Check back often as we continue to post timely updates on COVID-19.
Tackling the pandemic unexpectedly boosted many hospitalists’ careers. Read: Women hospitalists and the pandemic and learn about their struggles, opportunities and achievements.
September 15, 2023
Rising covid hospitalizations, looming tripledemic signs of new normal
While the news has been focused on the approval of new covid vaccines from Moderna and Pfizer, hospitals have been wondering what the fall will bring as hospitalizations from the virus continue their summer-long rise and flu season is right around the corner. A CDC report noted that last week marked the seventh week in a row that covid hospitalizations had risen, with admissions jumping 16% over the previous week. But public health officials aren’t worried, noting that while there were 17,400 new covid admissions in the last week of August this year, that number was 37,000 a year ago and 86,000 two years ago. Looking ahead, one report predicted that the “tripledemic” will likely peak in the U.S. in January with about 57,000 cases of covid, flu and RSV per week. Analysts, however, noted that number will be lower than last year’s peak of 80,000 cases per week. And while public health experts are reassuring the public that the country is adopting to a “new normal” and is not headed back to lockdowns and other restrictive measures, some politicians are warning that Democrats are bringing back covid mandates.
August 25, 2023
Is mandatory masking coming back to hospitals?
As covid hospitalizations have continued a steady increase through the summer, hospitals are talking about bringing back masks. An Annals of Internal Medicine opinion piece, for example, called for hospitals to consider the health of their high-risk patients and health care workers and create some kind of policy on masks. The authors said that because covid can spread so frequently by asymptomatic and presymptomatic individuals, and because cases are on the rise, hospitals need to apply “lessons learned from the pandemic into health care precautions and policies.” A Becker’s Clinical Leadership report noted that at least three hospitals in New York state and a health system in California reinstated mask mandates this month. Other systems are revisiting their masking regulations, particularly for units that treat immunocompromised and high-risk patients. The CDC dropped its universal masking guideline in September 2022.
Vaccines look effective against new variants, won’t be available for weeks
The uptick in covid hospitalizations is leading to more focus on vaccines. An Axios report said that covid manufacturers are predicting that their vaccines will offer protection against the EG.5 (Eris) variant and the Fornax variant, but the boosters are likely weeks away from being available for patients. A Politico report said that the Biden administration is working with retail pharmacies to get free vaccines to the uninsured in mid-September instead of October, as officials had previously promised. Data show that only about 17% of Americans got last year’s covid booster. Finally, a report in The Hill said that new polling data found that one-third of adults believe that covid vaccines caused thousands of sudden deaths.
August 18, 2023
Who were the doctors promoting covid misinformation online?
A report in JAMA Network Open looked at a group of 52 physicians from 28 specialties that used social media to spread misinformation and disinformation about the pandemic. Nearly one-third were affiliated with groups like America’s Frontline Doctors that the researchers said had a history of spreading medical misinformation. Claims that vaccines were unsafe were the most common and posted by 81% of the physicians. They also spread messages arguing that social distancing didn’t stop the spread of covid and promoted unapproved medications to prevent or treat covid. A Healthcare Dive article said that the most common social media platform used by the group was Twitter (now X), where physicians reached a median of nearly 65,000 followers with a single post. Medical boards have begun to punish some physicians for spreading disinformation about covid. A story on our site looks at several instances in which physicians are being sanctioned—and how some physicians are trying to fight back.
August 7, 2023
Amid rising covid hospitalizations, public health experts are confident
Covid hospitalizations are up, but public health officials don’t seem too worried. A Politico story said that even though covid hospitalizations have risen just over 10% in the last month or so, experts remain confident that the U.S. can manage the virus. One public health source explained that the uptick reflects “the new normal.” Another pointed out that the number of covid hospitalizations is near the all-time low and that unlike in the past, there’s no variant showing explosive growth. In addition, a large number of Americans have some protection from previous infections or vaccinations. A New York Times report noted that wastewater monitoring reports say the largest increases in covid positivity are in the Northeast and the South; the West and Midwest are showing the next highest levels. Test positivity is coming in at just under 8%, which is about the same level as the country saw in November of 2021, just before the rise of the Delta variant. Finally, the American College of Physicians last month released a policy paper recommending 13 pandemic preparations. A HealthLeaders story said those preparations include improving the health care supply chain and creating a comprehensive pandemic preparedness plan that is funded by Congress.
