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

BQ variants unseat BA.5

A pair of variants likely to dominate the early winter months are emerging from the Scrabble soup. BQ.1, a descendant of omicron BA.5, and its own offshoot BQ.1.1 have been steadily increasing for weeks, and now collectively make up more than 49% of U.S. cases

“Preliminary data suggests they are better at evading immunity from COVID vaccines, including the new bivalent boosters, or a previous COVID infection than past versions of omicron,” writes Aria Bendix at NBC News. “That may give these subvariants higher transmissibility, which could fuel a rise in cases this winter.”

Early research, not yet peer reviewed, suggests the BQ pair of variants are better at invading human cells and escaping antibody defenses. Apoorva Mandavilli at The New York Times reports that BQ.1.1 is up to 175 times more resistant to immune defense than the original COVID strain, according to research by the team of Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center.

“BQ.1.1 appears to be the most antibody-evasive variant that we’ve had to date,” Barouch told NBC.

This turnover of dominant variants could put Moderna’s and Pfizer’s latest bivalent vaccines, designed to target BA.5, behind the times. Moderna announced last week that its bivalent booster worked better than the original shots at creating antibodies against BA.5. Preliminary data with just 40 study subjects also suggests some protection against BQ.1.1, reports Matthew Herper at STAT.

“If you get the bivalent vaccine, you’ll increase your immunity to (BQ variants) by some extent,” virologist Andrew Pekosz of Johns Hopkins told NBC.

The good news: “Hospitalizations remain relatively stable,” notes The Washington Post. “This suggests the new mutated virus is not causing more serious illness — a welcome change.”

Disabled employment improving in pandemic’s wake

People with disabilities lost employment at about the same rate as others in the early days of the pandemic, but their employment rates have risen faster since the end of 2021, according to a November report by the National Bureau of Economic Research.

“The expansion in telework may have shifted the frontier of plausible employment opportunities for (people with disabilities),” write the authors, Ari Ne’eman and Nicole Maestas of Harvard University. “The economic recovery appears to have encouraged (people with disabilities) who had previously left (or never entered) the workforce to find employment.”

The researchers based their work on the Census Bureau’s Current Population Survey, and the findings match a recent report from the bipartisan Economic Innovation Group.

Companies that hire people with disabilities may not only find it easier to fill jobs, but also discover those employees excel at problem-solving due to ongoing experiences in their daily lives, writes Tanha Kaushal at Yahoo! Finance.

The Federal Reserve Bank of New York also notes that long COVID has created a new population of people with disabilities, which also contributes to the surge in employed people with disabilities.

Ne’eman and Maestras suggest that civil rights organizations, such as the U.S. Equal Employment Opportunity Commission, should monitor employers to ensure telework and other accommodations remain in place.

Public health experts losing jobs

As the nation enters its third COVID winter, amid an early and heavy-hitting flu season and hospitals overflowing with respiratory infection patients, thousands of public health workers are losing their jobs, reports Lauren Weber at Kaiser Health News.

During the pandemic, the nonprofit CDC Foundation was given nearly $289 million in COVID relief funding to hire about 4,000 nurses, epidemiologists, and communication specialists to support public health departments at the local and state level.

Now, the money is running out, and only about 800 of those employees are expected to keep their jobs.

“Even if funding were available to retain all 4,000 foundation employees, that would not have met public health staffing needs,” writes Weber. “The public health workforce in the U.S. has been underfunded for decades.”

One study suggests that 80,000 or more new employees would be necessary to meet the minimum needs of local and state public health departments.

Public health experts told Weber the chronic shortage leaves “the country unable to prevent and properly fight outbreaks.”

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COVID-19 vaccines tweaked to better match today’s omicron threat are expected to roll out in a few weeks but still up in the air is how much benefit the booster shots will offer, who should get one — and how soon.

Pfizer and rival Moderna both asked U.S. regulators this week to authorize modified versions of their booster vaccine — shots that are half the original recipe and half protection against BA.4 and BA.5, the newest versions of omicron.

The Food and Drug Administration ordered that recipe and now is evaluating what scientists call a “bivalent vaccine,” with a decision expected soon.

Dr. Peter Marks, the FDA’s vaccine chief, said Thursday that once authorized, the tweaked boosters could help right away — while BA.5 infections still are too high — as well as hopefully blunt yet another winter surge.

Marks told the Associated Press that the new boosters could rev up the immune system to prevent not just serious illness but maybe milder infections, too, like the original vaccines did earlier in the pandemic, before super-contagious mutants emerged.

