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Why are so many people getting Covid now? Can I get infected again? What’s this new variant BA.5, and is it worse than the Omicron variant?
BA.5 is an offshoot of the Omicron variant that’s now the dominant strain in the US, according to the Centers for Disease Control and Prevention.
Like previously dominant strains, BA.5 has mutations that have allowed it to spread easily and quickly overtake other variants. Specifically, BA.5 has three mutations in its spike protein that make it better at infecting cells and better at slipping past immune defenses.
It’s too early to know whether BA.5 and another strain, BA.4, cause more severe illness than other Omicron subvariants, CDC Director Dr. Rochelle Walensky said July 12.
“But we do know it to be more transmissible and more immune-evading,” Walensky said. “People with prior infection, even with BA.1 and BA.2, are likely still at risk for BA.4 or BA.5.”
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Can I use an expired at-home rapid antigen test? Why did the expiration dates for some at-home tests change?
The reason at-home antigen tests expire is because Covid-19 test components “may degrade, or break down, over time,” the US Food and Drug Administration says.
“Because of this, expired test kits could provide inaccurate test results.”
But the expiration dates for some at-home Covid-19 tests have been extended. That’s because when at-home antigen tests first hit the market, manufacturers only had several months of data as to how long the tests would work effectively.
“When the tests were first given the green light, when they were approved by the Food and Drug Administration, one of the things that the FDA asked the test developers to do is say, ‘OK, if I have the test at home and I have them on the shelf or on my bookshelf, for how long will they still be accurate?’” said Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center.
“Of course, in the beginning when the tests were first developed, the manufacturers waited let’s say 3 months or 6 months, and then they went to the Food and Drug Administration and said, ‘Here is the data,’” Schaffner said.
“Once the test manufacturer has more stability testing results, such as 12 or 18 months, the test manufacturer can contact the FDA to request that the FDA authorize a longer expiration date. When a longer expiration date is authorized, the test manufacturer may send a notice to customers to provide the new authorized expiration date, so the customers know how long they can use the tests they already have.”
Those wondering whether the expiration dates of their at-home tests have been extended can contact the manufacturer or visit its website.
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I just tested positive for Covid-19. What should I do now?
Much has changed since the beginning of the pandemic, including the emergence of more contagious variants, waning immunity from previous infection and initial vaccine doses, and the need for booster shots (or 2nd booster shots).
What hasn’t changed? The need to isolate immediately if you test positive for Covid-19 — regardless of whether you have symptoms, the US Centers for Disease Control and Prevention said.
“Everyone who has presumed or confirmed COVID-19 should stay home and isolate from other people for at least 5 full days (day 0 is the first day of symptoms or the date of the day of the positive viral test for asymptomatic persons). They should wear a mask when around others at home and in public for an additional 5 days,” the CDC’s website says.
Exactly how long you isolate depends on whether you have symptoms and how long they last. According to the CDC:
As for therapies, “it’s important you call your medical provider and ask if you are eligible for therapeutics,” said emergency physician Dr. Leana Wen, professor of health policy and management at the George Washington University Milken Institute School of Public Health.
For those who don’t have a regular medical provider, “the federal government has a therapeutics locator, including a “test-to-treat” option where people can go to get tested, see an urgent care provider, and get the therapies all at the same location,” Wen said. “Your local and state health departments will likely have additional information and resources, too.”
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Now that kids under age 5 can get vaccinated against Covid-19, where can I find vaccine availability? How many doses should younger children get, and how far apart?
Kids as young as 6 months old can now start getting pediatric doses of the Pfizer/BioNTech vaccine or Moderna vaccine.
Parents can keep track of vaccine availability at vaccines.gov.
The dosages of the vaccines for younger children are a fraction of the dosages for older children and adults.
For kids as young as 6 months old, the US Food and Drug Administration has authorized 3 doses of the Pfizer vaccine or 2 doses of the Moderna vaccine.
With the Pfizer/BioNTech vaccine, the US Centers for Disease Control and Prevention said kids ages 6 months through 4 years should get 3 doses at the following intervals:
With the Moderna vaccine, the CDC said children ages 6 months through 5 years should get their doses at the following intervals:
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Who can get a booster shot now? Are kids eligible for boosters (or 3rd doses of vaccine)? When should we get boosted?
Anyone age 5 and up who got a 2nd dose of the Pfizer/BioNTech vaccine at least 5 months ago can now get a booster shot (or 3rd dose) of vaccine.
The US Food and Drug Administration issued a statement saying 2nd doses of the vaccine eventually wane. The FDA said 3rd doses boosted antibody levels.
Even though Covid-19 tends to be less severe among children, “the omicron wave has seen more kids getting sick with the disease and being hospitalized, and children may also experience longer term effects, even following initially mild disease,” FDA Commissioner Dr. Robert M. Califf said in a written statement.
“Vaccination continues to be the most effective way to prevent COVID-19 and its severe consequences, and it is safe,” Califf said. “If your child is eligible for the Pfizer-BioNTech COVID-19 Vaccine and has not yet received their primary series, getting them vaccinated can help protect them from the potentially severe consequences that can occur, such as hospitalization and death.”
The recommended gap between 2nd doses and booster doses of the Pfizer vaccine has been shortened – from 6 months to 5 months, the US Centers for Disease Control and Prevention announced in January.
Those who got the 2-dose Moderna vaccine should get a booster shot 6 months after the second dose, the CDC said.
And those who got the single-dose Johnson & Johnson vaccine should get a booster shot after 2 months.
For booster shots, you don’t have to get the same brand of vaccine that you got for your initial vaccination. The FDA has said it’s OK to mix and match brands for the booster dose.
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Is it true Covid-19 symptoms can come back after taking Paxlovid?
“There is strong scientific evidence that it reduces the risk of hospitalization and death in patients with mild-to-moderate COVID-19 at high risk for progression to severe disease,” said Dr. John Farley, director of the Office of Infectious Diseases in the FDA’s Center for Drug Evaluation and Research’s Office of New Drugs.
But even doctors are puzzled as to why symptoms can return for some people within two weeks of finishing their Paxlovid. Infectious disease expert Dr. Kent Sepkowitz is one of them. He, too is a “rebounder” whose Covid-19 symptoms improved dramatically after taking Paxlovid, then returned several days later.
Farley said the FDA “is aware of the reports of some patients developing recurrent COVID-19 symptoms after completing a treatment course of Paxlovid. In some of these cases, patients tested negative on a direct SARS-CoV-2 viral test and then tested positive again.”
It’s not clear exactly how often rebound cases happen after taking Paxlovid. As of this spring, a clinical trial of the medication was still ongoing.
In a statement to CNN, Pfizer – the maker of Paxlovid – said that in the clinical trial, a small number of patients in both the group taking placebo pills and the group taking Paxlovid experienced higher viral loads 10 to 14 days after starting treatment compared with their viral loads at day 5.
Because investigators noted this in both groups, Pfizer said it doesn’t believe the phenomenon is tied to the medication. Investigators saw no link between patients’ viral loads and subsequent severe disease.