June 4, 2023
Long covid has become “disability roulette”
The CDC reports that the number of covid hospitalizations in the U.S. has hit a record low, falling below 9,000 weekly admissions for the first time since the CDC began tracking covid hospitalizations in mid-2020. But an editorial in the Boston Globe on long covid is titled “Americans play disability roulette,” and it makes this point: “No longer a mass death event, COVID-19 is an ongoing mass disability event,” with one in 10 Americans who become infected with covid experiencing some long-term condition. Research on Swiss patients published in The BMJ indicates that up to 18% of those who weren’t vaccinated before becoming infected have long-term symptoms post-infection for up to two years. And in NIH-funded research published by JAMA Network, the authors narrowed 37 long covid symptoms down to just 12—the first step, they say, in defining the syndrome and figuring out how best to treat it.
May 22, 2023
Did covid create universal care for one disease state?
While there’s been a lot of talk about what the end of the public health emergency for covid means for patient care, there’s a growing recognition that the pandemic changed how health care was financed, albeit briefly and only for covid. According to Healthcare Dive, the CDC reported that the uninsured rate fell 18% during the pandemic, largely because lawmakers opened up federal health plans and subsidized marketplaces. A record 16.3 million Americans signed up for ACA marketplace plans for 2023 enrollments, and enrollment in Medicaid and CHIP programs jumped. A New York Times report concluded that a “U.S. experiment on single-payer care just ended,” saying that the approach to financing covid care resembled proposals for Medicare-for-all plans suggested by advocates of universal coverage. The federal government covered vaccines and drugs for covid, and it required insurers to pay for testing. And when people didn’t have insurance, the government covered testing costs for them. A KFF Health News report found that the end of the public health emergency may have produced an unintended consequence: scammers billing Medicare for unsolicited covid tests for seniors. The HHS Office of Inspector General is getting complaints from around the country of unsolicited tests being billed to Medicare, likely through stolen Medicare numbers. One source said that a Medicare number is more valuable than a credit card or Social Security number because it can be used to buy such a wide range of products and services.
May 5, 2023
Feds end vax requirement for health workers, tracking efforts
The Biden administration announced that the covid vaccination requirement for health care facilities that do business with Medicare is coming to an end. While officials didn’t give a date for the end of the requirement, which was rolled out in November 2021, the public health emergency for covid expires on May 11. In related news, the CDC announced last week that it will stop tracking the spread of the virus in communities. The agency will instead track covid by looking at hospitalizations of people with the virus. The CDC is expected to announce a new tracking system in the coming weeks.
April 23, 2023
Experts: It’s OK to drop universal masking in health care settings
In a new Annals commentary, eight infectious disease specialists and epidemiologists say that it’s time to end mask mandates in health care settings, at least for now. While the authors say that the use of universal masking tamped down transmission and helped protect health care workers, continuing to do so while covid is endemic has certain costs, including impeding communication and contributing to a sense of isolation. Instead, health care personnel should continue to use masks and eye protection with any activities that generate face splashes or sprays, regardless of patient symptoms, while patients with symptoms should be masked. In other covid news, the CDC has signed off on a second bivalent booster for those who are 65 or older and for immunocompromised patients. And the HHS has announced a $1.1 billion program to provide free covid vaccines and treatments to uninsured patients.
April 15, 2023
It’s official! The pandemic is over
Or at least the national covid emergency has ended although the public health emergency will continue until May. This week, President Biden signed a Congressional resolution bringing to an end the national emergency that for more than three years allowed the federal government to take broad steps to respond to the pandemic and shore up the economy. Because many states and federal agencies have already begun unwinding pandemic-era rules and waivers, analysts say the impact of the national emergency coming to an end should be limited. Last year, legislators extended for two years waivers that allowed for the dramatic expansion and payment of telemedicine services. Medscape coverage points out that the HHS stopped updating its covid site in February and that national covid tracking sites and large testing labs have closed down. Public health experts disagree about whether more continuous monitoring should be kept in place.
April 7, 2023
Which states had the highest covid mortality?
