

Hospitalizations per 100K, by vaccination status in New York City. Top blue line is unvaccinated. Bottom lines are 1 booster and 2 boosters. Source Here
Bottom line

We may be in for a bumpy ride this winter. SARS-CoV-2 is already gaining ground thanks to weather and behavior change. We expect growth to accelerate with subvariants on the horizon. There’s a lot you can do, but the lowest hanging fruit is to get your fall booster. Also, if you’re older and test positive, remember Paxlovid.

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dk168 · Oct 5, 2022

I had my second seasonal booster today, and it was the new Pfizer/BioNTech bivalent one.

Feeling fine so far except starting to feel some soreness at the injection site.

DK

missy · Oct 7, 2022

By David Leonhardt

Good morning. The underuse of Covid treatments is leading to many needless deaths.

Alex Merto

The power of Paxlovid

A worrisome pattern has emerged with Paxlovid and other drugs that reduce the severity of Covid: Many people who would benefit most are not receiving the treatments, likely causing hundreds of unnecessary deaths every day in the U.S.

There seem to be two main explanations for the drugs’ underuse. The first is that the public discussion of them has tended to focus on caveats and concerns, rather than on the overwhelming evidence that they reduce the risk of hospitalization and death. The second explanation is that many Americans, especially Republicans, still do not take Covid seriously.

Today’s newsletter will dig into both issues.

“A large chunk of deaths are preventable right now with Paxlovid alone,” Dr. Ashish Jha, the White House Covid response coordinator, told me. He predicted that if every American 50 and above with Covid received a course of either Paxlovid or a treatment known as monoclonal antibodies, daily deaths might fall to about 50 per day, from about 400 per day in recent months.

Dr. Rebecca Wang, an infectious disease specialist at Dartmouth Hitchcock Medical Center, has said: “Never really in recent history for a respiratory virus can I think of an anti-viral medication being as effective, demonstrated in scientific literature, as what Paxlovid has shown.”

Dr. Robert Wachter, the chair of the medicine department at the University of California, San Francisco, told me that he thought the underuse of Paxlovid was already associated with thousands of preventable deaths in the U.S. “The public doesn’t seem to understand that the evidence around hospitalization and deaths is really powerful,” Wachter said.

Bad-news bias

By now, you have surely heard about the downsides and shortcomings of Paxlovid.

The drug can produce a metallic taste in the mouth. (One member of my family described it as among the worst tastes she had ever experienced.) Some research has also found that the drug might not cause a statistically significant reduction in hospitalization among younger adults. Most prominently, people who take Paxlovid can endure “rebound” Covid — as both President Biden and Jill Biden did — in which symptoms return after the five-day course of pills has ended.

All of this is true. It also does not change the big picture. Covid is a deadly virus, especially for older people, and Paxlovid reduces Covid’s severity. It does so by inhibiting the virus’s replication inside the human body, the same process that has made H.I.V. treatments so effective.

With Paxlovid, both randomized trials and data from electronic health records have pointed to its effectiveness. Some research finds an effect across all age groups, while other research finds one only among older patients. But that is not surprising. The Covid death rate for people under 50 is already so close to zero that reducing it in a statistically significant way is difficult.

“I think almost everybody benefits from Paxlovid,” Jha said. “For some people, the benefit is tiny. For others, the benefit is massive.” (People who can’t take Paxlovid because it interacts dangerously with another drug they’re taking can usually take monoclonal antibodies.)

A recent analysis of about 568,000 patients by Epic Research found that 0.016 percent of Covid patients over 50 who received Paxlovid died. The death rate for patients who did not get the drug was more than four times higher, or 0.070 percent. And yet the Epic data showed that only about 25 percent of patients eligible to receive Paxlovid actually did, even though the drug is widely available and free for patients.

Perhaps the most shocking statistic about Paxlovid’s underuse — and Jha used the word “shocking” when describing it to me — is that a smaller share of 80-year-olds with Covid in the U.S. is now receiving the drug than 45-year-olds with Covid, according to data he has seen. Many doctors are evidently worried about side effects or rebound cases among their more vulnerable patients.

Even in rebound cases, however, symptoms tend to be milder than they would have been without Paxlovid. After Dr. Anthony Fauci, another White House adviser, who’s 81, contracted Covid in June and then took Paxlovid, he experienced a rebound — and also believed that the drug kept him out of the hospital.

“Medicine is about weighing costs and benefits,” Wachter said. “The recommendation should be clear and unambiguous for people at high risk: The benefits of the drug outweigh the downsides.”

Red Covid

When I last wrote about “red Covid” — the concentration of Covid deaths in conservative communities because of vaccine skepticism — almost eight months ago, I explained why the partisan gap could eventually shrink: Republican communities might have built up more natural immunity through previous infections, and treatments like Paxlovid were becoming more widely available.

This spring and summer, the gap did narrow somewhat. But it has begun growing again in the past two months, according to an analysis by my colleague Ashley Wu.

Data through Oct. 4, 2022, excluding Alaska. | Sources: New York Times database, Edison Research

One possible explanation is that Paxlovid takeup rates appear to be lower in Republican areas, even though they are the very places where the drug could do the most good, because of lower vaccination rates. Government data shows that of the 20 states with the least Paxlovid use between late August and late September (per 100 diagnosed cases of Covid), 18 were won by Donald Trump in 2020.

Paxlovid data is between Aug. 29 and Sept. 25, 2022. | Sources: White House; Edison Research

The shunning of Paxlovid seems to be part of a pattern in which Republican voters have wrongly dismissed Covid as little different from the flu. That mistake has had tragic consequences. A new study by three Yale University researchers found that the wide partisan gap in Covid deaths remained even after controlling for other factors, like age.

Solutions

Jha told me that the Biden administration was committed to increasing the use of Paxlovid and monoclonal antibodies nationwide. “We are going to go after this problem hard,” he said. “We have got to fix it, and we’ve got to fix it in weeks.”

What might make a difference?

Persuading more doctors of Paxlovid’s benefits would probably have the biggest impact. Wachter thinks that accelerating research about rebound Covid — including whether a longer course of Paxlovid would help — could also increase use, given the fear around the issue. He added that he was surprised that government, academic and private researchers had still not learned more about what causes a rebound and how to prevent it.

chrono · Oct 7, 2022

Flu and booster shot made me extremely miserable; aching all over, nausea all day, and alternating between freezing and overheating.

missy · Oct 7, 2022

Feel better @chrono!

Paxlovid update: Effectiveness, rebounding, drug interactions

Katelyn Jetelina

Oct 7

One of our biggest public health challenges is to decrease the rate of severe COVID-19 disease in the face of pandemic fatigue, dried up funding, misinformation, and a changing virus. Paxlovid—an antiviral medication—is a tool we still have left.
However, recent data shows concerning trends of Paxlovid use. For example, less than 30% of 80-85 year-olds with COVID are getting a prescription for Paxlovid. This is a major problem. This group is at the highest risk for severe disease and death, even if vaccinated. Improving knowledge, confidence, and thus prescriptions and use should be a priority.
Here is the latest data on effectiveness, rebounding, and drug interactions with Paxlovid. (To see how Paxlovid works, go here.)

Effectiveness

As with vaccines, we rely on two types of data: clinical trials data and “real world” data. Both have limitations, so looking at them together gives us the best picture.
Clinical trials

The original Pfizer clinical trial tested the efficacy of Paxlovid on “high-risk” individuals: unvaccinated with at least one high risk characteristic, such age 65+ or a comorbidity. This trial was during the Delta wave. Paxlovid reduced hospitalization and death by 88%.
Pfizer had a second clinical trial testing the efficacy on “standard risk” individuals, for example younger people. The drug was not effective. Pfizer stopped the clinical trial early.