“The hope here is that by better matching things, not only will we get that benefit or even more, but we’ll also have that last for a longer period of time,” he said.

WHY DID FDA ORDER A RECIPE CHANGE?

BA.5 currently is causing nearly all COVID-19 infections in the U.S. and much of the world. Current COVID-19 vaccines match the coronavirus strain that circulated in early 2020. And while those vaccinations still offer strong protection against serious illness or death from COVID-19, there’s little effectiveness against infection from the wildly mutated omicron family.

The first update to the recipe is an an important but expected next step — like how flu vaccines get updated every year. True next-generation vaccines are still in development.

“We need to give a clear, forward-looking set of expectations,” said University of Pennsylvania immunologist E. John Wherry, who compares vaccine tweaks to periodically updating your computer software.

The gamble is that BA.5, or something similar, still will be circulating through the winter. (Vaccines target the spike protein that coat the coronavirus, and the BA.4 and BA.5 spikes are identical although those strains vary in other ways.)

HOW WERE THE MODIFIED SHOTS TESTED?

Pfizer and Moderna both studied an earlier tweak to their vaccines that targets the original omicron, called BA.1, that hit last winter, as well as even earlier variants.

To evaluate the combo shots, FDA is using data from human testing of the BA.1-tweaked doses plus mice tests of the BA.5-targeted version that Marks said show “a very good immune response.”

Human data on the newest tweak will come later in the year, to help assess the value of modified shots — especially whether they offer cross-protection if a new mutant comes along, Marks said. Moderna has started a clinical trial of its BA.5 combo shot; Pfizer and its partner BioNTech expect to open a similar study soon.

WILL THEY WORK BETTER?

No one knows. Dr. Paul Offit, a vaccine expert at the Children’s Hospital of Philadelphia and an FDA vaccine adviser, said the antibody jump from that earlier BA.1-tweaked candidate was “underwhelming.”

“What the administration is asking us to do is to accept this bivalent vaccine as significantly better” than another dose of today’s vaccine, he said. “It would be nice if there were data to support that.”

But while FDA hasn’t made a final decision, Marks said there’s evidence that the updated boosters are safe and that waiting for more study of their effectiveness would risk another mutant appearing before they could roll out.

They “essentially refresh the immune response,” he said. “Granted, it’s still a bit of a guess how long it will last but, this is doing our best.”

Given how outdated the current shots are, an update makes sense, said Dr. Walter Orenstein of Emory University, a former vaccine director at the Centers for Disease Control and Prevention. While he’d like to see more data, he plans to get the new booster.

WHO SHOULD GET AN UPDATED SHOT?

That’s up to the CDC, which called a meeting of its influential vaccine advisers next Thursday and Friday to help decide.

Pfizer wants to open its updated boosters to everyone 12 and older who’s already had a primary series of today’s vaccine, while Moderna has applied only for adult use. CDC will determine if people at highest risk should go first. Studies of doses for younger children are expected later in the year.

A government rollout plan anticipates that people who’ve already gotten their initial vaccinations would qualify for one of the new combination shots, regardless of how many boosters they’ve already had.

WHEN SHOULD THOSE ELIGIBLE GET THE NEW BOOSTER?

Marks is aiming for a very simple message: “It’s probably going to be everyone who has not had a booster within the past X number of months should go out and get the booster in a timely manner,” he said. Officials still have to decide just how many months, though.

How long to wait after your last vaccine dose or an infection is a critical decision, immunologists agree. That’s because if you still have a lot of antibodies in your bloodstream, they’ll counteract the brand new antibodies that the vaccine dose is supposed to produce.

So if you already got a booster in July or August and then seek the new combo shot in September, “you’ll receive very little additional boosting from that,” Penn’s Wherry said. He recommends waiting four to six months.

The CDC also will weigh in after after considering how many doses will be available in early September versus later in the fall. The Biden administration has purchased more than 170 million doses.

WILL PEOPLE ROLL UP THEIR SLEEVES AGAIN?

Americans have been reluctant to keep up with COVID-19 vaccinations. While three-quarters of Americans 12 and older have gotten their initial vaccinations, only half got a first booster shot — deemed crucial for the best protection against variants. And just a third of people 50 and older who were advised to get a second booster when omicron arrived did so.

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By Amber Dance

Omicron hospitalized record number of Black adults

Recent data indicates that during the winter surge, non-Hispanic Black adults were hospitalized at higher rates than any other ethnic group, at any time in the pandemic, according to a new report from the Centers for Disease Control and Prevention.