A new report in The Lancet looking at covid mortality by state populations finds that Hawaii (147 deaths per 100,000) and New Hampshire (215 per 100,000) had the lowest covid mortality rates. At the other end of the spectrum with the highest death rates were Arizona (581 per 100,000), Washington, D.C. (526 per 100,000) and New Mexico (521 per 100,000). According to the analysis, states with lower poverty rates and higher education rates had lower covid mortality, while states with larger percentages of Blacks and Hispanics in their population were associated with higher cumulative death rates. While the political affiliation of state governors was not associated with lower covid infection or mortality, higher employment in a state translated to a statistically greater number of infections and deaths. On average, every 1% increase in employment rates was associated with close to 1,600 more covid infections per 10,000. In related news, data published this week by VA researchers in JAMA compare the risk of dying in patients hospitalized with covid this winter vs. that risk for patients hospitalized with the flu. Their findings: In the 2022-23 winter, 5.9% of hospitalized covid patients died vs 3.7% in the flu group. That translates to a 60% higher risk of death in hospitalized patients with covid than with flu.
March 25, 2023
What will change in health care as the pandemic winds down?
With the White House poised to end the public health emergency in May, U.S. health care is looking ahead at what will change. A HealthLeaders report said that nursing homes will likely have to meet higher standards for training, and Medicare will put more limits on the care provided by NPs and PAs. Another change is that costs for covid vaccines, at least from Moderna, are going to explode. The company plans to raise its price from $26 to $130 per dose, a move that Democrats say is unconscionable because the vaccine was developed with nearly $2 billion in taxpayer money. Moderna CEO Stephane Bancel told a Senate committee this week that the price hike was justified in part because the company was losing lucrative contracts with the U.S. government. The volume of those contracts, Bancel said, allowed Moderna to charge less per dose.
What can we learn from looking at early days of the pandemic?
When it comes to the pandemic, not everyone is looking ahead. That was clear from several stories in the news this week. The White House, for example, signed into law a bill that will declassify information on the origins of covid. While analysts say the White House hopes the move shows there is no strong evidence that the virus was a lab creation, politicians are fishing for data that show the virus was manmade. For the first time, scientists this week released detailed data they say helps make the case that covid was spread by illegally traded wild animals. (Think raccoon dogs.) And in a nod to the challenges that public health officials faced during the pandemic, the New York Times published a report looking at the chaos and despair that permeated the CDC during the early days of the pandemic. Agency officials described struggling as they were pressured by political operators to downplay the pandemic and avoid issuing guidance that could have saved lives. Also this week, PBS aired a documentary on Antony Fauci, MD, that looks back at his 40-plus-year “career of crises,” including his handling of covid.
March 17, 2023
A new push to identify the origins of covid
Interest in the origins of covid appears to be on the upswing. Congress this week sent a bill to the White House requiring the U.S. to declassify intel its agencies have on the origins of covid. The bill was passed by all House members who were in attendance. It also passed the Senate unanimously. Also this week, the Director-General of the World Health Organization said that identifying the origins of covid is a “moral imperative.” The WHO spent three weeks in China in 2021 trying to track down covid’s origins, but it ended its investigation by concluding that more information is needed. China, however, has ruled that there is no need for any further visits from investigators. Interest in covid’s origins may have something to do with the Energy Department’s announcement a few weeks ago that “confirmed” a classified report that covid had escaped from a lab. Multiple other U.S. government agencies have come to a different conclusion, but the Energy Department report received significant attention. Finally, a new report released yesterday said researchers have found genetic evidence that covid may have crossed over to humans through “racoon dogs” being sold at a Wuhan market. Chinese authorities closed the market where the dogs had been sold to stop the spread of the virus, but researchers were able to collect genetic material by swabbing floors, walls and empty cages.
March 12, 2023
States look at loosening pandemic regs in health care settings
As states plan to lift covid rules in health care settings, several are looking at dropping masking and vaccination requirements. A Becker’s Hospital Review report noted that Oregon and Washington state officials have announced that they plan to lift masking requirements in health care facilities. California plans to drop those requirements in early April. The California Nurses Association is unhappy about the state’s plan to relax masking and vaccine requirements, warning that it will ultimately exacerbate the workforce shortage plaguing health care. A MedPage Today report said that a notable exception to the relaxing of pandemic regulations is the city of San Francisco, which will continue to require masks and vaccinations for health care workers. City health officials ended the public health emergency and rescinded most pandemic restrictions for the general population, however, in part because of the high vaccination rates among residents.