Real world data

A study published in Israel found Paxlovid reduced hospitalization by 70% and death by 80% but only for people aged 65+. There was no benefit for 40-64 year olds.
- The vast majority of people in this study had some level of immunity (vaccination or prior infection). This means that Paxlovid helps vaccinated older adults.
A study in Hong Kong found Paxlovid was useful among people >60 years old and <60 years old with a comorbidity. This study also included people who were vaccinated.
Another study in Hong Kong found that, among hospitalized patients, Paxlovid reduced viral load and helped patients recover faster.
A non-peer-reviewed report on 560,000 U.S. patients found similar patterns:
- Among those 65+ years, 73% had a lower chance of hospitalization and 79% a lower chance of death.
- When separated by vaccination status, the benefit remained. This analysis did not account for other variables that could explain this relationship, but the authors said this analysis is currently underway and, thus far, results have not changed.
  
  Unadjusted age distribution of COVID-19 hospitalization and death rates by Paxlovid use from March 1, 2022, through August 1, 2022, for patients with a complete primary series of COVID-19 vaccination but no documented booster vaccination.

Rebounding

COVID-19 rebound occurs when a person takes the drug for a few days, tests negative, and then tests positive again several days later. Since my last update, we still don’t know the “true” frequency in which thispens after Paxlovid. But we have discovered other important pieces to the rebounding puzzle:

Rebound doesn’t impact immunity. A small but important study found that rebounding after Paxlovid does not interfere with the immune system’s ability to develop protection. In other words, if you take Paxlovid, you will still make antibodies and T cells. In fact, this study found that you make more antibodies.
Rebounding is common without Paxlovid. A preprint found 1 out of 8 people rebounded without Paxlovid. Those that rebounded were more likely to be older. Among those that rebounded, only 10% had symptoms.
Rebounding may happen more frequently with Paxlovid. Another preprint found rebounding after Paxlovid (3 out of 11) was more common than rebounding without the drug (1 out of 25). Why this is the case is one of our biggest unanswered questions.
Rebounding is mild. Another important question is whether rebounding leads to severe disease or milder disease. In other words, does it cause harm? Small studies report the majority of people experience milder symptoms during rebound compared to the initial infection. LA County reports no severe COVID-19 cases after rebounding, too.

Interactions with medications

One limitation to Paxlovid is that it can interact with other medications. The older the person, the more comorbidities, and the more medications. This may explain suboptimal uptake. The good news is there aren’t too many drug-to-drug interactions. The Infectious Disease Society of Americareleased a report summarizing the the top 200 prescribed drugs and their interactions with Paxlovid. They found only 2 drugs have interactions so severe that Paxlovid should be avoided:

Rivaroxaban (Xarelto)
Salmeterol (Serevent)

With the help of a clinician, other medications can be managed so Paxlovid remains an option. Be sure to get advice from a clinician.

Other benefits?

Severe disease is not COVID-19’s only outcome, so a comprehensive assessment of Paxlovid is beneficial, especially if we are considering populations outside of 65+:

Transmission: A randomized control trial of more than 3000 people found that Paxlovid does not prevent COVID-19 infection.
Long COVID: Unfortunately we do not know whether Paxlovid reduces the risk of long COVID.

Bottom line

Vaccination is the safest and most effective way to stay out of the hospital. Paxlovid acts as a fantastic second line of defense among unvaccinated people and vaccinated older adults. This is the case even if they rebound. We are entering winter with limited tools, so Paxlovid needs to be top of mind. We’re simply missing too many opportunities to use it among high risk people.

missy · Oct 8, 2022

"
On Wednesday, the Centers for Disease Control and Prevention, in collaboration with the National Center for Health Statistics, released data on long covid. The Household Pulse Survey data finds that more than 80 percent of people with long covid experience limitations in day-to-day activities.

"

Long COVID

Household Pulse Survey

As part of an ongoing partnership with the Census Bureau, the National Center for Health Statistics (NCHS) recently added questions to assess the prevalence of post-COVID-19 conditions (long COVID), on the experimental Household Pulse Survey. This 20-minute online survey was designed to complement the ability of the federal statistical system to rapidly respond and provide relevant information about the impact of the coronavirus pandemic in the U.S. Data collection began on April 23, 2020.
Beginning in Phase 3.5 (on June 1, 2022), NCHS included questions about the presence of symptoms of COVID that lasted three months or longer. Beginning in Phase 3.6 (on September 14, 2022), NCHS included a question about whether long-term symptoms among those reporting symptoms lasting three months or longer reduced the ability to carry out day-to-day activities compared with the time before having COVID-19. Phase 3.6 will continue with a two-weeks on, two-weeks off collection and dissemination approach.

Estimates on this page are derived from the Household Pulse Survey and show the following outcomes for adults aged 18 and over:

The percentage of all U.S. adults who EVER experienced post-COVID conditions (long COVID). These adults had COVID and had some symptoms that lasted three months or longer.
The percentage of adults who EVER experienced post-COVID conditions (long COVID) among those who ever having COVID .
The percentage of all U.S. adults who are CURRENTLY experiencing post-COVID conditions (long COVID). These adults had COVID, had long-term symptoms, and are still experiencing symptoms.
The percentage of adults who are CURRENTLY experiencing post-COVID conditions (long COVID) among those who ever had COVID.

Beginning in Phase 3.6:

The percentage of any activity limitations (either ‘yes, a little’ or ‘yes, a lot’ responses) from long COVID, among adults who are currently experiencing long COVID and among all adults
The percentage of significant activity limitations (‘yes, a lot’ response) from long COVID, among adults who are currently experiencing long COVID and among all adults

The percentage of all U.S. adults who ever said they had COVID is also included to provide context for the other percentages. It should be noted that the percentage of adults who said they ever had COVID based on the Household Pulse Survey is lower than other estimates based on seroprevalence studies.
See the technical notes for more information on these measures.
Questions on post-COVID conditions (long COVID) were also included on the National Health Interview Survey (NHIS) in 2022. The NHIS, conducted by NCHS, is the major source for high-quality data used to monitor the nation’s health. NHIS data collection will continue through December 2023.

Use the drop-down menus to show data for selected indicators or categories. Select the buttons at the bottom of the dashboard to view national and state estimates. The data table may be scrolled horizontally and vertically to view additional estimates.

Access Dataset on Data.CDC.gov (Export to CSV, JSON, XLS, XML)[?]

Technical Notes

Survey Questions

Have you ever tested positive for COVID-19 (using a rapid point-of-care test, self-test, or laboratory test) or been told by a doctor or other health care provider that you have or had COVID-19?
Answer Choices: yes, no

How would you describe your coronavirus symptoms when they were at their worst?
Answer choices: I had no symptoms, I had mild symptoms, I had moderate symptoms, I had severe symptoms.

Did you have any symptoms lasting 3 months or longer that you did not have prior to having coronavirus or COVID-19?
Long term symptoms may include: Tiredness or fatigue, difficulty thinking, concentrating, forgetfulness, or memory problems (sometimes referred to as “brain fog”), difficulty breathing or shortness of breath, joint or muscle pain, fast-beating or pounding heart (also known as heart palpitations), chest pain, dizziness on standing, menstrual changes, changes to taste/smell, or inability to exercise.
Answer choices: yes, no

Do you have symptoms now?
Answer choices: yes, no

Do these long-term symptoms reduce your ability to carry out day-to-day activities compared with the time before you had COVID-19?
Answer choices: Yes, a lot; Yes, a little; Not at all

Data Source

The U.S. Census Bureau, in collaboration with multiple federal agencies, launched the Household Pulse Survey to produce data on the social and economic impacts of COVID-19 on American households. The Household Pulse Survey was designed to gauge the impact of the pandemic on employment status, consumer spending, food security, housing, education disruptions, and dimensions of physical and mental wellness.
The survey was designed to meet the goal of accurate and timely weekly estimates. It was conducted by an internet questionnaire, with invitations to participate sent by email and text message. The sample frame is the Census Bureau Master Address File Data. Housing units linked to one or more email addresses or cell phone numbers were randomly selected to participate, and one respondent from each housing unit was selected to respond for him or herself. Estimates are weighted to adjust for nonresponse and to match Census Bureau estimates of the population by age, sex, race and ethnicity, and educational attainment. All estimates shown meet the NCHS Data Presentation Standards for Proportions.

