WASHINGTON (AP) — About 10% of people appear to suffer long COVID after an omicron infection, a lower estimate than earlier in the pandemic, according to a study of nearly 10,000 Americans that aims to help unravel the mysterious condition.

Early findings from the National Institutes of Health’s study highlight a dozen symptoms that most distinguish long COVID, the catchall term for the sometimes debilitating health problems that can last for months or years after even a mild case of COVID-19.

Millions worldwide have had long COVID, with dozens of widely varying symptoms including fatigue and brain fog. Scientists still don’t know what causes it, why it only strikes some people, how to treat it -– or even how to best diagnose it. Better defining the condition is key for research to get those answers.

“Sometimes I hear people say, ’Oh, everybody’s a little tired,’” said Dr. Leora Horwitz of NYU Langone Health, one of the study authors. “No, there’s something different about people who have long COVID and that’s important to know.”

The new research, published Thursday in the Journal of the American Medical Association, includes more than 8,600 adults who had COVID-19 at different points in the pandemic, comparing them to another 1,100 who hadn’t been infected.

By some estimates, roughly 1 in 3 of COVID-19 patients have experienced long COVID. That’s similar to NIH study participants who reported getting sick before the omicron variant began spreading in the U.S. in December 2021. That’s also when the study opened, and researchers noted that people who already had long COVID symptoms might have been more likely to enroll.

But about 2,230 patients had their first coronavirus infection after the study started, allowing them to report symptoms in real time -– and only about 10% experienced long-term symptoms after six months.

Prior research has suggested the risk of long COVID has dropped since omicron appeared; its descendants still are spreading.

The bigger question is how to identify and help those who already have long COVID.

The new study zeroed in on a dozen symptoms that may help define long COVID: fatigue; brain fog; dizziness; gastrointestinal symptoms; heart palpitations; sexual problems; loss of smell or taste; thirst; chronic cough; chest pain; worsening symptoms after activity and abnormal movements.

The researchers assigned scores to the symptoms, seeking to establish a threshold that eventually could help ensure similar patients are enrolled in studies of possible long COVID treatments, as part of the NIH study or elsewhere, for apples-to-apples comparison.

Horwitz stressed that doctors shouldn’t use that list to diagnose someone with long COVID — it’s a potential research tool only. Patients may have one of those symptoms, or many -– or other symptoms not on the list — and still be suffering long-term consequences of the coronavirus.

Everyone’s doing studies of long COVID yet “we don’t even know what that means,” Horwitz said.

___

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

In about-face, Moderna announces plans to make vax free

Moderna’s COVID vaccine grew out of a longstanding collaboration with the U.S. National Institutes of Health, and the government granted the company nearly $2 billion to develop the shot. So why did Moderna plan to charge Americans up to $130 for the vaccine once the federal emergency ends in May?

That question has certainly been on Vermont Sen. Bernie Sanders’ mind. He is calling Moderna CEO Stéphane Bancel (net worth approximately $5.4 billion) before the Senate Health, Education, Labor and Pensions Committee on March 22.

Sanders called Moderna a “poster child” for pharmaceutical industry greed in an interview with Liz Goodwin at The Washington Post. 

“I hope, I really do hope, that these people will reconsider this outrageous decision and decide not to raise prices for the vaccine,” Sanders said.

His wish was granted last Wednesday as Moderna announced it would provide the vaccine gratis to under- and uninsured people.

“Everyone in the United States will have access to Moderna’s COVID-19 vaccine regardless of their ability to pay,” said company spokesperson Chris Ridley.

The Biden administration is also reportedly working on a plan to make COVID vaccines, tests and treatments free for uninsured people into 2024, write Adam Cancryn and David Lim at Politico.

The tentative plan would involve a limited stockpile that could be distributed following the end of the emergency declaration.

The U.S. still has 120 million bivalent boosters on hand, notes Spencer Kimball at CNBC.

The government has also made a deal to buy 1.5 million more doses of the Novavax COVID vaccine, potentially an updated version, reports Reuters.

As for Moderna, it has not specified how the planned patient assistance program to fund vaccination will work.

Sanders still expressed concern that the price hike for insurers will boost insurance costs, with taxpayers ultimately footing the bill.

He is not targeting Pfizer, which did not receive federal support through Warp Speed.

People of color face long COVID, related money woes

Those most likely to get a long COVID diagnosis tend to be female, white, and non-Hispanic, according to a study in BMC Medicine. 

These researchers analyzed more than 33,000 health records with long COVID diagnoses from a large National Institutes of Health database.