Florida hospital receives death threats over pandemic care report
Not everyone is ready to move on from the pandemic. Becker’s Hospital Review reported that after three “medical freedom” candidates were elected to the board of Florida’s Sarasota Memorial Hospital, the board demanded that the hospital investigate the care of covid patients. In part, board members wanted to know why therapies like ivermectin were not more widely used to treat covid. When a 70-person panel concluded that the hospital “performed strongly” during the pandemic and its care helped covid patients recover, staff began receiving abusive messages that included death threats. Hospital officials said that most of the commenters are from outside of the state. Retired Lt. Gen. Michael Flynn, the Trump administration’s first national security advisor, attended the board meeting. He weighed in by saying that the investigation was akin to letting a “fox inside the henhouse.” In related news, if patients want a prescription for ivermectin or hydroxychloroquine to help with their covid, they need look no farther than Stella Immanuel, MD, another controversial figure associated with the former president. A MedPage Today report found that in 2021, Dr. Immanuel wrote more than 69,000 scripts for hydroxychloroquine and 32,000 scripts for ivermectin. By comparison, rheumatologists prescribing hydroxychloroquine for autoimmune diseases write an average of about 561 scripts for the drug a year. One physician interviewed for the report said that giving patients a drug with zero benefits and the potential for harm “verges on malpractice.”
March 5, 2023
New data revive controversial theories about covid
Several recent reports have breathed new life into some of the most controversial theories about covid more than three years after the pandemic began. News reports this week indicated that the Energy Department had confirmed that a classified report determined that covid had escaped from a lab. Officials acknowledged that they had “low confidence” in the evidence used to support that conclusion, and analysts pointed out that multiple other agencies have a different view of the pandemic’s origins, but the announcement reinvigorated anti-maskers and anti-vaxxers. One news article said that covid skeptics are seeing the report as evidence that they were right all along and that mainstream science can’t be trusted. The Energy Department report came on the heels of a meta-analysis looking at mask mandates from the well-respected Cochrane Library in late January. That analysis found insufficient evidence that masking reduces viral infections at the population level, but analysts noted that the data weren’t clear cut. And while the study conceded that “there is uncertainty about the effects of face masks,” anti-maskers and anti-vaxxers touted it as irrefutable evidence that masking is completely ineffective—and that scientists and physicians had gotten everything about the pandemic wrong. Finally, a physician group pushing another discredited theory—using ivermectin to treat covid—has found a new angle for the drug: treating the flu and RSV. While the CDC says there are no clinical data from humans to support using ivermectin to treat these infections, the Front Line Covid-19 Critical Care Alliance is offering “treatment protocols” to support using ivermectin for not only covid, but the flu and RSV. The group says that to date, its “protocols” have been downloaded more than a million times.
February 24, 2023
New covid infection? Expect 10 months of immunity
A meta-analysis that looks at the protection conferred by covid infections finds that most patients have a strong immunity to reinfection (as well as to symptomatic disease and severe disease) for at least 10 months. The analysis, which appears in The Lancet, looked at 65 studies that contained data from 19 countries. The authors found that patients infected with an earlier strain than omicron had lower immunity to omicron in terms of reinfection and symptomatic disease (less than 55%) but protection against severe disease from the omicron variant remained high. “(T)he level of protection” from past infection, the authors wrote, “appears to be at least as durable, if not more so, than that provided by two-dose vaccination with the mRNA vaccines.”
February 17, 2023
Looking for a softer landing as covid emergency ends
With the covid public health emergency set to end in May, providers are getting a handle on which telehealth and other health care waivers and exemptions will continue and which may be over. Congress has extended through 2024 some waivers issued during the emergency period, including the one for Medicare’s hospital at home program. But payment parity for telehealth services for Medicare patients is expected to end as will the waiver allowing providers to prescribe controlled substances without an in-person visit. Axios reports that a recent analysis found providers are particularly worried about ending the waiver that allows Medicare patients to be eligible for SNF services without a three-day hospitalization, which has been credited with shorter acute care stays. It remains to be seen if Congress over the next several weeks will target measures to extend more waivers. Speaking of endings: R.I.P. to the Johns Hopkins covid dashboard, which is ceasing operations on March 10. The influential tracker, which debuted March 3, 2020, helped inform public health and business decisions and has garnered more than 2.5 billion views.