Black adults were four times as likely as white adults to be hospitalized during the winter omicron wave.

Part of the reason is likely lower immunization rates, writes Akilah Johnson at The Washington Post. Black people made up 31% of all hospitalized, unvaccinated patients during the omicron surge. Fewer than 40% of Black Americans had receive two vaccine shots by Jan. 26, according to the CDC report.

Unequal access to health care and racism in the health care industry have driven disparities throughout the pandemic, notes Noah Y. Kim at Mother Jones.

Hospitalization rates also increased over the winter for Asian and Pacific Islander adults. Rates fell in American Indian, Alaska Native and Latino populations, the CDC reported.

Vaccines block severe illness from omicron BA.1, BA.2 too

The CDC also reported that COVID-19 vaccines did their job during the omicron BA.1 outbreak, despite the variant’s highly contagious nature, reports Katie Shepherd at The Washington Post.

Vaccines from Moderna and Pfizer, both based on mRNA technology, protected people from the worst outcomes of needing a ventilator to breathe or death. “Receiving two or three doses of an mRNA COVID-19 vaccine was associated with a 90% reduction in risk for COVID-19–associated invasive mechanical ventilation or death,” the report states.

Getting a booster enhanced protection against serious illness. Among people who contracted COVID, unvaccinated people were nine times more likely to die than people who received the initial two-dose vaccine course, and 21 times more likely to die than those who’d been boosted as well, writes Shepherd.

The mRNA vaccines’ efficacy against milder illness has been shown to wane, dropping to 78% protection against hospitalization within four months of a booster.

And the Johnson & Johnson vaccine, despite its lesser reputation, now seems to be working about as well as the mRNA formulas against infection, hospitalization and death — even among those who haven’t sought a booster shot — reports Apoorva Mandavilli at The New York Times. Not everyone is convinced this is true, she adds, and it’s not clear why it now appears more effective.

The next big test for the vaccines will be omicron BA.2, now dominating the globe and making up just over a third of U.S. cases.

While several nations are currently facing omicron outbreaks, fueled in large part by the BA.2 variant, U.S. case rates remain low. Hospitalizations are the lowest they’ve been since last summer.

Experts now predict a rise in U.S. cases due to BA.2, but nothing like winter’s surge. “Hopefully, we won’t see a surge,” the NIH’s Dr. Anthony Fauci said last week. “I don’t think we will.”

One preprint study from Qatar, not yet peer reviewed, suggests the mRNA vaccines work as well against BA.2 as they did against BA.1, though the protection afforded by boosters still wanes within months, reports Saima May Sidik at Nature.

Moderna tees up to vaccinate youngest children

Moderna announced last week that its clinical trial of two COVID-19 vaccine doses for children between 6 months and 5 years were successful, writes Molly Walker at MedPage Today: The shots were safe, and they induced antibody levels equivalent to those of vaccinated adults.

But the vaccine’s real-world efficacy against omicron, at first glance, seems less than stellar: during the winter surge, the shots were 37.5% effective against illness, which the company defined as a positive COVID-19 test plus at least one symptom, for children ages 2 to 5. For those under 2, efficacy was just slightly higher at 43.7%.

Since the trial wasn’t specifically designed to measure efficacy, those numbers aren’t statistically certain, but Moderna said efficacy was definitely more than zero, reports Carolyn Y. Johnson at The Washington Post.

The FDA originally sought vaccine efficacy levels against infection of 50% or higher, but that was before the omicron variant. Moderna said these numbers from the pediatric vaccine were comparable to the protection that two doses of its vaccine gave adults during omicron.

And children have proven comparatively resilient to coronavirus, which means there may have been less room for improvement. No children in either of the trial’s vaccinated or placebo groups became ill enough to require hospitalization, so it’s impossible to say for certain if the vaccine protected against severe disease or death, or by how much.

As for safety, while more than one in 10 of the children 5 and younger had a fever after vaccination, these were generally mild. There were no cases of heart inflammation (myocarditis) or death after the vaccination.

“40% with adequate safety data could be very meaningful, especially to higher risk individuals,” former FDA chief scientist Luciana Borio told STAT.

Moderna is also testing a third, booster shot in children of all ages, and planning to apply for authorization of the vaccine in children aged 6 to 11. The company’s vaccine authorization for teens has been stalled over concerns about a risk for myocarditis, which is less common in younger kids.

Several other nations have already authorized the Moderna vaccine for teens and kids as young as 6.