People diagnosed with long COVID also tended to live in ZIP codes with low rates of poverty and good access to health care, noted STAT’s Elizabeth Cooney. 

Yet other studies show that acute COVID has disproportionately plagued communities of color and those with high levels of income inequality, among other social factors, the study authors note. 

That suggests the trends the researchers observed in long COVID rates do not reflect actual patterns of the condition, “but may instead illustrate racial and social disparities in access to and experience with health care in the USA,” the authors wrote.

There are also disparities in how long COVID manifests, according to another study in the Journal of General Internal Medicine.

“Identifying potential racial and ethnic disparities in long COVID is an important step toward making sure we have an equitable response to the long-term consequences of coronavirus infection,” study author Dr. Dhruv Khullar of Weill Cornell Medicine said in a press release.

Khullar and colleagues examined New York City health records from more than 62,000 patients who had COVID and nearly 250,000 who did not, between March 2020 and October 2021. Nearly half of the patients were white, one-third were Hispanic, and one-fifth were Black. The researchers checked for 137 different long COVID symptoms.

Among people who weren’t sick enough to require hospitalization, Black patients had higher odds of certain post-COVID conditions, such as blood clots in the lungs or diabetes. Black people who were hospitalized also had higher rates of chest pain.

Hispanic patients, whether hospitalized or not, were more susceptible than white patients to develop symptoms including headaches and chest pain after COVID.

White patients were more likely to report neurological symptoms.

Another new study in JAMA Network Open found that among 825 adults hospitalized for COVID, three-quarters had heart and lung problems such as coughing, breathlessness and irregular heart beat six months later. After a year, more than half still suffered fatigue, reports Cecelia Smith-Schoenwalder at U.S. News & World Report. 

About half of the people in that study had financial problems six months after their infection, and money issues were much more common in people who were Black, Hispanic, or of another nonwhite or unknown race.

It’s not clear why specific symptom risk varies by race and ethnicity, Khullar said.

“We hope our study encourages clinicians, researchers and policymakers to pay attention to potential differences in long COVID across racial and ethnic groups.”

Johns Hopkins, NYT halt COVID tracking efforts

A major pandemic mainstay for data tracking is shutting down, reports Betsy Ladyzhets at her COVID-19 Data Dispatch.

The Johns Hopkins Coronavirus Resource Center began tracking the pandemic on Jan. 22, 2020 — one day after the first reported U.S. case of COVID-19, more than a week before the World Health Organization and U.S. government declared the virus a public health emergency, and nearly two months before California became the first state to lock down. 

The Center will shut down March 10, reports Rob Stein at NPR. The data will remain freely accessible, according to the university.

The Hopkins tracker filled “a void when the CDC and other government agencies failed to provide the frequent, user-friendly updates people wanted,” writes Ladyzhets.

Time Magazine called the Center “2020’s go-to data source.”

“The website quickly became critical for deciding everything from where drug companies should test vaccines to where Hollywood should film movies,” reports Stein. “Even the White House and the British prime minister were relying on Hopkins data.”

The site logged more than 2.5 billion views since it launched.

But with states reporting data less frequently now, and the CDC having amplified its own data reporting, Hopkins decided it’s time to shut the site down.

The New York Times cited similar reasons for ending its own data collection for the paper’s COVID tracker. “As case and death reporting at the local level has become less frequent and comprehensive, the daily data we have been able to gather has become less useful for indicating real-time trends about the virus,” wrote the Times’ graphics editor Wilson Andrews on the project’s GitHub repository.

The Times will continue to update its dashboard, but will rely on federal data. Andrews wrote the changeover in data sources will mostly likely take place in March.

Ladyzhets writes that the changeover makes sense; at this point in the pandemic, federal sources are probably more reliable than efforts that tot up data from individual locations. That doesn’t mean it’s without problems. “Federal data still suffer from case undercounting, lack of standardization (for some metrics), and other issues,” she notes.

The CDC has also extended its contract with Biobot Analytics to surveil wastewater from more than 400 locations for both COVID variants and mpox through at least the end of July. 

“Even so,” Ladyzhets writes, “this feels like the end of an era for pandemic tracking.”

Remember stomach flu? Norovirus surges back

This winter saw a rise in viruses that were stymied by COVID-19 lockdown measures: first influenza and RSV, and now stomach flu caused by norovirus is hitting pre-pandemic levels, reports Alice Park at Time.

While rarely deadly, the gastrointestinal bug is highly contagious — spread by contact with an infected person or objects they touched, as well as food — and certainly unpleasant, causing vomiting, nausea and diarrhea. 

Young children, the elderly, and people with other illnesses are particularly susceptible to dehydration as a result. 

