Category: Corona Virus Vaccine

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Dont call it a tripledemic yet.

Influenza, respiratory syncytial virus (RSV) and COVID-19 are circulating this fall, but not yet at the rate that worried public health agencies a year ago.

As we approach the time of winter when these diseases usually peak, around December to February, experts warn that the patterns can change at any time and advise people to take precautionary measures, such as getting vaccines.

For those who are concerned about respiratory viruses, there is good news: the Food and Drug Administration approved two RSV vaccines and another shot for use in vulnerable populations.

Several vaccine makers also have updated their COVID-19 boosters, which are recommended for those who are over age 5.

Public health experts generally expect a milder flu season this year. Last year was especially severe as social activities returned to normal and COVID-19 social distancing rules ended. Experts say that more than two years of staying at home and taking precautionary measures protected people from influenza viruses, but also reduced their immunity once they resumed normal social activity.

We are seeing pretty decent matches with the flu vaccine, which is going to help and we havent seen a big take off locally and nationally yet of the flu, said Dr. Marlene Millen, an internal medicine doctor at UC San Diego.

If you still havent gotten the latest vaccines for flu and COVID-19, it is not too late. Heres what you should know about this cold and flu season.

The big answer is that it is uncertain, said Dr. Peter Chin-Hong, infectious disease physician at UC San Francisco.

Experts say the exact patterns of infection of any of these respiratory viruses cannot be predicted due to several factors, such as human interaction, travel and preventative habits. According to the California Department of Public Health, it is too soon to know how severe each of the diseases will be this season.

As more people are heading indoors for school, fitness routines, and festive gatherings, Californians are getting exposed to respiratory viruses, said Dr. Toms Aragn, director of the state Public Health Department in a press release. Anyone can be affected by winter illnesses, however, some individuals, including older adults, people with weakened immune systems or chronic conditions, pregnant people and young children are at higher risk for severe illness and death.

Dr. Marlene Millen, UC San Diego

Chin-Hong said that while infections from COVID-19 have plateaued in the past few months, there may be an uptick in infections on the horizon, especially among vulnerable populations.

The states respiratory infections reports show that RSV infections are currently rising ahead of flu and COVID-19. But the state also has more tools to battle the disease compared to last year. The new RSV shots, combined with the leftover immunity from last year, Chin-Hong said, may result in a comparatively milder RSV season from last year.

What experts are worried about is the rate of infections for all three of these respiratory diseases peaking together at the same time, which can overwhelm health care systems. That scenario is now known as a tripledemic.

Every year, thats a possibility. I always cross my fingers that that doesnt happen because we get very busy in the hospitals, especially in the clinics and other places, Millen said. Every year since COVID, it has been a concern that all three will kind of peak at once. And if that happens, then our health care system gets even more strained.

Millen said even though infections could spread faster than predicted, there is no reason to panic.

These arent new viruses, so all of the risks are already there, she said. The biggest thing is listening to what is going on and paying attention.

Several treatments can help reduce serious infections and death rates. Experts also say that people should continue to exercise preventative measures such as wearing masks, washing hands and staying away from crowded places as they did during the height of the COVID-19 pandemic.

All three viruses have similar symptoms in that they attack the respiratory system and cause symptoms like cold, fever, cough, stuffy or runny nose, body ache and fatigue, as well as chills. Infections from all three viruses can also be asymptomatic.

Doctors recommend isolating if you develop any respiratory systems or fever at all, to avoid putting others around you at risk, especially young children and the elderly.

If youre sick, stay home, Millen said. Viral loads are really high in those first few days of illness and thats when spreading illnesses happens, so just wait.

For influenza and COVID-19, the state Department of Public Health recommends vaccinations for all who are 6 months or older. Anyone over 6 months old should get the annual flu shot, while those 5 years and older should also get the updated COVID-19 booster this year.

For RSV, doctors recommend all those who are eligible to get vaccinated. This includes adults who are 60 or older, pregnant women, infants who are 8 months or younger and high risk children between 8-19 months old.

For those who do not have health insurance, California has several resources to get free vaccines, including federally qualified health centers, Bridge Access Program for COVID-19 vaccines, and the Vaccines for Children program.

Earlier this year, three shots were approved for RSV: two vaccines and an antibody shot.

