Nicknamed “Nimbus,” the new subvariant NB.1.8.1 has been described in news reports in China as having more obvious signs of “razor blade throat” — what patients describe as feeling like their throats are studded with razor blades.

Although “razor blade throat” may seem like a new term, the description of incredibly painful sore throats associated with COVID-19 has emerged before in the United States, like having a throat that feels like it’s covered with shards of glass. But the increased attention to this symptom comes as the Nimbus subvariant has caused surges of COVID-19 in other countries.

“Before Omicron, I think most people presented with the usual loss of taste and smell as the predominant symptom and shortness of breath,” said Dr. Peter Chin-Hong, a UC San Francisco infectious-disease expert. But as COVID has become less likely to require hospitalization, “people are focusing on these other aspects of symptoms,” such as an extraordinarily painful sore throat.

Part of the Omicron family, Nimbus is now one of the most dominant coronavirus subvariants nationally. For the two-week period that ended June 7, Nimbus comprised an estimated 37% of the nation’s coronavirus samples, now roughly even with the subvariant LP.8.1, probably responsible for 38% of circulating virus. LP.8.1 has been dominant over the past few months, according to the Centers for Disease Control and Prevention.

The Nimbus subvariant has also been increasing since May in California, the state Department of Public Health said in an email to the Los Angeles Times. Projections suggest the Nimbus subvariant comprises 55% of circulating virus in California, up from observations of just 2% in April, the agency said Friday.

“We are seeing some indicators of increased COVID-19 activity, including the rise of the NB.1.8.1 variant, elevated coronavirus levels in wastewater, and an uptick in the test positivity rate,” Dr. Elizabeth Hudson, regional chief of infectious diseases for Kaiser Permanente Southern California, wrote in an email to The Times.

“Wastewater surveillance across Southern California shows variability: Santa Barbara watersheds are reporting moderate-to-high levels, Ventura and Los Angeles counties are seeing low-to-moderate levels, Riverside is reporting low levels, while San Bernardino is experiencing high activity,” Hudson said.

While viral concentrations remain relatively low, Los Angeles County has observed an increase in coronavirus levels in sewage, the local Department of Public Health told The Times. For the week that ended May 30 — the most recent available — viral levels in wastewater rose by 13% versus a comparable period several weeks earlier.

In addition, there is a slight increase in the rate in which COVID surveillance tests are turning up positive in L.A. County. For the most recent week, 5% of COVID surveillance tests showed positive results for infection, up from 3.8% in early May. COVID-related visits to the emergency room remain low in Los Angeles County.

There were still low rates of COVID-19 illness in San Francisco, the local Department of Public Health said.

Yet coronavirus levels in wastewater in Northern California’s most populous county, Santa Clara County, are starting to increase, “just as they have over past summers,” the local Public Health Department said in an email to The Times. As of Friday, coronavirus levels in the sewershed of San José was considered “high.” Viral levels were “medium” in Palo Alto and “low” in Sunnyvale. Nimbus is the most common subvariant in the county.

Across California, coronavirus levels in wastewater are at a “medium” level; the last time viral levels were consistently “low” was in April, according to the state Department of Public Health’s website.

“Future seasonal increases in disease levels are likely,” the California Department of Public Health said in an email to The Times Friday.

The uptick in COVID comes as many medical professional organizations and some state and local health officials are objecting to the Trump administration’s recent moves on vaccine policy, which some experts fear will make it more difficult for people to get vaccinated against COVID-19 and other diseases.

Federal officials in May weakened the CDC’s official recommendations from recommending the COVID vaccine to everyone age 6 months and up. The CDC now offers “no guidance” on whether healthy pregnant women should get the COVID vaccine, and now asks that parents of healthy children talk with a healthcare provider before asking that their kids get inoculated.

The American College of Obstetricians and Gynecologists issued a rebuke of the changing vaccine recommendations for pregnant women, accusing the U.S. Department of Health and Human Services — led by the vaccine-skeptic secretary, Robert F. Kennedy Jr. — of “propagating misinformation.” The American Pharmacists Assn. wrote that dropping the vaccine recommendation for pregnant women did “not appear to be based on the scientific evidence provided over the last few years.”

And an open letter by 30 organizations specializing in health — including the American Medical Assn. — said that “we must continue to prioritize high levels of COVID-19 vaccine coverage in pregnant patients to protect them and their infants after birth.”

Chin-Hong said he recommends pregnant women get vaccinated “one million percent.”

“The data are incredibly clear that pregnant women do have a higher rate of complications, hospitalization and premature births when they did not get vaccinated [against COVID] compared to the ones that did,” said Dr. Yvonne Maldonado, an infectious-disease expert at Stanford University. The vaccines also help newborns, as antibodies generated by the mom-to-be cross the placenta, and can protect the newborn for a certain number of months, she said.

That’s essential protection, given that newborns can’t be vaccinated under 6 months of age, Maldonado said. If newborns are infected, they have relatively high rates of hospitalization — as high as those age 65 and over, Maldonado said.

Then, last week, Kennedy abruptly fired all members of a highly influential committee that advises the CDC on vaccine policy. In an op-ed to the Wall Street Journal, Kennedy criticized the previous members of the Advisory Committee on Immunization Practices, founded in 1964, as being “plagued with persistent conflicts of interest and has become little more than a rubber stamp for any vaccine.”