The virus kills between 570 and 800 people each year.

Between mid-January and mid-February, the test positivity rate for norovirus in the U.S. rose from 10.5% to 17%.

“There have been more outbreaks this year compared to last year, when numbers were low because pandemic protocols such as mask-wearing and social distancing likely hampered the virus’ ability to spread,” writes Park. “That suggests that the recent upticks this year are likely a resetting back to pre-pandemic cycles of infection.”

Mary Kekatos at ABC News reports the best way to avoid norovirus is a method familiar from the start of the pandemic: wash your hands with soap and warm water for 20 seconds.

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By Amber Dance

U.S. returns to pre-pandemic immigration policies.

Thousands of people are waiting in Mexican border cities for the anticipated Dec. 21 expiration of a Trump-era restriction on U.S. entry during the pandemic.

Hundreds have already crossed the Rio Grande, reports Lauren Villagran of the El Paso Times.

The Title 42 rule allowed officials to quickly expel migrants at the border, including many of those seeking asylum. It has been applied more than 2.4 million times, reports José Ignacio Castañeda Perez at USA Today.

The policy and arguments over its legality have been tied up in the courts for months. The Biden administration attempted to rescind the policy in May, but was blocked by the courts at
that time.

The rule is now coming to an end in response to a Nov. 15 court ruling that found the “arbitrary and capricious” policy was unlawful and did not protect the U.S. from the coronavirus. The Biden administration has appealed the November ruling, aiming to preserve the CDC’s right to institute similar rules in the future.

A set of Republican-led states has also filed an appeal to keep the policy in place, arguing its termination “will cause an enormous disaster at the border,” reports Suzanne Monyak at Roll Call. The Border Patrol is reportedly unprepared to handle the anticipated surge of migrants. Immigration advocates, who have documented expelled migrants suffering violence in Mexico, will be glad to see the policy end, USA Today reports.

Legal immigration, meanwhile, has rebounded after a pandemic-induced lull in visa approvals, reports Camilo Montoya-Galvez at CBS News. The State Department issued nearly half a million visas to overseas applicants in 2022, a number comparable to totals from 2018 and 2019. “The rebound, an enormous part of it, is the easing of pandemic restrictions and the reopening of consulates,” said Julia Gellat, an analyst with the nonpartisan Migration Policy Institute. “But I also think the Biden administration is really concentrating on this.”

CDC documents thousands of long COVID deaths

Long COVID has led to not only debilitating symptoms, but death for thousands of Americans, according to a new CDC report. 

Researchers scoured death certificates from 2020 through mid-2022 for a medical code referring to COVID-19 and key words related to long COVID, identifying 3,544 such deaths. Long COVID was not necessarily the main cause of death, but could be listed as a contributing factor.

“The results added to growing recognition of how serious long-term post-COVID medical problems can be,” writes Pam Belluck at The New York Times. “The study appeared to be primarily capturing deaths of people who experienced serious initial infection with the coronavirus and who survived that phase but went on to have organ damage and other severe complications.”

Long COVID can exacerbate chronic conditions or boost the risk of heart or vascular disease, reports MuckRock in its own analysis of long COVID deaths in several U.S. regions. (Journalists can analyze the data on their own here.) For example, a COVID infection can create blood clots that can kill well after the virus is gone.

In the CDC’s study, out of more than 1 million death certificates with the COVID-19 code, 0.3% included long COVID terminology.

The count is almost certainly an underestimate, reports Elizabeth Cooney at STAT: “That tiny fraction of records only hints at the whole story, two experts told STAT, while another has doubts about drawing any conclusions from it at all.”

Dr. Eric Topol of the Scripps Research Translational Institute told Cooney that death certificate data are unreliable for tracking any cause of death. They are a particularly problematic source with something like long COVID, a chronic condition that can contribute to death in myriad complex ways.

Long COVID deaths reflected the pandemic’s broader racial and ethnic disparities. The long COVID death rate was highest among American Indian and Alaska Native people, a disparity the CDC study authors attribute to less access to health care in these groups.

But Black and Hispanic people, despite higher death rates from acute COVID infections, did not have higher long COVID death rates. That may be because there were fewer survivors left to
experience long COVID in those populations, the authors suggest.

In both the MuckRock and CDC studies, long COVID deaths were prevalent among older people. Muckrock’s team also found that many people who died of long COVID lacked college degrees and worked blue-collar, frontline or essential jobs.

Vaccines have saved millions of lives

The first COVID-19 vaccines were authorized two years ago, and they’ve saved about 3.2 million lives, according to a new report from The Commonwealth Fund. (The Fund also supports
programs at the Center for Health Journalism.)

