Payment integrity continues to be a pressing issue with pandemic relief funds, the Government Accountability Office said in its 10th comprehensive report on the federal governments coronavirus response released on Wednesday.
The watchdog reiterated its previous recommendations that Congress consider amending the Payment Integrity Information Act of 2019 to designate all new executive agency programssuch as those created specifically to respond to the COVID-19 pandemicmaking more than $100 million annually in payments as susceptible to significant improper payments for their initial years of operation. GAO also recommended that the Office of Management and Budget require agencies to certify the reliability of submitted improper payment data; OMB neither agreed nor disagreed.
Other recommendations in the new report involved the Federal Emergency Management Agencys COVID funeral assistance program and the Centers for Disease Control and Prevention's COVID-19 surveillance and data collection efforts.
Moderna is now formally asking the Food and Drug Administration for emergency use authorization for its vaccine for young children. The company said in a press release on Thursday that the submission will be complete next week. Dr. Robert Califf, FDA commissioner, said during a hearing on Thursday that the agency will move along to review Modernas application and not wait for Pfizer/BioNTechs submission, which was a potential previous plan, ABC News reported.
Also, Peter Marks, director of the FDAs Center for Biologics Evaluation and Research, told The Washington Post in an interview published on Friday, We are not going to delay things unnecessarily here.
In other vaccine news, Pfizer/BioNTech submitted an application to the FDA on Tuesday for emergency use authorization for a booster shot for kids ages five to 11, following a strong immune response in phrase two/three clinical trials.
The FDA announced on Friday a tentative schedule for its Vaccines and Related Biological Products advisory committee to meet to discuss forthcoming applications for vaccine authorizations. The agency is committed to a thorough and transparent process that considers the input of our independent advisors and provides insight into our review of the COVID-19 vaccines, Marks said in a statement. We intend to move quickly with any authorizations that are appropriate once our work is completed.
Earlier this week, the House Select Subcommittee on the Coronavirus Crisis released a report that argues Trump political appointees overruled Defense Department career officials in order to approve a $700 million loan to a trucking company for a CARES Act program for national security. The career officials assessed that the company, YRC Worldwide Inc. (now named Yellow Corporation) was not critical to national securitya requirement under the CARES Act, said a press release. Career officials found that Yellows services could be replaced by other companies and expressed concern about an ongoing Department of Justice lawsuit against Yellow for fraudulently overcharging DoD, which Yellow misleadingly described as merely a contractual dispute.
The Immigrationand Customs Enforcement processing center in South Texas (that is owned and operated by GEO Group Inc.) took some actions to prevent the spread of COVID-19; however, it didnt consistently enforce some guidelines, said a new report from the Homeland Security Department inspector general, based on an unannounced inspection in September 2021.
Dr. Deborah Birx, White House COVID-19 response coordinator under President Trump, told ABC News that she and the other doctors on the COVID-19 response team, including Dr. Anthony Fauci, agreed that if one of them were fired, then they would all resign.
In her newly released book, she wrote that the Trump administration should get credit for removing barriers and speeding up the process to develop vaccines and treatments through Operation Warp Speed, a public-private partnership. That being said, I was continually struck by the disconnect between words and actions with this administration and this president.
The White House released a report on Thursday about what the Biden administration has done to help small businesses, such as through COVID-19 relief programs. For example, the report outlines improvements made in 2021 to the Small Business Administration's COVID-19 economic injury disaster loan program.
President Biden will skip the eating portions of the White House Correspondents Association dinner on Saturday due to COVID-19 precautions, White House Press Secretary Jen Psaki said earlier this week. Following the high number of COVID-19 positive cases after the Gridiron dinner earlier this month, there has been concern about the dinner and related events in Washington, D.C. Dr. Anthony Fauci, chief medical advisor to the president and director of the National Institute of Allergy and Infectious Diseases, backed out of the dinner due to his personal risk level.
Help us understand the situation better. Are you a federal employee, contractor or military member with information, concerns, etc. about how your agency is handling the coronavirus? Email us at newstips@govexec.com.
Mumbai, in the meantime, on Friday reported 93 Covid-19 cases, taking the tally to 10,59,728, while the death toll remained unchanged at 19,562, a civic official said. Tamil Nadu recorded 54 new Covid-19 infections, pushing the total caseload in the state to 34,53,883.