Maldonado, a professor in pediatric infectious diseases and epidemiology, was one of the fired vaccine advisors. She called their mass dismissal unprecedented in the history of the ACIP.

“We are absolutely in uncharted territory here,” Maldonado said. “I think it’s going to be really hard to understand what vaccines are going to go forward. … They’re also going to review the entire vaccination schedule.”

In general, routine review of vaccine schedules are a good thing, and prior reviews have concluded that the current recommended shots are safe and effective, Maldonado said. But the criteria being circulated by recently appointed federal officials “could actually wind up refusing to recommend, say, measles vaccine or HPV vaccine, because I’ve seen some of the misinformation that has been out there about some of these vaccines. …

“And if any of that is accepted as truth, we could wind up losing some of these vaccines,” Maldonado said.

“The question, then, is: ‘Would those vaccines disappear?’ … Hard to know,” she said. But it’s also possible that federal officials could begin to stop paying for certain vaccines to be administered to children of low-income families.

She rejected Kennedy’s characterization of the committee as a rubber stamp for vaccine makers. “Generally, a decision to not pursue a vaccine happens usually well before anything gets to a vote,” Maldonado said.

A joint statement by the governors of California, Oregon and Washington condemned Kennedy’s dismissal of the vaccine advisors as “deeply troubling for the health of the nation” and defended the fired vaccine advisors as having been “carefully screened for major conflicts of interest.”

“We have grave concerns about the integrity and transparency of upcoming federal vaccine recommendations and will continue to collaborate to ensure that science and sound medicine prevail to prevent any loss of life,” Gov. Gavin Newsom said in a statement Thursday.

Traditionally, the advisory committee’s recommendations on who should get vaccinated were adopted by the director of the CDC.

“It was one of the most depressing weeks in American health … a dark period for everyone right now, and demoralizing,” said Chin-Hong, of UC San Francisco. “It’s very destabilizing.”

The American Academy of Pediatrics called the purge of the vaccine advisors “an escalating effort by the administration to silence independent medical expertise and stoke distrust in lifesaving vaccines.” Kennedy’s handpicked replacements include people known for their criticism of vaccines, the Associated Press reported.

The mass firing “likely puts vaccine access and insurance coverage at serious risk,” the L.A. County Department of Public Health said in a statement. “It corrodes trust in the recommended schedule for vaccines, not only by the public, but by medical providers who rely on the ACIP for science-based, apolitical guidance.”

The departments of public health for California, Oregon and Washington said they “continue to recommend all individuals age 6 months and older should have access and the choice to receive currently authorized COVID-19 vaccines, with an emphasis on protecting higher risk individuals, such as infants and toddlers, pregnant individuals, and others with risks for serious disease.”

The L.A. County Department of Public Health said in a statement that, “at this time in Los Angeles County, current vaccine recommendations for persons aged 6 months and older to receive the COVID-19 vaccine remain in effect and insurance coverage for COVID-19 vaccines is still in place.”

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The directive was sent to all 50 states and will cancel roughly $12 billion in funding. California officials said they couldn’t immediately say how the cuts would affect state services.

“We are working to evaluate the impact of these actions,” Erica Pan, the state department’s director and state public health officer, said in a statement.

The funding was awarded during the height of the COVID-19 pandemic to aid the state with its respiratory virus monitoring, testing and response, immunizations and vaccines for children, and to help address health disparities, Pan said.

The cuts were reported earlier by NBC News, which quoted a statement from U.S. Department of Health and Human Services spokesman Andrew Nixon saying that the “COVID-19 pandemic is over, and H.H.S. will no longer waste billions of taxpayer dollars responding to a nonexistent pandemic that Americans moved on from years ago.”

It is unclear how much funding the state had been awarded and how much is now being pulled, but a 2023 news release shows that the CDC awarded the state a $37-million grant to help strengthen the state’s health infrastructure, workforce and data systems.

According to the release, the grant award’s start date was Dec. 1, 2022, and was set to last through Nov. 30, 2027.

It couldn’t immediately be determined how much of the award has already been spent, but much of it was designated to support county health departments, including the Los Angeles County Department of Public Health, Riverside County Department of Public Health, Long Beach Health Department, Orange County Health Department and San Bernardino County Department of Public Health.

In addition, two other large awards were provided by the CDC to California in the immediate wake of the COVID pandemic: a $555-million grant during 2020 and $1.7 billion as part of the Coronavirus Response and Relief Supplemental Appropriations Act of 2021.

The state Department of Public Health didn’t immediately respond for a request for comment on what programs could be affected by the CDC’s cancellation of funding, nor how the state’s infectious-disease monitoring, testing, response and immunization programs could be affected.

The Los Angeles County Department of Public Health received notices from the federal government that COVID-associated funding was going to be rescinded, a spokeswoman for the department said. It also received an informal notice from the state that COVID-related grants for vaccination services probably would be terminated.

“In total, these actions to rescind … COVID-associated funding will impact more than $45 million in core L.A. County Public Health funding,” the spokeswoman said. “Much of this funding supports disease surveillance, public health lab services, outbreak investigations, infection control activities at healthcare facilities, and data transparency. We are working to determine the impacts of the announcement of the loss of this funding.”