Despite that success, vaccine uptake and efficacy are both on the wane. Just over 14% of people have received the latest, updated booster.

And those boosters are already out of date: The BQ strains currently dominating the U.S., as well as the XBB variant on the rise, are “barely susceptible” to the antibodies created by
existing vaccines, according to a new study in the journal Cell.

That reduced efficacy could set the nation up for a surge in breakthrough infections and reinfections, but the shots should hold up against severe disease and hospitalization, reports
Spencer Kimball at CNBC.

Researchers are calling for a new generation of COVID vaccines, reports Aria Bendix at NBC News. Formulas that are given through the nose or mouth might be better at halting transmission, and vaccines that target multiple variants or viral components might reduce the need for ongoing boosters.

“Coming up with a vaccine that’s going to last longer and cover a wider range of the COVID family is a life and death problem,” said Dr. Tom Frieden, former CDC director and president of Resolve to Save Lives, a public health organization.

COVID and flu plague nation

Pediatrician Dr. Christina Lane sums up the fall of 2022: it’s like “a big bomb of viruses went off,” she told Ariana Eunjung Cha at The Washington Post. Cases of both influenza and COVID are on the rise, but RSV may have already peaked. In response, major cities are recommending masking, but a dip in COVID cases in Los Angeles appears to have pulled that county back from the brink of a new mask mandate.

Free tests by mail relaunched

U.S. households can order four more COVID test kits for free by mail this winter as part of the government’s response to the current surge, report Adam Cancryn and David Lim at Politico. The program’s first three rounds of free tests proved popular, but it was put on hold in September to ensure there would be inventory available now. Politico reports that the Biden administration used funds leftover from 2021’s American Rescue Plan to purchase additional tests.

The tests by mail are part of the White House’s latest “Winter Preparedness Plan,” released Thursday. The plan also includes free tests distributed at clinics and community centers, support to deliver vaccines and treatments, and preparations to deploy health care professionals and supplies to areas where they’re needed. The White House has requested more than $9 billion to help fight the ongoing pandemic, but a divided Congress appears unlikely to approve the additional funds.

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The study, which included more than 56,000 Veterans with a positive SARS-CoV-2 test, showed that those given the oral antiviral medication in the first 5 days of a COVID-19 infection had a 25% decreased risk of developing 10 of 12 different Long COVID conditions studied — including heart disease, blood disorders, fatigue, liver disease, kidney disease, muscle pain, neurocognitive impairment and shortness of breath.

The decreased risk of long COVID associated with Paxlovid treatment exists regardless of whether it was a participant’s first infection or a reinfection and regardless of whether the participant was unvaccinated, vaccinated or boosted.

“Paxlovid reduces the risk of severe COVID-19 in the acute phase, and now, we have evidence that it can help reduce the risk of long COVID,” said Dr. Ziyad Al-Aly, chief of research and development at the VA St. Louis Health Care System, who led the study. “This treatment could be an important asset to address the serious issue of long COVID.” 

“This groundbreaking study is going to improve the lives of Veterans and all Americans,” said VA Secretary Denis McDonough. “VA’s researchers have conducted life-saving studies throughout the pandemic, and Dr. Al-Aly’s excellent work here is yet another example of VA leading the way.”

In December 2021, the FDA approved Paxlovid for COVID-positive patients at a high risk for severe COVID-19. Paxlovid is a combination of two medications — nirmatrelvir and ritonavir. Paxlovid has been shown to lower the risk of hospitalization and death COVID-19 in infected patients. Paxlovid has to be prescribed within five days of symptoms, and it is important for individuals to contact their health care providers if they test positive for COVID-19 to see if they would benefit from being prescribed lifesaving oral antiviral treatments.

Throughout the pandemic, VA has conducted groundbreaking research on COVID and Long COVID. More information about those efforts can be found here.

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By Amber Dance

Protesters demand action on long COVID

President Joe Biden may consider the pandemic “over” — as he controversially said on CBS’ 60 Minutes — but those words stung for people with long COVID, some of whom protested outside the White House last Monday.

They joined forces with people who have myalgic encephalomyelitis, or chronic fatigue syndrome, another condition scientists suspect is triggered by infection. ME/CFS can leave people unable to work or bedbound. Many of those who showed up expected to spend days in bed recovering from the exertion of the protest.

“Millions of us are being disabled by post-viral disease, and we need urgent action from our government,” said Ben HsuBorger, advocacy director for protest organizer MEAction, in a statement from the group. “We are calling on President Biden to declare ME/CFS and long COVID a national emergency.”