Weighted Response Rate and Sample Size

Time Period	Weighted Response Rate	Sample Size
Sep 14 - Sep 26, 2022	4.7%	50,258
Jul 27 - Aug 8, 2022	4.4%	46,190
Jun 29 - Jul 11, 2022	5.7%	57,534
Jun 1 - Jun 13, 2022	6.2%	62,157

Showing 1 to 4 of 4 entries

Limitations

The Household Pulse Survey is different from other surveys. NCHS, the Census Bureau, and other federal statistical agencies are considered the preeminent source of the nation’s most important benchmark surveys. Many of these surveys have been in production for decades and provide valuable insight on health, social, and economic trends. However, the production of benchmark data requires a relatively long lead time, and personal interviews (face-to-face or telephone) require additional time. While efforts are underway to introduce COVID-19 questions into these surveys, that process can take months, sometimes years, before data are made available.
The Household Pulse Survey is different: It was designed to go into the field quickly, to be administered via the web, and to disseminate data in near real-time, providing data users with information they can use now to help ease the burden on American households and expedite post-pandemic recovery. The Census Bureau is fielding the Household Pulse Survey as a demonstration project, with data released as part of its Experimental Statistical Products Series.
Confidence intervals included in the tables on this page only reflect the potential for sampling error. Nonsampling errors can also occur and are more likely for surveys that are implemented quickly, achieve low response rates, and rely on online response. Nonsampling errors for the Household Pulse Survey may include:

Measurement error: The respondent provides incorrect information, or an unclear survey question is misunderstood by the respondent. The Household Pulse Survey schedule offered only limited time for testing questions.
Coverage error: Individuals who otherwise would have been included in the survey frame were missed. The Household Pulse Survey only recruited households for which an email address or cell phone number could be identified.
Nonresponse error: Responses are not collected from all those in the sample or the respondent is unwilling to provide information. The response rate for the Household Pulse Survey was substantially lower than most federally sponsored surveys.
Processing error: Forms may be lost, data may be incorrectly keyed, coded, or recoded. The real-time dissemination of the Household Pulse Survey provided limited time to identify and fix processing errors.

For more information on nonresponse bias for the Household Pulse Survey, please visit https://www2.census.gov/programs-su...ntation/hhp/2020_HPS_NR_Bias_Report-final.pdf.
For more information on the Household Pulse Survey, please visit https://www.census.gov/data/experimental-data-products/household-pulse-survey.html.

"

In adults, these data also find that 14.2 percent who have tested positive for the coronavirus experienced long covid for some period of time, while nearly 2 percent of people who tested positive continue to experience long-term symptoms of long covid that have significant impact on their day-to-day activities.

“We want to highlight that there are quite a few people in the country whose day-to-day activities are still significantly impacted by long covid,” said Stephen Blumberg, director in the division of Health Interview Statistics at the National Center for Health Statistics. “It lets people know what the consequences of contracting covid may be.”

Despite the potentially deleterious — and enduring — consequences of a coronavirus infection, only 7.6 million people in the United States have received the updated booster shot targeting the omicron variant. That’s a stark difference from the first vaccines authorized in late 2020 — more than 200 million received the full dose of the primary series of shots.

"

missy · Oct 8, 2022

COVID Attacks DNA in Heart, Unlike Flu, Study Says

Carolyn Crist

COVID-19 causes DNA damage to the heart, affecting the body in a completely different way than the flu does, according to a recent study published in Immunology.
The study looked at the hearts of patients who died from COVID-19, the flu, and other causes. The findings could provide clues about why coronavirus has led to complications such as ongoing heart issues.
"We found a lot of DNA damage that was unique to the COVID-19 patients, which wasn't present in the flu patients," Arutha Kulasinghe, one of the lead study authors and a research fellow at the University of Queensland in Australia, told the Brisbane Times.

"So in this study, COVID-19 and flu look very different in the way they affect the heart," he said.
SUGGESTED FOR YOU

Kulasinghe and colleagues analyzed the hearts of seven COVID-19 patients, two flu patients, and six patients who died from other causes. They used transcriptomic profiling, which looks at the DNA landscape of an organ, to investigate heart tissue from the patients.
Due to previous studies about heart problems associated with COVID-19, he and colleagues expected to find extreme inflammation in the heart. Instead, they found that inflammation signals had been suppressed in the heart, and markers for DNA damage and repair were much higher. They're still unsure of the underlying cause.
"The indications here are that there's DNA damage here, it's not inflammation," Kulasinghe said. "There's something else going on that we need to figure out."

The damage was similar to the way chronic diseases such as diabetes and cancer appear in the heart, he said, with heart tissue showing DNA damage signals.
Kulasinghe said he hopes other studies can build on the findings to develop risk models to understand which patients may face a higher risk of serious COVID-19 complications. In turn, this could help doctors provide early treatment. For instance, all seven COVID-19 patients had other chronic diseases, such as diabetes, hypertension, and heart disease.
"Ideally in the future, if you have cardiovascular disease, if you're obese or have other complications, and you've got a signature in your blood that indicates you are at risk of severe disease, then we can risk-stratify patients when they are diagnosed," he said.
The research is a preliminary step, Kulasinghe said, due to the small sample size. This type of study is often difficult to conduct because researchers have to wait for the availability of organs, as well as request permission from families for post-mortem autopsies and biopsies, to be able to look at the effects on dead tissues.

"Our challenge now is to draw a clinical finding from this, which we can't at this stage," he added. "But it's a really fundamental biological difference we're observing [between COVID-19 and flu], which we need to validate with larger studies."

Sources:

Immunology: "Transcriptomic profiling of cardiac tissues from SARS-CoV-2 patients identifies DNA damage."

Brisbane Times: "Unlike flu, COVID-19 attacks DNA in the heart: new research."

missy · Oct 8, 2022

Sore Throat Becoming Dominant COVID Symptom: Reports

Carolyn Crist

Having a sore throat is becoming a dominant symptom of COVID-19 infection, with fever and loss of smell becoming less common, according to recent reports in the U.K.
The shift could be a cause of concern for the fall. As the main symptoms of the coronavirus change, people could spread the virus without realizing it.
"Many people are still using the government guidelines about symptoms, which are wrong," Tim Spector, a professor of genetic epidemiology at King's College London, told The Independent.

Spector co-founded the COVID ZOE app, which is part of the world's largest COVID-19 study. Throughout the pandemic, researchers have used data from the app to track changes in symptoms.

"At the moment, COVID starts in two-thirds of people with a sore throat," he said. "Fever and loss of smell are really rare now, so many old people may not think they've got COVID. They'd say it's a cold and not be tested."
COVID-19 infections in the U.K. increased 14% at the end of September, according to data from the U.K.'s Office for National Statistics. More than 1.1 million people tested positive during the week ending Sept. 20, up from 927,000 cases the week before. The numbers continue to increase in England and Wales, with an uncertain trend in Northern Ireland and Scotland.
The fall wave of infections has likely arrived in the U.K., Spector told The Independent. Omicron variants continue to evolve and are escaping immunity from previous infection and vaccination, which he expects to continue into the winter.

But with reduced testing and surveillance of new variants, public health experts have voiced concerns about tracking the latest variants and COVID-19 trends.
"We can only detect variants or know what's coming by doing sequencing from PCR testing, and that's not going on anywhere near the extent it was a year ago," Lawrence Young, a professor of virology at the University of Warwick, told The Independent.
"People are going to get various infections over the winter but won't know what they are because free tests aren't available," he said. "It's going to be a problem."