The two vaccines are approved for use in elderly and pregnant women. The vaccine for pregnant women is recommended to be used between weeks 32 and 36 of the pregnancy and will reduce the risk of infection in newborns. The vaccine for seniors is available for all adults 60 or older as they are at higher risk from infections than younger adults.

The antibody preparation provides lab-prepared monoclonal antibodies to infants and young children at high risk from infections who may not be able to produce their own antibodies. This shot is recommended for all infants under 8 months as well as high-risk children between 8-19 months old.

There is currently a shortage of the antibody shot, which is causing concern among pediatricians, especially as RSV infections rise this winter.

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visitwww.chcf.orgto learn more.

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California's 'tripledemic' season is off to a mild start. What to know ... - KPBS

A container of syringes with pre-measured shot doses of the Pfizer-BioNTech vaccine is pictured. Photo: Jeff Miller

The effectiveness of mRNA vaccines in reducing disease severity and hospitalization from COVID-19 is well established. Now, new research from the University of Wisconsin School of Veterinary Medicine advances our understanding of how these vaccines protect the lungs following breakthrough infections from emerging variants of SARS-CoV-2, the virus that causes COVID-19.

Published on Oct. 5 in the journal JCI Insight, the study is the first to directly demonstrate the role of memory CD8 T cells in mRNA vaccine-induced immunity to COVID-19. Memory CD8 T cells are a specialized type of white blood cell that rapidly respond when re-exposure to a pathogen occurs.

They are often referred to as trained assassins because they control viral infections by targeting and then destroying virally infected cells. This study, conducted in mice, shows that memory CD8 T cells were necessary and sufficient in controlling SARS-CoV-2, independent of antibodies. Researchers demonstrated this by showing how the protection afforded by mRNA vaccines was lost in mice when memory T cells were depleted prior to SARS-CoV-2 infection.

Scientists widely accept that CD8 T cells provide a more robust form of protection because the viral fragment they target to kill infected cells does not change considerably with each new viral variant. Antibodies on the other hand, typically lose their ability to prevent infection because the part of the virus they target changes with each new mutation.

Marulasiddappa Suresh

Marulasiddappa Suresh, professor of immunology in the School of Veterinary Medicine Department of Pathobiological Sciences, says this study sheds new light on the protective mechanisms mRNA vaccines use to lessen severe disease following breakthrough infections. It also raises important new questions about the role of memory T cells in limiting the spread of the virus, the frequency with which we get vaccinated and the most effective methods for vaccine delivery.

The key finding of our research shows that memory T cells play an essential role in mediating SARS-CoV-2 viral control in lungs, independent of antibodies, says Suresh, who was also the studys principal investigator. We hope this new understanding of vaccine-induced immunity will inform the development of new vaccines and treatment strategies that more effectively combat the emergence of global variants and limit the impact theyll have on our health in the future.

While previous studies have documented a strong correlation between vaccine-induced T cells and more positive outcomes following infection with SARS-CoV-2, the ability to study these protective mechanisms in detail is not possible in humans. As a result, researchers administered various doses of the Pfizer BioNTech COVID-19 mRNA vaccine to a specialized mouse model in order to study the defining characteristics of T cell responses induced by the vaccine. Their results showed the T cell response to mRNA vaccine in the peripheral blood is largely similar between mice and humans. They also found that T cells actively sought out the virus in the respiratory tract airways, lung vasculature, and mediastinal lymph nodes to effectively reduce the burden of SARS-CoV-2 in the lungs.

Other key findings show that intramuscular immunization produced unexpectedly high frequencies and numbers of memory T cells in the airways of the respiratory tract the main portal of entry for SARS-CoV-2. According to Suresh, future research on this topic will need to assess the biological significance of nasal and airway resident memory T cells in protection against emerging variants of SARS-CoV-2 and whether individuals who recover from breakthrough SARS-CoV-2 infections will require further vaccinations.

Its still unclear if the combination of vaccine-induced immunity and infection-induced immunity is sufficient to provide broad mutation-resistant immunity to future SARS-CoV-2 variants, he says.

Other members of the research team from the UW School of Veterinary Medicine include Brock Kingstad-Bakke, Thomas Cleven, Hailey Bussan, Hongtae Park, Peter Halfmann and Yoshihiro Kawaoka from the Department of Pathobiological Sciences; and Jay Mishra and Sathish Kumar from the Department of Comparative Biosciences. Other important contributors include researchers from the University of North Carolina, Chapel Hill; University of Tokyo; and Japans National Center for Global Health and Medicine Research Institute.