The group is calling for more public education, research, economic support and access to treatments.

Protesters also requested that anti-pandemic measures, such as federal funding for testing and vaccinations, continue.

Long COVID is particularly challenging for people of color, due to inequities in health care access and medical discrimination, writes Troy Farah at Scientific American. (Farah’s reporting was undertaken as a CHJ 2022 California Fellow.)

If scientists and physicians had paid more attention to ME/CFS in the past, they might have been better prepared for the millions of Americans who have long COVID now, argues Brian Vastag, a former Washington Post science reporter who has ME/CFS, at WebMD.

While the National Institutes of Health has been given more than $1 billion to fund long COVID research, progress has been sluggish, notes Jamie Ducharme at Time.

Bills to advance research and support for individuals have stalled in Congress.

Unless something changes, long COVID advocate and patient Charlie McCone told Ducharme, the virus will “continue taking folks out like fish in a barrel.”

COVID aid slashed poverty rates

Thanks to two years of federal pandemic aid, there are nearly 50% fewer poor children in the U.S. and overall poverty rates are at the lowest level ever recorded, according to the Census Bureau.

The extra child tax credit, along with other measures adding up to trillions of dollars, are behind the change, write Lydia DePillis and Jason DeParle at The New York Times.

Food insecurity among children also dropped in 2021, according to the USDA.

Overall, health coverage also changed for the better, with about 1.1 million more people insured in 2021 than in 2020. That’s mostly because people were able to stay in state Medicaid programs without being forced to requalify during the pandemic, report Selena Simmons-Duffin and Jennifer Ludden at NPR’s All Things Considered.

But with aid programs expiring and inflation skyrocketing, many families are facing financial difficulties anew. The expanded child tax credit ended in December 2021.

When the U.S. public health emergency declaration ends, more than 15 million people might lose Medicaid, many due to difficulties with renewal paperwork rather than lack of eligibility, according to a government report. The emergency declaration is next up for renewal in October.

“Americans wonder if the government can shape successful policies that address poverty,” Luke Shaefer of the University of Michigan told the Times. “This offers incontrovertible evidence that it can.”

Dozens charged in Minnesota pandemic aid fraud case

Federal prosecutors charged 47 people with stealing $250 million meant to feed needy children during the pandemic, in what the Justice Department says is the largest COVID fraud scheme to date.

An additional person was arrested, after the announcement, before boarding a one-way flight to Ethiopia.

According to the charges, the defendants conspired to claim government funds for more than 125 million fake meals through a network of charities, restaurants and individuals connected to a Minnesota nonprofit called Feeding Our Future. They allegedly then spent the money on luxuries including jewelry, automobiles and international real estate.

“Authorities say the defendants took advantage of loosened eligibility rules — and a lack of oversight — due to the pandemic,” writes Ken Dilanian at NBC News.

The conspirators allegedly generated random names and ages for imaginary children being served. One red flag was found in reimbursement forms that said the program consistently served 2,500 meals every weekday, with none of the supposed children missing a single day, reports Amy Forliti at AP News.

One participant allegedly claimed to serve 5,000 children daily out of a second-story apartment, reports David A. Fahrenthold at The New York Times. The neighbor across the hall said she hadn’t observed thousands of children entering the address.

When the Minnesota Department of Education sought to verify the aid, Feeding Our Future director Aimee Bock responded with a lawsuit accusing the state of racial discrimination, reports Kevin Johnson at USA Today.

Bock has pleaded not guilty.

The government has so far recovered $50 million, reports AP.

This is one among many such fraud cases. “Virtually every day lately, the Department of Justice has announced at least one case of fraud related to COVID-19 funds,” writes Poynter’s Al Tompkins at his Covering COVID-19 newsletter.

The Labor Department has opened 39,000 investigations, and the Small Business Administration is analyzing 2 million loan applications that may be fraudulent, reports Farhernthold at The New York Times.

Biden comments could complicate ongoing pandemic response

President Joe Biden set off a spate of headlines last week when, during an appearance on 60 Minutes, he appeared to casually downgrade the COVID-19 crisis to a thing of the past.

“The pandemic is over,” Biden said.

To many, it seemed a premature declaration of victory. More than 400 people in the U.S. are dying of COVID every day. The CDC still recommends that more than one-third of the population consider wearing masks due to local hospitalization and case rates. Few young children have received the vaccines they’ve been eligible for since June, and only about a third of Americans have received a single booster shot.

Biden himself later clarified that he meant the situation “basically is not where it was.”