In other news, at least 63 per cent parents say schools should make online classes available if district COVID-19 positivity rate crosses 5 per cent so that learning is not disrupted for impacted students, according to a new survey.
"Twenty-seven per cent of surveyed parents said once the Covid test positivity rate (TPR) in a district crosses 2 per cent, online classes should be started. While 63 per cent parents said if district TPR crosses 5 per cent, schools should make online classes also available so that learning is not disrupted for impacted students," it said.
The Standing Technical Sub-Committee of the NTAGI has recommended inclusion of the Serum Institutes Covovax in the national COVID-19 vaccination programme for children aged 12 to 17 years, sources said on Friday. Indias drug regulator had approved Covovax for restricted use in emergency situations in adults on December 28 last year and in the 12-17 age group, subject to certain conditions, on March 9.
The COVID-19 working group of the NTAGI (National Technical Advisory Group on Immunisation) had earlier reviewed data related to Covovax and okayed it. The NTAGIs Standing Technical Sub-Committee which met on Friday has recommended that the vaccine can be used for 12-17 years age group, an official source said.
READ | NTAGI panel recommends inclusion of Covovax in vaccination drive for 12-17 age group
BEIJING
China says it halted railroad freight traffic with North Korea as it deals with the spread of the coronavirus in the border town of Dandong.
The countries had reopened trade between Dandong and North Koreas Sinuiju in January after a two-year pause while the North imposed one of the worlds most restrictive pandemic border closures despite the strain on its broken economy.
Chinese Foreign Ministry spokesperson Zhao Lijian said Friday the decision to suspend the freight services was taken in light of the current epidemic situation in Dandong, but he gave no other details.
The Dandong city government on Monday ordered all residents to swiftly return home and stay there to stem the spread of the virus. It said the government would make strenuous efforts to ensure the daily needs of residents but made no mention of links with North Korea and did not say when the lockdown would be lifted.
While many countries are dropping restrictions and trying to live with the virus, China has been sticking to a zero-COVID approach, which requires mass testing and lockdowns and keeping its international borders largely shut.
North Koreas decision to tentatively reopen cross-border trade with China, its main ally and economic lifeline, possibly reflected a growing urgency in its need for outside relief.
North Korea still claims to have a perfect record in keeping out COVID-19 from its territory a claim widely doubted. But the closure of its border to nearly all trade and visitors for two years further shocked an economy already damaged by decades of mismanagement and crippling U.S.-led sanctions over its nuclear weapons and missile program.
Experts say the North would have focused on importing fertilizers to boost food production, factory goods to spur dismal industrial production, and construction materials to support ambitious development projects that leader Kim Jong Un touts as major accomplishments.
The North has been accelerating its weapons tests in recent months, including its first test of an intercontinental ballistic missile since 2017 in March, as it revives brinkmanship to pressure the United States to accept it as a nuclear power and remove sanctions.
South Koreas Unification Ministry, which deals with inter-Korean affairs, didnt immediately provide more details on the suspension of freight traffic between North Korea and China.
WICHITA, Kan. (KSNW) More Kansans tested positive for the coronavirus this week compared to last week. The Kansas Department of Health and Environment (KDHE) shows that 2,017 people tested positive for the coronavirus in the past seven days. That number is 443 higher than the previous seven days.
The KDHE said the seven-day average of cases is 259 which is 63 more than last week. The state did not release any new information about COVID-19 variant numbers.
COVID-19 hospitalizations did not fluctuate much. There are 81 people hospitalized with the virus this week, four more than last week. Of those, 75 are adults and six are children. Thirteen of the adults are in intensive care.
The Kansas COVID-19 death toll increased by 38, bringing it to 8,635. Only two of the deaths happened in the past week. When the death toll increases, it is sometimes because officials have finalized death certificates from older cases. The seven-day rolling average of daily new deaths decreased to zero.
The KDHE data shows more than 23,000 Kansans got COVID-19 vaccinations in the past week:
Of Kansans who are eligible to get vaccinated, 66.98% have received at least one dose, while 58.4% have completed a vaccine series.
The KDHE releases its coronavirus updates each Friday afternoon.