This study was supported by PHS grant U01 AI124299, R21 AI149793-01A1, R21 AI173757-01A1.

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New study shows mRNA vaccine harnesses T-cell power to combat ... - University of Wisconsin-Madison

Even though 2020 is in the rearview (thankfully), Covid-19 likely isnt going away anytime soonits still a serious health threat for many people, especially those who are at high risk of getting very sick from the virus. And many dont realize it.

According to the

As we head into winter and the potential for a Covid-19 surge, Pfizers Know Plan Go campaign can help you identify if you or a loved one is at high risk for severe illness from the virus, and, most importantly, encourages you to make a plan and act quickly if you experience symptoms or test positive. This includes speaking with your doctor, who will be able to advise whether a prescription treatment option may be right for you to help reduce the risk of severe illness and hospitalization.

One person who is looking to help get the word out is the decorated swimmer, Michael Phelps.

Anyone can be caught off guard by Covid-19, even someone who makes their health a priority. I put in a lot of work to stay in good shape, both physically and mentally, so when I tested positive for Covid-19, I was surprised at how sick I felt, says Phelps, who has struggled with depression for a good portion of his life. The first day when I stepped out of bed, I thought my knees were going to shatter. I felt like every bone was just going to break. I didnt know how to react because I didnt know enough about why I was feeling so terrible. I was definitely scared.

Phelps later learned that his depression puts him at a high risk for severe Covid-19, which makes sense because Ive experienced how mental health can affect physical health, he says. This was really eye-opening for me, and I know Im not alone. There are so many people who dont know theyre at high risk for getting very sick from Covid-19.

Early in the pandemic, uncertainty about the virus caused a lot of fear and anxiety. Fortunately, many more resources are available today to help people navigate Covid-19including Pfizers Know Plan Go.

Once you know youre at high risk of severe Covid-19, its time to develop a plan:

In the event that Covid-19 strikes, its critical to act fast and reach out to a doctor immediately, as mild symptoms can quickly become severe. I cant stress enough how important it is to speak with your doctor right away if you have symptoms or test positive, Phelps says.

Your doctor can tell you if a prescription treatment option is right for you, based not only on your risk factors, but also on your medical history and current medications.

I was lucky to have the right support system and a team of professionals in place to help me navigate my Covid-19 journey, but others arent as fortunate, says Phelps. Being part of the Know Plan Go initiative is important to me to help raise awareness and inspire others to act fast and speak with a doctor when they get Covid-19.

Go to http://www.KnowPlanGo.com to learn more about factors that put you or your loved ones at high risk for severe Covid-19, how to develop a plan prior to experiencing any symptoms or testing positive, and the importance of acting quickly should Covid-19 strike.

Pfizer Inc. All rights reserved. PP-C1D-USA-0023. November 2023.

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Here's What Michael Phelps Wants You to Know About Covid-19 - Men's Health

Graduate student Steven Wall Jr. and Ivelin Georgiev, PhD. Photo by Donn Jones

by Bill Snyder

Children are an underutilized source of potential antibody therapies to counteract the ever-evolving COVID-19 pandemic, according to researchers at Vanderbilt University Medical Center.

Reporting Nov. 6 in Cell Reports Medicine, Ivelin Georgiev, PhD, and colleagues demonstrated that antibodies isolated from childrens blood samples displayed high levels of neutralization and potency against variants of the COVID-19 virus, SARS-CoV-2, even when the children had not previously been exposed to or vaccinated against those variants.

These results indicate that childrens samples can play an important role in the discovery of effective SARS-CoV-2 antibody therapeutics, the researchers concluded.

This is important because, while monoclonal antibodies developed at VUMC and elsewhere initially were quite effective in neutralizing SARS-CoV-2, the virus ability to mutate rapidly has enabled it to escape from every monoclonal antibody product currently on the market. It is crucial to find antibodies that can broadly neutralize all variants of the virus, said Georgiev, the papers corresponding author, and associate professor of Pathology, Microbiology & Immunology, Biomedical Informatics, Chemical and Biomolecular Engineering, and Computer Science at Vanderbilt.

Children have been thought to be unlikely sources for new antibody therapies because their immune systems are immature, and they tend to be more susceptible to severe viral illnesses including those caused by influenza, respiratory syncytial virus (RSV), and human metapneumovirus.