“We remain confident in its clinical effectiveness at preventing severe outcomes from Covid-19 in high-risk patients,” Pfizer said.
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How well do current booster shots of Covid-19 vaccine work against Omicron? Do I really need a booster shot if I’ve been fully vaccinated?
People who are boosted have more protection against Covid-19 illness and even infection compared to people who are past due for a booster shot — and significantly more protection than those who haven’t been vaccinated at all, studies suggest.
In December 2021, when the Omicron variant became dominant in the US, data from 25 state and local health departments revealed a weekly average of 148.6 Covid-19 cases per 100,000 people who had been fully vaccinated and boosted, according to a study published by the US Centers for Disease Control and Prevention.
Among those who had been fully vaccinated but not yet boosted, the average weekly rate jumped to 254.8 cases per 100,000.
And for those who had not been vaccinated at all, the rate of infection was significantly higher — 725.6 cases per 100,000.
Another study showed booster shots helped prevent people from becoming sick with Omicron.
An analysis of about 13,000 US Omicron cases found that the odds of developing a symptomatic infection were 66% lower for people who had received 3 doses of an mRNA vaccine compared to those who had received only 2 shots, according to a study published in the medical journal JAMA. The gap was even greater between people who had been boosted and those who hadn’t gotten a single dose of vaccine.
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Which vaccine gives the best protection against breakthrough infections?
A CNN analysis of data from the US Centers for Disease Control and Prevention showed the Johnson & Johnson vaccine had the lowest breakthrough infection rate during a 5-week span starting in late December.
In January, during the Omicron surge, breakthrough infections were highest among those who received the Pfizer/BioNTech vaccine, followed by people who got the Moderna vaccine. Those vaccinated with the Johnson & Johnson shot had the lowest incidence of breakthrough infections.
But any vaccine is better than no vaccine at all. During the Delta and Omicron surges, unvaccinated people were more than twice as likely to get infected compared to those who got Pfizer or Moderna shots. And the odds of getting Covid-19 were more than 3 times higher for unvaccinated people compared to those who got the Johnson & Johnson vaccine.
A study published March 17 in the medical journal JAMA Network Open found the Johnson & Johnson vaccine was 76% effective in preventing Covid-19 infections and 81% effective in preventing Covid-related hospitalizations before and during the Delta surge. The study also showed the J&J vaccine provided lasting immunity at least 6 months after vaccination.
So while studies have shown the Pfizer and Moderna mRNA vaccines prompt a powerful immune response, it can wane over time. Johnson & Johnson’s vaccine might not spark as strong of an immune response shortly after vaccination, but it’s known to have greater durability.
“Over time, the efficacy of the Pfizer and Moderna vaccines goes down, the efficacy of the J&J vaccines remains stable,” said Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston.
In December, the CDC recommended the Pfizer and Moderna vaccines over the Johnson & Johnson shot due to data suggesting a rare blood clotting syndrome called TTS is more common among some people who got a J&J vaccine – particularly women ages 30 to 49.
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Is it time to get a 2nd booster shot? Who can get a 4th dose of vaccine now?
The US Food and Drug Administration has authorized second booster shots of the Pfizer/BioNTech and Moderna vaccines for adults age 50 and older.
Even healthy adults ages 50 and up can get the additional dose as early as 4 months after their 1st booster dose of any Covid-19 vaccine. The US Centers for Disease Control and Prevention has given permissive recommendation for those additional boosters, meaning Americans in that age group can get the extra shot if they want one. But it’s not an official recommendation.
As for the rest of the general public, it’s possible a 4th dose might be recommended for healthy Americans heading into the fall, said Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research. But he said there’s still much uncertainty as to how the pandemic may further evolve.
A fall timeline could be convenient for people who want to get their flu shots at the same time. And respiratory viruses such as coronavirus and influenza tend to peak in the colder months.
Since October, the FDA has allowed Americans ages 12 and up who are severely immune-deficient to get 4 doses of the Pfizer/BioNTech or Moderna vaccines.
According to the CDC, people are considered moderately or severely immunocompromised if they have:
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How safe and effective are 2nd booster shots? Are there side effects to getting a 4th dose of vaccine?
A 2nd booster shot (or the 4th overall dose) of the Moderna or Pfizer/BioNTech mRNA vaccines appeared to be safe and gave a “substantial” boost to immunity when given about 7 months after the 1st booster (or the 3rd overall dose), according to a new study published May 9.
“Fourth-dose Covid-19 mRNA booster vaccines are well tolerated and boost cellular and humoral immunity,” UK scientists wrote in the study published in The Lancet.
“Peak responses after the fourth dose were similar to, and possibly better than, peak responses after the third dose.”
The researchers gave study participants a half dose of the Moderna vaccine or a full dose of the Pfizer vaccine in a random selection in January, about 7 months after they received their first booster. The 2nd booster didn’t seem to have any major side effects. The biggest complaints were arm pain and fatigue.
The additional booster also generated an immune response at day 14 that was higher than that at day 28 after the 3rd dose of the Pfizer or Moderna Covid-19 vaccine.
Moderna’s fourth dose seemed to do slightly better than Pfizer’s, but it’s unclear why. Scientists said 4th doses of either vaccine generated what scientists called a “significant fold change” in protective antibodies and also boosted T-cells.
Antibodies are a first line of immune protection that can stop a virus from infecting cells. T-cells come in later and destroy infected cells. T-cells can’t protect against mild infections, but they can keep infections from progressing to severe disease.
The researchers also found that some people who had higher levels of antibodies before their 4th doses of vaccine had only “limited” boosting. Those with a history of Covid-19 had a similar limited response. The authors say this suggests there may be a ceiling or maximum response that can come with a 4th vaccine dose.
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Is the pandemic over yet?
Many Americans were confused when Dr. Anthony Fauci told PBS that the US was “out of the pandemic phase” — but told CNN the next day that the pandemic was not over.
“We don’t have 900,000 new infections a day and tens and tens and tens of thousands of hospitalizations and thousands of deaths,” the director of the National Institute of Allergy and Infectious Diseases told PBS on April 26. “We are at a low level right now. So if you’re saying, ‘Are we out of the pandemic phase in this country?’ We are.”
On April 27, Fauci told CNN the US is still grappling with a pandemic — especially as new Covid-19 cases and hospitalizations have started creeping up again.
“We’re not over the pandemic. Don’t let anybody get the misinterpretation that the pandemic is over,” Fauci told CNN. “But what we are in is a different phase of the pandemic — a phase that’s a transition phase, hopefully headed toward more of a control where you can actually get back to some form of normality without total disruption of society, economically, socially, school-wise, etc.”
Fauci said while coronavirus probably won’t be eradicated, the level of virus in society could be kept very low if people are intermittently vaccinated, possibly every year.
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How long does immunity after a booster shot last? Am I still protected against Omicron?
For people who are up to date on their Covid-19 vaccines and boosters, protection against illness from the Omicron variant drops off several months after the last dose – but protection against hospitalization and death remains high, researchers have found.
When it comes to the Omicron variant, an April 20 presentation from the US Centers for Disease Control and Prevention shows that after 2 to 4 months:
But people with regular immune functions still had about 86% protection against hospitalization 3 months after a booster shot — though protection among immunocompromised people waned more quickly.