COVID-19 cases are also increasing across Europe, which could mark the first regional spike since the BA.5 wave, according to the latest data from the European CDC. (In the past, increases in Europe have signaled a trend to come in other regions.)

People ages 65 and older have been hit the hardest, the data shows, with cases rising 9% from the previous week. Hospitalizations remain stable for now, although 14 of 27 countries in the European region have noted an upward trend.

"Changes in population mixing following the summer break are likely to be the main driver of these increases, with no indication of changes in the distribution of circulating variants," the European CDC said.

For now, most COVID-19 numbers are still falling in the U.S., according to a weekly CDC update published Friday. About 47,000 cases are being reported each day, marking a 13% decrease from the week before. Hospitalizations dropped 7% and deaths dropped 6%.

At the same time, test positivity rose slightly last week, from 9.6% to 9.8%. Wastewater surveillance indicates that 53% of sites in the U.S. reported a decrease in virus levels, while 41% reported an increase last week.

The CDC encouraged people to get the updated Omicron-targeted booster shot for the fall. About 7.5 million Americans have received the updated vaccine. Half of the eligible population in the U.S. hasn't received any booster dose yet.

"Bivalent boosters help restore protection that might have gone down since your last dose – and they also give extra protection for you and those around you against all lineages of the Omicron variant," the CDC wrote. "The more people who stay up to date on vaccinations, the better chance we have of avoiding a possible surge in COVID-19 illness later this fall and winter."

Sources

The Independent: "UK 'blind' to new immune-evasive Covid variants creating 'perfect storm' for devastating wave."

U.K. Office for National Statistics: "COVID-19 Infection Survey, UK: "

Karl_K · Oct 9, 2022

scheduled for tue for the new pfizer booster shot and a flu shot.
Not sure about the flu shot because I dont want anything in my bad arm. Will see what they say about both in the same arm.
They had a ton of schedule openings for both mon, tue and wed at cvs.

OboeGal · Oct 9, 2022

Karl_K said:
scheduled for tue for the new pfizer booster shot and a flu shot.
Not sure about the flu shot because I dont want anything in my bad arm. Will see what they say about both in the same arm.
They had a ton of schedule openings for both mon, tue and wed at cvs.

You could possibly get one of the shots in one of your legs instead of your arm. I know they often will give young children intramuscular shots in the leg instead of arm.

GemmaBella · Oct 10, 2022

Karl_K said:
scheduled for tue for the new pfizer booster shot and a flu shot.
Not sure about the flu shot because I dont want anything in my bad arm. Will see what they say about both in the same arm.
They had a ton of schedule openings for both mon, tue and wed at cvs.

My mother got the flu and Covid shot in the same arm. She did not have any issues. Good luck to you!

Karl_K · Oct 10, 2022

GemmaBella said:
My mother got the flu and Covid shot in the same arm. She did not have any issues. Good luck to you!

Kewl thanks for the info.

missy · Oct 10, 2022

"

I Won't Be Tossing My Mask Any Time Soon

— Hospital masking is about more than just us healthcare workers

by Anastasia Wasylyshyn, MD October 6, 2022

A photo of a female physician wearing a N95 mask and holding one out.

During a television interview on September 18, everyone heard President Biden say "the pandemic is over." Healthcare workers want this to be true as much as anyone else, but is it?
After 2 and a half years, we have certainly come a long way. First, we learned about how to best care for patients with COVID-19. Then, we developed multiple therapeutics to treat the infection. And perhaps most importantly, we have administered more than 12 billion COVID-19 vaccinations worldwide to prevent serious disease and death.

Many elements of normal, pre-pandemic life have returned. In grocery stores, masks are off and toilet paper is back on the shelves. Many office workers have returned to their cubicles, though much of our nation's work remains virtual. But, particularly in hospitals, this virus is still ubiquitous. In my hospital, we are still admitting patients with COVID-19 as well as covering for staff affected by the virus, and masks continue to be regular fixtures on the faces of healthcare workers and patients. Increasingly, the community and the hospital feel like two different worlds.
As we have watched the rest of the world adapt to the pandemic and slowly reopen, many healthcare workers have wondered when it will be our turn. When will things finally "return to normal?"
There is room for optimism: the currently circulating Omicron variants do not have the same proportion of severe outcomes as earlier variants. Our COVID-19 community levels have teetered at the border of medium and high for the past 5 months, rather than cycling through surges as before. Many of our current COVID-19-positive patients are primarily admitted for non-COVID-19 diagnoses and are found incidentally to have COVID-19 infection on admission. Our community guidance on masking has relaxed, and many of our behaviors outside of work have returned to a pre-pandemic "normal." Given my general health, I rarely wear a mask when out in the community. I may get COVID-19 again, but I also assess that my risk of severe outcomes is low and my access to appropriate therapeutics to further reduce the risk of severe illness is high. I am comfortable making these decisions for myself and my family.
https://www.yalemedicine.org/news/5...ron strain has,than Delta, which preceded it.
We are currently at the precipice of another significant step toward normalcy with the latest officially sanctioned guidance from the CDC: "When SARS-CoV-2 Community Transmission levels are not high, healthcare facilities could choose not to require universal source control." It is not the strongest or most directive statement the CDC has ever released, and the discussions about how best to interpret and make use of this guidance are ongoing.
Masks remain a fraught aspect of our pandemic response. They are a clear and visible barrier between healthcare workers and our patients -- in both the positive and the negative sense. Masks are a vital piece of healthcare worker personal protective equipment. They help to protect our most vulnerable patients from any miasma we may be harboring and spreading before becoming symptomatic. They help to protect us from inadvertent patient coughs and sneezes. I have lost count of the number of personal exposures to contagious, pre-symptomatic patients I have withstood without becoming infected, thanks to simple surgical masks. The negative aspects of masks as a barrier are simultaneously apparent in my work and in my life. As physicians, we are struggling to appear empathic and kind with only the top halves of our faces while breaking bad news. Patients with hearing impairments are now struggling to participate in their own care. Visitors cannot kiss their loved ones, maybe for the last time, without breaking rules.
https://www.medpagetoday.com/special-reports/exclusives/100955
The University of Michigan Hospitals have made a statement that they will not be considering changes in policy for universal masking in patient care activities, and I am steadfastly supportive. Though they may be fewer in proportion, we are still seeing severe outcomes related to COVID-19, just as we always have with influenza, respiratory syncytial virus (RSV), or any of the other seemingly "minor" viral illnesses that decompensate our most tenuously compensated patients. In our hospital system, where our most vulnerable are gathered closely together, the chance of causing a serious infection through a preventable exposure cannot be ignored. In fact, given what we have learned over the course of the pandemic, there is reason to posit that masks may become a new "standard precaution" during respiratory virus seasons going forward, given the significant decreases in healthcare-acquired influenza or RSV while universal masking has been in place.

We are all eager to ditch the masks, but I won't be tossing my mask away completely any time soon. I am not comfortable making the same decisions for my patients that I would make for myself. They don't have a choice about being ill enough to require hospital admission, dialysis, or infusion therapy -- and they are at our mercy for care.
Just as we dutifully perform "time outs" before procedures, and use maximal barrier precautions when placing central lines, I would encourage us to continue masking when caring for patients, at least for the time being. I will be, and will continue to work on, smiling with my eyes.
Anastasia Wasylyshyn, MD, is an infectious disease specialist and clinical assistant professor at University of Michigan Health.
"

missy · Oct 10, 2022

Is the Pandemic Really Over?