This move means Moderna could leapfrog Pfizer in the race to vaccinate younger children. Despite enthusiasm from regulators eager to protect these children, the only age group still ineligible for vaccination, Pfizer’s application was put on hold after two doses didn’t generate the level of antibody response seen in teens and adults. Pfizer is also testing a third dose, with results expected in April.

The different results from the two companies may lie in the doses used. Pfizer’s dose for the youngest children is 3 micrograms of the active ingredient, while Moderna’s is 25 micrograms.

Expiry of pandemic relief imperils school meal programs

Millions of children rely on the National School Lunch Program, which received additional funding during the pandemic. That funding is now set to expire at the end of June.

Loosened rules that allowed programs more flexibility, such as waiving the requirement that children eat together in groups, are also coming to an end.

During the pandemic, school programs could spend the extra money on fruits and veggies. Going back to the old ways will mean less funding, higher expenses and less healthy meals, reports NPR’s Allison Aubry.

For example, for students to eat as a group during the summer break, some rural districts must send busses around so the kids who qualify for school meals can eat together, on the bus. With prices rising for gas as well as food, doing so will mean less money for decent meals on the roving cafeteria.

The decision to extend the waivers lies with Congress, and thus far lobbying by nutrition advocates and school food directors has been unsuccessful.

As a result, kids could miss more than 95 million meals over the summer of 2022, said Lisa Davis, head of the national No Kid Hungry campaign.

Ending the flexible programs would have real consequences for children’s health, notes Aubry. Poor nutrition is linked to chronic conditions such as diabetes and obesity, which in turn increase the risk for severe COVID disease.

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Pfizer’s COVID-19 vaccine gave children 5 and older strong protection against hospitalization and death even during the omicron surge that hit youngsters especially hard, U.S. health officials reported Tuesday.

New data from the Centers for Disease Control and Prevention come a day after a study of New York children suggested the vaccine may not be as effective in 5- to 11-year-olds as in older kids — especially at blocking milder infections. That data raised the question of whether kid-sized doses given to those under 12 might be too low.

But the CDC said data from multiple other states suggests the issue isn’t children’s ages or dose size — it’s omicron. Vaccination generally is less effective against the hugely contagious omicron variant than earlier versions of the coronavirus — and vaccinations for 5- to 11-year-olds began just weeks before omicron began circulating.

“As a parent of a very young child, I think I would do everything to keep them out of the emergency department in the middle of the night,” said CDC epidemiologist Ruth Link-Gelles. “What we see from the data that we have is that the vaccine continues to provide good protection against more severe outcomes.”

Pediatricians say the back-and-forth results may seem confusing but that parents need to understand the shots are still the best way to prevent serious illness.

“If you’re vaccinated, you may get a mild infection and we’re just going to have to learn to live with that,” said Dr. Paul Offit of the Children’s Hospital of Philadelphia.

He said the New York study was too small to draw conclusions and also can’t account for variables such as infections going uncounted in kids tested at home instead of a clinic. He said youngsters admitted to his hospital with severe COVID-19 are the unvaccinated “and it’s hard to watch.”

The CDC reported Tuesday that between April and early January there were nine deaths related to COVID-19 among vaccinated children ages 5 to 17 — compared to 121 deaths among unvaccinated children that age.

Also, the CDC examined pediatric hospitalizations in 10 states from last April to the end of January. The vaccine proved 74% effective against hospitalization in 5- to 11-year-olds. Only two vaccinated children were hospitalized compared to 59 unvaccinated children.

In comparison, the vaccine was 92% to 94% effective against hospitalization in 12- to 15-year-olds and 16- to 17-year-olds. Most of the hospitalizations in the adolescents occurred when the earlier delta variant was dominant, while most of the hospitalizations of those younger than 12 occurred during the omicron wave, which started in early December.

Tuesday’s study also found that during the time when omicron was predominant, the vaccine was 51% effective in preventing emergency room or urgent-care visits by 5- to 11-year-olds. That was fairly similar to the 45% effectiveness for 12- to 15-year-olds who’d gotten their second dose months earlier.

What about less serious outcomes?

A report released Monday from researchers with New York’s state health department analyzed health records week-by-week from early December through the end of January. Vaccine effectiveness against any COVID-19 infection dropped from 68% to just 12% by the height of omicron’s wave. But among kids 12 and older, that effectiveness dropped to just 51%.

Remarkably, the data suggested 12-year-olds appeared to have the most protection of any age — prompting the researchers to ask if maybe the dose should be reexamined.