According to 2025-26 state budget figures, Gov. Gavin Newsom allocated $5.1 billion to the state’s health department; about $2.3 billion of that comes from federal funding.

Although Congress initially authorized the money for state health programs as part of its COVID relief bills, it has since been allowed to be targeted to other programs, such as testing and surveillance for other respiratory viruses.

California has been ground zero for the H5N1 bird flu since last March. Thirty-eight people in the state have been infected with the virus, most of them dairy workers who were exposed working with infected cows or milk. However, two of the people were children; the cause of their infection has not been determined.

The virus has also infected 756 dairy herds; more than 75% of the state’s total dairy herds.

In addition, there have been eight measles cases since the beginning of the year, in addition to thousands of seasonal flu, COVID-19, norovirus and RSV cases.

Pan said the state will continue to advance public health and work to protect people.

“All Californians deserve to live in healthy and thriving communities, which is the role of public health,” she wrote in her statement, saying her department is “committed to seeking the resources required to support the critical, lifesaving infrastructure needed to keep people healthy and protect them against infectious disease, vaccine-preventable diseases and health emergencies.”

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National trends underscore a public health need to broaden outpatient mental health care access to more distressed, older, and unemployed adults

U.S. adults experienced considerable psychological distress and adverse mental health effects as a result of the COVID-19 pandemic according to a study at Columbia University Mailman School of Public Health and Columbia University Irving Medical Center. Based on insurance claims, mental health care provider surveys, and electronic health records the research further revealed a decline in in-person outpatient mental health visits during the acute phase of the pandemic. Findings are reported in the Annals of Internal Medicine(link is external and opens in a new window).
 
“The trends and patterns we observed in the United States align with reports globally concluding that several mental health problems, including depression, and generalized anxiety disorder, have become more prevalent during than before the pandemic,” said Mark Olfson, MD, MPH, professor of Epidemiology at Columbia Mailman School of Public Health, and Dollard Professor of Psychiatry, Medicine & Law at Columbia University Irving Medical Center.
 
To characterize the psychological distress experienced, determine the level of outpatient mental health care, and describe patterns of in-person versus telemental health care, the researchers studied the responses of adults from the Medical Expenditure Panel Surveys by the Agency for Healthcare Research and Quality Component, a nationally representative survey of over 85,000 people. Psychological distress was measured with a 6-point scale range and outpatient mental health care use was determined via computer-assisted personal interviews.
 
The rate of serious psychological distress among adults increased from 3.5 percent to 4.2 percent from 2018 to 2021. While outpatient mental health care increased overall as well — from 11.2 percent to 12.4 percent, the rate among adults with serious psychological distress decreased from 46.5 percent to 40.4 percent. Young adults (aged 18 to 44 years significantly increased outpatient mental health care but this pattern was not observed for the middle-aged (aged 45 to 64 years) and older adults (aged >65 years).  Similarly, more employed adults reported outpatient mental health treatment care compared to the unemployed.

In 2021, 33 percent of mental health outpatients received at least one video visit. The likelihood of receiving in-person, telephone, or video mental health care varied across sociodemographic groups; percentages of video care were higher for younger adults than for middle-aged or older adults, women compared with men, college graduates compared with adults with less education, the seriously distressed, lower-income, unemployed, and rural patients.
 
“Thanks to a rapid pivot to telemental health care, there was an overall increase during the pandemic of adults receiving outpatient mental health care in the United States.  However, the percentage of adults with serious psychological distress who received outpatient mental health treatment significantly declined.  Several groups also had difficulty accessing telemental health care including older individuals and those with lower incomes and less education,” observed Olfson. “These patterns underscore critical challenges to extend the reach and access of telemental health services via easy-to-use and affordable service options.” 

“Increasing our understanding of the patterns we observed in terms of access to outpatient mental health care including in-person, telephone-administered, and internet-administered outpatient mental health services could inform ongoing public policy discussions and clinical interventions,” noted Olfson. “Identifying low-cost means of connecting lower-income patients to telemental health should be a priority, as well as increasing public investment to make access to high-speed broadband universal.”
 
“The national profile of adults who receive outpatient mental health care via telemental health – the younger adult, the employed, higher-income, and privately insured adults, raises concerns about disparities in access to virtual mental health care,” said Olfson.  “Unless progress is made in reducing these barriers, primary care clinicians will continue to encounter challenges in connecting their older, unemployed, and lower income patients to video-delivered outpatient mental health care.”
 
Co-authors are Chandler McClellan and Samuel H. Zuvekas, Agency for Healthcare Research and Quality; Melanie Wall, Columbia Mailman School of Public Health; and Carlos Blanco, National Institute on Drug Abuse.

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WASHINGTON (AP) — Treasury Secretary Janet Yellen is pushing back against Republican criticism of the Democrats’ big coronavirus pandemic response package and making an election-year pitch that the current state of the U.S. economy “vindicates” the steps taken in 2021 to “get our economy back on track.”

With falling inflation, unemployment at 3.7% and the U.S. apparently defying predictions of a recession, Yellen defended the $1.9 trillion American Rescue Plan in remarks Wednesday at a U.S. Conference of Mayors meeting in Washington.