CDC Mask Guidelines based on community-level transmission:Low (green):No mask needed indoors (get tested if you have symptoms)Medium (yellow):Mask recommended for high-risk patients (discuss with your healthcare provider)High (orange):Should wear mask indoors in publicKansas coronavirus cases updated Apr. 29, 2022CDC Community transmission rates updated Apr. 29, 2022Sources:Kansas Department of Health and EnvironmentCenters for Disease Control
In a recent edition of eBioMedicine, researchers discussed the validity of the equation derived by Khoury et al.to predict the efficacy of new coronavirus disease 2019 vaccines, which was subsequently reported by Muena et al., in a real-world setting.
Khoury et al. derived an equation to predict the efficacy of new coronavirus disease 2019 (COVID-19) vaccines using the neutralizing antibody (Nab) titer ratio between vaccinated and naturally severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected individuals. They demonstrated a correlation between the mean Nab titer and vaccine efficacy against symptomatic SARS-CoV-2 infection across the seven different vaccine platforms.
The efficacy estimates of seven COVID-19 vaccines were compared to Nab responses to identify an immunological correlate of protection (CoP) across different vaccine platforms. The researchers had made former estimates during the Phase III trials and the corresponding Nab responses during phase I/II trials.
Muena et al. investigated the dynamics of the antibody responses in naturally infected individuals in Chile. They compared this data to Nab titers elicited following vaccination with the CoronaVac and BNT162b2 vaccines.
Notably, the CoronaVac vaccine is an inactivated whole virus vaccine and BNT162b2 is a messenger ribonucleic acid (mRNA)-based vaccine. The Nab titers elicited in response to both the vaccines during the vaccination campaign in Chile were compared with the efficacies predicted from these ratios using the equation derived by Khoury et al.
Muena et al. also assessed and compared the anti-nucleocapsid (anti-N) antibody responses of SARS-CoV-2-infected and convalescent individuals. In particular, they assessed Nab titers in convalescent individuals vaccinated with the CoronaVac or BNT162b2 vaccines.
Similarly, they assessed Nab titers in infection-nave individuals who received two doses of CoronaVac or BNT162b2 vaccines to compare the difference in their Nab titers and estimate the efficacy of both the vaccines.
The efficacies predicted for CoronaVac and BNT162b2 were 65.9% and 92.6%, respectively, in the Chilean population. However, using the Khoury et al. equation, Muena et al. predicted effectiveness of around 50% and 97% for CoronaVac and BNT162b2, respectively. Likewise, the Nab titer ratios for CoronaVac and BNT162b2 were 0.2 and 5.2, respectively.
In naturally SARS-CoV-2-infected individuals, Muena et al. found strong responses to the SARS-CoV-2 N antigen. However, there was little response after two doses of CoronaVac. Although CoronaVac has the whole SARS-CoV-2 virion, it appears that the N antigen is a poor stimulant for the B cell responses.
Therefore, the observed T cell responses were more pronounced following vaccination with CoronaVac than BNT162b2 in another study comparing the efficacy of two vaccines. This also explains the observed lower efficacy of CoronaVac based on Nab responses than observed in the Chilean population. Muena et al. also identified obesity as a risk factor for poor response to the CoronaVac vaccine.
Overall, the data from Muena et al. and published results of Phase III trials in Turkey and Indonesia revealed that the Khoury et al. equation underestimated the efficacy of CoronaVac.
In the future, more studies should examine the immunogenicity and effectiveness of different COVID-19 vaccines in a similar subset of the population. This could help validate the clinical benefits of vaccine booster doses against SARS-CoV-2 variants of concern (VOC), based on Nab responses. An additional benefit could be aiding the development of COVID-19 vaccines incorporating viral antigens from VOCs based on the Khoury et al. model.
To date, a total of 2,528 cases with SARS-CoV-2 variants have been identified and investigated in residents of Dallas County, including 288 cases of B.1.1.7 (Alpha); 4 cases of B.1.351 (Beta); 1,825 cases of B.1.617.2 (Delta); 30 cases of B.1.427 (Epsilon); 28 cases of P.1 (Gamma); 14 cases of B.1.526 (Iota); 5 cases of C.37 (Lambda); 4 cases of B.1.621 (Mu); 326 cases of B.1.1.529 (Omicron); and 3 cases of P.2 (Zeta). Four hundred and thirty-seven cases have been hospitalized and 57 have died. Forty-eight COVID-19 variant cases were reinfections. Seven hundred and nine people were considered fully vaccinated before infection with a COVID-19 variant.