The Pfizer shots are the only vaccine available to U.S. children, and those ages 5 to 11 receive one-third of the dose given to everyone 12 and older. Also, everyone 12 and older is urged to get a booster dose to rev up protection against omicron.

The CDC’s latest study didn’t track infections the same way, but Link-Gelles said surveillance data from 29 other states doesn’t suggest a difference between the younger and older kids.

Unvaccinated 5- to 11-year-olds were 1.3 times more likely to get COVID-19 in January — at the height of the omicron surge — than vaccinated youngsters, according to new CDC data. For 12- to 17-year-olds, the unvaccinated were 1.5 times more likely to get COVID-19 than their vaccinated peers that month.

It’s disappointing that protection against infection isn’t higher, and it may take more research to tell if younger children might fare better with a different dose, said Dr. Richard Besser, a pediatrician and president and CEO of the Robert Wood Johnson Foundation, who wasn’t involved with the new studies.

Pfizer currently is testing a booster dose for 5- to 11-year-olds.

But meanwhile, “we do know that these vaccines are safe, we do know they reduce the risk of hospitalization,” Besser stressed.

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Is omicron leading us closer to herd immunity against COVID-19?

Experts say it’s not likely that the highly transmissible variant — or any other variant — will lead to herd immunity.

“ Herd immunity is an elusive concept and doesn’t apply to coronavirus,” says Dr. Don Milton at the University of Maryland School of Public Health.

Herd immunity is when enough of a population is immune to a virus that it’s hard for the germ to spread to those who aren’t protected by vaccination or a prior infection.

For example, herd immunity against measles requires about 95% of a community to be immune. Early hopes of herd immunity against the coronavirus faded for several reasons.

One is that antibodies developed from available vaccines or previous infection dwindle with time. While vaccines offer strong protection against severe illness, waning antibodies mean it’s still possible to get infected — even for those who are boosted.

Then there’s the huge variation in vaccinations. In some low-income countries, less than 5% of the population is vaccinated. Rich countries are struggling with vaccine hesitancy. And young children still aren’t eligible in many places.

As long as the virus spreads, it mutates — helping the virus survive and giving rise to new variants. Those mutants — such as omicron — can become better at evading the protection people have from vaccines or an earlier infection.

Populations are moving toward “herd resistance,” where infections will continue, but people have enough protection that future spikes won’t be as disruptive to society, Milton says.

Many scientists believe COVID-19 will eventually become like the flu and cause seasonal outbreaks but not huge surges.

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Omicron, the highly contagious coronavirus variant sweeping across the country, is driving the daily American death toll higher than during last fall’s delta wave, with deaths likely to keep rising for days or even weeks.

The seven-day rolling average for daily new COVID-19 deaths in the U.S. has been climbing since mid-November, reaching 2,267 on Thursday and surpassing a September peak of 2,100 when delta was the dominant variant.

Now omicron is estimated to account for nearly all the virus circulating in the nation. And even though it causes less severe disease for most people, the fact that it is more transmissible means more people are falling ill and dying.

“Omicron will push us over a million deaths,” said Andrew Noymer, a public health professor at the University of California, Irvine. “That will cause a lot of soul searching. There will be a lot of discussion about what we could have done differently, how many of the deaths were preventable.”

The average daily death toll is now at the same level as last February, when the country was slowly coming off its all-time high of 3,300 a day.

More Americans are taking precautionary measures against the virus than before the omicron surge, according to a AP-NORC poll this week. But many people, fatigued by crisis, are returning to some level of normality with hopes that vaccinations or prior infections will protect them.

Omicron symptoms are often milder, and some infected people show none, researchers agree. But like the flu, it can be deadly, especially for people who are older, have other health problems or who are unvaccinated.

“Importantly, ‘milder’ does not mean ‘mild,’” Centers for Disease Control and Prevention Director Dr. Rochelle Walensky said this week during a White House briefing.

Until recently, Chuck Culotta was a healthy middle-aged man who ran a power-washing business in Milford, Delaware. As the omicron wave was ravaging the Northeast, he felt the first symptoms before Christmas and tested positive on Christmas Day. He died less than a week later, on Dec. 31, nine days short of his 51st birthday.

He was unvaccinated, said his brother, Todd, because he had questions about the long-term effects of the vaccine.

“He just wasn’t sure it was the right thing to do — yet,” said Todd Culotta, who got his shots during the summer.