When it comes to protection against hospitalization, “We saw no evidence of waning but in the immunocompromised,” said Sara Tartof, an epidemiologist for Kaiser Permanente in Southern California.
“In the immunocompromised, vaccine effectiveness basically starts low and gets lower.”
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I’m confused: Do I still have to wear a mask on planes or other public transportation?
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How protected am I from Covid-19 if I wear a mask in public places but others around me don’t?
While face masks offer the most protection against the spread of virus-carrying particles in the air when everyone wears them, masks can protect the wearer alone, research suggests, by acting as a barrier between particles and their nose and mouth.
One-way masking — when one person is masked and others are not — depends mainly on two factors: how well your mask fits and how effectively the mask material filters out particles that can carry viruses, said Chris Cappa, a professor of civil and environmental engineering at the University of California, Davis who studies aerosol particles and masks.
Masks like N95s and KN95s will generally be more protective than surgical masks or cloth masks because they can make a tighter seal against your face, he told CNN. So, “a well-fit N95 can reduce the amount of potentially infectious particles that you inhale by more than a factor of 20 times,” Cappa said.
In addition to wearing a high-quality, well-fitting mask, taking steps including getting vaccinated, testing yourself for Covid-19 and making sure spaces you’re in are well-ventilated can make it safe for people — even those at higher risk for more severe illness — to travel, said Dr. Preeti Malani, chief health officer in the Division of Infectious Diseases at the University of Michigan in Ann Arbor.
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Do vaccines or monoclonal antibody treatments work against the BA.2 virus?
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Do we still need to wear masks in public? When and where do I still need to mask up indoors?
The answers largely depend on where you live and your health status, according to updated guidance from the US Centers for Disease Control and Prevention.
Previously, indoor masking was recommended for those living in areas with “high” or “substantial” transmission of Covid-19. That meant most Americans lived in counties where indoor masking was recommended.
But on February 25, the CDC released a new set of metrics called COVID-19 Community Levels. “CDC recommends using county COVID-19 Community Levels to help determine which COVID-19 prevention measures to use for individuals and communities,” the agency said.
The metrics include:
The CDC uses those metrics to label communities as high, medium or low. You can see what category your county falls under here.
In areas with “high” levels, the CDC advises wearing a mask in public indoor settings – including schools. In areas with “medium” levels, the CDC advises talking with your doctor about wearing a mask if you’re at increased risk for Covid-19. In areas with “low” Covid-19 community levels, there is no recommendation for mask wearing.
But the guidelines are not rules, and there may be places where masks are still required. And there may be times when additional safety measures are needed, the CDC said.
“Recommendations based on COVID-19 Community Levels may not apply to healthcare settings such as hospitals or long-term care facilities,” the CDC said.
“Some community settings such as schools and some high-risk congregate settings such as correctional facilities and homeless shelters might include additional layers of prevention.”
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Do monoclonal antibody treatments work against Omicron? Are there other therapies that work against the Omicron variant?
The US Food and Drug Administration has limited the use of certain monoclonal antibody treatments for Covid-19 because “data show these treatments are highly unlikely to be active against the omicron variant,” the FDA said.
Those monoclonal antibody treatments include Eli Lilly’s bamlanivimab plus etesevimab and Regeneron’s casirivimab plus imdevimab.
The FDA has decided to limit the use of these treatments for “only when the patient is likely to have been infected with or exposed to a variant that is susceptible to these treatments.”
“Based on Centers for Disease Control and Prevention data, the omicron variant of SARS-CoV-2 is estimated to account for more than 99% of cases in the United States as of Jan. 15. Therefore, it’s highly unlikely that COVID-19 patients seeking care in the U.S. at this time are infected with a variant other than omicron, and these treatments are not authorized to be used at this time,” Dr. Patrizia Cavazzoni, director of the FDA’s Center for Drug Evaluation and Research, said in a January 24 statement.
“This avoids exposing patients to side effects, such as injection site reactions or allergic reactions, which can be potentially serious, from specific treatment agents that are not expected to provide benefit to patients who have been infected with or exposed to the omicron variant.”
Earlier in January, the National Institutes of Health amended its treatment guidelines to no longer recommend those two treatments.
In December, the FDA said sotrovimab was the only monoclonal antibody treatment that remained effective against the new Omicron variant.
However, “there are several other therapies – Paxlovid, sotrovimab, Veklury (remdesivir), and molnupiravir – that are expected to work against the omicron variant, and that are authorized or approved to treat patients with mild-to-moderate COVID-19 who are at high risk for progression to severe disease, including hospitalization or death,” the FDA’s statement said.
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If I can’t get a Covid-19 test right now, how can I tell if I have Covid-19 or flu symptoms?
“Both COVID-19 and flu can have varying degrees of symptoms, ranging from no symptoms (asymptomatic) to severe symptoms,” the US Centers for Disease Control and Prevention says.
But the outcomes can be different. “In general, COVID-19 seems to spread more easily than flu and causes more serious illnesses in some people,” the CDC says. “Compared with people who have flu infections, people who have COVID-19 can take longer to show symptoms and be contagious for longer.”
Covid-19 and the flu can have similar symptoms, such as:
But unlike the flu, Covid-19 can lead to long Covid — with symptoms weeks or months after a coronavirus infection.
“Long COVID can happen to anyone who has had COVID-19, even if their illness was mild, or if they had no symptoms,” the CDC says.
If you think you might have Covid-19 symptoms but can’t get tested, doctors say it’s best to assume you have Covid-19 and stay home.
“While the virus that causes COVID-19 and flu viruses are thought to spread in similar ways, the virus that causes COVID-19 is generally more contagious than flu viruses,” the CDC says.
“Also, COVID-19 has been observed to have more superspreading events than flu. This means the virus that causes COVID-19 can quickly and easily spread to a lot of people and result in continual spreading among people as time progresses.”
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Why can’t some people get an organ transplant unless they’ve been vaccinated? Is this a way to punish people who are unvaccinated?
Some organ transplant centers require patients to be vaccinated against Covid-19 before getting a transplant. But it’s not about punishing the unvaccinated; it’s about trying to maximize the odds of survival.
Organ transplant recipients have an increased risk of severe Covid-19 if they become infected. Patients with organ transplants have their immune systems artificially suppressed during recovery to prevent their bodies from rejecting the new organ. That means adequate vaccination is especially important for organ transplant patients.
“We strongly recommend that all eligible children and adult transplant candidates and recipients be vaccinated with a COVID-19 vaccine that is approved or authorized in their jurisdiction,” said a joint statement from the American Society of Transplant Surgeons, the American Society of Transplantation, and The International Society for Heart & Lung Transplantation.
“We support the development of institutional policies regarding pre-transplant vaccination. We believe that this is in the best interest of the transplant candidate, optimizing their chances of getting through the perioperative and post-transplant periods without severe COVID-19 disease, especially at times of greater infection prevalence.”
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How can I get free face masks?