The stimulus package, which was passed into law without a single GOP vote, is regularly cited by Republicans as the cause for two years of accelerating price spikes that hurt millions of American households.

“Many had argued that this rescue plan wasn’t needed. But I believe seeing where we are today vindicates the approach we took,” Yellen said. “President Biden and I believed that the most dangerous risk was in going too small.”

As President Joe Biden seeks reelection, he is trying to convince voters who are gloomy about the economy that inflation is under control and the economy is strong.

Some 76% of U.S. adults polled by The Associated Press-NORC Center for Public Affairs Research in December said they want the government to work on issues related to the economy this year, nearly the same as the 75% who said so at this point in 2022.

About 85% of Republicans and 65% of Democrats named the economy as a top issue.

An October AP-NORC poll stated that roughly three-quarters of Americans described the nation’s economy as poor.

At the mayors’ conference, Yellen said the Biden administration’s COVID-19 spending benefited states and local governments — and that had the administration’s response been smaller the U.S. economy could be worse off.

“Wages are up and wage gains have been broadly shared, including by younger and less educated workers,” Yellen said, adding that the U.S. had recovered “faster than our peers around the world.”

A top Federal Reserve official, Christopher Waller, said Tuesday that he is increasingly confident inflation will continue falling this year back to the Fed’s 2% target level.

Waller said inflation was slowing even as growth and hiring remain solid, a combination that he called “almost as good as it gets.”

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Donald Trump “flip-flipped” on abortion, overreached in response to COVID-19 and failed to uphold his campaign pledge to get Mexico to pay for a wall on the southern U.S. border, Florida Gov. Ron DeSantis said Tuesday in Iowa.

DeSantis, who is in a distant second place behind Trump in most national polls in the battle for the 2024 Republican presidential nomination, stepped up his case against the former president during a CNN town hall in Des Moines five weeks before the state’s first-in-the-nation caucuses.

He zeroed in on abortion in a state where evangelical voters form the backbone of the GOP, contrasting Trump’s recent skepticism about strict anti-abortion laws with his earlier comments about protecting the sanctity of life.

“You should be consistent in your beliefs, especially on something that’s very fundamental, and he has not been consistent,” DeSantis said. “And there’s a lot of voters in Iowa who really care about this, who need to know how he’s changed his position.”

DeSantis last month picked up the endorsement of Bob Vander Plaats, a prominent Iowa evangelical leader who has also questioned Trump’s commitment to the anti-abortion movement. Trump has responded by emphasizing his support from more than 150 pastors around the state.

Abortion has become a flashpoint in U.S. politics since a Supreme Court majority shaped by Trump’s three appointments eliminated the constitutional right to abortion, helping to power unexpectedly strong Democratic performances in the 2022 midterms. Trump has not backed a national abortion ban and has criticized the way many Republican politicians talk about the issue. He has implied that a Florida law DeSantis signed, which outlaws abortions after about six weeks of pregnancy, is “ too harsh.”

Asked about the case of Kate Cox, a Texas woman who sought an abortion when her health deteriorated as she carried a fetus with a fatal condition, DeSantis was vague. He said “these are very difficult issues” and pointed to the Florida law’s exceptions allowing abortions when the mother’s life is in danger, though in Cox’s case, the Texas Supreme Court ruled that her pregnancy complications did not constitute the kind of medical emergency under which abortions are allowed.

DeSantis has staked his campaign on a strong showing in Iowa’s leadoff caucuses on Jan. 15, but he’s struggled to break out of a distant second place. Like most of his rivals, he has largely treated the front-runner gingerly, avoiding direct criticism of Trump, who remains popular with GOP primary voters.

But sprinkled through the CNN town hall was a case to Trump-supporting voters that it’s time to move on. Trump, he said, is no longer the colorful “America First” advocate whom Republicans embraced in 2016.

“Now a lot of it’s about him,” DeSantis said.

And he worked to pierce rosy memories of Trump’s tenure in the White House. He said Trump erred in his response to COVID-19, an issue that helped catapult DeSantis to GOP prominence when he refused to go along with strict lockdowns that most other governors imposed early in the pandemic.

“The first three years of the Trump administration, the economy’s better than it has been, but that last year with COVID, I think was mishandled dramatically,” DeSantis said. “Shutting down the country was a huge mistake. Printing trillions and trillions of dollars was a huge mistake.”

DeSantis also took aim at one of the defining themes of Trump’s first run for the White House: his promise to build a wall along the U.S.-Mexico border and have the Mexican government pay for it.

“That didn’t happen,” DeSantis said. “And why didn’t it happen? Well, one, I think he got distracted, and he didn’t do it on day one. But, two, he didn’t utilize the levers of power that he had.”

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ST. LOUIS (AP) — Firefighter and paramedic Mike Camilleri once had no trouble hauling heavy gear up ladders. Now battling long COVID, he gingerly steps onto a treadmill to learn how his heart handles a simple walk.

“This is, like, not a tough-guy test so don’t fake it,” warned Beth Hughes, a physical therapist at Washington University in St. Louis.

Somehow, a mild case of COVID-19 set off a chain reaction that eventually left Camilleri with dangerous blood pressure spikes, a heartbeat that raced with slight exertion, and episodes of intense chest pain.