As of 4/22/2022, a total of 473 confirmed and probable cases were reported in CDC week 15 (week ending 4/16/22), which is a weekly rate of 17.9 new cases per 100,000 residents.
As of the week ending 4/16/2022, about 81% of Dallas County residents age 12 years and older have received at least one dose of the COVID-19 vaccine, including 98% of residents age 65 years and older; 86% of residents between 40-64 years of age; 78% of residents 25-39 years of age; 68% of residents 18-24 years of age; and 62% of residents 12-17 years of age. In the cities of Addison, Coppell, Highland Park, Irving, and Sunnyvale, greater than 94% of residents 18 years of age and older have received at least one dose of the COVID-19 vaccine. In the cities of Cedar Hill, Desoto, Farmers Branch, Garland, Lancaster, and University Park, greater than 81% of residents 18 years of age and older have received at least one dose of the COVID-19 vaccine
About 45.7% of COVID-19 cases diagnosed in Week 15 were Dallas County residents who were not fully vaccinated. In Dallas County, 55,219 cases of COVID-19 breakthrough COVID-19 infections in fully vaccinated individuals have been confirmed to date, of which 3,980 (7.2%) were hospitalized and 691 have died due to COVID-19.
Of all Dallas County residents tested for COVID-19 by PCR during the week ending 4/16/2022 (CDC week 15), 4.7% of respiratory specimens tested positive for SARS-CoV-2. For week 15, area hospital labs have continued to report elevated numbers and proportions of respiratory specimens that are positive for other respiratory viruses by molecular tests: parainfluenza (4.78%), rhinovirus/enterovirus (34.01%), and RSV (3.02%).
There are currently 10 active long-term care facility outbreaks. A cumulative total of 6,455 residents and 4,363 healthcare workers in long-term facilities in Dallas have been diagnosed with COVID-19. Of these, 1,337 have been hospitalized and 911 have died. About 16% of all deaths reported to date have been associated with long-term care facilities.
There has been 1 outbreak of COVID-19 in a congregate-living facility (e.g. homeless shelters, group homes, and halfway homes) reported within the past 30 days. A cumulative total of 1,135 residents and staff members (840 residents and 295 staff) in congregate-living facilities in Dallas have been diagnosed with COVID-19.
New cases are being reported as a daily aggregate, with more detailed data dashboards and summary reports updated on Friday evenings, available at: https://www.dallascounty.org/departments/dchhs/2019-novel-coronavirus/daily-updates.php.
Local health experts use hospitalizations, ICU admissions, and ER visits as three of the key indicators as part of determining the COVID-19 Risk Level (color-coded risk) and corresponding guidelines for activities during our COVID-19 response. The most recent COVID-19 hospitalization data for Dallas County, as reported to the North Central Texas Trauma Regional Advisory Council, can be found at www.dallascounty.org/covid-19 under Monitoring Data, and is updated regularly. This data includes information on the total available ICU beds, suspected and confirmed COVID-19 ER visits in the last 24 hours, confirmed COVID-19 inpatients, and COVID-19 deaths by actual date of death. The most recent forecasting from UTSW can be found here.The most recent COVID-19 Data Summaries for Dallas County, TX can be found at the bottom of this page.
WASHINGTON Vice President Kamala Harriss coronavirus infection is raising questions that some in the nations capital wish would remain unspoken: Is it safe for President Biden to attend the so-called nerd prom, otherwise known as the White House Correspondents Dinner? Should the dinner even be held?
The flashy event, where journalists, politicians and policy wonks mingle with celebrities, is returning in person on Saturday after a two-year absence because of the pandemic. It will be the first time a president has attended since 2016. Expected attendance: 2,600.
As the nation lurches out of the acute phase of the pandemic and into what some are calling the new normal, the dinner like so much of American life is prompting a good deal of risk-benefit calculation. Dr. Anthony S. Fauci, Mr. Bidens top medical adviser for the coronavirus, said on Tuesday that he had decided not to attend because of my individual assessment of my personal risk.