At one urban hospital in Kansas, 50 COVID-19 patients have died this month and more than 200 are being treated. University of Kansas Hospital in Kansas City, Kansas, posted a video from its morgue showing bagged bodies in a refrigeration unit and a worker marking one white body bag with the word “COVID.”

“This is real,” said Ciara Wright, the hospital’s decedent affairs coordinator. “Our concerns are, ‘Are the funeral homes going to come fast enough?’ We do have access to a refrigerated truck. We don’t want to use it if we don’t have to.”

Dr. Katie Dennis, a pathologist who does autopsies for the health system, said the morgue has been at or above capacity almost every day in January, “which is definitely unusual.”

With more than 878,000 deaths, the United States has the largest COVID-19 toll of any nation.

During the coming week, almost every U.S. state will see a faster increase in deaths, although deaths have peaked in a few states, including New Jersey, Pennsylvania, Iowa, Maryland, Alaska and Georgia, according to the COVID-19 Forecast Hub.

New hospital admissions have started to fall for all age groups, according to CDC data, and a drop in deaths is expected to follow.

“In a pre-pandemic world, during some flu seasons, we see 10,000 or 15,000 deaths. We see that in the course of a week sometimes with COVID,” said Nicholas Reich, who aggregates coronavirus projections for the hub in collaboration with the CDC.

“The toll and the sadness and suffering is staggering and very humbling,” said Reich, a professor of biostatistics at University of Massachusetts, Amherst.

In other developments:

— The White House said Friday that about 60 million households ordered 240 million home-test kits under a new government program to expand testing opportunities. The government also said it has shipped tens of millions of masks to convenient locations around the country, including deliveries Friday to community centers in Delaware, Maryland and Virginia.

— The national drugstore chain Walgreens is among pharmacies receiving the government-provided masks. The chain has started offering N95 masks for free at several stores, as long as supplies last. The company’s website lists locations in the Midwest for the initial wave of stores offering masks, but Walgreens said more stores will offer them soon.

— The leading organization for state and local public health officials has called on governments to stop conducting widespread contact tracing, saying it’s no longer necessary. The Association of State and Territorial Health Officials urged governments to focus contact tracing efforts on high-risk, vulnerable populations such as people in homeless shelters and nursing homes.

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By Amber Dance

Older Americans struggle to access tests, jobs

Seniors insured by Medicare got a slap in the face with the news that the government program, unlike private insurance, won’t be reimbursing them for rapid COVID tests they purchase from stores.

“It seems like we are being discriminated against,” retiree Mark McCardle told CNN’s Tami Luhby. “We have to work harder to get at test than younger people who are probably healthier.”

The out-of-pocket costs are likely to impact Black and Latino Medicare beneficiaries in particular, since those two groups are more likely to struggle with out-of-pocket Medicare costs.

Tens of millions of older individuals and people with disabilities receive health care through Medicare. They can still get four free rapid tests by mail from Covidtests.gov as well as free testing, if they have a doctor’s order, at clinic and lab sites.

Michelle Andrews of NPR traces the problem back to the federal laws that regulate the program. Over-the-counter products aren’t usually covered by Medicare, and there’s no reimbursement mechanism in place. The Centers for Medicare and Medicaid Services, the federal agency that oversees Medicare, is reportedly seeking a solution.

Along with health care costs, employment is a struggle for many older Americans, as Michael Sainato reports for The Guardian. Many people lost work during the pandemic, but few employers are interested in potential hires so close to retirement age.

At least 1.7 million older workers retired during the pandemic recession, with Black employees and people without a college degree bearing the brunt of the wave, according to a 2021 report by the Schwartz Center for Economic Policy Analysis. People whose jobs required regular contact with the public were particularly affected.

People who retire before age 65 and aren’t disabled aren’t eligible for Medicare, and most of them don’t receive Social Security benefits, either.

Even if they do, Social Security isn’t enough to live on for substitute teacher Elaine Simmons, 62, who spoke with Sainato. “I want my permanent job,” she said, but “I don’t see the likelihood of getting employment at this point.”

Scientists track omicron sub-variant

An omicron lineage known as BA.2 appears to be even more contagious than its parent and is spreading fast in at least 49 countries and 17 US states.

Unlike the original omicron variant, it’s missing a small genetic change that enabled easy identification of omicron via PCR, so some scientists are calling it a “stealth” variant. However, it’s readily detectable as a COVID-19 infection, and identifiable by genetic sequencing.

The Health Minister of Denmark, where BA.2 has overtaken the original omicron variant BA.1, said last week that BA.2 “must be more contagious.” Early estimates suggest it’s about 50% more transmissible than omicron BA.1. (The original omicron was already about 500% more transmissible than delta.)

