Plus, the COVID ‘emergency’ expires soon but hospitals execs want it extended, the COVID-diabetes connection, and more. Email not displaying correctly?
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** Can you be ‘too boosted’ with COVID-19 vaccines?
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A syringe is prepared with the Pfizer COVID-19 vaccine at a vaccination clinic at the Keystone First Wellness Center in Chester, Pa., on Dec. 15, 2021. (AP Photo/Matt Rourke, File)

When the U.S. Food and Drug Administration’s advisory panel meets tomorrow ([link removed]) , it will take up the issue of vaccine boosters and whether the FDA should recommend or just allow a second booster shot.

The Mercury News raised the question ([link removed]) of whether it is possible that we might become booster-dependent if we get a vaccine every four months or so. The experts quoted say it is possible, but there is not enough evidence to know yet:

Early this year, the European Medicines Agency’s Head of Vaccines Strategy, Marco Cavaleri, raised the concern that excess boosting could weaken rather than strengthen our immunity.

Dr. Sarah Fortune, a professor at the Harvard T.H. Chan School of Public Health Department of Immunology and Infectious Diseases, told the German news organization Deutsche Welle ([link removed]) a week later that Cavaleri likely was referring to possible exhaustion of the T cells that help protect the body from infection.

“T cells become dysfunctional when they repeatedly see antigen in certain contexts,” Fortune told Deutsche Welle. Vaccines introduce antigens to generate an immune response. But Fortune added that the studies on T cell exhaustion are based on HIV or cancer patients “where the antigen is there all the time, not just repeated vaccination.”

Of course, there is precedent for giving repeated doses of a vaccine — for childhood diseases and even tetanus shots — but those are spread out over a longer period. And we know that the overuse of antibiotics, for example, weakens antibiotics’ effect over time.

The FDA’s Vaccines and Related Biological Products Advisory Committee will also discuss when it is time for a new formulation of the COVID-19 vaccine to protect against new strains of the virus.

A NOTE FROM POYNTER
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** The COVID ‘emergency’ expires April 15, but hospitals execs want it extended
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Eight hospital groups plus the American Hospital Association sent a letter to Health and Human Services Secretary Xavier Becerra ([link removed]) urging him to renew the Public Health Emergency declaration that will expire April 15. The hospitals say they need the PHE designation to deal with shortages of essential medical supplies and staffing. The hospitals also say that even while the pandemic’s effects are less now, there is a backlog of medical cases that were delayed by the pandemic.

The hospitals listed a number of ways that they get relief by the country being under the health emergency designation:

The PHE declaration allows you to take certain actions in response to the COVID-19 pandemic. These include waivers of certain Medicare, Medicaid, CHIP, and HIPAA Privacy Rule requirements, such as: conditions of participation; staff licensure requirements for practicing in other states; limitations from liability for certain providers; sanctions under the Emergency Medical Treatment and Labor Act for direction or relocation of an individual; important telehealth waivers; and deadlines and time tables for performance of required activities, such as quality reporting. Also, the additional 6.2% in Federal Medical Assistance Percentage funding for the state Medicaid programs, designated in the Families First Coronavirus Relief Act, is tied to the length of the PHE and the continuous coverage requirement has been essential in helping provide health care coverage to vulnerable populations during the economic downturn.

HHS has extended the PHE eight times since Jan. 27, 2020, with the most recent renewal in January 2022 ([link removed]) . The hospital groups want an extension past the end of this month.


** The COVID-diabetes connection
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The New York Times opened a story with this statement ([link removed]) :

After older people and nursing home residents, no group perhaps has been harder hit by the pandemic than people with diabetes. Experts hope policymakers will take notice, and finally get serious about tackling the nation’s diabetes crisis.

More than one-third of people who died from COVID-19 also had diabetes, according to this new study ([link removed]) . Of course, that statistic may have more layers than it seems since diabetes is linked to so many other factors, such as obesity and high blood pressure.

Look at the data and see what the demographics of people who died from COVID-19 had in common, including age, gender and diabetes.

The mean age of people hospitalized for COVID-19 was 71.1 ± 12.9 years,

63.6% were males

75.6% had type 2 diabetes

4.6% had type 1 diabetes

19.8% had prediabetes.

The Times story lays out why we should pay attention to the significant vulnerabilities that people with diabetes face, especially in a pandemic:

“It’s hard to overstate just how devastating the pandemic has been for Americans with diabetes,” said Dr. Giuseppina Imperatore, who oversees diabetes prevention and treatment at the Centers for Disease Control and Prevention.

Diabetes patients hospitalized with Covid spend more time in the I.C.U., are more likely to be intubated ([link removed]) and are less likely to survive ([link removed]) , according to several studies ([link removed]) , one of which found ([link removed]) that 20 percent of hospitalized coronavirus patients with diabetes died within a month of admission. Though researchers are still trying to understand the dynamics between the two diseases, most agree on one thing: Uncontrolled diabetes impairs the immune system and decreases a patient’s ability to withstand a coronavirus infection.