But Mr. Biden, who at 79 is two years younger than Dr. Fauci, will be there, as will his wife, Jill Biden. The White House press secretary, Jen Psaki, told reporters on Tuesday that Ms. Harriss diagnosis had not changed the presidents thinking about the dinner, which she described as an opportunity to talk about the importance of journalism in the world.
Just like many Americans, he makes risk assessments, Ms. Psaki said, adding, Thats an event hes attended many times in the past, and he made a decision through consultations that it was an event he could attend and wanted to attend again.
On Wednesday, after this article was published online, the White House made a slight shift in course; Ms. Psaki told reporters that the president might wear a mask at the dinner when he was not speaking, and would not attend the eating portion so he could attend in a safe way.
In interviews, public health experts were largely, though not entirely, supportive of Mr. Bidens choice. The organizers of the dinner are taking precautions, including requiring all attendees to be vaccinated and to provide proof of a negative Covid test taken that day. With vaccines and antiviral drugs available, some experts said, the time for shunning large gatherings is in the past, at least for most healthy people.
The dinner, in a cavernous ballroom at the Washington Hilton, is not the only large-scale event the president was scheduled to attend this week. On Wednesday, he delivered a eulogy at the funeral of Madeleine K. Albright, the former secretary of state an event that drew an estimated 1,400 mourners, most of them masked. On Sunday, Mr. Biden will travel to Minnesota to speak at a memorial service for former Vice President Walter Mondale.
Many public health experts are making calculations of their own. Dr. Carlos del Rio, an infectious disease specialist at Emory University, said he had just returned from Lisbon, where he was among 8,000 attendees of the European Congress of Clinical Microbiology & Infectious Diseases. It was a risk that, with precautions, he was willing to take.
Everybody was vaccinated, everybody was masked except when speaking, he said. But we also went to restaurants and did other things, and I didnt get infected, so I feel very good about that.
Jennifer Nuzzo, an epidemiologist who is leading a new program on pandemic preparedness at Brown Universitys School of Public Health, said she recently attended a large indoor conference and was one of the few wearing masks. She has not gotten Covid-19 and does not want to, but, she said, I am also not completely rearranging my life trying to dodge it.
Everyone has a different risk tolerance, and experts say it is important not to judge other peoples choices. But the president, being the president, has an obligation to the public to not get sick, said Dr. Arthur L. Caplan, the director of N.Y.U. Langones division of medical ethics. He said Mr. Biden should not attend the dinner, ticking off the reasons in an email.
He is high-risk and occupies a very high office at a time of war, Dr. Caplan wrote, adding: He must be hypersafe. The correspondents dinner is highly optional. With the V.P. sick, he really needs to protect himself. His office imposes a duty of precaution.
Ms. Psaki conceded that Mr. Biden could contract Covid, adding that if he did, the White House would be very transparent about it. She said the White House took numerous precautions beyond those of most workplaces to protect Mr. Biden, including social distancing, regular testing and wearing masks during meetings.
Yet she also noted that the president was traveling more lately, having concluded that getting out into the country was vitally important to him, to his presidency, to the American people.
Still, there is an uneasy feeling here and a worry that maybe a gathering of 2,600 people, including journalists and politicians who have spent more than two years warning about the dangers of the pandemic, may not be the best look.
Well, there is a question of whether its EVER appropriate to engage in an exercise in gaudy, celebrity-drenched self-adulation, David Axelrod, a Democratic strategist who was a senior adviser to President Barack Obama, wrote in an email, but thats a separate question.
However, Mr. Axelrod added, The country plainly is eager to move on, and people are regularly gathering in public places stadiums, theaters, restaurants and, as a political matter, Im sure the president is eager to embrace the sense that the siege is largely behind us.
Yet there is no shortage of reminders that the siege may not, in fact, be largely behind us.
The Gridiron Dinner, another gathering of A-listers in the capital, turned into a superspreader event this month. More than 70 attendees later tested positive for the coronavirus, including three members of Mr. Bidens cabinet Attorney General Merrick B. Garland, Agriculture Secretary Tom Vilsack and Commerce Secretary Gina Raimondo as well as Mayor Eric Adams of New York.
The Gridiron freaked everybody out, Sally Quinn, the Washington journalist, socialite and widow of Ben Bradlee, the former executive editor of The Washington Post, told Axios. I know a number of people who are not going because they are not wanting to chance it, she added, referring to the correspondents dinner.