— Katelyn Jetelina, PhD, MPH, explains the "weird stage between pandemic and endemic"

by Emily Hutto, Associate Video Producer

https://assets7.ign.com/master/videos/zencoder/2022/10/03/,640/d031c897a4f28e0362b001a3af1904cd-347000,853/d031c897a4f28e0362b001a3af1904cd-724000,960/d031c897a4f28e0362b001a3af1904cd-1129000,1280/d031c897a4f28e0362b001a3af1904cd-1910000,1920/d031c897a4f28e0362b001a3af1904cd-3906000,-1664822003/master.m3u8

missy · Oct 10, 2022

COVID Rebound After Pfizer Treatment Likely Due to Robust Immune Response, Study Finds

By Leroy Leo and Julie Steenhuysen
October 07, 2022

(Reuters) - A rebound of COVID-19 symptoms in some patients after taking Pfizer's antiviral Paxlovid may be related to a robust immune response rather than a weak one, U.S. government researchers reported on Thursday.
They concluded that taking a longer course of the drug - beyond the recommended five days - was not required to reduce the risk of a recurrence of symptoms as some have suggested, based on an intensive investigation of rebound in eight patients at the National Institutes of Health's Clinical Center.
All patients in the study had developed robust immune responses, but researchers found higher levels of antibodies in the patients who experienced a rebound.
The team said their data argues against the hypothesis that impaired immune responses are the reason symptoms return in some patients.

"Our findings suggest that a more robust immune response rather than uncontrolled viral replication characterizes these clinical rebounds," the team wrote.

The study, published in the journal Clinical Infectious Diseases, followed numerous reports of individuals who took Paxlovid as recommended within five days of infection and saw a return of symptoms after they completed the five-day course of treatment.
President Joe Biden and National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci both experienced a COVID rebound after taking the medicine.
The cases raised concerns that Pfizer's two-drug antiviral treatment could interfere with development of a long-lasting immune response.

The study involved six people whose COVID symptoms returned after taking Paxlovid, and two with rebound symptoms after apparent recovery who did not take the pills. Their responses were compared to a group of six people who had COVID but did not experience a rebound. All volunteers had been vaccinated and boosted and all were infected with some version of the Omicron variant of the virus.
Blood from study volunteers underwent intensive investigation to assess their immune response during the acute infection phase and the rebound phase.
All of the rebound patients had experienced significant improvement in their symptoms before their rebound. Of those who had a rebound after Paxlovid, four had milder symptoms than during their initial infection, one had the same level of severity and one reported worse symptoms.
None of the rebound patients required additional treatment or hospitalization.

Rebound symptoms may be partially driven by a robust immune response to residual virus in the respiratory tract, the study authors suggested. They concluded that the drug does not impede the immune response in some individuals, as some had feared.

Larger and more detailed studies are needed to further understand COVID symptom rebound, the research team said, adding that the current data supports the need for isolation of such patients.

The researchers also suggested that there is still a need to evaluate longer courses of Paxlovid in immunocompromised individuals where the immune response may be ineffective.

(Reporting by Leroy Leo in Bengaluru and Julie Steenhuysen in Chicago; Editing by Bill Berkrot)

missy · Oct 10, 2022

COVID Wave Looms in Europe as Booster Campaign Makes Slow Start

By Ludwig Burger and Natalie Grover
October 07, 2022

(Reuters) - A new COVID-19 wave appears to be brewing in Europe as cooler weather arrives, with public health experts warning that vaccine fatigue and confusion over types of available vaccines will likely limit booster uptake.
Omicron subvariants BA.4/5 that dominated this summer are still behind the majority of infections, but newer Omicron subvariants are gaining ground. Hundreds of new forms of Omicron are being tracked by scientists, World Health Organisation (WHO) officials said this week.
WHO data released late on Wednesday showed that cases in the European Union (EU) reached 1.5 million last week, up 8% from the prior week, despite a dramatic fall in testing. Globally, case numbers continue to decline.
Hospitalisation numbers across many countries in the 27-nation bloc, as well as Britain, have gone up in recent weeks.

In the week ended Oct 4, COVID-19 hospital admissions with symptoms jumped nearly 32% in Italy, while intensive care admissions rose about 21%, compared to the week before, according to data compiled by independent scientific foundation Gimbe.

Over the same week, COVID hospitalisations in Britain saw a 45% increase versus the week earlier.
Omicron-adapted vaccines have launched in Europe as of September, with two types of shots addressing the BA.1 as well as the BA.4/5 subvariants made available alongside existing first-generation vaccines. In Britain, only the BA.1-tailored shots have been given the green light.
European and British officials have endorsed the latest boosters only for a select groups of people, including the elderly and those with compromised immune systems. Complicating matters further is the "choice" of vaccine as a booster, which will likely add to confusion, public health experts said.

But willingness to get yet another shot, which could be a fourth or fifth for some, is wearing thin.
"For those who may be less concerned about their risk, the messaging that it is all over coupled with the lack of any major publicity campaign is likely to reduce uptake," said Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine.
FALSE SENSE OF SECURITY
"So on balance I fear that uptake will be quite a bit lower."

"Another confounder is that quite a high proportion of the population might have also had a COVID episode in recent months," said Penny Ward, visiting professor in pharmaceutical medicine at King’s College London.

Some may erroneously feel that having had a complete primary course and then having fallen ill with COVID means they will remain immune, she added.

Since Sept. 5, when the roll-out of new vaccines began in the European Union, about 40 million vaccine doses produced by Pfizer-BioNTech and Moderna have been delivered to member states, according to data from the European Centre for Disease Prevention and Control (ECDC).

However, weekly vaccine doses administered in the EU were only between 1 million and 1.4 million during September, compared with 6-10 million per week during the year-earlier period, ECDC data showed.

Perhaps the biggest challenge to uptake is the perception that the pandemic is over, creating a false sense of security.

"There must be some complacency in that life seems to have gone back to normal – at least with regards COVID and people now have other financial and war-related worries," said Adam Finn, chair of ETAGE, an expert group advising the WHO on vaccine preventable diseases in Europe.

He added that some law-makers, too, were dropping the ball.

Italy's Gimbe science foundation said the government, soon to be replaced after an election, was ill prepared for the autumn-winter season, and highlighted that a publication on the government's management of the pandemic had been blocked.

The health ministry declined to comment.

Meanwhile, British officials last week warned that renewed circulation of flu and a resurgence in COVID-19 could pile pressure on the already stretched National Health Service (NHS).

(Reporting by Ludwig Burger in Frankfurt, Natalie Grover and Jennifer Rigby in London, Emilio Parodi in Milan, Editing by William Maclean)

12

missy · Oct 10, 2022

Nearly 4 Million Americans Received Updated COVID Boosters Last Week: CDC

Reuters staff
October 07, 2022

(Reuters) -Around 3.9 million people in the United States received updated COVID-19 booster shots over the past week, the Centers for Disease Control and Prevention said on Thursday.
The CDC said a total of 11.5 million Americans had received the shot as of Oct. 5, the first five weeks the booster has been available. This is up from the 7.6 million people who received the shot as of Sept. 28.
The 11.5-million figure represents only 5.3% of the 215.5 million people in the United States aged 12 or older who are eligible to receive the shots because they have completed their primary vaccination series.
The shots are being administered at a slower pace than last year, when the United States initially authorized COVID boosters just for older and immunocompromised people. Around 20 million people received their third shot in the first five weeks of that vaccination campaign.

A recent survey conducted by the nonprofit Kaiser Family Foundation found that nearly two-thirds of adults in the United States do not plan to get updated COVID-19 booster shots soon.

Asscherhalo_lover · Oct 10, 2022

Karl_K said:
scheduled for tue for the new pfizer booster shot and a flu shot.
Not sure about the flu shot because I dont want anything in my bad arm. Will see what they say about both in the same arm.
They had a ton of schedule openings for both mon, tue and wed at cvs.