He’s far from alone. How profound a toll COVID-19 has taken on the nation’s heart health is only starting to emerge, years into the pandemic.

“We are seeing effects on the heart and the vascular system that really outnumber, unfortunately, effects on other organ systems,” said Dr. Susan Cheng, a cardiologist at Cedars-Sinai Medical Center in Los Angeles.

It’s not only an issue for long COVID patients like Camilleri. For up to a year after a case of COVID-19, people may be at increased risk of developing a new heart-related problem, anything from blood clots and irregular heartbeats to a heart attack –- even if they initially seem to recover just fine.

Among the unknowns: Who’s most likely to experience these aftereffects? Are they reversible — or a warning sign of more heart disease later in life?

“We’re about to exit this pandemic as even a sicker nation” because of virus-related heart trouble, said Washington University’s Dr. Ziyad Al-Aly, who helped sound the alarm about lingering health problems. The consequences, he added, “will likely reverberate for generations.”

___

Heart disease has long been the top killer in the nation and the world. But in the U.S., heart-related death rates had fallen to record lows in 2019, just before the pandemic struck.

COVID-19 erased a decade of that progress, Cheng said.

Heart attack-caused deaths rose during every virus surge. Worse, young people aren’t supposed to have heart attacks but Cheng’s research documented a nearly 30% increase in heart attack deaths among 25- to 44-year-olds in the pandemic’s first two years.

An ominous sign the trouble may continue: High blood pressure is one of the biggest risks for heart disease and “people’s blood pressure has actually measurably gone up over the course of the pandemic,” she said.

Cardiovascular symptoms are part of what’s known as long COVID, the catchall term for dozens of health issues including fatigue and brain fog. The National Institutes of Health is beginning small studies of a few possible treatments for certain long COVID symptoms, including a heartbeat problem.

But Cheng said patients and doctors alike need to know that sometimes, cardiovascular trouble is the first or main symptom of damage the coronavirus left behind.

“These are individuals who wouldn’t necessarily come to their doctor and say, ‘I have long COVID,’” she said.

___

In St. Louis, Camilleri first developed shortness of breath and later a string of heart-related and other symptoms after a late 2020 bout of COVID-19. He tried different treatments from multiple doctors to no avail, until winding up at Washington University’s long COVID clinic.

“Finally a turn in the right direction,” said the 43-year-old Camilleri.

There, he saw Dr. Amanda Verma for worsening trouble with his blood pressure and heart rate. Verma is part of a cardiology team that studied a small group of patients with perplexing heart symptoms like Camilleri’s, and found abnormalities in blood flow may be part of the problem.

How? Blood flow jumps when people move around and subsides during rest. But some long COVID patients don’t get enough of a drop during rest because the fight-or-flight system that controls stress reactions stays activated, Verma said.

Some also have trouble with the lining of their small blood vessels not dilating and constricting properly to move blood through, she added.

Hoping that helped explain some of Camilleri’s symptoms, Verma prescribed some heart medicines that dilate blood vessels and others to dampen that fight-or-flight response.

Back in the gym, Hughes, a physical therapist who works with long COVID patients, came up with a careful rehab plan after the treadmill test exposed erratic jumps in Camilleri’s heart rate.

“We’d see it worse if you were not on Dr. Verma’s meds,” Hughes said, showing Camilleri exercises to do while lying down and monitoring his heart rate. “We need to rewire your system” to normalize that fight-or-flight response.

Camilleri said he noticed some improvement as Verma mixed and matched prescriptions based on his reactions. But then a second bout with COVID-19 in the spring caused even more health problems, a disability that forced him to retire.

___

How big is the post-COVID heart risk? To find out, Al-Aly analyzed medical records from a massive Veterans Administration database. People who’d survived COVID-19 early in the pandemic were more likely to experience abnormal heartbeats, blood clots, chest pain and palpitations, even heart attacks and strokes up to a year later compared to the uninfected. That includes even middle-aged people without prior signs of heart disease

Based on those findings, Al-Aly estimated 4 of every 100 people need care for some kind of heart-related symptom in the year after recovering from COVID-19.

Per person, that’s a small risk. But he said the pandemic’s sheer enormity means it added up to millions left with at least some cardiovascular symptom. While a reinfection might still cause trouble, Al-Aly’s now studying whether that overall risk dropped thanks to vaccination and milder coronavirus strains.

More recent research confirms the need to better understand and address these cardiac aftershocks. An analysis this spring of a large U.S. insurance database found long COVID patients were about twice as likely to seek care for cardiovascular problems including blood clots, abnormal heartbeats or stroke in the year after infection, compared to similar patients who’d avoided COVID-19.

A post-infection link to heart damage isn’t that surprising, Verma noted. She pointed to rheumatic fever, an inflammatory reaction to untreated strep throat –- especially before antibiotics were common — that scars the heart’s valves.

“Is this going to become the next rheumatic heart disease? We don’t know,” she said.

But Al-Aly says there’s a simple take-home message: You can’t change your history of COVID-19 infections but if you’ve ignored other heart risks –- like high cholesterol or blood pressure, poorly controlled diabetes or smoking -– now’s the time to change that.

“These are the ones we can do something about. And I think they’re more important now than they were in 2019,” he said.