When it comes to SARS-CoV-2, however, children experience significantly less severe disease compared to adults. Even when adolescents have severe disease, they are hospitalized less often than adults, require shorter hospital stays, and are less likely to die from COVID-related complications.

In the VUMC study, blood samples from children ages 5 months to 18 years old were collected between July and August 2021, and divided into two groups: those with no known exposure to SARS-CoV-2 infection or vaccination, and those who had been infected or vaccinated. The researchers employed a variety of sophisticated techniques including LIBRA-seq (Linking B-cell Receptor to Antigen Specificity through sequencing), which was developed at VUMC, and which rapidly and efficiently identified multiple neutralizing monoclonal antibodies against SARS-CoV-2 in the samples.

Fluorescence-activated cell sorting, next-generation sequencing, and a computational pipeline enabled high-throughput mapping of the amino-acid sequences of antibodies that bound viral antigens.

The researchers found that neutralizing antibodies identified in children had similar genetic features to antibodies from adults, and that children use similar mechanisms for neutralizing the COVID-19 virus.

What was surprising was that the antibodies isolated from children potently neutralized SARS-CoV-2 variants that have become resistant to virtually all approved monoclonal antibody therapeutics.

Not only are children a potential source of new therapies against COVID-19, but deciphering their antigen-specific antibody repertoires could prove useful in improving the treatment of other infectious diseases, and the development of next-generation pediatric vaccines, the researchers reported.

Steven Wall, a graduate student in the Georgiev laboratory, was the papers first author. VUMCs Naveenchandra Suryadevara, PhD, and Andrea Shiakolas, PhD, and Changil Kim, PhD, from the Karolinska Institute in Stockholm, Sweden, contributed equally to the paper. Other VUMC co-authors were Clint Holt, Emma Irbe, Perry Wasdin, Yukthi Suresh, Elad Binshtein, PhD, Elaine Chen, PhD, Seth Zost, PhD, Elizabeth Canfield, James Crowe Jr., MD, Mary Ann Thompson-Arildsen, MD, PhD, and Robert Carnahan, PhD.

The research was supported in part by National Institutes of Health grants R01AI131722-S1 and R01AI157155, as well as the Hays Foundation COVID-19 Research Fund, the Mercatus Center Fast Grants program at George Mason University, the G. Harold and Leila Y. Mathers Charitable Foundation, the Defense Advanced Research Projects Agency of the U.S. Department of Defense, the Dolly Parton COVID-19 Research Fund at Vanderbilt, and Merck KGaA.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Children's antibodies highly potent against COVID-19: study | VUMC ... - VUMC Reporter

A recent study published in the Canadian Medical Association Journal revealed that virtual urgent care (VUC) had minimal impact on emergency department visits or hospital admissions in Ontario, Canada, during the COVID-19 pandemic. However, a significant number of study participants who initially sought virtual urgent care eventually attended an emergency department in person.

Virtual urgent cares purpose is to assist in redirecting folks with minor health concerns away from in-person emergency department visits to decrease high volumes of patients that dont necessarily need to be there.

The COVID-19 pandemic significantly impacted the Canadian healthcare system, especially early on when social distancing posed challenges for arranging non-urgent, in-person visits. This period witnessed an almost 80% decline in in-person primary care visits and a 50% decrease in emergency department visits, which lead to a surge in the adoption of virtual care tools.

For a better understanding of healthcare use and the outcomes of VUC, researchers of the study observed both variables in comparison to similar patients who opted for an in-person emergency department visit.

Researchers used patient-level encounter data from 14 pilot programs in Ontario where individuals used VUC services. Researchers then collected the data and connected it to administrative databases, which helped them figure out how people used healthcare services and what happened in the 30 days after.

Results revealed that out of the 19,595 patients who used VUC, researchers matched 2,129 patients who were quickly referred to the emergency department by a VUC provider with those who physically went to the emergency department.

The rates of hospital admissions during the first visit (9.4% vs. 8.7%), 30-day emergency department visits (17.0% vs. 17.5%) and hospital admissions (12.9% vs. 11.0%) were similar between these two groups.

Of the 14,179 patients seen by a VUC provider without a documented referral to the emergency department, those who used VUC were more likely to have in-person emergency department visits within 72 hours (13.7% vs. 7.0%), 7 days (16.5% vs. 10.3%), and 30 days (21.9% vs. 17.9%).