His remarks could interfere with his administration’s ongoing efforts to secure additional pandemic funding from a Congress that has declined to open its purse for months now, writes Dan Diamond at The Washington Post.

Administration officials also told Diamond that Biden’s comments would make it harder to persuade people to get the latest round of boosters, which have been updated to target the omicron variant currently in circulation.

The impromptu declaration inspired reporters to discuss when exactly a pandemic can be declared over.

“There are no accepted metrics or defined international rules that tell us when we can call the code on this horrible event,” writes Helen Branswell at STAT. Experts told her that in a sense, a pandemic ends when people stop taking extra protective measures and get back to their normal lives.

In that case, writes Branswell, “the pandemic is done like dinner.”

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The guidebook outlines a whole health, patient-centered approach to treating Long COVID, and it includes key information about Long COVID signs, symptoms, and treatment recommendations.

VA is releasing this guidebook as a continuation of our pledge to share COVID-19 best practices and lessons learned with other government agencies, private health care systems and practitioners.

“From the first day of the pandemic, VA’s clinicians and researchers have been on the front lines – saving lives and learning how to treat COVID-19 and Long COVID,” said VA Secretary Denis McDonough. “This guidebook packages up the best practices we’ve learned about treating Long COVID, and it will help health care providers across America improve the lives of Veterans and non-Veterans alike.”

As the largest health care system in the country, VA’s Veterans Health Administration clinicians and researchers were among the first health care providers to recognize the national pattern that a secondary illness was occurring in those who had initially recovered from COVID-19.

Since then, VA has established a multi-disciplinary Long COVID Community of Practice Team and opened more than 20 Long COVID programs. VA research has also led to key findings about Long COVID, including that patients who recovered from COVID-19 were significantly more likely to have heart and vascular disease a year after infection; patients who contracted COVID-19 had a 60% higher risk of mental health challenges one year after recovering; and more.

Whole Health focuses on an individual’s well-being by developing a personalized health plan based on values, needs and goals. Regarding Long COVID, Whole Health will help clinicians better define, assess, refer and manage the signs, symptoms and potential subsequent conditions of the illness. With the possibility of varying symptoms in one patient, a Whole Health approach will also allow clinicians to prioritize treatment based on the patient’s needs.

The guidebook will be periodically updated and republished as the scientific community learns more about Long COVID. This work is being done in coordination with the National Research Action Plan on Long COVID.

Visit VA’s public health webpage for more information on VA’s approach to COVID-19 and other COVID-19 response reports.

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By Amber Dance

Disparities in booster access continue 

As the country prepares for yet another round of COVID-19 boosters this fall, Black and Hispanic populations may be left behind.

A new study in Health Affairs finds that while Black and white people had lower rates of uptake for the first dose of a COVID vaccine, Black and Hispanic people were least likely to get a booster shot. It’s not clear why Hispanic people seem to be getting fewer boosters after strong uptake of the initial vaccines. 

That drop-off could have important health consequences because immunity wanes with time and the latest omicron variants undermine the level of protection offered by two shots alone.

One factor in the racial disparities seems to be lower access to vaccination sites in counties with high Black populations and in rural areas, reports Lindsey Mulrooney at Pharmacy Times. 

“People may choose not to get vaccinated or may be willing to get vaccinated but face barriers including transportation and language, as well as the inability to take time off work,” write the Health Affairs authors from the RAND Corporation. “These disparities suggest that additional resources may be needed to mitigate inequities for the Black community and that booster-specific outreach may benefit Hispanic communities.”

The RAND authors suggest that vaccine equity efforts are particularly challenging in the U.S., because federal and state agencies must coordinate efforts, compared to other countries like the U.K. where there is a single vaccine delivery system. 

State-level emergency orders end as cases remain high

Most states have now let their COVID-19 public health emergency declarations drop, reports Adeel Hassan at The New York Times.

By late August, the emergency declarations will have expired in all but a handful of states, according to data from the National Academy for State Health Policy. 

“Earlier in the pandemic, there were broad statewide actions; now they are more targeted,” Hemi Tewarson, executive director of the Academy, told The Times. “If you think how emergency orders are used, it makes sense if you see where we are into the arc of the pandemic.” 

The federal emergency declaration, renewed in July, will now run until at least October. This grants a host of benefits, such as expanded access to Medicaid for low-income Americans.

The dwindling emergency orders reflect growing attempts by state officials to return to normalcy even as the nation is stuck in a “horrible plateau,” says USA Today, with more than 100,000 new cases and more than 400 deaths every day, particularly among the elderly. “It’s been this way for the past couple of months, and we’re getting used to it,” Dr. Daniel Griffin of Pro Health Care in New York told the outlet’s Adrianna Rodriguez.

