Coronavirus Files: COVID is getting tougher to track, while possible surge puts vulnerable at risk



By Amber Dance

Is COVID surging in the U.S.? Would we even know?

Case counts are rising in the Northeastern U.S., writes German Lopez at The New York Times, but it’s hard to say whether it’s the start of a surge.

“It might be a ripple relative to previous waves,” Harvard epidemiologist William Hanage told Lopez.

A new wave would “wreak unequal havoc,” write a trio of experts in an opinion essay at MedPage Today. A second omicron wave would be extra damaging for the same groups hit hardest by the recent winter surge: Black Americans, young children not yet eligible for vaccination, un-boosted older individuals, immunocompromised people, and members of poor and rural communities where access to antiviral COVID drugs such as Paxlovid is limited.

“We worry that the ‘new normal’ will be plentiful boosters and rapid, easy access to antivirals for the well-off, while the least-off are left behind,” write the authors.

Any spring surge would also be the first real-world test of new safety guidelines the CDC adopted in February, which put more emphasis on preventing severe illness and death rather than infections overall, writes Keren Landman at Vox.

Case counts are becoming increasingly unreliable. More people are using at-home antigen tests that go unreported. At the same time, fewer tests are being performed because health care providers can no longer be reimbursed to test uninsured patients, and many people may be asymptomatic during infection, writes University of Texas epidemiologist Katelyn Jetelina on her blog.

By one estimate, only about 7% of COVID cases are captured in official numbers.

“The country could be in the midst of a surge right now and we might not even know it,” writes Madison Muller at Bloomberg.

Thus far, hospitalization rates remain low, and the CDC’s map still puts most U.S. counties in the green. The fraction of COVID tests coming back positive can also hint at trends.

And one of the best tools is in the sewer, write Lena H. Sun and Dan Keating at The Washington Post. The CDC’s network now monitors wastewater from sites covering nearly one-third of the U.S. population. Virus levels remain low but are increasing in about two-thirds of those sites.

Biden extends federal emergency declaration

The coronavirus pandemic, which has now killed nearly 1 million people in the U.S. and made 2021 the deadliest year in the nation’s history, is still considered a public health emergency, at least until July. Last Wednesday, the Biden administration added another 90 days to the emergency declaration, which has already spanned more than two years.

The move gives states and other agencies more time to prepare off-ramps to normal operations.

It also continues enhancements to healthcare for people on Medicaid and Medicare, writes Noah Weiland at The New York Times.

The emergency declaration extended access to telehealth, an ongoing boon for older and vulnerable individuals who face mobility challenges or don’t want to risk an in-person visit, as well as those in rural areas.

Medicare, as well as private insurers, will continue to foot the bill for at-home test kits while the emergency continues.

The emergency declaration also boosts payments to hospitals caring for Medicare patients with COVID-19.

Ongoing concerns about omicron also led the CDC to extend the mask mandate on public transportation, including airplanes, until May 3.

Philadelphia, meanwhile, has become the first major city to reinstate an indoor masking requirement.

Pfizer’s booster amps up protection in elementary-age children

Kids ages 5 through 11 could be lining up for their boosters within a month or so.

Pfizer announced plans last week to ask the FDA for emergency authorization of its booster in this age group, which has been able to obtain the standard two-dose vaccine series since last fall.

According to a company press release, the booster shot increased the number of antibodies capable of neutralizing both the original coronavirus and the omicron variant.

That’s pretty much all the release says. “The study did not show how long the antibodies last, or test effectiveness against COVID disease,” writes Sharon La Franiere at The New York Times. “The data was not published or peer-reviewed, and at least one expert said it was impossible to assess the study without more information.”

Certain children with weak immune systems in this age group are already advised to get an extra dose, writes Lauran Neergaard for AP.

While pediatric cases are often mild, they can turn severe.

The FDA and CDC “will have to decide if healthy elementary-age kids really need a booster, and if so, when,” writes Neergaard.

Pfizer’s trial provided the booster doses six months after the initial vaccines.

The parents of children younger than 5 are still waiting on the first doses for their kids. The winter omicron wave led to five times as many hospitalizations, compared to the delta surge, among this age group.

Pfizer is testing a third dose in young children, hoping to improve on the lackluster results from just two.

Moderna’s two-dose series yielded as many antibodies as adult vaccination, but was less than 50% effective at stopping omicron infection. Even if regulators are satisfied with those statistics, families still probably have a month or more to wait.

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