The annual gala, hosted by the White House Correspondents Association, has been a fixture of Washington political life for decades.
Accompanied by a long weekend of spinoff parties, the event raises money for scholarships and honors journalists for distinguished White House coverage. It typically features celebrity entertainment this years featured guest is Trevor Noah and a roast of the president. But the gala has drawn criticism for coming across as an unseemly bacchanal in which journalists cozy up to the people they cover. The New York Times has not allowed its reporters to attend since 2007.
President Donald J. Trump shunned the dinner during his four years in office. The pandemic kept Mr. Biden away last year.
The correspondents association is clearly aware of the sensitivities. Youve had lots of questions, its president, Steven Portnoy of CBS News, wrote to members in an email this month. So heres an update from me on our Covid-19 mitigation strategy.
Citing advice from Dr. Fauci, who suggested same-day testing in addition to a vaccination requirement when asked if large-scale events should proceed, Mr. Portnoy said guests would be required to provide proof of vaccination and a same-day negative antigen test via Bindle, a verification app.
He also added some advice of his own, telling members that if they were eligible for a fourth dose of vaccine, they should consider getting one.
As for Mr. Biden, Dr. Leana Wen, a former Baltimore city health commissioner who has been a vocal proponent of returning to pre-Covid routines, said the president must ask what is important to him. The mitigation measures at the dinner mean Mr. Biden is likely to avoid severe disease if he gets infected, she said. If he wants to avoid infection entirely, she added, he should not go.
However, that is not what living with Covid looks like, and I think that it is very important for him to model that ultimately what Americans should care about is avoiding severe disease, Dr. Wen said, adding, Especially if there are precautions such as testing and vaccination, he needs to show that we can resume our prepandemic lives.
Dr. Wen said she would not be attending the dinner for a different reason: I was not invited.
3 ways pediatricians can help persuade caregivers to have their children vaccinated.
By Doug Harris Published: April 29, 2022
Some parents are hesitant to have their children vaccinated against COVID-19. Pediatricians are in a unique position to help drive COVID-19 vaccine discussions with parents and ease caretakers concerns. Heres how they can accomplish that.
The FDA approved a COVID-19 vaccine for children ages 5 to 11 in late October, providing a welcome tool to help pediatricians protect their patients. According to the American Academy of Pediatrics, more than 12.9 million children have tested positive for the virus. And those who were not vaccinated against COVID-19 have seen worse outcomes. For example, one study found that twice as many unvaccinated children ages 5 to 11 were hospitalized, compared with their vaccinated peers as the Omicron variant spiked earlier this year.
Despite these developments and statistics, COVID-19 vaccine hesitancy persists among parents. According to the Kaiser Family Foundation, 36% of parents with children ages 5 to 11 years old say they definitely will not get them vaccinated. Meanwhile, only 11% will only have their children vaccinated if mandated, and 10% are taking a wait-and-see stance.
Some parents cite access and transportation issues, as well as reservations about second doses and boosters. Others harbor a level of distrust and express a desire to learn more about the vaccine, including how it affects other children. Vaccine hesitancy may also be higher among parents of color, suggesting it could exacerbate health inequities that have been heightened by the pandemic.
So, how can pediatricians approach these delicate conversations, and also work to encourage and persuade parents to vaccinate their children against COVID-19? Here are three suggestions:
Pediatricians have always played a crucial role in arming parents with reliable information. They can do the same with COVID-19 by bringing a sensitive, science-based approach to vaccine discussions.
Meanwhile, COVID-19 vaccines for children younger than 5 may be approved in the coming months, so these conversations with parents could become more frequent and important. As trusted health care providers, pediatricians will be in a unique position to lead and influence the conversation with parents about the next phase of COVID-19 vaccination.
If you liked this article, sign up for Pediatrics Today SmartBrief. Its among SmartBriefs more than 250 free industry-focused email newsletters.
Doug Harris is a health care editor at SmartBrief. Connect with him on LinkedIn.
As the United States transitions out of a pandemic footing and into a new normal, it is also undergoing a shift in which Covid-19 metrics most accurately tell the story of the pandemic. The old standbys case numbers, namely arent as reliable anymore. So whats going to replace them?