Diabetes is a pernicious disease that is at once ubiquitous and invisible, partly because most people with the condition do not appear outwardly ill. It affects 34 million Americans, or 13 percent of all adults, but draws less funding ([link removed]) and public attention than other major killers like cancer, Alzheimer’s and heart disease.

The COVID-19/diabetes connection also helps to explain why Black and Hispanic patients fared worse in the pandemic, since they are also disproportionally experiencing diabetes.


** US nursing home deaths from COVID hit new low
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Here is some encouraging news. The CDC’s latest data ([link removed]) shows nursing home deaths from COVID-19 have hit a new pandemic low.
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(CDC)

The good news comes with a warning that the last time we saw a dip this low it was just before new variants, first delta and then omicron, hit and raised the threat level back up.

A couple of graphics down the page on the CDC website I saw another statistic that gave me pause. Deaths among nursing home workers are not dropping.
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(CDC)

The two charts, the first of the nursing home residents and the second of the nursing home workers, underscore this point: More than eight out of 10 nursing home residents are vaccinated, and three-fourths have gotten booster shots. And while a similar percentage of nursing home workers is vaccinated, the latest federal data from nursing homes show less than half of nursing home workers have been boosted.
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(Centers for Medicare and Medicaid Services)


** China’s emergency COVID response: 2,000 military medics and 10,000 medical workers
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The pandemic is growing worse ([link removed]) in Shanghai, where the government shifted into a higher gear, if that is possible, to battle 60,000 COVID-19 cases. 9,000 of those cases came just one day ago.


** Not insured? Here is what COVID tests will cost you out of pocket
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The federal programs that paid for COVID-19 tests for uninsured people have run out of money. Now, if you have no insurance and want a PCR test, this is what ABC News says ([link removed]) you will pay:

Quest Diagnostics, one of the largest testing companies in the country, told ABC News that patients who are not on Medicare, Medicaid or a private health plan will now be charged $125 dollars ($119 and a $6 physician fee) when using one of its QuestDirect PCR tests either by ordering a kit online or visiting one of the 1,500 Quest or major retail locations that administer the tests, such as Walmart or Giant Eagle.

This week, federal funding to cover the cost of COVID-19 testing and treatment for uninsured Americans officially dried up; any further infusion of cash hinges on Congress passing the White House's request for billions more in COVID relief, which is still stuck at an impasse ([link removed]) .

Quest has begun notifying its clients and partners they can no longer expect to be reimbursed for uninsured claims, barring additional funding from Congress.

30 million Americans have no health insurance. Health care strategists say ([link removed]) making testing costly to millions of Americans will make them reluctant to get tested and make it more difficult to track the virus throughout the year.


** Gas prices send e-scooter and e-bike sales soaring
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In this June 8, 2019 photo, Janice Goodwin rides her electric-assist bicycle on a paved road in Acadia National Park at Bar Harbor, Maine. (AP Photo/David Sharp)

Maybe it’s the gasoline prices and maybe it is spring fever behind a big demand for e-scooters and e-bikes. The Wall Street Journal reports ([link removed]) :

Miami e-scooter marketplace and manufacturer Fluidfreeride ([link removed]) has sold more than twice as many units this month compared with last, founder Julian Fernau says. Sales are 70% higher than in March 2021, he added, and website traffic is up about 30% since gasoline prices began to shoot up at the fastest rate on record ([link removed]) earlier this month. At Bird ([link removed]) , another manufacturer, sales have increased 60% and website traffic is up 30% during the same time, according to a spokeswoman.

Reddit and Facebook groups devoted to e-scooters have ballooned in recent months. The Electric Scooter Guide Facebook group ([link removed]) shot up from 1,000 members a year and a half ago to 38,000 now, says Mr. Vosk, David Vosk, community manager for review site the Electric Scooter Guide ([link removed]) who runs the group. There are about 12,000 posts or comments a day, with members asking about everything from help fixing a brake to the best scooter for beginners.

App-based scooter rental programs, where users pay by the minute to ride, are also booming in popularity. In New York City, daily average ridership has increased nearly 70% in March compared with February, Bird says.


** Journalists investigating breathtaking medical bills
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I hope you have sampled the Bill of the Month crowdsourced investigations ([link removed]) by Kaiser Health News ([link removed]) and NPR ([link removed]) that dissect and explain medical bills. It is such good public service reporting that deep-dives into cases where people got charged phenomenal amounts of money for sometimes routine care.

This month, a North Carolina man had to find a way to settle a $489,000 bill that included a $70,000 tab for ambulance rides. At one point, an insurance company sent him $70,000, which he sent to the care provider, and then the insurance company demanded the money back.

You have to ask why it takes an investigative team of journalists to sort out these kinds of quagmires and where would these patients turn if there was no journalist to take on their case? It makes me realize that we could use hundreds of these investigative units nationwide.

We’ll be back tomorrow with a new edition of Covering COVID-19. Are you subscribed? Sign up here ([link removed]) to get it delivered right to your inbox.
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