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WASHINGTON (AP) — The Biden administration will end most of the last remaining federal COVID-19 vaccine requirements next week when the national public health emergency for the coronavirus ends, the White House said Monday.

Vaccine requirements for federal workers and federal contractors, as well as foreign air travelers to the U.S., will end May 11. The government is also beginning the process of lifting shot requirements for Head Start educators, healthcare workers, and noncitizens at U.S. land borders.

The requirements are among the last vestiges of some of the more coercive measures taken by the federal government to promote vaccination as the deadly virus raged, and their end marks the latest display of how President Joe Biden’s administration is moving to treat COVID-19 as a routine, endemic illness.

“While I believe that these vaccine mandates had a tremendous beneficial impact, we are now at a point where we think that it makes a lot of sense to pull these requirements down,” White House COVID-19 coordinator Dr. Ashish Jha told The Associated Press on Monday.

Deeply polarizing at the time and the subject of numerous legal challenges — many of which were successful — the vaccination requirements were imposed by Biden in successive waves in late 2022 as the nation’s vaccination rate plateaued even amid the emergence of new, more transmissible variants of COVID-19.

More than 100 million people at one time were covered by Biden’s sweeping mandates, which he announced on Sept. 9, 2021, as the delta variant of the virus was sickening more people than at any time up to that point in the pandemic. Biden had ruled out such requirements before taking office that January, but came to embrace them to change the behavior of what he viewed to be a stubborn slice of the public that refused to be inoculated, saying they jeopardized the lives of others and the nation’s economic recovery.

“We’ve been patient. But our patience is wearing thin, and your refusal has cost all of us,” Biden said at the time. The unvaccinated minority “can cause a lot of damage, and they are.”

Federal courts and Congress have already rolled back Biden’s vaccine requirements for large employers and military servicemembers.

Mandates remain for many employees of the National Institutes of Health, Indian Health Service and Department of Veterans Affairs — which implemented their own requirements for healthcare staff and others independent of the White House — will remain while those agencies review their own requirements, the administration said.

Over 1.13 million people in the U.S. have died of COVID-19 since the pandemic began more than three years ago, including 1,052 people in the week ending April 26, according to the Centers for Disease Control and Prevention. That was the lowest weekly death toll from the virus since March 2020.

“COVID continues to be a problem,” Jha said. “But our healthcare system or public health resources are far more able to respond to the threat that COVID poses to our country and do so in a way that does not cause problems with access to care for Americans.”

He added, “Some of these emergency powers are just not necessary in the same way anymore.”

More than 270 million people in the U.S., or just over 81% of the population, have received at least one dose of a COVID-19 vaccine, according to the CDC.

For more than a year, U.S. health officials have been eyeing a long-term response to COVID-19 that is more similar to the approach to influenza, with updated shots yearly targeted at the latest strains of the virus — particularly for the most vulnerable. But fewer than 56 million people in the U.S., or 17% of the population, have received a dose of the updated bivalent boosters that became available in September 2022 and provide better protection against the omicron variants that remain in circulation.

“We don’t have a national mandate for flu vaccines in the same way, and yet we see pretty good uptake of flu vaccines,” Jha said. “The goal here really is to continue to encourage people to get vaccinated, but I don’t think mandates are going to be necessary for getting Americans vaccinated against COVID in the future.”

While federal mandates are ending, Jha predicted that some employers, especially medical facilities, may decide to maintain their COVID-19 vaccination requirements. He noted that the hospital where he practices has had a flu vaccine requirement for employees for 20 years.

Jha dismissed concerns that the ending of the international traveler vaccination requirement would increase the risk of a new variant from overseas entering the U.S. Biden has already rolled back virus testing requirements for both American citizens and foreign travelers to the U.S.

Jha said the U.S. was already protected by a traveler genomic surveillance program, which, for instance, tests for different virus strains in aircraft wastewater.

“We think that we are much more able to identify if a new variant shows up in the United States and respond effectively,” he said. “And I think that’s what makes the need for a vaccine mandate for travelers less necessary right now.”

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WASHINGTON (AP) — Older Americans and people with weak immune systems can get an extra COVID-19 booster dose this spring.

The Centers for Disease Control and Prevention on Wednesday signed off on a more flexible booster schedule for people who remain at the highest risk from COVID-19 — giving them the choice of a second “bivalent” Pfizer or Moderna booster, the most up-to-date formula.

“Many in the population are experiencing vaccine fatigue but there is a subset who are eager to receive additional doses,” CDC’s Dr. Sara Oliver told an agency advisory panel that expressed support for the change.

The move came a day after the Food and Drug Administration took steps to make coronavirus vaccinations simpler for everyone. From now on, anyone getting a Pfizer or Moderna dose — whether it’s a booster or their first-ever vaccination — will get an updated version rather than the outdated original shots.

Here are some things to know:

WHO NEEDS A BOOSTER?

Anyone who’s gotten their original vaccinations but hasn’t had an updated booster yet can still get one. Only 42% of Americans 65 and older — and just 20% of all adults — have gotten one of those updated boosters since September.

WHO CAN GET A SECOND UPDATED BOOSTER?

People 65 or older who already had one Pfizer or Moderna updated booster can roll up their sleeves again as long as it’s been at least four months since that last shot.