At least three data sets are now being watched closely by the public health experts who spoke to Vox. Together, they help shed light on whats happening now, whats likely to happen, and how well were doing at dealing with whats already happened over the course of the pandemic.
The first, hospital data, covers the present, showing the level of severe illness in a given area and the strain being put on the local health care system. The second, new data on emerging variants, concerns the future and the potential for radical mutations to send the pandemic spinning out into a dangerous new direction. And the third, data on long Covid, reaches from the past and further into the future, as scientists attempt to gain a better grasp of the collateral damage the virus has left in its wake after infecting roughly 60 percent of the US population in the past two years.
Keep in mind that the most important pandemic metrics have been a moving target since 2020. The percentage of tests that came back positive was watched closely as an indication of how widespread the virus was in a given place at a given time. But nowadays, with so many people taking at-home antigen tests and never reporting the results to anyone, most experts consider that metric now to be unreliable. Case numbers, the raw count of positive tests, were an obvious signal to watch for a long time too; not only did they track the crests and dips of different waves, any growth in cases was predictably followed by a rise in hospitalizations and deaths in the subsequent weeks.
But many experts have stopped tracking cases too closely as well. They have the same reporting problem if you get a positive at-home test result but dont report it, your case doesnt show up in the official count but its more than that. Covid-19 is going to be around in the future, as society and the economy are adjusting to a new reality in which most people are expected to tolerate a certain risk of contracting Covid-19. If the public health goal is no longer to constrain case numbers, then they arent as meaningful in telling us whether or not our public health strategy is achieving its goals.
Instead, what many public health experts are tracking now is severe illness, meaning hospitalizations and deaths. The data coming out of local hospitals can still give us a good idea of the toll Covid-19 is exacting, the strain its putting on local health systems, and early indications that existing immunity may be fading.
Im not watching case rates. We expect there to be lots of mild cases, Bill Schaffner, the medical director of the National Foundation for Infectious Diseases and a professor at Vanderbilt University, told me. But if hospitalization rates start to go up, theres probably more substantial waning immunity from vaccines and previous infections.
This is a new phase in the pandemic. Theres broader testing, vaccines, treatments, and new variants. Public health interventions are ending, leaving individuals to make their own risk assessments and choices about how to protect themselves. All of that demands a new approach to the coronavirus data that has become omnipresent in the last two years.
The dozen public health experts I contacted for this story were unanimous: They will watch hospital data most closely going forward. Some of those experts are still keeping tabs on cases as a general sign of the trends on the ground and because of the potential effect of long Covid to have a lasting effect in even mild cases.
But others said they were discarding cases as a major indicator, given the reporting limitations and the reality that society is shifting into a new phase of the pandemic where contracting Covid-19 is treated, for many people, as a tolerable risk. Theyre relying instead on metrics that measure the amount of severe disease in a community.
The vaccines cannot prevent every infection but are excellent in terms of preventing severe disease, and so I am looking at that metric as our metric of success in managing Covid-19 in this country, Monica Gandhi, an infectious diseases doctor at the University of California San Francisco, told me.
The overall number of hospitalizations is a good indicator of how prevalent Covid-19 is in a given community at a given time. But some number of Covid-19 hospitalizations may end up proving incidental, like if a person came to the hospital for a different reason and merely tested positive for the coronavirus as part of routine screening.
Thats why some experts said they were also looking specifically at the number of ICU patients admitted with Covid-19, more likely to be a real indicator of a severe Covid case, and the number of deaths attributed to the virus. Increases in those numbers would be a sign of something worrisome, either the virus evolving to become more lethal or existing immunity starting to wane.
ICU beds filling up would also mean the hospital runs the risk of not being able to care for all of its patients, which could worsen outcomes for patients and even contribute to unnecessary deaths. As Amesh Adalja, a senior scholar at Johns Hopkins University, told me, seeing hospital operations compromised because of an influx of Covid-19 admissions is one of the things that would cause him serious concern.
A rising mortality rate could also be a sign that the virus is evolving to become more dangerous. When I asked David Celentano, who leads the epidemiology department at the Johns Hopkins Bloomberg School of Public Health, what in the metrics would freak him out, he said: A major increase in mortality, which might be associated with a new variant. That is my nightmare.