Scientists are analyzing the variant further, but so far, experts say there’s no reason to panic. BA.2 doesn’t appear to cause more severe disease than BA.1.

“Variants have come, variants have gone,” virologist Robert Garry told Lenny Bernstein at The Washington Post. “I don’t think there’s any reason to think this one is a whole lot worse than the current version of omicron.”

Studies reveal clues to long COVID

Two new scientific studies offer clues as to who might be susceptible to long COVID, potentially leading researchers towards a blood test taken at the start of infection to predict long-term risk.

One study pointed to four factors associated with higher risk for long-term symptoms, as Pam Belluck lays out in The New York Times. The most important factor was the presence of antibodies that attack parts of the person’s own body.

Another was high levels of coronavirus genetic material, a measure of viral load, in the bloodstream early in the infection.

Third was the reactivation of an entirely different virus: Epstein-Barr, responsible for the weekslong fatigue of mononucleosis in teens and young adults. By age 35, most adults have tangled with this virus, often without even noticing any symptoms. But the virus remains dormant in the body, and it can reawaken.

The researchers also found a link between Type 2 diabetes and long COVID.

Another study found people who went on to develop long COVID tended to be middle-aged, with a history of asthma, and had unusually low levels of two particular kinds of antibodies called IgM and IgG3 during their initial infection, reports Erika Edwards at NBC News.  

Belluck at The Times cautions that confirmation from other studies is needed, but Dr. Steven Deeks of UC San Francisco told her what’s exciting is that these four factors give physicians something to target.

One possibility: antiviral medications that lower than viral load or fight Epstein-Barr might stave off COVID’s long-term effects.

FDA says remdesivir is in, monocloncal antibodies are out

The antiviral drug remdesivir will now be available outside hospitals in settings such as infusion centers and the home, the FDA announced on Jan. 21.

The agency also expanded its emergency authorization for the drug to include children, along with adults and teens, who are at high risk of severe COVID-19, reports Molly Walker at MedPage Today.

The FDA also all but revoked the emergency authorization for two kinds of monoclonal antibody treatments, saying they don’t work for omicron. The omicron variant currently makes up more than 99% of US cases. The medications are now only authorized when there’s reason to believe a patient was exposed to or infected with one of the other variants, Walker reports.

Meanwhile, two recent studies suggest that CBD — derived from the marijuana plant — and two chemicals found in hemp might stop the virus from infecting cells or copying itself. But don’t light up that joint just yet, caution Nicholas Florko and Andrew Joseph at STAT.

Scientists don’t yet know if these compounds would fight COVID in people. Plus, products sold as CBD may not be pure or concentrated, said Marsha Rosner, author of one of the studies. And THC, the chemical that produces a high, appeared to counter CBD’s benefits in the preliminary research.

Legal whiplash continues around vaccine and mask mandates

Health care workers in 25 states and the District of Columbia were required by the federal government to have their first COVID vaccine doses by Jan. 27, and other states will see deadlines in coming weeks.

But the Occupational Safety and Health Administration has officially withdrawn a vaccine mandate for large employers, due to a recent Supreme Court ruling against it.

The legal morass continues for other states and institutions.

In Texas, a federal judge blocked the Biden administration’s vaccine mandate for federal workers, citing the Supreme Court’s decision against a mandate for workers at large companies.

The Texas ruling may not matter to most federal employees: 98% have already had their immunizations. “It was not immediately clear what effect the ruling would have on a mandate imposed upon military personnel by the Pentagon,” notes Kaia Hubbard at U.S. News & World Report.

Lawsuits over school mask requirements are simmering in at least five states, and coming to a head in Virginia, where Gov. Glenn Youngkin outlawed school mask mandates with an executive order on Jan. 15, his first day in office.

In response, seven school boards filed a lawsuit, reports Paradise Afshar at CNN. Parents in Chesapeake, Va., have also sued.

Other school districts — about half of the districts in the state — are simply flouting the order to continue requiring masks, reports Hannah Natanson at The Washington Post.

Youngkin bit back in an op-ed in a Washington Post op-ed.

“There is no one better to determine what is best for children, especially after two years of a pandemic, than their parents,” he wrote. “And only they should be able to decide whether wearing a mask in school is the right choice for their children.”

Masks are also causing strife in New York. On Jan. 24, a judge there blocked a state mandate that people must mask up or show proof of vaccination to enter indoor public spaces.