I just got both in the same arm a week ago, it was not an issue at all.

missy · Oct 11, 2022

Long COVID Persists in People With Symptomatic SARS-CoV-2 Infection

— At 1 year, 15% of long COVID patients had ongoing cognitive or respiratory problems or fatigue

by Judy George, Deputy Managing Editor, MedPage Today October 10, 2022

Long COVID -- defined as one or more clusters of symptoms lasting 3 months or longer -- occurred in about 6% of people with symptomatic SARS-CoV-2 infection, a modeling study based on 1.2 million global COVID patients showed.

After adjusting for pre-COVID health status, an estimated 6.2% (95% uncertainty interval [UI] 2.4-13.3) of people with symptomatic infection experienced at least one of three long COVID symptom clusters in 2020 and 2021, according to Theo Vos, PhD, of the University of Washington in Seattle, and colleagues from the Global Burden of Disease Long COVID Collaborators group in JAMA.

This included:

In people ages 20 and older, long COVID symptom clusters were more common in women (10.6%, 95% UI 4.3-22.2) than men (5.4%, 95% UI 2.2-11.7). For those under age 20, long COVID affected 2.8% (95% UI 0.9-7.0) of symptomatic COVID patients of both sexes.
Estimated symptom duration was 9 months (95% UI 7.0-12.0 months) for hospitalized COVID patients and 4 months (95% UI 3.6-4.6 months) for those who weren't hospitalized. By the 1-year mark, 15.1% of all those with long COVID still had symptoms.
The global analysis involved Bayesian meta-regression and pooling of 54 studies and two medical record databases, incorporating data for 1.2 million people with symptomatic SARS-CoV-2 infection from 22 countries.
"We synthesized available knowledge on the occurrence, severity, and duration of three common symptom clusters of long COVID," Vos told MedPage Today.
https://jamanetwork.com/journals/jama/fullarticle/2797443
"Importantly, we anchored our estimates on the difference between those who experienced a SARS-CoV-2 infection and those who did not, or by comparing people rating symptoms before and after they had COVID-19," Vos explained.
"As all these symptoms are common, not correcting would lead to overestimation," he added. "Worse so -- as some people do -- is when you count any of many symptoms as defining long COVID and do not correct for their occurrence in those not having been infected."
"We have not covered the full spectrum of long COVID symptoms," Vos acknowledged. And the symptom severity for some patients was substantial -- "on the order of what we measure for people with deafness or long-term consequences of more severe traumatic brain injury," he noted.
"An analysis of the largest contributing cohort with most detailed information suggested that, among those reporting not having recovered and worse off in terms of general health, we largely missed people reporting similar symptoms at a lesser severity level," he said. "It means we are undercounting."
https://jamanetwork.com/journals/jama/fullarticle/2797443
Of the 54 studies included in the analysis, 44 were published and 10 were collaborating cohort studies in Austria, the Faroe Islands, Germany, Iran, Italy, the Netherlands, Russia, Sweden, Switzerland, and the U.S. Published studies included 10,501 hospitalized and 42,891 non-hospitalized COVID patients. Cohort studies included 10,526 hospitalized and 1,906 non-hospitalized patients.
In addition, data from two U.S. electronic medical record databases -- spanning 250,928 hospitalized and 846,046 non-hospitalized patients -- were used. Data collection was from March 2020 to January 2022 and did not cover the Omicron variant wave.

The analyses were based on the World Health Organization clinical case definition of long COVID. Symptoms were new-onset and persisted for 3 months after symptomatic SARS-CoV-2 infection.

The estimated proportion of people with at least one of the three long COVID symptom clusters was greater in patients admitted to ICUs (43.1%, 95% UI 22.6-65.2) or general hospital wards (27.5%, 95% UI 12.1-47.

than among people not hospitalized (5.7%, 95% UI 1.9-13.1).

In more than a third (38.4%) of all long COVID cases, two or all three of the symptom clusters overlapped.
The analysis had several limitations, Vos and colleagues noted. "The 95% UIs around the estimates are wide, reflecting limited and heterogeneous data," they wrote.
Algorithms had to be formulated for each study to achieve cluster definition consistency. The researchers also assumed long COVID followed a similar course in all geographic locations.
"While we estimate that the majority of cases recover within a year, it still leaves many persons with ongoing symptoms," Vos noted. "The information is not yet there to determine the course of their symptoms beyond 1 year."

Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more.

missy · Oct 11, 2022

Infectious Disease>Public Health

'I Didn't Think COVID-19 Was Real': Why 40% Misled During the Pandemic

— One-fifth didn't mention that they had or might have COVID-19 during doctors' office screenings

by Zaina Hamza, Staff Writer, MedPage Today October 10, 2022

Three in five Americans say they either misled others about their COVID-19 infection or vaccination status, or didn't follow pandemic-related public health measures, a new study indicated.

In a survey involving over 1,700 respondents, 41.6% suggested they either misrepresented and/or did not adhere to at least one of nine survey items, most commonly 24.3% saying they were taking more precautions than they really were and 22.5% who said they broke quarantines, reported Andrea Levy, PhD, MBE, of Middlesex Community College in Middletown, Connecticut, and colleagues.

Other frequently cited examples of non-adherence included people avoiding testing when they had or thought they might have COVID (21%), and not mentioning that they had or might have COVID-19 during screening at doctors' offices (20.4%), the group wrote in JAMA Network Open.

"COVID-19 safety measures can certainly be burdensome, but they work," Levy said in a press release. "When people are dishonest about their COVID-19 status or what precautions they are taking, it can increase the spread of disease in their community."

"For some people, particularly before we had COVID vaccines, that can mean death," Levy added.

People most commonly cited a desire to feel normal or to exercise their personal freedom as reasons for their misrepresentation or non-adherence. Other reasons included:

"Some individuals may think if they fib about their COVID-19 status once or twice, it's not a big deal," said coauthor Angela Fagerlin, PhD, of the University of Utah in Salt Lake City, in a statement. "But if, as our study suggests, nearly half of us are doing it, that's a significant problem that contributes to prolonging the pandemic."
People tended to be more likely to be adherent or truthful the older they were: ages 18-29 (OR 4.87, 95% CI 3.27-7.34); ages 30-39 (OR 3.16, 95% CI 2.16-4.70), ages 40-49 (OR 2.59, 95% CI 1.73-3.92), ages 50-59 (OR 2.09, 95% CI 1.35-3.25).
Exploratory analyses suggested that misrepresentation/non-adherence was more common among those with a greater distrust for science (OR 1.14, 95% CI 1.05-1.23).
"It's a real phenomenon; we see it all around us every day," Dirk Sostman, MD, president of the Houston Methodist Academic Institute, told MedPage Today.
"Our country was founded on a philosophy of individual liberty, and in many spheres of life we tend to err on the side of allowing one person's liberty to infringe on another person's safety," said Sostman, who was not involved in this study.
https://www.medpagetoday.com/infectiousdisease/covid19vaccine/99594
But he noted that with increasing levels of population immunity, the stakes are lower and "non-compliance has lesser potential consequences than it once did."
"Since the risks are lower and people want to put fear and restrictions behind them, they are more likely to bend the rules," explained Sostman.
For their study, Levy's group sent a total of 2,260 emails from Dec. 8-23, 2021 to U.S. adults to participate in an online survey (with an 80% response rate). The final sample included 1,733 participants, of which 27.5% were confident they'd been infected with COVID-19 at some point, and 53% had received at least one dose of vaccine.
Mean participant age was 41, two-thirds were women, and two-thirds were white. About a third considered themselves democrats, and a little more than a fourth were republicans. No significant relationships were observed between misrepresentations/non-adherence and gender identity, political affiliation, vaccination attitude, race/ethnicity, education level, and mask use in stores.
https://www.medpagetoday.com/infectiousdisease/covid19vaccine/99594
In response to who people turned to for a source of COVID-19 information, 62% said their physician, 53% said the CDC, 51% their local health department, while 7% said a certain population and 5% a certain celebrity.