The schedule is a little different for people with weak immune systems. Most can choose a second Pfizer or Moderna updated booster at least two months after their first. Under the latest FDA and CDC guidelines, they also could get additional doses if and when their physician decides they need one.

WHY THE EXTRA LEEWAY?

Older adults continue to have the highest rates of hospitalization from COVID-19, even as cases have declined. But a frail 85-year-old may want another booster right away while a robust 65-year-old may not see the need — or might instead time another shot for peak protection ahead of a summer vacation or other special event.

CDC officials stressed there’s even more variety among immune-compromised patients, from people with only mild impairment to those trying to replenish immunity that grueling cancer treatment knocked out.

The changes put the U.S. in line with Britain and Canada, which also are offering certain vulnerable populations a spring shot. It’s a reasonable choice, Dr. Matthew Laurens, of the University of Maryland School of Medicine, said before the announcement.

“We do have vaccines that are available to protect against these severe consequences, so why not use them?” he said. “They don’t do any good just sitting on a shelf.”

WILL YOUNGER, HEALTHIER PEOPLE GET A FALL DOSE?

Stay tuned. The FDA will hold a public meeting in June to consider if the vaccine recipe needs more adjusting to better match the latest coronavirus strains — just like it adjusts flu vaccines every year. And part of that discussion will be whether younger, healthier people also need a booster.

The updated Pfizer and Moderna shots being used now target the BA.4 and BA.5 omicron versions, which have been replaced by an ever-changing list of omicron descendants. Still, while protection against mild infections is short-lived, those updated doses continue to do a good job fighting severe disease and death even against the newest variants.

TOTS ARE LEAST LIKELY TO BE VACCINATED YET

CDC’s advisers were dismayed at how few of the youngest children are vaccinated. Just 6% of 2- to 4-year-olds have gotten their initial COVID-19 shots and 4.5% of those younger than 2. Far fewer got an updated booster.

The FDA’s new rules mean tots under 5 who’ve never been vaccinated can get the most up-to-date formula – two Moderna shots or three of the Pfizer-BioNTech version. Unvaccinated 5-year-olds can get two Moderna doses or a single Pfizer shot. And tots already fully or partially vaccinated may get a bivalent shot or two depending on their vaccination history.

WHAT ABOUT THE NOVAVAX VACCINE?

Novavax makes a more traditional type of COVID-19 vaccine, and its original formula remains available for people who don’t want the Pfizer or Moderna option. Novavax also is getting ready in case FDA urges a fall update, by manufacturing several additional formulas. ___ The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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By Amber Dance

Pandemic lessons may improve long-term health equity

Hard-won achievements against the COVID pandemic and mpox outbreak may help public health officials combat inequities going forward, write Margo Snipe and Kenya Hunter at Capital B.

The pair describe how partnerships with community organizations narrowed the racial gap in vaccination rates in Boston, San Francisco, and Atlanta.

For example, the Boston team deployed health ad campaigns in up to 11 languages, including Spanish and Haitian Creole.

They also ensured that workers at COVID vaccine sites looked like members of the Black communities they wanted to reach.

Officials hope to continue and expand these efforts to counter other health issues, such as diabetes and cardiovascular disease, among underserved populations.

“We’re not just thinking about vaccination, but also thinking about ongoing access to testing, access to influenza vaccination, and really providing comprehensive services,” said Dr. Bisola Ojikutu, executive director of Boston’s health commission.

“Instead of pulling back, we have continued to move forward.”

COVID death rates varied by state

Hawaii saw 147 deaths from COVID per 100,000 people during the pandemic, the lowest rate in the U.S.

Contrast that with Arizona’s 581 deaths per 100,000, the highest rate in the nation.

A new paper in The Lancet delves into the social and political factors that might underlie the nearly fourfold difference across states, using data covering 2020 through mid-2022.

“Death rates in the hardest-hit U.S. states resembled those of countries with no health care infrastructure whatever,” writes Melissa Healy at the Los Angeles Times

The authors found that a lower poverty rate and higher levels of education were linked to lower infection and death rates.

Larger populations of Black or Hispanic individuals were tied to higher death rates.

Vaccine mandates for state employees, mask use and high vaccine uptake were also associated with better COVID outcomes.

High levels of trust of other people, which led to willingness to protect others, was also linked to lower death rates.

“How we feel about one another matters,” said study author and political scientist Thomas J. Bollyke. “The solidarity between people — the feeling that others will also do the right thing, that you’re not being taken advantage of — is a big driver in your willingness to adopt protective behaviors.”

That kind of trust has been declining in the U.S. since the late 20th century, Bollyke added.

In addition, trust in the government has dropped among Black Americans and Republicans during Biden’s tenure, according to a 2022 Pew Research Center report.

A high proportion of Trump voters was also linked to a higher death rate.

“The COVID-19 pandemic clearly exacerbated fundamental social and economic inequities, but science-based interventions and policy changes provided clear impact on mortality rates at the state level,” said ABC News contributor Dr. John Brownstein.

Will we get a spring boost?

The FDA is mulling an additional round of bivalent boosters, possibly for people older than 65 and immunocompromised individuals, reports Rob Stein at NPR.