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Are cloth masks any good anymore? With the more contagious Omicron variant, should I be wearing a cloth mask, surgical mask, KN95 or N95?
The US Centers for Disease Control and Prevention recently updated its mask guidelines, recommending people “wear the most protective mask you can that fits well and that you will wear consistently.”
“Loosely woven cloth products provide the least protection, layered finely woven products offer more protection, well-fitting disposable surgical masks and KN95s offer even more protection, and well-fitting (National Institute for Occupational Safety and Health)-approved respirators (including N95s) offer the highest level of protection,” the CDC says.
The updated guidance, issued January 14, came after weeks of public debate about whether cloth masks should be ditched in favor of more effective masks due to the highly transmissible Omicron variant.
“Cloth masks are little more than facial decorations. There’s no place for them in light of Omicron,” CNN medical analyst and emergency physician Dr. Leana Wen said in December.
“We need to be wearing at least a 3-ply surgical mask,” she said, such as the ones often sold in drugstores and have an adjustable nose wire. “You can wear a cloth mask on top of that, but do not just wear a cloth mask alone.”
Ideally, in crowded places, “you should be wearing a KN95 or N95 mask,” Wen said. They include materials such as polypropylene fibers that act as both mechanical and electrostatic barriers to help prevent the spread of tiny particles.
When someone is speaking, wearing a face mask can slash the distance that droplets and aerosols travel by half (or more, depending on the type of mask), a recent study published in The Journal of Infectious Diseases suggests.
Without face masks, droplets and aerosols traveled up to about 4 feet when someone was speaking, researchers at the University of Central Florida in Orlando found.
Single-layer cloth masks reduced that maximum distance to about 2 feet. And 3-ply, disposable surgical masks reduced the distance of droplet and aerosol travel all the way down to 0.5 feet, the researchers found. The study did not include KN95 nor N95 masks.
While the CDC acknowledges KN95 and N95 respirators provide more protection than surgical masks and cloth masks, it doesn’t say Americans should ditch cloth masks. But cloths masks should have nose wires and multiple layers of fabric that can block light “when held up to bright light source,” the CDC says. They also shouldn’t have exhalation valves, vents or other openings.
“CDC continues to recommend that any mask is better than no mask,” CDC Director Dr. Rochelle Walensky said January 12, “and we do encourage all Americans to wear a well-fitting mask to protect themselves and prevent the spread of Covid-19.”
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What is MIS-C? How many kids get it? Does it only affect children who had severe Covid-19? What are the signs of MIS-C?
MIS-C is multisystem inflammatory syndrome in children.
It’s “a rare but serious condition associated with COVID-19 in which different body parts become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs,” the US Centers for Disease Control and Prevention said.
(A similar syndrome called MIS-A can happen in adults after getting Covid-19.)
With children, MIS-C happens when “the virus induces your body to make an immune response against your own blood vessels” – which can cause inflammation of the vessels, said pediatrician Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital in Philadelphia.
More than 6,400 children have suffered from MIS-C, according to the CDC, and at least 55 have died. The median age of MIS-C patients is 9 years old.
MIS-C “is a rare complication that typically occurs 2 to 4 weeks following SARS-CoV-2 infection,” the American Academy of Pediatrics said. (SARS-CoV-2 is the virus that causes Covid-19.)
And long-term Covid-19 complications can happen even among children who initially had mild or no symptoms, the group said.
“Usually children are picked up incidentally as having (coronavirus). Someone in the family was infected, a friend was infected, so they got a PCR test. And they’re found to be positive. … Then they’re fine,” Offit said.
“Then a month goes by, and they develop a high fever. And evidence of lung, liver, kidney or heart damage. That’s when they come to our hospital.”
The CDC said parents should seek medical care if a child has an ongoing fever plus at least one of the following:
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Can at-home rapid antigen tests pick up the Omicron variant?
They can — but they work better if you take more than one, Dr. Anthony Fauci said.
Fauci said a single rapid antigen test — like the ones often taken at home, with results in about 15 minutes — are not as sensitive at detecting Omicron as PCR tests, which are processed in a lab.
But “if you do (rapid antigen tests) maybe 2 or 3 times over a few-day period, at the end of the day, they are as good as the PCR,” said Fauci, director of the National Institute of Allergy and Infectious Diseases.
“People should not get the impression that those tests are not valuable. They are very valuable. They are valuable for screening. They’re valuable if you do them more than once in a sequential way to tell you whether you’re infected,” Fauci said.
The US Food and Drug Administration recently said rapid antigen tests may be less likely to detect an Omicron infection — but the tests are still useful.
“Studies are under way to confirm the reason for the apparent decreased sensitivity,” the FDA told CNN in a statement. “Once that is known, adjustments to existing tests can be undertaken by each developer with support from the FDA, if appropriate.”
If you think you have Covid-19 symptoms but can’t get tested, doctors say it’s best to assume you have Covid-19 and stay home.
Even if you don’t have the Omicron variant, the symptoms may be from another contagious virus such as the flu or RSV. So it’s still important to wear a high-quality mask and avoid others whenever possible.
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What should I do if I test positive for Covid-19? How long do I need to isolate if I might have the Omicron variant?
“Given what we currently know about COVID-19 and the Omicron variant, CDC is shortening the recommended time for isolation from 10 days for people with COVID-19 to 5 days, if asymptomatic, followed by 5 days of wearing a mask when around others,” the US Centers for Disease Control and Prevention said.
The decision was motivated by research showing most Covid-19 spread “occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after,” the CDC said in late December.
“Therefore, people who test positive should isolate for 5 days and, if asymptomatic at that time, they may leave isolation if they can continue to mask for 5 days to minimize the risk of infecting others.”
The CDC said those whose “symptoms are resolving” can also leave isolation after 5 days, as long as they also wear a mask for the next 5 days.
But the CDC was criticized for not mentioning testing for those who want to leave isolation at 5 days.
On January 4, the CDC said those who have access to a rapid antigen test may want to take it toward the end of the 5-day isolation period.
If the test is positive, isolated people are advised to keep isolating until 10 days after their symptoms started. If the test is negative, isolated people can end their isolation — but are advised to wear a mask around other people until day 10.
For those who have a fever or other symptoms that haven’t even improved after 5 days, “you should wait to end your isolation until you are fever-free for 24 hours without the use of fever-reducing medication and your other symptoms have improved,” the CDC said January 4. “Continue to wear a well-fitting mask. Contact your healthcare provider if you have questions.”
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What should I do if I was recently exposed to someone who now has Covid-19? How long do I have to quarantine?
It depends on whether you’re fully vaccinated and boosted, the US Centers for Disease Control and Prevention says.
Those who have received a booster shot “do not need to quarantine following an exposure, but should wear a mask for 10 days after the exposure,” the CDC said in a December 27 update.
“For people who are unvaccinated or are more than six months out from their second mRNA dose (or more than 2 months after the J&J vaccine) and not yet boosted, CDC now recommends quarantine for 5 days followed by strict mask use for an additional 5 days,” the CDC said.
“Alternatively, if a 5-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure.”
For anyone who was exposed to someone with Covid-19, it’s a good idea to get tested 5 days after exposure, the CDC said.