One day later, an appeals court judge overturned that decision, keeping the mask mandate in place.

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GENEVA (AP) — The World Health Organization chief said Tuesday that 90 million cases of coronavirus have been reported since the omicron variant was first identified 10 weeks ago — amounting to more than in all of 2020, the first year of the COVID-19 pandemic.

With many countries easing their restrictive measures amid public fatigue about them, WHO Director-General Tedros Adhanom Ghebreyeus cautioned that omicron should not be underestimated even though it has shown to bring less severe illness than earlier variants — and cited “a very worrying increase in deaths in most regions of the world.”

“We are concerned that a narrative has taken hold in some countries that because of vaccines — and because of omicron’s high transmissibility and lower severity — preventing transmission is no longer possible and no longer necessary,” he told a regular WHO briefing on the pandemic.

“Nothing could be further from the truth,” Tedros added. “It’s premature for any country either to surrender or to declare victory. This virus is dangerous and it continues to evolve before our very eyes.”

WHO said four of its six regions worldwide are seeing increasing trends in deaths.

Many European countries have begun easing lockdown measures, including Britain, France, Ireland and the Netherlands. Finland will end its COVID-19 restrictions this month.

On Tuesday, Denmark’s government scrapped most restrictions aimed at fighting the pandemic, saying it no longer considers COVID-19 “a socially critical disease.” The nation of 5.8 million has in recent weeks seen more than 50,000 new cases a day, but the number of patients in intensive care units has declined.

“Now is not the time to lift everything all at once. We have always urged — always urged — caution in applying interventions as well as lifting those interventions in a steady and in a slow way, piece by piece,” said Maria Van Kerkhove, WHO’s technical lead on COVID-19.

Dr. Michael Ryan, the WHO emergencies chief, said countries with higher vaccination rates “have more choices” about whether to ease their restrictions, but said they should assess factors like their current epidemiology, at-risk populations, immunity in the population, and access to health care tools to fight the pandemic.

Speaking to countries’ governments, he said: “Every country has to find its feet, know where it is, know where it wants to go, and chart its path … You can look at what other countries are doing. But please don’t just follow blindly what every other country is doing.”

Ryan expressed concern that “political pressure will result in people in some countries opening prematurely — and that will result in unnecessary transmission, unnecessary severe disease, and unnecessary death.”

Meanwhile, Van Kerkhove also said a group of experts that was set up last year to look into the emergence of new pathogens like the coronavirus — and assess its origins — is expected to issue a report “in the coming weeks.” She said the group, known by the acronym SAGO, has held about a half-dozen meetings since its first one in late November.

She said the group would, among other things, look at early epidemiological studies and “our current understanding of the origins of this particular pandemic, building upon previous missions that have gone to China and worked with Chinese scientists.” She alluded to the work of another WHO-led team that traveled to China, where the pandemic first emerged, and reported on the outbreak in March last year.

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When am I contagious if infected with omicron?

It’s not yet clear, but some early data suggests people might become contagious sooner than with earlier variants — possibly within a day after infection.

The U.S. Centers for Disease Control and Prevention says people with the coronavirus are most infectious in the few days before and after symptoms develop. But that window of time might happen earlier with omicron, according to some outside experts.

That’s because omicron appears to cause symptoms faster than previous variants – about three days after infection, on average, according to preliminary studies. Based on previous data, that means people with omicron could start becoming contagious as soon as a day after infection.

With previous variants, people became contagious two to four days after infection. And people remain contagious a couple days after symptoms subside.

Researchers say it’s too early to know whether that shorter incubation period for omicron translates into earlier contagiousness. But it would help explain the variant’s rapid spread.

Dr. Amy Karger of the University of Minnesota Medical School recommends that people test themselves at three days and five days after exposure if possible.

“A lot of people are turning positive by day three,” Karger says, referring to omicron. “There’s basically an opportunity here to catch people earlier than you would with the other variants.”

If you only have one test, it’s fine to wait until day five, Karger says.

People who have COVID-19 symptoms should get tested immediately if possible.

Lab-developed tests are more sensitive than rapid tests so they should be able to pick up the virus by day three after exposure, if not earlier.

People who don’t develop symptoms generally have much lower viral levels, so it’s far less clear when or if they become infectious.

Still, those who test positive but don’t have symptoms should isolate for at least five days, under the latest CDC guidelines. The agency came under criticism for not requiring a negative test before leaving isolation, but even after tweaking the guidelines officials said that step should be optional.

People with symptoms should stay isolated until they have been fever-free for at least 24 hours.

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