"People really listen to public figures about this stuff, so we need to leverage that," said Levy. "We also need to do things like improve access to testingand make staying home from work in quarantine more financially feasible."

The authors acknowledged limitations to the data: the sample was not fully representative of all U.S. individuals and the findings may be prone to bias and "should be interpreted with caution," the researchers noted.

Zaina Hamza is a staff writer for MedPage Today, covering Gastroenterology and Infectious disease. She is based in Chicago.

missy · Oct 11, 2022

Three COVID Scenarios That Could Spell Trouble for the Fall

Marcia Frellick
October 07, 2022

As the United States enters a third fall with COVID-19, the virus for many is seemingly gone — or at least out of mind. But for those keeping watch, it is far from forgotten as deaths and infections continue to mount at a lower but steady pace.
What does that mean for the upcoming months? Experts predict different scenarios, some more dire than others — with one more encouraging.
In the United States, more than 300 people still die every day from COVID and more than 44,000 new daily cases are reported, according to the Centers for Disease Control and Prevention (CDC).

But progress is undeniable. The stark daily death tolls of 2020 have plummeted. Vaccines and treatments have dramatically reduced severe illness, and mask requirements have mostly turned to personal preference.

Epidemiologists and other medical experts laud the progress, but as they look at the maps and the numbers, they see several scenarios ahead that signal a coming wave of disease, among them more-resistant variants coupled with waning immunity, the potential for a "twindemic" with a flu/COVID onslaught, and underuse of lifesaving vaccines and treatments.

Variants Loom/Waning Immunity

Omicron variant BA.5 still makes up about 80% of infections in the United States, followed by BA4.6, according to the CDC, but other subvariants are emerging and showing signs of resistance to current antiviral treatments.

Eric Topol, MD, founder and director of the Scripps Research Translational Institute and Medscape's editor-in-chief, said about COVID this fall: "There will be another wave, magnitude unknown."
He said subvariants XBB and BQ.1.1 "have extreme levels of immune evasion and both could pose a challenge," explaining that XBB is more likely to cause trouble than BQ.1.1 because it is even more resistant to natural or vaccine-induced immunity.
Topol points to new research on those variants in a preprint posted on the bioRxiv server. The authors' conclusion: "These results suggest that current herd immunity and BA.5 vaccine boosters may not provide sufficiently broad protection against infection."

Another variant to watch, some experts say, is Omicron subvariant BA.2.75.2, which has shown resistance to antiviral treatments. It is also growing at a rather alarming rate, says Michael Sweat, PhD, director of the MUSC (Medical University of South Carolina) Center for Global Health in Charleston. That subvariant currently makes up under 2% of US cases but has spread to at least 55 countries and 43 US states after first appearing at the end of last year globally and in mid-June in the United States.

A nonpeer-reviewed preprint study last month from Sweden found that the variant in blood samples was neutralized on average "at titers approximately 6.5-times lower than BA.5, making BA.2.75.2 the most [neutralization-resistant] variant evaluated to date."

Katelyn Jetelina, PhD, assistant professor in the Department of Epidemiology at University of Texas Health Science Center, told Medscape Medical News the US waves often follow Europe's, and Europe has seen a recent spike in cases and hospitalizations not related to Omicron subvariants, she said, but to weather changes, waning immunity, and changes in behavior.

The World Health Organization reported Wednesday that while cases were down in every other region of the world, Europe's numbers stand out, with an 8% increase in cases from the week before.

Jetelina cited events such as Oktoberfest in Germany, which ended last week after drawing nearly 6 million people over 2 weeks, as a potential contributor, and people heading indoors as weather patterns change in Europe.

Ali Mokdad, PhD
Ali Mokdad, PhD, chief strategy officer for population health at the University of Washington in Seattle, told Medscape Medical News he is less worried about the documented variants we know about than he is about the potential for a new immune-escape variety yet to emerge.

"Right now we know the Chinese are gearing up to open up the country, and because they have low immunity and little infection, we expect in China there will be a lot of spread of Omicron," he said. "It's possible because of the number of infections we could see a new variant."

Mokdad said waning immunity could also leave populations vulnerable to variants.

"Even if you get infected, after about 5 months, you're susceptible again. Remember, most of the infections from Omicron happened in January or February of this year, and we had two waves after that," he said.

The new bivalent vaccines tweaked to target some Omicron variants will help, Mokdad said, but he noted, "people are very reluctant to take it."

Jennifer Nuzzo, DrPH, professor of epidemiology and director of the Pandemic Center at Brown University School of Public Health in Providence, Rhode Island, worries that in the United States we have less ability this year to track variants as funding has receded for testing kits and testing sites. Most people are testing at home — which doesn't show up in the numbers — and the United States is relying more on other countries' data to spot trends.

"I think we're just going to have less visibility into the circulation of this virus," she told Medscape Medical News.

Jetelina noted Australia and New Zealand just wrapped up a flu season that saw flu numbers returning to normal after a sharp drop in the last 2 years, and North America typically follows suit.

"We do expect flu will be here in the United States and probably at levels that we saw prepandemic. We're all holding our breath to see how our health systems hold up with COVID-19 and flu. We haven't really experienced that yet," she said.

There is some disagreement, however, about the possibility of a so-called "twindemic" of influenza and COVID.

Richard Webby, PhD, an infectious disease specialist at St. Jude Children's Research Hospital in Memphis, Tennessee, told Medscape Medical News he thinks the possibility of both viruses spiking at the same time is unlikely.

"That's not to say we won't get flu and COVID activity in the same winter," he explained, "but I think both roaring at the same time is unlikely."

As an indicator, he said, at the beginning of the flu season last year in the Northern Hemisphere, flu activity started to pick up, but when the Omicron variant came along, "flu just wasn't able to compete in that same environment and flu numbers dropped right off." Previous literature suggests that when one virus is spiking it's hard for another respiratory virus to take hold.

Vaccine, Treatment Underuse

Jennifer Nuzzo, DrPH
Another threat is vaccines, boosters, and treatments sitting on shelves.

MUSC's Sweat referred to frustration with vaccine uptake that seems to be "frozen in amber."

As of October 4, only 5.3% of people in the United States who were eligible had received the updated booster launched in early September.

Nuzzo says boosters for people at least 65 years old will be key to severity of COVID this season.

"I think that's probably the biggest factor going into the fall and winter," she said.

Only 38% of people at least 50 years old and 45% of those at least 65 years old had gotten a second booster as of early October.

"If we do nothing else, we have to increase booster uptake in that group," Nuzzo said.

She said the treatment nirmatrelvir/ritonavir (Paxlovid, Pfizer) for treating mild-to-moderate COVID-19 in patients at high risk for severe disease is greatly underused, often because providers aren't prescribing it because they don't think it helps, are worried about drug interactions, or are worried about its "rebound" effect.

Nuzzo urged greater use of the drug and education on how to manage drug interactions.

"We have very strong data that it does help keep people out of hospital. Sure, there may be a rebound, but that pales in comparison to the risk of being hospitalized," she said.

Calm COVID Season?

Not all predictions are dire. There is another little-talked-about scenario, Sweat said — that we could be in for a calm COVID season, and those who seem to be only mildly concerned about COVID may find those thoughts justified in the numbers.

Omicron blew through with such strength, he noted, that it may have left wide immunity in its wake. Because variants seem to be staying in the Omicron family, that may signal optimism.

"If the next variant is a descendant of the Omicron lineage, I would suspect that all these people who just got infected will have some protection, not perfect, but quite a bit of protection," Sweat said.

Topol, Nuzzo, Sweat, Webby, Mokdad, and Jetelina have reported no relevant financial relationships.