The COVID death rate is similar to the rate of influenza deaths at the peak of flu season — but that season only lasts a few months. With COVID, “many experts don’t foresee much change anytime soon,” writes Andrew Joseph at STAT.

The state emergencies, declared in March 2020, had a range of effects such as expanding telehealth access and making it easier for the National Guard to travel state highways.

In response to pandemic restrictions, some state legislatures have now made it harder to declare a public health emergency or extend one, Hassan reports. For example, starting in 2023, the Arizona governor will require legislative approval to declare a public health emergency.

Other states have enacted laws so that an emergency is no longer required for certain health measures. For example, Virginia will now allow out-of-state health workers to enter the state to care for patients without any emergency status. 

Meanwhile, viral threats continue: The Biden administration declared monkeypox a public health emergency on Thursday. The U.S. has the world’s biggest outbreak of this virus, reports Karen Weintraub at USA Today, and appears to be repeating many of the mistakes made with COVID, notes anthropologist and pandemic expert Wendy Orent in an LA Times op-ed.

CDC to issue new school guidance

A preview of new CDC community guidelines obtained by CNN reveals less emphasis on regular testing in schools and relaxed quarantine and social distancing recommendations, report Brenda Goodman and Elizabeth Cohen. 

The draft guidelines, circulated among educators and public health officials, are not yet final.

It’s likely the CDC will no longer recommend kids exposed to COVID undergo testing to stay in the classroom. Such “test to stay” programs were costly for schools. 

The new guidance will likely also suggest that people who are exposed to COVID and not up to date on vaccines do not need to quarantine but rather just wear a mask around others and test after 5 days.

The agency intends to emphasize good ventilation in buildings rather than maintaining 6 feet of personal space. Most schools have not upgraded their ventilation systems recently, and Al Tompkins at Poynter suggests journalists should quiz schools about the topic.

The recommendation for people who do have COVID to remain in isolation is expected to stay in place.

“Sources say the tweaks reflect both shifting public sentiment toward the pandemic — many Americans have stopped wearing masks or social distancing — and a high level of underlying immunity in the population,” write CNN’s Goodman and Cohen.

Many schools, despite struggling with outbreaks and staff shortages during the pandemic, are making few policy changes for the new year, report Sharon Lurye and Collin Binkley at AP News.

Most schools across the country will be mask-optional going into the new school year, reports Jacqueline Howard at CNN.

Los Angeles Unified School District, which has held to aggressive COVID-19 safety protocols throughout much of the pandemic, will be mask-optional and drop its practice of weekly COVID testing, reports Howard Blume at the Los Angeles Times. It is also deferring a vaccination mandate originally scheduled to go into effect this autumn.

Washington, D.C.’s district will be an outlier in requiring vaccination for students 12 and older, report Lauran Lumpkin and Perry Stein at The Washington Post. But this could disproportionately exclude students of color from the classroom; Black teens have a 60% vaccination rate compared to 85% of all students. 

Ongoing disruptions in school schedules could make it harder for students, particularly at low-income schools, to catch up on learning time lost during the pandemic, Harvard education policy expert Thomas Kane told AP.

“If we don’t get active in trying to close those gaps,” Kane said, “they’re going to become permanent and there will be huge consequences for kids.”

Critics assail government response to long COVID

The Biden administration just released two reports on long COVID, and plans to establish an office devoted to the nebulous but debilitating condition. But patients and physicians say the plans don’t go far enough to meet the current needs of millions of Americans suffering from lingering symptoms.

“Advocacy groups say that while the reports are a good start, they are woefully inadequate in addressing the very questions patients and their physicians have had for more than two years,” writes Erika Edwards at NBC News. 

Between 7.7 million and 23 million Americans have long COVID — it’s difficult to pin down a number — and 1 to 4 million may be unable to work due to ongoing symptoms.

One new report focuses on services to help people with long COVID and health care providers treating them. The new government office would coordinate activities between the government, patients, and physicians, but it’s not clear there are funds to support it, Edwards notes.

A separate report called the National Research Action Plan on Long COVID emphasizes the need to accelerate research and improve patient care, with an eye to health equity and partnerships with public and private organizations.

More than a year ago, Congress gave the National Institutes of Health $1.15 billion dollars to study long COVID, but progress has been sluggish, writes Rachel Cohrs at STAT.

In fact, Cohrs notes, the money was temporarily borrowed from NIH to help house unaccompanied children at the Mexico border. 

