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The CDC’s COVID Booster Strategy Is Failing
If officials at the Centers for Disease Control and Prevention were hoping that tying an annual COVID booster to the fall flu shot would increase uptake, it isn’t working. Less than 3% of eligible Americans have gotten the new booster this fall. That’s down from last year’s abysmal 17%. And vaccination rates aren’t as high as they should be among the most vulnerable — nursing home staff and residents.
Part of this slow start could be due to the delays in getting doses to providers. But some of the problems with the rollout were to be expected. Barring the arrival of some virulent new variant, wouldn’t we have done better to focus our limited resources on the oldest and most at-risk?
That’s the logic most other countries have adopted, following the recommendations of the World Health Organization: offering boosters to those at risk of severe disease but being prepared to re-vaccinate the broader population if a much more dangerous variant emerges.
That would be a better approach than the CDC’s policy, which runs the risk of squandering money and public trust on a broad vaccination campaign that isn’t really necessary. That approach will put the U.S. on the back foot if a more virulent form of the virus does evolve.
COVID Antiviral Paxlovid to See Price Increase Following 400% Vaccine Hike
After raising the price of COVID-19 vaccines more than fourfold this year, Pfizer CEO Albert Bourla told investors Monday that the company will also likely hike the price of its lifesaving COVID-19 antiviral treatment, Paxlovid, raising further concern about access and healthcare costs.
The price of the drug is already $530 for a treatment course. That’s what the U.S. government paid for the drug in the emergency phase of the pandemic. But, as the drug moves from government distribution to the commercial market this year, the price is expected to increase. So far, it’s unclear what the new price will be.
In a company investor call Monday, Bourla said only that the “pandemic price” of $530 is likely to be “lesser” than the commercial price and that negotiations are beginning. One financial analyst who follows the company, Evercore ISI’s Umer Raffat, told CNN that the price could go up roughly three- to fivefold, to as much as $2,500 per course.
U.S. Halts Collection on Some Past-Due COVID Loans, Sparking Federal Probes
The U.S. government has halted some efforts to collect an estimated $62 billion in past-due pandemic loans made to small businesses, concluding that aggressive attempts to recover the money — a portion of which may have been lost to fraud — could cost more than simply writing off the debt.
The Small Business Administration, which manages the program, adopted the policy last April, prompting the agency’s watchdogs to compute the potential losses in a September report that found the practice “risks” violating federal law. The internal directive since then has sparked an outcry on Capitol Hill, where House Republicans on Wednesday opened an investigation and joined their Senate GOP counterparts in demanding documents from the SBA.
At the height of the coronavirus pandemic, Congress created the COVID-19 Economic Injury Disaster Loan program, known as EIDL, which provided low-interest loans to cash-starved companies. From 2020 until it stopped accepting new applications in May 2022, the initiative disbursed roughly $380 billion to help firms stay afloat and maintain their payrolls amid the worst economic crisis since the Great Depression.
Unlike other pandemic-era programs, Congress required EIDL borrowers to pay back their loans, and some quickly appeared to fall behind: By March, the inspector general for the SBA projected that a subset of loans totaling about $62 billion were up to 30 days past due, or delinquent for longer and that the number would probably grow.
COVID Relief Payments Triggered Feds to Demand Money Back From Social Security Recipients
As the nation reeled from COVID-19, the federal government sent many Americans a financial lifeline. But some recipients say the COVID relief payments have triggered financial distress by jeopardizing their Social Security benefits.
The government has demanded they repay much larger amounts — thousands of dollars in benefits for the poor and disabled distributed by the Social Security Administration.
“The government gave this money to them with one hand. They should not be trying to take it back with the other,” said Jen Burdick, an attorney at Community Legal Services of Philadelphia who has helped many people contest repayment demands.
The COVID clawbacks show the trauma the Social Security Administration can cause when it claims to have overpaid beneficiaries, many of them highly vulnerable, and then calls on them to pay the money back. And the collection efforts illustrate the limitations and dysfunction that have come to define the agency.
Serotonin Levels Are Depleted in Long COVID Patients, Study Says, Pointing to a Potential Cause for ‘Brain Fog’
If you’ve been following the mystery of long COVID since it emerged in 2020, you’ll recall interferons and serotonin have been clues from the start as combatants in the body’s prolonged battles against the virus. Theories about why symptoms persist long after the acute infection has cleared often point to two suspects: viral reservoirs where SARS-CoV-2 lingers and inflammation sparked by the infection that doesn’t subside.
New research published on Monday in Cell implicates both interferons and serotonin in long COVID in a way that brings together those hypotheses and could also explain “brain fog,” or the neurocognitive difficulties people endure. A team led by researchers from the University of Pennsylvania concludes that when long COVID depletes peripheral serotonin — the kind that circulates in our bodies and not just the brain — that deficit impairs memory and other brain functions. The authors hope further research will lead to testing potential treatments.
The mechanisms are also linked to excessive blood clotting and autonomic dysfunction, in which the nervous system can’t control processes like heart rate or blood pressure. “We found that it’s really across the board that these decreases of serotonin are noted, so it’s not only in those with neurocognitive effects but also with pulmonary effects and cardiovascular dysfunction,” Benjamin Abramoff, director of Penn Medicine’s Post-COVID Assessment and Recovery Clinic and a study co-author, said. “It seems to be a universal phenomenon.”