“If symptoms occur, individuals should immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19,” the CDC said.
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What makes the Omicron variant so different from other variants? Don’t we get new Covid-19 variants all the time?
As coronavirus keeps spreading, new mutations and new variants are expected to develop.
But the new Omicron variant has an unusually high number of mutations, including dozens on the spike protein — the structure used by a virus to latch onto and get inside cells under attack.
“It has a lot of mutations — more than 50. That’s a new record,” said Dr. Francis Collins, director of the US National Institutes of Health.
More than 30 of those mutations are in the spike protein — the part of the virus targeted by leading Covid-19 vaccines.
Scientists have been trying to learn how much the Omicron variant might evade the antibodies produced from vaccination or natural infection.
“We worry if the spike protein is of a different shape, maybe the antibodies won’t stick quite as well. That’s the reason for the concern,” Collins said.
“On the other hand, all of the previous variants, which have also had differences in the spike protein, have responded to vaccines — and especially boosters,” he said.
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Can vaccinated people get infected with the Omicron variant?
Variants transmission family work/life schools/education
We’re about to see friends and family, but we don’t have enough at-home, rapid tests for everyone. Who should we test for Covid-19?
Ideally, “everybody should get tested right before that gathering,” CNN medical analyst and emergency physician Dr. Leana Wen said.
If you have very limited tests available, test those who are at the highest risk of recent Covid-19 exposure — not those at the highest risk of illness, Wen said.
In other words, “Don’t test grandma, who’s been hunkering down and being very careful. She’s unlikely to be spreading Covid to everybody else,” Wen said.
“Test the college student who just came home who may have been in bars and restaurants last week. So use those tests in a judicious way and think about the 2-out-of-3 rule: vaccines, masking or testing. You need to have 2 out of 3 things to gather safely.”
Family treatment & prevention travel work/life transmission
What should I do if I can’t get a Covid-19 test (or test results) before an event?
“I would say consider the risk level of the people who you’re meeting with,” said Mercedes Carnethon, vice chair of preventive medicine at Northwestern University Feinberg School of Medicine.
She said anyone unable to get tested may want to reconsider meeting with:
Families with unvaccinated children who can’t get tested in time should also reconsider meeting with vulnerable relatives, Carnethon said, as those children might be infected but asymptomatic.
But even testing does not certain safety, said Dr. Jorge Rodriguez, an Los Angeles internal medicine specialist.
For example, a test taken immediately after a new infection might not detect the virus – “and the test wouldn’t have been positive until tomorrow or the next day,” he said.
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Can I get a Covid-19 vaccine (or booster shot) and a flu shot at the same time?
“Yes, you can get a COVID-19 vaccine and a flu vaccine at the same time,” the US Centers for Disease Control and Prevention said.
“If you haven’t gotten your currently recommended doses of COVID-19 vaccine, get a COVID-19 vaccine as soon as you can,” the CDC said.
The ability to get both vaccines at the same time can make it more convenient for Americans to try to stay healthy, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
“If that means going in and getting the flu shot in one arm (and) the Covid shot in the other, that’s perfectly fine,” Fauci said.
But don’t assume you’re protected right afterward. “Remember, after you are vaccinated, your body takes about two weeks to develop antibodies that protect against flu,” the CDC said.
Similarly, you’re not fully vaccinated against Covid-19 until two weeks after the final dose.
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I’ve already had Covid-19. Can I still get infected with the Omicron variant?
The Texas man, in his 50s, had not been vaccinated, Harris County health officials said.
For months, the US Centers for Disease Control and Prevention has said vaccines provide stronger protection against Covid-19 than previous infection alone.
“If you have had Covid-19 before, please still get vaccinated,” CDC Director Dr. Rochelle Walensky said in August, citing research published during a Delta variant surge. “This study shows you are twice as likely to get infected again if you are unvaccinated.”
With the new Omicron variant, the risk of getting reinfected is 5.4 times higher with Omicron than it was with Delta, according to a team of disease modelers at Imperial College London.
“This suggests relatively low remaining levels of immunity from prior infection,” the team wrote in a December report.
Health experts say the best way to help protect against the Omicron variant is to get vaccinated and boosted.
Transmission treatment & prevention myths & misinformation transmission
I'm fully vaccinated, but my kids are too young to get shots -- and we're visiting family members this week. With the Omicron variant spreading rapidly, what should we do?
“I think that depends on people’s individual risk tolerance,” CNN medical analyst and emergency physician Dr. Leana Wen said.
Some, like Dr. Peter Hotez, decided to cancel a planned visit from in-laws this holiday season.
“Unfortunately, I had to ask them not to come because I thought that it was a little too risky for them in terms of travel with all the Omicron circulating,” said Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.
For families who still want to get together with extended relatives, Wen suggests following the “2-out-of-every-3 rule.”
“We have 3 major tools at our disposal: vaccination, testing and masking,” she said.
“We should have 2 out of every 3 things. And so if you’re not vaccinated, you should be masking, and if you’re gathering with people, testing,” Wen said.
“If you are vaccinated, also get that booster, too. But if you want to get together with people indoors without masks, then make sure that people are tested that same day. If you’re unable to get that test, people should still be wearing masks indoors.”
For children too young to get vaccinated — and who obviously can’t wear a mask while eating — “the key in that case is to surround the unvaccinated kids with others who are vaccinated,” Wen said.
“This is classic herd immunity — others protect the young kids who can’t mask. And if everyone tests, that’s the second layer of protection.”
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Does "fully vaccinated" mean two shots or three now?
The US Centers for Disease Control and Prevention still says people are fully vaccinated:
But the CDC has recommended additional booster shots for all adults who are 2 months past their Johnson & Johnson vaccination or 6 months past their Moderna vaccination.
The CDC has also recommended a booster shot of the Pfizer vaccine for everyone ages 16 and up who are 6 months past their second dose.
“I’ve always said this is a three-dose vaccine,” said vaccinologist Dr. Peter Hotez, a professor and dean of the National School of Tropical Medicine at Baylor College of Medicine.
“The reason is when you get that third dose, you get a 30- to 40-fold rise in virus-neutralizing antibodies, and therefore there’s more spillover protection against new variants – including Omicron,” Hotez said December 15.
“The third dose gives you 70% to 75% protection against symptomatic illness.”
Dr. Anthony Fauci said it’s inevitable that the definition of “fully vaccinated” will change.
“It’s going to be a matter of when, not if,” said the director of the National Institute of Allergy and Infectious Diseases.
“For me, as a public health person, I just say get your third shot,” Fauci said, referring to eligible Pfizer and Moderna vaccine recipients.
“Forget about what the definition is. I just want to see people be optimally protected. And for me, that’s unequivocally and unquestionably getting a third shot boost.”
Vaccine variants treatment & prevention work/life myths & misinformation
What should I do if I’m physically unable to go out and get a vaccine or booster shot?
“If you have difficulty reaching a vaccination site, you may be able to get an in-home vaccination,” the CDC says.
The CDC suggests contacting the following to see if they provide at-home vaccination in your area:
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What exactly is in the Covid-19 vaccines? I’ve heard so many rumors and don’t know what to believe.