The NIH has launched a 40,000-person study to track long COVID, but as of March, it had enrolled just 1,366 people. Neurology professor and former long COVID patient Lauren Stiles called the study “a slow-moving glacier.” 

And many advocates would prefer to see more focus on testing potential treatments.

“Their goals do not match the goals of people who are suffering,” said Diana Berrent, founder of Survivor Corps, a long COVID patient group.

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Samuel Lovett | Contributed

Thousands of people unable to work because of the effects of long Covid are feared to be missing out on financial support, with patients struggling to access and apply for the government ’s disability benefits scheme.

More than 300,000 people in the UK have been left with debilitating, persistent symptoms after catching the virus – but figures show only a tiny fraction of these have successfully claimed benefits.

Politicians and campaign groups warn not enough has been done to remove barriers to applying for financial aid.

“A vast number of severely impaired people are simply not getting the help they need and are entitled to,” said Dr Jo House, a spokesperson for Long Covid Support, which has around 50,000 members, the majority of whom are in the UK.

Latest figures show that in January just 937 individuals with the condition had successfully claimed Personal Independence Payment (PIP), which entitles them to up to £150 a week.

But figures for last month show that 322,000 people in the UK were reporting that their ability to undertake day-to-day activities had been limited “a lot” by long Covid, according to the Office for National Statistics. Some 172,000 of these said they had struggled every day for the past 12 months.

Jenny Ceolta-Smith, of Long Covid Support’s employment group, said there were “multiple barriers in place” when applying for the disability benefit.

She said the assessment process failed to take into account the episodic and fluctuating nature of the condition. “They might be able to perform a one-off activity, but then not do so later in the day,” she said.

Ms Ceolta-Smith, who waited eight months to receive PIP after first making a claim in July 2021, said the application process was also complicated by the need to provide medical evidence to support a claim of mental or physical impairment.

“My assessment was via the phone. When I reported having mental health issues, they said I wasn’t receiving treatment or medication for this. But many people have lengthy delays in accessing mental health services, so don’t have the written evidence to support their claim.

“The same applies for fatigue, breathing or other physical conditions related to Covid. If people haven’t been able to visit a long Covid clinic or referred elsewhere, there’s a lack of medical evidence. GPs will have some data, but it’s going to be a challenge.”

Coupled with the extensive paperwork and general poor health of those seeking PIP, the application process “can be very arduous”, Ms Ceolta-Smith added, with many patients “weighing up whether to bother if they’re only going to get rejected”.

Labour’s Jonathan Ashworth, the shadow secretary for work and pensions, said the right to statutory sick pay for long Covid sufferers should be reinstated, adding that the number of people successfully claiming PIP was “just the tip of the iceberg when it comes to those who need financial support to live with the condition”.

The Department for Work and Pensions (DWP) said it was unable to provide a figure for how many people with long Covid had applied for PIP. The number has risen month on month since March 2021, when the benefits scheme first acknowledged the condition as a disability.

PIP provides help with living costs for people with a long-term physical or mental health condition who have difficulty carrying out everyday tasks. The payment can be awarded to these individuals even if they’re continuing to work.

The payment is split into two, providing financial aid for daily living and for mobility-related needs. Depending on the severity of their condition, a long Covid sufferer could receive up to £89.60 for the former and up to £62.55 for the latter, amounting to £152.15 in total. Patients are eligible for assessment if they’ve had persistent symptoms for more than three months.

But since March 2021, just 1,584 people with long Covid have been assessed by the PIP programme. Out of these, 937 are currently receiving benefits, while the remaining 647 are awaiting final clearance from the government, have been rejected, or are appealing against the outcome of their application.

The DWP said award lengths and rates depend on individual circumstances. Payments for other long-term conditions are typically provided for many months, even years.

Layla Moran MP, chair of the all-party parliamentary group on coronavirus , said the low number of successful claimants over the past 12 months “suggests the government is failing to address the impact of long Covid both on people’s health and the UK workforce”.

She called on ministers to “review current financial support available to people who are, as a result [of long Covid], losing their jobs and income”.

The DWP said that the true number of people receiving PIP is likely to be higher than 937. This is because the programme was amended in March 2021 to acknowledge and record long Covid claimants. Before then, awardees suffering from long-term symptoms were classified according to the main disabling condition identified at the time, such as respiratory illness or fatigue, rather than Covid.

A government spokesperson said: “For anyone with a disability or long-term health condition, including long Covid, there is a strong financial safety net, including statutory sick pay, ESA and universal credit.

“PIP is available to people with long-term health conditions or disabilities and is assessed on the basis of someone’s needs and not a diagnosis or condition.”

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