For now, hospitalizations (down 8 percent over the last two weeks), ICU occupancies (down 21 percent), and deaths (down 25 percent) are still declining from their omicron peak. That is part of the reason that, in spite of a recent uptick in case numbers, the US government and businesses are continuing to push toward resuming normal activities. Theyre not trying to restrain case numbers anymore; these measures of severe illness have become paramount instead.
Data on new variants were top of mind for all of the public health experts I consulted. Radical mutations in the coronavirus are one development that could disrupt societys attempt to get back to normal. New variants are identified through genomic sequencing, though clues about emerging iterations of the virus can also be found in sewage, which is becoming a more integral part of our Covid-19 surveillance network.
Whenever any new variant is identified, experts told me that they are interested in three specific data points: how easily can it be transmitted, whether it causes more severe illness, and how easily it evades immunity from vaccines and previous infections.
If we had a virus that were to some degree substantially transmissible and could notably evade the protection of our vaccines, then wed be in trouble, Schaffner said.
The other set of data that will determine Covid-19s long-term consequences is on long Covid. Such long-term symptoms after an infection have loomed large over the pandemic, inspiring fears that a mild case of Covid-19 could still end up affecting patients for months after they ostensibly recover.
But there is still a lot we dont know about long Covid. Some preliminary surveys have suggested as many as 30 percent of people who get infected with Covid-19 may end up having persistent symptoms. But experts are doubtful the number is actually that high and are pushing for standardized attempts to quantify the problem. In the coming months and years, we should start to get an empirical understanding of how many people are affected, who they are, and what the consequences have been.
We need a much better study of long Covid. It is real and will likely lead to a sustained cost in terms of chronic illness for a large number of people, but how large that number is remains uncertain, William Hanage, a Harvard University epidemiologist, told me. Claims that 30 percent of people who recover have long Covid are not credible. However, even 1 percent would mean a lot.
The US government, businesses, and society at large are making the pivot to living with Covid-19. The virus is going to be with us going forward, so from hospitals to sewers to long Covid, its through these three metrics that the next revelations about where things are heading will be found.
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COVID-19 transmission rates are back up to the medium level in some Bay Area counties, according to the CDC.
In San Mateo County, the positivity rate is near 6% with nearly 800 new cases in the past day, but what theyre not seeing is the ICU hospital beds filled with COVID patients for the most severe cases.
In many cases, infection rates are even higher than they were during the height of the delta variant. But health officials say the new BA.2 variant thats infecting most people now is not causing as many severe illnesses.
At the peak of the delta surge, we had 25 people in the hospital, in Marin County, 10 in ICU, said Marin County Public Health Officer Dr. Matt Willis. Right now, were seeing only six total in the hospital, none in the ICU.
So despite the infectious nature of this variant, many people are feeling safer now about being out in public, even maskless.
I think its pretty safe, said Avash Pardhootman of San Francisco. Hospitalizations and deaths are low, so I think its looking upwards for the world, and everyone as whole.
And it took a lot for Pardhootman to get there after losing his father to COVID in 2021.
For a long time, it seemed like things may never turn around.
It did for a while, especially when things were crazy, peak pandemic but now I think the outlook is much different, said Pardhootman.
One of the Bay Areas top experts on COVID says shes started to return to a more normal lifestyle despite a rise in cases in some areas.
I have two children. Theyre vaccinated. Im vaccinated and boosted and we have been living and Ill tell you I was on a plane last week when they dropped the mask mandates and not very many people are masking on planes, said Dr. Monica Gandhi of UCSF.
Gandhi said people should feel safer because 60% of the population has now been exposed to the virus and 75% of kids under the age of 17 have built up natural antibodies. But she said COVID is here to stay.
For one thing, its in 29 species of animals, said Gandhi. Its not going to go away. But, what we have to do is prevent severe disease and we have very high levels of immunity in the Bay Area so we have to start living with it.
But some people arent quite ready to drop the masks just yet and will rely on testing and keep to their small circles until they feel more comfortable that the worst of covid is behind us for good.
I work in the public, and I dont know where everyone has been, so its better to be safe than sorry for now at least, said Nisha Aeri of Belmont.
And with large gatherings for proms, Mothers Day and graduations on the horizon, Marin Countys health leader is still warning people to be wise about masking and getting tested before those big get-togethers.
Theyre easily available. Theyre accurate. In terms of positive treat it as a positive result, said Dr. Willis.