The CDC lists active and inactive ingredients for each of the three coronavirus vaccines used in the US.
“None of the vaccines contain eggs, gelatin, latex, or preservatives,” the CDC said.
And contrary to popular myths, the vaccines don’t have microchips and can’t make you magnetic.
“All COVID-19 vaccines are free from metals such as iron, nickel, cobalt, lithium, rare earth alloys or any manufactured products such as microelectronics, electrodes, carbon nanotubes, or nanowire semiconductors.”
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Can a PCR or rapid test tell me which type of variant I might have if I have Covid-19?
Diagnostic tests like PCR tests and rapid antigen tests can help detect whether you’ve been infected with coronavirus. But they can’t tell you exactly which strain you have.
It takes another layer of testing, involving genetic sequencing, to determine what strain or variant caused the infection.
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If vaccine makers are already working on Omicron-specific boosters, shouldn’t I just wait to get one of those doses instead of getting a booster shot now?
“The answer is no,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
“If you are eligible … don’t wait,” Fauci said.
“Get that extra boost now because we know when you do that, the level of antibodies that rise and go up following a boost is much, much higher than the peak level that you get after your second dose of a two-dose vaccine,” he said.
“Our experience with variants such as the Delta variant is that even though the vaccine isn’t specifically targeted to the Delta variant, when you get a high enough level of an immune response, you get spillover protection even against a variant that the vaccine wasn’t specifically directed at.”
Pfizer and Moderna have been working on Omicron-specific booster shots — just in case they might be needed.
But even if Omicron-specific shots are needed, it would take a while to get them rolled out to the public.
Vaccine variants treatment & prevention myths & misinformation
How did the Omicron variant get its name? Didn’t they skip some letters in the Greek alphabet?
Since May, the World Health Organization has been assigning Greek letters to notable new coronavirus variants.
Before Omicron, the last two variants of interest or concern were called Lambda and Mu. The next letter in the Greek alphabet is Nu, followed by Xi.
But WHO skipped over Nu and Xi and went straight to Omicron for the latest variant of concern, which has the scientific name B.1.1.529.
The reason? “Nu is too easily confounded with ‘new’ and Xi was not used because it is a common surname,” WHO said in an email to CNN.
“And WHO best practices for naming new diseases suggest ‘avoiding causing offense to any cultural, social, national, regional, professional or ethnic groups.’”
Schools/education variants myths & misinformation
What do we know about the safety and efficacy of Covid-19 vaccines in younger children? Are there any side effects?
Pfizer said its vaccine is safe and 90.7% effective against symptomatic Covid-19 in children ages 5 to 11, based on clinical trial data. Trial participants who got the vaccine received two doses, spaced three weeks apart.
After monitoring trial participants for three months after the shots, there were no serious side effects such as myocarditis or pericarditis, Pfizer said.
“The side effects we’re seeing in the kids are really identical to what we’re seeing in adults,” said Dr. Bob Frenck, director of the Vaccine Research Center at Cincinnati Children’s Hospital, one of the Pfizer pediatric trial sites. Such side effects include a sore arm, fatigue, headache and fever in about 10% of children. Those side effects don’t last more than a day or two.
Separately, Moderna has been testing various doses of its Covid-19 vaccine in children. On October 25, Moderna said interim trial results showed its vaccine was well tolerated and generated a robust immune response in children ages 6 to 11.
Some participants had side effects such as fatigue, headache, fever and pain at the injection site. Moderna said planned to submit its data to the FDA.
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If my child is 11, should I wait until she turns 12 to get a larger dose of Covid-19 vaccine? Or should she get a pediatric dose of the Pfizer vaccine for kids ages 5 to 11?
“I wouldn’t wait,” said Dr. Paul Spearman, a member of the US Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee.
He said data presented to the committee by Pfizer “showed that a 10-microgram dose — so a third of the dose that is licensed for adults — was equally effective in terms of generating neutralizing antibodies, one of the most important means of protecting people from Covid-19.”
One advantage of the smaller (but equally effective) doses for children was reduced side effects, said Dr. Bob Frenck, director of the Vaccine Research Center at Cincinnati Children’s Hospital — one of the Pfizer pediatric trial sites.
“So, one-third of the dose that we’re giving adults, or even one-third of the dose that was used in 12-year-olds and above, was just as immunogenic. We got just as good an immune response as the 30-microgram dose, and there were less side effects,” Frenck said.
“A lot of people are asking us: ‘Does this mean you’re giving us less of a vaccine?’ I said, well, we’re giving you less antigen, but their immune response is so good that they’re making the same immune response – so there’s no need to provide more vaccine,” he said.
For parents of larger 10- or 11-year-olds who are panic a pediatric dose might not be enough, weight is not important when it comes to vaccines, said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.
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How many kids were in Pfizer’s Covid-19 trial for ages 5 to 11? Do kids get the same doses as adults? And do kids get one shot, or two?
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Why were kids in vaccine trials divided by age groups and not weight? Wouldn’t size or weight matter more than age when determining dosage?
In this case, weight isn’t important, said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.
“I think people have a misconception about the way vaccines work. They think of them in the same way as drugs. If you give, for example, an antibiotic like amoxicillin, your weight matters because the antibiotic is distributed throughout your bloodstream,” Offit said.
“That’s not true with vaccines. With vaccines, you get those as a shot in the arm, and that’s taken up by the local draining lymph nodes. So really weight doesn’t matter.”
Adolescents ages 12 and up who get the Pfizer/BioNTech vaccine get the same dosage that adults get – 30 micrograms per dose.
Researchers have been trying to see which doses give the best combination of high efficacy and minimal side effects among younger children.
In September, Pfizer announced its Covid-19 vaccine was safe and generated a “robust” antibody response in children ages 5 to 11. It said the “preferred dose for safety, tolerability and immunogenicity” among that age group was 10 micrograms per dose – one-third the dosage for teens and adults.
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Why bother getting vaccinated if there’s still a chance you could get Covid-19?
No vaccine is 100% effective, but the Covid-19 vaccines significantly reduce the chances of severe illness and death — across multiple age groups.
For adults under age 50, the rate of Covid-19 hospitalizations among those unvaccinated was 15 times higher than for those fully vaccinated, according to August data from the US Centers for Disease Control and Prevention. Among those ages 50 to 64, the hospitalization rate is 31 times higher for unvaccinated people.
And the risk of dying from Covid-19 is more than 11 times higher for unvaccinated adults than it is for vaccinated adults, according to the CDC data.
For seniors, who are more susceptible to severe Covid-19, that gap is smaller. Among those 80 and older, the risk of dying from Covid-19 in August was about five times higher among those unvaccinated compared to those fully vaccinated.
Of the breakthrough cases resulting in death, 85% were among people age 65 and older, according to the CDC.
But those cases are extremely rare. As of October 12, about 7,178 breakthrough Covid-19 infections resulting in death had been reported, and 187 million people had been fully vaccinated, according to the CDC. In other words, about 0.004% of fully vaccinated people died of Covid-19.