However, hospital admissions were similar within 72 hours (1.1% vs. 1.3%) and higher within 30 days for patients discharged home from the emergency department (2.6% vs. 3.4%).

Authors of the study suggest that the increased use of healthcare services following virtual follow-up visits might be due to virtual clinicians facing limitations in physically examining patients.

This limitation could lead clinicians to refer patients back to the emergency department for an in-person evaluation more readily if they have persistent symptoms, they said.

Its recommended that future research efforts should focus on identifying quality-of-care and virtual care practices care to foster a culture of continuous improvement.

Researchers suggest future investigations should highlight and examine the root causes of low healthcare use after a VUC visit as it will help determine necessary changes and improvements that will help improve these trials.

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Virtual Urgent Care's Slight Impact on Emergency Visits During the ... - Managed Healthcare Executive

Respiratory virus season is only starting, and demand has already outstripped supply for the newly approved and potentially lifesaving monoclonal antibody injection for preventing respiratory syncytial virus (RSV) in children.

David Margraf, PharmD, PhD, pharmaceutical research scientist at the Resilient Drug Supply Project (RDSP), said the nirsevimab-alip (Beyfortus) shortage is reminiscent of the COVID-19 vaccine rollout. RDSP is part of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP), publisher of CIDRAP News.

"Wealthier nations secured most early vaccine supplies, which led to delayed vaccine rollouts in many low- and middle-income countries," he said. "Even in the United States, wealthier communities had better access to vaccines, and rural areas also faced challenges due to distance and scarce resources."

The US Food and Drug Administration (FDA) approved the long-acting drug in July, and in August the Centers for Disease Control and Prevention (CDC) recommended the prescription drug to protect all infants up to 8 months old entering their first RSV season and for high-risk children up to 24 months in their second season. RSV is the No. 1 cause of hospitalization among US infants.

On September 5, the CDC warned that RSV activity was picking up in the southeastern United States, often a bellwether for the rest of the country.

"Despite an aggressive supply plan built to outperform past pediatric immunization launches, demand for this product, especially for the 100 mg doses used primarily for babies born before the RSV season, has been higher than anticipated," Beyfortus co-developer Sanofi said in an October 26 statement.

Margraf said that while the FDA evaluates the manufacturing processes and facilities, the capacity of the manufacturer to meet demand is not a major consideration in the approval process. "However, the FDA does work with pharmaceutical companies post-approval to address issues related to shortages, especially with critical drugs," he said. "It may be time for the FDA to assess manufacturing capacity in the drug approval process."

Sanofi said it was working with the CDC and to ensure equitable distribution of available doses of the drug to Medicaid-eligible, uninsured, or American Indian/Alaska Native children through the Vaccines for Children (VFC) program. The company said it, along with co-developer and manufacturing partner AstraZeneca, would take a similar approach to distribution of the $495-a-dose drug on the private market.

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RSV-preventing injection in shortage as respiratory virus season ... - University of Minnesota Twin Cities

Implementation of an antimicrobial stewardship program (ASP) was associated with a significant reduction in antibiotic consumption and antimicrobial resistance in children with severe bacterial pneumonia at a pediatric intensive care unit (PICU) in China, researchers reported yesterday in the Journal of Global Antimicrobial Resistance.

In the single-center study, researchers from Beijing Children's Hospital set out to examine the impact of ASP 2018, a set of guidelines issued by China's National Health Commission that emphasize strict control of antibiotic use, particularly for vulnerable populations such as children, the elderly, and pregnant women. Under those guidelines, the hospital created a management team of pharmacists, clinicians, infectious disease specialists, microbiologist, and administrators to regularly inspect the use of antibiotics.

To assess the impact of the ASP, the researchers compared resistance rates, antibiotic consumption, and clinical outcomes among children with severe pneumonia in the PICU before and after implementation of the program. The study evaluated data on 287 children, including 165 before the intervention (May 2016 to April 2018) and 122 after the intervention (May 2018 to April 2020).

After the ASP implementation, Staphylococcus aureus replaced Streptococcus pneumoniae as the predominant gram-positive bacterium and Klebsiella pneumoniae replaced Pseudomonas aeruginosa as the most common gram-negative bacterium. The resistance of S pneumoniae to clindamycin, erythromycin, and tetracycline was significantly reduced, while S aureus resistance to tetracycline was reduced from 59.1% to 32.5% after ASP implementation.