Marcia Frellick is a freelance journalist based in Chicago. She has written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, Cincinnati Enquirer, and St. Cloud (Minnesota) Times. Follow her on Twitter: @mfrellick

missy · Oct 11, 2022

‘How do we move the needle?’

Nearly three years into the pandemic, Covid-19 is still killing hundreds of Americans each day. Getting vaccinated remains the best strategy to reduce the risk of dying from the disease – and yet about a third of eligible Americans still haven’t yet received their first two shots.

The numbers get even more dismal when it comes to boosters. Just about half of Americans have received their first booster dose.
What would motivate these people to get vaccinated? That’s the billion-dollar question.
Well, maybe it’s not actually a question of dollars at all, according to recently published research.
Financial incentives have been shown to increase uptake of other vaccines, like flu shots. Mireille Jacobson, an economist and associate professor of gerontology at the University of Southern California, was curious how they might impact Covid vaccination rates.
“Like most of the world, we were eager to figure out what could get people vaccinated,” she says. “How do we move the needle for individual decisions for getting vaccinated?”
So she and her colleagues designed a study to test whether offering up to $50 would encourage people to get Covid vaccines. They ran the study from May through July 2021 in California’s Contra Costa County, a mostly suburban area that stretches inland from the San Francisco Bay.
At the same time, several states, including California, were offering monetary incentives, including entering vaccinated residents in lotteries for big cash prizes. But would efforts like that make a difference?
Jacobson’s results, published in August in the peer-reviewed journal Vaccine, were clear: Money did not motivate people to get the shots.
“It was pretty disappointing not to see anything,” Jacobson says. Other research also showed that the state-based lotteries had small effects, if any, on vaccine uptake.
Matthew Motta, an assistant professor at Boston University who studies why people don’t get vaccinated, says he wasn’t surprised.
With Covid, he says, many of the people who chose to remain unvaccinated have strong political or social reasons for making that choice.
“It’s not a $50 exchange trying to get people out of bed and get vaccinated,” he says. “It’s a $50 exchange for people to both motivate to vaccinate as well as to abandon some of their deeply held principles and ideals, which is a tough sell.”
A more effective approach, Motta says, would be to tailor messages and interventions for different groups of people, addressing the differing reasons they have hesitated to get vaccinated.
But financial incentives might work better for booster shots. Many people who received their initial series of vaccines haven’t been boosted. For those people, it’s more likely that logistical hurdles are playing a role in lagging uptake numbers. It can be hard to schedule booster appointments, and depending on how you react to your shot, it might mean a day or more home from work. When the original Covid shots were offered, government organizations went out of their way to help people get vaccinated. Now, people are mostly left to fend for themselves.
“These logistical concerns loom larger even for those who previously were willing to vaccinate,” Motta says. “Perhaps cash incentives could work for this group. That’s something I think would be very interesting to test.” — Ike Swelitz

Asscherhalo_lover · Oct 11, 2022

Welp COVID finally got me, a week after my booster shot no less. I thought my allergies were acting up as usual. I stuck to this house this weekend. Negative test yesterday and a blazing positive today. So far it just feels like my usual allergy progression with a sinus infection. DH is negative so far as are the kids.

Coronavirus Updates October 2022

Super_Ideal_Rock

Will future strains be less of a concern?​

Super_Ideal_Rock

Good Riddance​

What we’re reading​

Super_Ideal_Rock

California Bill Barring Docs From Telling COVID Lies Signed Into Law​

— Law won't stop docs who spread misinfo on social media; only during direct patient care​

Super_Ideal_Rock

Super_Ideal_Rock

Around 3.2 Million Americans Received Updated COVID Boosters Last Week: CDC​

Super_Ideal_Rock

As Australia Calls End to COVID Emergency Response, Doctors Warn of Risk to Public​

Ideal_Rock

Super_Ideal_Rock

Super_Ideal_Rock

Super_Ideal_Rock

The power of Paxlovid​

Bad-news bias​

Red Covid​

Solutions​

Super_Ideal_Rock

Super_Ideal_Rock

Feel better @chrono!​

​

Paxlovid update: Effectiveness, rebounding, drug interactions​

Effectiveness​

Rebounding​

Interactions with medications​

Other benefits?​

Bottom line​

Super_Ideal_Rock

Long COVID​

Technical Notes​

Survey Questions​

Data Source​

Limitations​

Super_Ideal_Rock

COVID Attacks DNA in Heart, Unlike Flu, Study Says​

Super_Ideal_Rock

Sore Throat Becoming Dominant COVID Symptom: Reports​

Sources​

Super_Ideal_Rock

Brilliant_Rock

Shiny_Rock

Super_Ideal_Rock

Super_Ideal_Rock

I Won't Be Tossing My Mask Any Time Soon​

— Hospital masking is about more than just us healthcare workers​

Super_Ideal_Rock

Is the Pandemic Really Over?​

— Katelyn Jetelina, PhD, MPH, explains the "weird stage between pandemic and endemic"​

Super_Ideal_Rock

COVID Rebound After Pfizer Treatment Likely Due to Robust Immune Response, Study Finds​

Super_Ideal_Rock

COVID Wave Looms in Europe as Booster Campaign Makes Slow Start​

Super_Ideal_Rock

Nearly 4 Million Americans Received Updated COVID Boosters Last Week: CDC​

Ideal_Rock

Super_Ideal_Rock

Long COVID Persists in People With Symptomatic SARS-CoV-2 Infection​

— At 1 year, 15% of long COVID patients had ongoing cognitive or respiratory problems or fatigue​

Super_Ideal_Rock

'I Didn't Think COVID-19 Was Real': Why 40% Misled During the Pandemic​

— One-fifth didn't mention that they had or might have COVID-19 during doctors' office screenings​

Super_Ideal_Rock

Three COVID Scenarios That Could Spell Trouble for the Fall​

Variants Loom/Waning Immunity​

Vaccine, Treatment Underuse​

Calm COVID Season?​

Super_Ideal_Rock

‘How do we move the needle?’​

Ideal_Rock

Will future strains be less of a concern?

Good Riddance

What we’re reading

California Bill Barring Docs From Telling COVID Lies Signed Into Law

— Law won't stop docs who spread misinfo on social media; only during direct patient care

Around 3.2 Million Americans Received Updated COVID Boosters Last Week: CDC

As Australia Calls End to COVID Emergency Response, Doctors Warn of Risk to Public

The power of Paxlovid

Bad-news bias

Red Covid

Solutions

Feel better @chrono!

Paxlovid update: Effectiveness, rebounding, drug interactions

Effectiveness

Rebounding

Interactions with medications

Other benefits?

Bottom line

Long COVID

Technical Notes

Survey Questions

Data Source

Limitations

COVID Attacks DNA in Heart, Unlike Flu, Study Says

Sore Throat Becoming Dominant COVID Symptom: Reports

Sources

I Won't Be Tossing My Mask Any Time Soon

— Hospital masking is about more than just us healthcare workers

Is the Pandemic Really Over?

— Katelyn Jetelina, PhD, MPH, explains the "weird stage between pandemic and endemic"

COVID Rebound After Pfizer Treatment Likely Due to Robust Immune Response, Study Finds

COVID Wave Looms in Europe as Booster Campaign Makes Slow Start

Nearly 4 Million Americans Received Updated COVID Boosters Last Week: CDC

Long COVID Persists in People With Symptomatic SARS-CoV-2 Infection

— At 1 year, 15% of long COVID patients had ongoing cognitive or respiratory problems or fatigue

'I Didn't Think COVID-19 Was Real': Why 40% Misled During the Pandemic

— One-fifth didn't mention that they had or might have COVID-19 during doctors' office screenings

Three COVID Scenarios That Could Spell Trouble for the Fall

Variants Loom/Waning Immunity

Vaccine, Treatment Underuse

Calm COVID Season?

‘How do we move the needle?’