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Is it true children can’t get very sick from Covid-19? How many kids have actually been hospitalized with Covid-19?
More than 72,000 children have been hospitalized with Covid-19 since August 2020, according to the CDC.
And it’s not just children with preexisting conditions getting hospitalized.
Almost half – 45.7% – of children hospitalized with Covid-19 between March 2020 and October 2021 had no known underlying condition, according to CDC data from almost 100 US counties.
And while pediatric Covid-19 deaths are rare, at least 1,015 children in the US have died from Covid-19, according to CDC data.
During the Delta variant surge, some hospitals saw an increase in pediatric Covid-19 patients.
At the University of Mississippi Medical Center, “we’ve had infants as small as 6 to 8 months old up to the teenage years,” Associate Vice Chancellor for Clinical Affairs Dr. Alan Jones said in July.
“It appears as though this particular variant, the Delta variant, while being more infectious is also causing more children to be symptomatic,” he said.
“Whether that just is that it causes a little more severe illness than other variants or that it is just more prevalent — and so we’re seeing more symptomatic cases — we’re not sure … but it’s probably multifactorial.”
Some youngsters have suffered long-term effects from Covid-19 or multisystem inflammatory syndrome in children (MIS-C) – a rare but potentially serious condition that can happen in children weeks after a coronavirus infection.
More than 6,400 children have suffered from MIS-C, according to the CDC.
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My kids don’t want to wear a mask. What should I do?
If possible, buy a few different brands of masks and see which one is most comfortable for your child, emergency physician and CNN Medical Analyst Dr. Leana Wen said.
“Different people have different comfort levels,” she said. For example, some children might like one brand of kid-sized surgical masks over another.
Other children might feel more comfortable wearing kid-sized KN95 masks, which allow more room for the nose and mouth.
“The most important thing is to find the best that you can consistently wear throughout the day,” Wen said. “You don’t want to find a mask that you’re trying to pull off your face every 20 minutes.”
Buying masks with fun designs or with your child’s favorite characters on them can also help, psychologist Christopher Willard said. Children can also customize their masks by drawing on them with markers.
And, of course, parents can set a good example by also wearing a mask.
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What are the side effects of a Covid-19 vaccine booster?
Data suggests side effects from a booster dose of a mRNA Covid-19 vaccine have been similar in frequency and type to those seen after second doses — and were “mostly mild or moderate and short-lived,” CDC Director Dr. Rochelle Walensky said September 28.
The two-shot vaccines from Moderna and Pfizer both use genetic material called messenger RNA, or mRNA, to deliver immunity.
Walensky cited a study published that day by the CDC. It covers 22,191 people who received a third dose of an mRNA vaccine and made reports to CDC’s v-safe system, a voluntary, smartphone-based app that lets people report how they feel after they’ve been vaccinated. The reports were made from August 12 (when the US Food and Drug Administration OK’d additional doses for certain immunocompromised people) through September 19.
Among those 22,191 who made reports, about 7,000 – nearly 32% – reported any health impacts. More than 6,200 – about 28% – reported they were unable to perform normal daily activities, mostly commonly on the day after vaccination.
The most common complaints were injection site pain (71%), fatigue (56%) and a headache (43.4%). Of those who reported general pain, only about 7% described it as “severe.” Severe was defined as pain that makes “daily activities difficult or impossible.”
Nearly 2% said they sought medical care and 13 people were hospitalized, but it was not clear from the v-safe reports why these people sought medical care or were hospitalized. Those who sought medical attention are contacted by staff members from the Vaccine Adverse Event Reporting System and encouraged to make a report, it said.
Of the 22,191 people, 12,591 happened to have tracked how they felt after all three doses. Out of that smaller group, 79.4% reported a local reaction to the third shot and 74.1% reported a systemic reaction. That’s similar to what they reported after a second dose, when 77.6% reported local reactions and 76.5% reported systemic reactions.
No unexpected patterns of adverse reactions were identified, the report said.
Some people reported getting a booster from different company than their original vaccine or getting a second dose of the single-dose Johnson & Johnson vaccine, but the report’s authors said the numbers in both cases were too small to draw any conclusions.
Vaccine treatment & prevention
What should I do if I lost my Covid-19 vaccination card?
Contact the vaccination provider site where you received your vaccine. “Your provider should provide you a new card with up-to-date information about the vaccinations you have received,” the CDC said.
“If the location where you received your COVID-19 vaccine is no longer operating, contact your state or local health department’s immunization information system (IIS) for assistance,” the CDC said.
“Please contact your state or local health department if you have additional questions about vaccination cards or vaccination records.”
To be clear: “CDC does not maintain vaccination records or determine how vaccination records are used, and CDC does not provide the CDC-labeled, white COVID-19 vaccination record card to people. These cards are distributed to vaccination providers by state and local health departments,” the agency said.
And don’t try to use a forged or fraudulent vaccination card — that could land you in prison.
Should pregnant women get vaccinated?
“COVID-19 vaccination is recommended for all people 12 years and older, including people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future,” the CDC said.
“Evidence about the safety and effectiveness of COVID-19 vaccination during pregnancy has been growing,” the CDC said in an August 11 update.
Scientists say Covid-19 — not the Covid-19 vaccine — can put a woman at higher risk of severe illness during pregnancy.
Covid-19 can lead to “adverse pregnancy outcomes, such as preterm birth,” said Sascha Ellington, team lead for emergency preparedness and response in the CDC’s Division of Reproductive Health.
“This vaccine can prevent Covid-19, and so that’s the primary benefit.”
Family vaccine treatment & prevention work/life myths & misinformation
What are the chances of long Covid if someone fully vaccinated gets a breakthrough infection?
Vaccine work/life family myths & misinformation
If I’ve already had Covid-19, should I still get vaccinated? What if I got monoclonal antibody treatment?
“Yes, you should be vaccinated regardless of whether you already had COVID-19,” the CDC says.
“Evidence is emerging that people get better protection by being fully vaccinated compared with having had COVID-19. One study showed that unvaccinated people who already had COVID-19 are more than 2 times as likely than fully vaccinated people to get COVID-19 again,” the CDC’s website says.
“If you were treated for COVID-19 with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine. Talk to your doctor if you are unsure what treatments you received or if you have more questions about getting a COVID-19 vaccine.”
“Many of the vaccines that we’ve made in history are actually stronger than the virus is itself at creating immunity,” epidemiologist Dr. Larry Brilliant said.
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Is it true you’re just as likely to get the Delta variant from any vaccinated person as you are from any unvaccinated person?
No. “The greatest risk of transmission is among unvaccinated people who are much more likely to get infected, and therefore transmit the virus,” the CDC said about the Delta variant on August 26.
A study published by the CDC in late August showed vaccinated people were 5 times less likely to get infected than unvaccinated people.
When a fully vaccinated person does get a breakthrough infection, “your chances of having symptoms go down by 8-fold” compared to an unvaccinated person, National Institutes of Health Director Dr. Francis Collins said August 1.
“People infected with the Delta variant, including fully vaccinated people with symptomatic breakthrough infections, can transmit the virus to others,” the CDC said. “CDC is continuing to assess data on whether fully vaccinated people with asymptomatic breakthrough infections can transmit the virus.”