Resistance rates of K pneumoniae to amoxicillin/clavulanic acid and trimethoprim/sulfamethoxazole (SXT), and Acinetobacter baumannii to cefotaxime and SXT, also declined significantly. The isolation rate of multidrug-resistant strains decreased significantly as well, from a high of 16.8% before intervention to 6.7% after intervention.

Meanwhile, total consumption (defined daily doses [DDD] per 100 patient-days) of five antimicrobials (cephalosporins, carbapenems, macrolides, antifungal agents, and linezolid) decreased by 21.9% overall. No increase in length of hospital stay or mortality was observed.

The study authors say that while only a small number of PICUs in China have the staff to implement the ASP, the experience at their hospital "may provide some references for its promotion and application nationwide."

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Childhood abuse linked to higher risk of adult COVID-19 death - University of Minnesota Twin Cities

The types of parks chosen for analysis

The total number of park visits determined from SafeGraph points of interest (POIs) located in NYC parks was 20,913,290 in 2019, but only 10,279,798 in 2020, representing a decrease of 49.2 percent.

There are 18 types of parks listed in the NYC Open Space Parks Data29. However, the top eight types of parks accounted for 91.35% of total park visits in 2019 and 92.17% in 2020, respectively, and are thus the focus of this study (Fig.1). These parks are classified by the NYC Department of Parks and Recreation29 as (1) Community Park, (2) Flagship Park, (3) Jointly Operated Playground, (4) Nature Area, (5) Neighborhood Park, (6) Playground, (7) Recreation Field/Courts, and (8) Triangle/Plaza. The detailed classification standard can be found in Table S-7.

Locations of parks in New York City. Each point represents an individual park. The number of parks and the median park area are shown for each park type.

We calculated four metrics associated with the number of park visits and the number of park visitors, namely (1) all visits: the total number of visits from all visitors; From the SafeGraph documentation, the duration of a visit must last at least 4min, and there could be multiple visits from a single visitor during the time period when the data were collected; (2) all visitors: the total number of unique visitors, regardless of their origin; (3) US visitors: the total number of unique visitors whose home locations are within the US; (4) NYC local visitors: the total number of unique visitors whose home locations are within NYC. Since temperature has been reported as a vital factor influencing park visitation30,31, we corrected the data for the effects of temperature, as described in the Data and methods section. The total numbers of these four types of visit/visitor counts by park type, and after the temperature correction, are summarized in Table S-1.

We examined the park visits and visitors change rate in each NYC borough by computing the total number of park visits or visitors in a month in that borough, then calculating the percentage change in 2020 visits (or visitors) compared to 2019 (i.e., (the visits in 2020the visits in 2019)/the visits in 2019). Manhattan was divided into lower Manhattan and upper Manhattan using 86th street as a divide. Results for total visits, total visitors, US visitors, and NYC visitors are shown in Fig.2.

Park visits and visitors change rate by borough, which is calculated as the percent change of total monthly park visits/visitors in 2020 compared to 2019. The letters on the right of each figure are the Tukey HSD multi-group comparison results, the same letters indicate the boroughs belong to the same group.

Starting from March 2020, the parks in all boroughs experienced decreased total visits (Fig.2a). April 2020 was the month with the greatest percentage decrease in visits compared to 2019, then visits slowly increased as the months progressed. Lower Manhattan had the greatest decrease in park visits from March to December (overall 61.1%, with a maximum of 86.6% in April 2020), while Staten Island experienced the smallest decrease (overall 20.3%, with a maximum of 57.5% in April 2020). All other boroughs experienced similar changes in visits, and shared a similar trend through time. All visitors (Fig.2b), U.S. visitors (Fig.2b), and NYC visitors (Fig.2d) had the same pattern with the greatest decrease in April, followed by a slow rebound with progressing time. Again, lower Manhattan had the largest decrease in unique visitors while Staten Island the smallest (Fig.2bd).