February 10, 2023
Covid hospitalizations drop while a new antiviral shows promise
It’s been a tough winter with close to 40% of American households over the holidays affected by one of several viruses. According to a Medscape write-up, survey results indicate that 27% of households had someone sick with the flu while one in 10 households had someone sick with covid or RSV. Now, covid admissions continue to fall while flu positivity is also in decline. Orthrus may be the next covid variant of concern, one that already accounts for about one-fourth of all new cases in the U.K. (In the U.S., that variant caused fewer than 2% of new cases in January.) On the bright side, a new antiviral is showing promise in cutting covid hospitalizations. Scientific American reports that one injection of pegylated interferon lambda given to patients within seven days of developing covid symptoms cut their risk of being hospitalized or having to go to an ED by 51%. As for excess mortality due to covid, a JAMA Internal Medicine research letter finds that American physicians suffered 622 more deaths than expected between March 2020 and December 2021—although doctors had substantially lower level of excess mortality than the general population.
February 3, 2023
The covid health emergency will end this spring
The Biden administration announced this week that the national and public health emergencies declared for covid will end May 11. According to STAT, that means that the federal response to covid going forward will be handled through normal agencies and channels. As for fallout to ending the public health emergency, covid vaccine prices may soar as high as $130 a dose once vaccines purchased by the federal government run out. In addition, at-home covid tests will no longer be free and hospitals will no longer be paid extra for treating Medicare patients with covid. AP reports that many Americans (estimated at between 5 million and 15 million) may lose Medicaid coverage, although many should be eligible for low-cost ACA plans. Another big pandemic-era benefit is ending even sooner: The Washington Post writes that some SNAP (Supplemental Nutrition Assistance Program) benefits, which were expanded during the pandemic, will expire in March. Benefit advocates say that paring those benefits back will put participants, particularly seniors, at higher risk of food insecurity and translate to a loss of as much as $3 billion in food purchases.
January 28, 2023
Tripledemic threat wanes but covid deaths remain high
The threat of a tripledemic—covid, flu and RSV—peaked in early December, with both hospitalizations and ED visits for each of those conditions declining before the end of the year. According to the latest CDC figures, flu activity continues to fall, with this year’s flu season producing 25 million cases, 270,000 hospitalizations and 17,000 deaths so far. But experts warn that flu seasons often have two peaks and that the XBB.1.5 covid subvariant, a highly transmissible strain now dominant in the Northeast, may spread throughout the country. Meanwhile, the New York Times reports that the covid death rate in the U.S. continues to top 500 per day. Preliminary data suggest that covid was the third leading cause of death (behind heart disease and cancer) in 2022 for the third year in a row. And a new JAMA Network Open research letter points out that as many as 80% of the results of home covid tests aren’t publicly reported.
Pandemic survey: 55% of emergency workers report trauma symptoms
While results of a survey conducted in early 2021 found that 5.5% of health workers surveyed met criteria for probable post-traumatic stress disorder, a much larger group—55%—had subthreshold PTSD symptoms. Those symptoms, according to the study, put the workers experiencing them at higher risk of health and sleep problems. The authors surveyed members of emergency departments affiliated with the University of Pittsburgh Medical Center as well as members of EMS agencies in several states. Among all the job categories surveyed, doctors and APPs reported the fewest physical health problems, while nurses and patient support staff reported the most sleep problems. HealthLeaders reports that nurses and patient support staff were also more likely to report subthreshold PTSD symptoms than ambulance workers and those in transport services. The study was printed in the Journal of Psychiatric Research.
January 20, 2023
XBB grows (again) in the U.S., more clues about long covid
As XBB.1.1.5 last week grew to account for nearly half of covid cases in the U.S., a Lancet study concludes that hybrid immunity—a combination of vaccination and previous infection—offers the greatest protection, and might allow those people to extend the intervals between boosters. There was some good news in an analysis of China’s wave of covid that suggested the infection has probably peaked, but researchers say that a lack of data makes it impossible to say that with certainty. But there was less good news in a preprint that found certain socioeconomic and demographic factors make people more likely to suffer from long covid. Put simply, long covid was linked to people who were recently unemployed, experiencing financial hardship and feeling anxious and depressed. Even worse, another study found that pregnant women are seven times more likely to die from covid and three times more likely to be rushed to the ED compared to uninfected pregnant women. And in related news, more than a year after New York State began requiring that health care workers be vaccinated, a state Supreme Court judge struck down the mandate. A Becker’s Hospital Review article said the judge ruled that the state’s governor and department of health overstepped their authority because the covid vaccine is not included in the state’s public health law.