The research rests on an analysis of metabolites in the blood that compared people with long COVID to people who recovered completely, as well as animal models recreating infection and viral persistence. Serotonin levels were markedly lower in long COVID patients, likely driven by elevated interferon levels. Some long COVID patients still had some virus in stool samples, indicating reservoirs in their gastrointestinal tracts. That’s where interferons, proteins released by the immune system to fight the virus, set off inflammation that cuts down levels of a serotonin precursor, the amino acid tryptophan.
Mixed Signals for Paxlovid and Long COVID Risk in CDC Study — Antiviral Protected Older At-Risk Patients, but Appeared to Increase Risk in Teens
Use of nirmatrelvir-ritonavir (Paxlovid) during the acute phase of COVID-19 appeared to significantly reduce the risk of post-COVID conditions (PCCs) in older adults at high risk for severe disease but may have increased the risk in adolescents, according to a large case-control study from the CDC.
In adults ages 50 and up, the risk of PCCs was lower among those who received nirmatrelvir-ritonavir, with relative risks (RRs) of one or more PCCs of 0.91 (95% CI 0.91-0.92) and two or more PCCs of 0.86 (95% CI 0.85-0.87), reported Alexandra Dalton, Ph.D., of the CDC’s Coronavirus and Other Respiratory Viruses Division, during a late-breaking abstract session at the IDWeek annual meeting.
However, in adolescents ages 12 to 17, the overall risk of PCCs in those who received the antiviral was significant for one or more PCCs, including hypertension, asthma, and type 2 diabetes, but not significant for two or more PCCs.
For adults ages 18 to 49, the use of nirmatrelvir-ritonavir appeared neutral with regard to PCC risks, with some variation. Dalton pointed to a slightly increased risk of asthma, but a decreased risk of thromboembolic events.
Why Do Infants Seem to Avoid Severe COVID?
With COVID-19 rates rising around the country, and an updated vaccine now available, researchers are still trying to understand how immunity to COVID-19 works, and the best ways to build and sustain it.
One of the possibly richest areas of research might be infections among the very young, who tend to be spared from more serious COVID-19 disease. Hospitalization rates for infants four years old or under dropped to under 1 per 100,000 earlier this year, and have recently inched up slightly to 2 per 100,000 in the middle of September, compared to rates for people over 65 years old, which hit a low of 6 per 100,000 earlier this year and climbed up to 17.6 in September.
In a study published recently in the journal Cell, researchers led by Bali Pulendran, a professor of pathology, microbiology, and immunology at Stanford University School of Medicine, report some key differences in how infants and adults experience COVID-19 infections, which could lead to new ways of generating stronger and more durable immunity in the future.
“We hadn’t expected to see this in infants. When adults get infected, they see an increase in the antibody response in the months following the infection, and then a sharp decay in that level. But in the babies, we didn’t see that happening. In fact, in some babies, the antibodies kept rising, and in others they plateaued, but they did not decline,” says Pulendran.
The scientists also discovered another key difference in the way babies responded to the COVID-19 virus. While adults develop a strong inflammatory response in the blood soon after infection, as the virus triggers a flood of cytokines and other compounds that can cause complications associated with serious COVID-19 disease, infants did not develop this same reaction in the blood. In fact, in their blood, levels of these inflammatory markers did not increase appreciably.
New Pill Helps COVID Smell and Taste Loss Fade Quickly
New clinical trial data suggest that an antiviral pill called ensitrelvir shortens the duration of two unpleasant symptoms of COVID-19: loss of smell and taste. The medication is among the first to alleviate these effects and, unlike other COVID-19 treatments, is not reserved only for people at high risk of severe illness.
Early in the pandemic, roughly 40–50% of people with COVID-19 experienced impaired smell or taste. The antiviral drug molnupiravir speeds recovery of these senses, but generally, only the most vulnerable people can take it.
That is not true for ensitrelvir. In Japan, where it received emergency approval last year, the drug is available to individuals with mild to moderate symptoms, regardless of their risk factors. Its developer, Shionogi in Osaka, Japan, is continuing to conduct clinical trials of the drug, which has not yet been approved outside Japan.
COVID Infection Can Damage the Brains of Dogs, Study Suggests
Dogs experimentally infected with the SARS-CoV-2 Delta variant but not showing neurologic or respiratory signs of COVID-19 had evidence of degenerative brain disease on necropsy.
The study, led by Konkuk University researchers in South Korea, was published late last week in Emerging Infectious Diseases. The research team intranasally infected six female beagle dogs with the SARS-CoV-2 Delta virus. The six dogs shared cages with six dogs that weren’t experimentally infected. Three uninfected dogs inoculated with a placebo served as controls.
Antibodies were detected in the blood of infected dogs as early as 4 days postinfection. No significant changes in body weight or temperature were observed, and none of the dogs showed neurologic or respiratory signs of COVID-19.
SARS-CoV-2 DNA was detected in the brain at weeks 10, 12, and 14 postinfection only. Infected dogs exhibited abnormal changes to the blood-brain barrier (BBB), primarily at weeks 38, 40, and 42 days. Necropsies at all time points uncovered evidence that the virus had severely damaged BBB cells and crossed the BBB.