“Those doses are going to be expiring and will be thrown out,” said Dr. Peter Hotez of the Texas Children’s Hospital for Vaccine Development. “It makes sense to have those shots in arms instead of being tossed.”

A spring booster could address waning immunity in those who got their fall boosters but remain at risk for severe disease or death. 

It’s likely that protection from the bivalent vaccine wanes within months, as occurred with the original-formula shot, and that an additional vaccination would boost protection, writes Dr. Leana S. Wen at The Washington Post.

“The benefit might be negligible for healthy young people,” writes Wen. But she argues that a booster would be an appropriate option for immunocompromised people and older individuals who want to maximize their protection.

Last week, the World Health Organization issued its new guidelines on vaccination. 

The WHO suggested that an additional booster should be available after six or 12 months for older adults, younger adults with conditions such as diabetes, adults and children who are immunocompromised, pregnant people, and frontline health workers.

It said that healthy adults, up to age 50–60, can stop after their first booster.

And the WHO no longer specifically recommends COVID vaccination for children and teens.

The WHO noted that countries should base their individual approaches on their own disease burden and health spending, and that these guidelines only apply to the current COVID situation.

In the U.S., the CDC still recommends that everyone ages six months and older get up to date with COVID vaccines, which includes the bivalent booster for nearly everyone.

The difference between CDC and WHO advice could further confuse the public, microbiologist Stanley Perlman told Bloomberg’s Karen Leigh and Tanaz Meghjani.

COVID’s effect on the brain grows clearer

There may be two categories of long COVID’s effects on the brain, reports Judy George at MedPage Today. 

Researchers found that people who were sick enough to require hospitalization during their initial bout with COVID were most likely to suffer problems with attention, working memory and processing speed.

In contrast, those whose initial infection was milder tended toward brain fog, headaches, dizziness, and loss of smell and taste.

The different groups may require different treatments, said Dr. Ziyad Al-Aly of the Washington University in St. Louis, who wasn’t involved in the research.

Researchers have also strengthened the neurologic link between long COVID and myalgic encephalomyelitis (ME), commonly known as chronic fatigue syndrome, another condition that can occur post-infection.

In a small brain imaging study, scientists found similarities between long COVID and ME patients, in that both showed an enlarged brainstem, reports Carly Casella at Science Alert.

The brainstem controls brain function as well as respiration, heart function, and digestion.

Its increased size could reflect the presence of a virus, inflammation and swelling, or degeneration of the nerves, according to the study authors.

COVID exposure in pregnant people has also been linked to neurodevelopmental disorders, such as intellectual disabilities or movement disorders, in the boys they deliver (but not girls), reports Nina Cosdon at Contagion Live.

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NEW ORLEANS (AP) — President Joe Biden’s order that federal employees get vaccinated against COVID-19 was blocked Thursday by a federal appeals court.

The 5th U.S. Circuit Court of Appeals in New Orleans rejected arguments that Biden, as the nation’s chief executive, has the same authority as the CEO of a private corporation to require that employees be vaccinated.

The ruling from the full appeals court, 16 full-time judges at the time the case was argued, reversed an earlier ruling by a three-judge 5th Circuit panel that had upheld the vaccination requirement. Judge Andrew Oldham, nominated to the court by then-President Donald Trump, wrote the opinion for a 10-member majority.

The ruling maintains the status quo for federal employee vaccines. It upholds a preliminary injunction blocking the mandate issued by a federal judge in January 2022. At that point, the administration said nearly 98% of covered employees had been vaccinated.

And, Oldham noted, with the preliminary injunction arguments done, the case will return to that court for further arguments, when “both sides will have to grapple with the White House’s announcement that the COVID emergency will finally end on May 11, 2023.”

Opponents of the policy said it was an encroachment on federal workers’ lives that neither the Constitution nor federal statutes authorize.

Biden issued an executive order in September 2021 requiring vaccinations for all executive branch agency employees, with exceptions for medical and religious reasons. The requirement kicked in the following November. U.S. District Judge Jeffrey Brown, who was appointed to the District Court for the Southern District of Texas by Trump, issued a nationwide injunction against the requirement the following January.

The case then went to the 5th Circuit.

One panel of three 5th Circuit judges refused to immediately block the law.

But a different panel, after hearing arguments, upheld Biden’s position. Judges Carl Stewart and James Dennis, both nominated to the court by President Bill Clinton, were in the majority. Judge Rhesa Barksdale, nominated by President George H.W. Bush, dissented, saying the relief the challengers sought does not fall under the Civil Service Reform Act cited by the administration.

The broader court majority agreed, saying federal law does not preclude court jurisdiction over cases involving “private, irreversible medical decisions made in consultation with private medical professionals outside the federal workplace.”

A majority of the full court voted to vacate that ruling and reconsider the case. The 16 active judges heard the case on Sept. 13, joined by Barksdale, who is now a senior judge with lighter duties than the full-time members of the court.

Judge Stephen Higginson, a nominee of former President Barack Obama, wrote the main dissenting opinion. “For the wrong reasons, our court correctly concludes that we do have jurisdiction,” Higginson wrote. “But contrary to a dozen federal courts — and having left a government motion to stay the district court’s injunction pending for more than a year — our court still refuses to say why the President does not have the power to regulate workplace safety for his employees.”

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