January 14, 2023
Doc harassed for fake tweet about covid vaccines posted in her name
A Miami critical care physician found herself in the crosshairs of the antivaxxer community after someone published a fake tweet in her name. Natalia Solenkova, MD, had built a Twitter following of 30,000 by talking about covid and her work in underserved areas. That following may be why someone released this tweet in her name: “I will never regret the vaccine. Even if it turns out I injected actual poison and have only days to live. My heart is and was in the right place. I got vaccinated out of love, while antivaxxers did everything out of hate. If I have to die because of my love for the world, then so be it. But I will never regret or apologize for it.” A CNBC report says that one clue that the tweet was a fake was that it was 53 characters over Twitter’s 280-character limit. That didn’t stop antivaxxers from flooding Solenkova. It also didn’t stop podcasters like Joe Rogan from talking about it. (When Rogan found out it was fake, he apologized for discussing it.) One analyst said the episode may point out the desperation of antivaxxers to have something or someone to demonize.
XBB.1.5 surges and warnings about Evusheld, further spread
As RSV and the flu show signs of fading, the XBB.1.5 strain of covid is continuing to spread “like a rocket” in some parts of the country. The FDA is warning that Evusheld may not be able to neutralize XBB.1.5 but notes that it is waiting on more information. The WHO is urging travelers to wear masks, to prevent the spread of the variant, and a growing number of U.S. schools are bringing back mask mandates. ID physicians are warning that the new variant is so contagious that both people who have and haven’t had covid will likely become infected. In an op-ed in The Washington Post, Eric Topol, MD, warns that public health agencies should be reinvesting in new vaccines to combat the variant. A new BMJ study found that for most mild infections, symptoms of long covid cleared after a year. A STAT article quotes the researchers as saying they were surprised that most symptoms cleared in that time frame.
January 6, 2023
As XBB.1.5 dominates U.S., public health emergency will continue
With the Omicron subvariant XBB.1.5 estimated to account for 40% of cases of covid in the U.S. and up to 75% of cases in the Northeast, public health authorities are warning of a winter surge that could rival the spike seen over the summer. Experts are also keeping an eye on the outbreak in China, although reliable information is hard to find. While the Chinese government has protested the testing of Chinese citizens travelling abroad as not based on science, news reports from Italy say that half of arrivals from two recent flights from China tested positive. And back in the U.S., the federal government is expected to continue the public health emergency past Jan. 11. Extending the emergency for a 12th time will allow the government to continue to pay for covid tests, vaccines and treatments. When the emergency is rescinded, therapies like Paxlovid will no longer be free. Some say that will cause sticker shock among health care providers and patients alike.
Covid misinformation is hanging on as stubbornly as the virus itself
Covid isn’t the only thing that won’t go away. Neither, apparently, will misinformation and disinformation about the virus. A New York Times report said that Twitter’s decision to cut processes responsible for reining in inaccurate and dangerous information is contributing to the spread of covid misinformation. Between Nov. 1 and Dec. 5 of last year, researchers gathered more than 500,000 English-language tweets containing phrases like “deep state,” “hoax” and “bioweapon” that had more than 1.6 million lies and 580,000 retweets. A Kaiser Health News report looks at how covid misinformation has possibly hurt other public health efforts, like pediatric flu vaccines (down 3.7%) and flu vaccines in pregnant women (down 18%). And for a final example of the ridiculousness of covid misinformation, consider the flood of tweets that tried to link the cardiac arrest a Buffalo Bills player suffered on the field—and on live TV—earlier this week. A Washington Post article says that “anti-vaxxers and right-wing provocateurs” tried to blame the injury on the covid vaccine. A long-running narrative has said that “hundreds” of pro athletes have dropped dead on playing fields because they got a covid vaccine.
Today’s Hospitalist has been reporting on covid-19 since January 2020. Click here for earlier updates.