We examined the park visits and visitors change rate across the eight selected park types, by computing the total number of visits or unique visitors in a month to each park type and then calculating the percentage change of visits/visitors in 2020 compared to 2019 (Fig.3). There was a decrease in all types of visits and visitors to all eight park types across the city when comparing 2019 to 2020 for the months of March to June (Fig.3ad). For NYC local visitors, Triangle/Plazas (overall 62.9%, with a maximum of 82.9% in April 2020) and Flagship Parks (overall 57.0%, with a maximum of 78.7% in April 2020) had the largest decrease, followed by Jointly Operated Playground, Playground, Community Park, Neighborhood Park, then Recreation Field/Courts. Nature Areas had the smallest decrease in the number of NYC local visitors (overall 3.6%, with a maximum of 44.5% in April 2020) with some months even showing an increase. Beginning in June, the number of NYC local visitors to Nature Areas returned to about the same level as 2019 and even increased in some months (with a maximum increase of 29.0% in July 2020) (Fig.3d). The other three types of visits/visitors shared similar trends as NYC local visitors (Fig.3ac).

Park visits and visitors change rate by park type, which is calculated as the percent change of total monthly park visits/visitors in 2020 compared to 2019. The letters on the right of each figure are the Tukey HSD multi-group comparison results, any common letter shared by two park types indicates that the two park types were found to belong to the same group.

In order to better understand the needs and park usage of local urban residents, we focused our remaining analyses on data for NYC residents (also subsequently referred to as NYC local visitors) only. We also defined the visitor census block group (visitor CBG) as the home census block group where a visitor lived; and defined the park census block group (park CBG) as the census block group that a park was in, or was the closest to.

The CBGs (neighborhoods) that surround parks were divided into three income groups: lower, middle and upper, based on per capita income. The results for park visits change rate between 2019 and 2020 for each of the analyzed park types are provided in Fig.4.

NYC park visitors change rate by park type and by income level of park CBGs. The letters before the income groups are the Tukey HSD multi-group comparison results, any common letter shared by two income level groups indicates that the two groups were found to belong to the same group.

All eight park types saw decreased NYC local visitors regardless of the park CBG income level (Fig.4). Overall, parks in lower-income neighborhoods experienced statistically greater decreases in NYC local visitors than those in upper-income neighborhoods. No trend in visits change rate with income level was observed for Jointly Operated Playground, Neighborhood Park, Playground, and Triangle/Plaza. Community Parks and Nature Areas showed greater reductions in NYC local visitors in lower-income neighborhoods but showed no difference between middle- and upper-income neighborhoods. Flagship Parks showed greater reductions in NYC local visitors in lower- and middle-income neighborhoods. The outlier to the overall trend is Recreational Field/Courts, which showed greater reductions in NYC local visitors in upper-income neighborhoods than in lower-income neighborhoods.

The travel distance of visitors was used to examine how the travel behavior of NYC residents to parks changed during the early stages of the COVID-19 pandemic. In this section, the mean travel distances were computed for the time period from March to December in 2019 and 2020, as the major outbreak of the pandemic and the associated travel restrictions began in March 2020.

Overall, the mean travel distance of NYC residents to all parks reduced from 5.9km in 2019 to 5.1km in 2020 over March to December, representing a change of 13.2% (95% CI 13.4%, 13.1%). In 2020, there was a significant decrease in travel distance compared to 2019 for all study park types except for the Jointly Operated Playground, Playground, and Nature Area park types (Fig.5).

(a) Mean travel distance by park type. (b) Percentage change of mean travel distance by park type, with 95% CI error bars.

Before the pandemic, the mean travel distances to the Triangle/Plaza and Flagship Park types were the longest, both averaging 7.1kmover March to December in 2019; while the travel distances to the Playground and Jointly Operated Playground were the shortest, averaging 5.0km and 4.5km, respectively. The Nature Area, Jointly Operated Playground and Playground park types experienced a smaller decrease than average or even a slight increase, which were 1.2% (95% CI 2.0%, 0.3%), 1.9% (95% CI 2.5%, 1.3%) and 1.1% (95% CI 0.6%, 1.7%), respectively. All other types of parks experienced a greater reduction in travel distance (Table S-4).

The overall mean travel distances of NYC residents from lower-, middle- and upper-income level CBGs were 5.3km, 6.5km, and 6.0km, respectively, from March to December in 2019; and were 4.7km, 5.6km, and 5.0km, respectively, in the same period in 2020 (Fig.6a,b). In general, people from lower-income CBGs traveled a statistically shorter distance to parks than those from middle-income and upper-income CBGs in both 2019 and 2020. This pattern was common across all types of parks, except for Nature Areas and Triangle/Plazas, to which visitors from upper-income CBGs traveled the shortest distance.

(a,b) Mean travel distance by park type and by income level of visitor CBGs; The letters to the right of the mean travel distances are the Tukey HSD multi-group comparison results between income groups for each park type, any common letter shared by two income groups indicates that the two groups were found to belong to the same group. (c) Percentage change of mean travel distance by park type and by income level of visitor CBGs, with 95% CI error bars.

Overall, visitors from higher income CBGs had the greatest reduction in travel distance (Fig.6c). The percentage change of travel distance for visitors from lower-income, middle-income and upper-income CBGs are 10.7% (95% CI 11.0%, 10.4%), 13.9% (95% CI 14.2%, 13.7%), and 15.8% (95% CI 16.2%, 15.5%), respectively (Table S-5).

The specific changes varied by park type. For Community Park, Flagship Park, Jointly Operated Playground, Nature Area and Triangle/Plaza park types, the visitors from upper income level CBGs experienced the greatest percentage reduction in travel distance. While for Recreation Field/Courts, the visitors from upper income level CBGs had the smallest percentage reduction in travel distance.

The mean travel distances to parks located in lower-, middle- and upper-income level CBGs were 5.7km, 5.6km, and 6.3km, respectively, from March to December in 2019, and were 4.9km, 4.7km, and 5.6km, respectively, during the pandemic from March to December in 2020 (Fig.7a,b). In general, people tended to travel a statistically longer distance to parks in upper-income CBGs than to parks in middle-income and lower-income CBGs in both 2019 and 2020, with the exception of Community Park and Flagship Park in 2019.

(a,b) Mean travel distance by park type and by income level of park CBGs; The letters to the right of the mean travel distances are the Tukey HSD multi-group comparison results between income groups for each park type, any common letter shared by two income groups indicates that the two groups were found to belong to the same group. (c) Percentage change of mean travel distance by park type and by income level of park CBGs, with 95% CI error bars.

The travel distance to parks located in upper-income level CBGs had the smallest percentage decrease (Fig.7c), which was 10.6% (95% CI 10.9%, 10.3%), while it was 16.0% (95% CI 16.3%, 15.7%) for parks located in middle-income CBGs, and was 14.1% (95% CI 14.4%, 13.8%) for parks located in lower-income CBGs (Table S-6).

Examining by park type, for Community Park, Flagship Park, Recreational Field/Courts and Triangle/Plaza park types, the parks located in upper-income level CBGs experienced the smallest percentage reduction in travel distance. While for Nature Area, Jointly Operated Playground and Playground park types, the parks located in lower income level CBGs had an increase in travel distance.

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WASHINGTON Select Subcommittee on the Coronavirus Pandemic Chairman Brad Wenstrup (R-Ohio) and Representative Nicole Malliotakis (R-N.Y.) are pressing New York Governor Kathy Hochul to hand over information related to her states disastrous COVID-19 nursing home policies after repeated obstruction. Since the start of the pandemic, the Select Subcommittee has sent more than eight letters to Governor Hochul, former Governor Andrew Cuomo, and the Cuomo Administration requesting access to all documents and communications surrounding New Yorks deadly must-admit COVID-19 nursing home mandate. Governor Hochuls office has failed to produce a single responsive document.

In a recent attempt to obfuscate and deflect responsibility, Governor Hochuls office asked the New York State Department of Health (NYSDOH) to respond to the Select Subcommittee on behalf of the Governor. This evasion of accountability raises further questions about Governor Hochuls role in covering-up for the failures of her predecessor Andrew Cuomo. Today, Chairman Wenstrup and Representative Malliotakis are calling on Governor Hochul and New York State Department of Health Commissioner James McDonald to act transparently and provide the Select Subcommittee with all information related to the fatal COVID-19 nursing home directives.

This Select Subcommittee expects your response to this letter, not another deflection of responsibility. These deflections are especially concerning considering your promise to be fully transparent regarding the data surrounding COVID-19 deaths and nursing home readmissions. We are simply requesting that transparency, wrote the lawmakers in their letter to Governor Hochul.

Instead of fulsomely producing documentsespecially those in the custody or control of the Governors Officethe Governor deflected responsibility to the New York State Department of Health (NYSDOH). While the NYSDOH has produced limited responsive documents, to date, it has yet to answer all of the Select Subcommittees questions, wrote the lawmakers in their letter to New York State Department of Health Commissioner McDonald.

Read the letter to Governor Kathy Hochul here and the letter to New York State Department of Health Commissioner James McDonald here.

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