Even if a vaccinated person gets a breakthrough infection and is contagious, “vaccinated people appear to spread the virus for a shorter time,” the CDC said.
“For people infected with the Delta variant, similar amounts of viral genetic material have been found among both unvaccinated and fully vaccinated people. However, like prior variants, the amount of viral genetic material may go down faster in fully vaccinated people when compared to unvaccinated people,” the CDC said. “This means fully vaccinated people will likely spread the virus for less time than unvaccinated people.”
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Why should anyone care whether I’m vaccinated if they’re already vaccinated?
Avoiding vaccination can harm your loved ones and help create even more contagious or more dangerous variants for everyone, doctors say.
Full vaccination reduces the chances of getting and spreading coronavirus.
Children too young to be vaccinated and people who are immunocompromised also rely on the vaccination of others to help protect them, said Dr. William Schaffner, a professor in the Division of Infectious Diseases at Vanderbilt University Medical Center.
But vaccination is also important to help prevent more contagious or more dangerous variants from forming — such as one that might evade vaccines and harm those who are fully vaccinated.
“If we are going to continue to allow this virus to spread, we’re going to continue to allow … variants to be created,” said Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital in Philadelphia.
Viruses frequently mutate as they replicate among infected people. If the mutations are significant, they can lead to a more contagious variant.
“Think of a virus as a necklace full of different-colored beads,” board-certified internist Dr. Jorge Rodriguez said.
“In position No. 1, you need a red bead. Position No. 2 is a green bead. That’s the genetic code – that sequence of bead colors,” he said.
“When a virus replicates, it is supposed to make an exact replica of those bead colors. But every once in a while, maybe a green bead gets into where a red bead is supposed to be.”
When mutations provide the virus an advantage — such as the ability to replicate faster or to hide from the immune system – that version will outcompete others.
The only way to get rid of variants is to lower the number of infections, said Penny Moore, an expert in viruses at South Africa’s National Institute for Communicable Diseases.
That’s a big reason why doctors say people should get vaccinated as soon as they can. Those who don’t get vaccinated aren’t just risking their own health — they’re also jeopardizing the health of others.
“Unvaccinated people are potential variant factories,” Schaffner said. “The more unvaccinated people there are, the more opportunities for the virus to multiply.”
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Does a vaccine need to be fully approved by the FDA for an employer or business to mandate vaccination?
Work/life schools/education vaccine myths & misinformation
When will the other Covid-19 vaccines get fully approved by the FDA?
Vaccine work/life treatment & prevention
What should I do if I’m wearing a mask but have to sneeze?
If there are tissues nearby, you can take your mask off and sneeze into the tissue before putting your mask back on, CNN Chief Medical Correspondent Dr. Sanjay Gupta said.
For kids in school — or anyone else who might have to wear a mask all day — keep a backup mask in a baggie in case the first mask gets dirty. You can put the dirty mask in the baggie.
It’s also a good idea to keep backup masks in your car in case of any mask accidents.
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Is it safe to go on vacation?
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What's the difference between the Delta and Delta Plus variants?
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What should I tell friends, family or coworkers who are hesitant to get vaccinated?
“It is a normal human reaction to be afraid,” pediatrician Dr. Edith Bracho-Sanchez said. “They’re having a normal reaction, and perhaps they haven’t been able to sit down with their physician.”
She suggests finding a time to have a calm, rational conversation — when neither person is angry or likely to start a fight.
“The first thing I would say is ‘I get it. I totally get where you’re coming from and I understand that you’re concerned about this,’” Bracho-Sanchez said.
It’s also important to cite scientific data — like the truth about side effects, the safety of Covid-19 vaccines and why it’s important for young, healthy people to get vaccinated.
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How much does a Covid-19 vaccine cost?
“It’s all free. The government is paying for this,” said Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital in Philadelphia.
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What are the side effects of the vaccines?
Some people have reported feeling temporary, flu-like symptoms. Don’t freak out if this happens to you, health experts say.
“These are immune responses, so if you feel something after vaccination, you should expect to feel that,” said Patricia Stinchfield of Children’s Hospitals and Clinics of Minnesota.
“And when you do, it’s normal that you have some arm soreness or some fatigue or some body aches or even some fever,” Stinchfield said.
Read more about what to do if you do get side effects and why side effects are often a good sign.
The Pfizer/BioNTech vaccine has shown no serious safety concerns, Pfizer said. Pfizer has said side effects “such as fever, fatigue and chills” have been “generally mild to moderate” and lasted one to two days.
Moderna said its vaccine did not have any serious side effects. It said a small percentage of trial participants had symptoms such as body aches and headaches.
With the Johnson & Johnson vaccine, the most common side effects were pain at the injection site, headache, fatigue and muscle pain. While the CDC recommends the Johnson & Johnson vaccine, “women younger than 50 years old especially should be aware of the rare but increased risk of thrombosis with thrombocytopenia syndrome (TTS),” the agency says. “TTS is a serious condition that involves blood clots with low platelets. There are other COVID-19 vaccine options available for which this risk has not been seen.”
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What is aerosolized spread? What’s the difference between aerosols and droplets?
Aerosolized spread is the potential for coronavirus to spread not just by respiratory droplets, but by even smaller particles called aerosols that can float in the air longer than droplets and can spread farther than 6 feet.
Respiratory aerosols and droplets are released when someone talks, breaths, sings, sneezes or coughs. But the main difference is size.
“If you have droplets that come out of a person, they generally go down within 6 feet,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
But aerosols (aka droplet nuclei) are smaller – less than 5 microns in diameter, according to the World Health Organization.
“Aerosol means the droplets don’t drop immediately,” Fauci said. “They hang around for a period of time.”
This becomes “very relevant” when you are indoors and there is poor ventilation, he said.
Multiple case studies suggest coronavirus can spread well beyond 6 feet through airborne transmission, such as during choir practices, said Dr. Amy Compton-Phillips, chief clinical officer of Providence Health System.
In Washington state, for example, 53 members of a choir fell sick and two people died after one member attended rehearsals and later tested positive for Covid-19.
Last July, 239 scientists backed a letter urging public health agencies to recognize the potential for aerosolized spread.
“There is significant potential for inhalation exposure to viruses in microscopic respiratory droplets (microdroplets) at short to medium distances (up to several meters, or room scale), and we are advocating for the use of preventive measures to mitigate this route of airborne transmission,” the letter said.
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This pandemic is taking a toll on my mental health. How can I get help if I’m feeling isolated and depressed?
The Crisis Text Line is available texting to 741741. Trained volunteers and crisis counselors are staffed 24/7, and the service is free.
The Substance Abuse and Mental Health Services Administration Disaster Distress Helpline provides 24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to disasters. Call 1-800-985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor.
For health care professionals and essential workers, For the Frontlines offers free 24/7 crisis counseling and support for workers dealing with stress, anxiety, fear or isolation related to coronavirus.
For more resources, check out CNN’s guide to giving and getting help during the pandemic.
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What “underlying conditions” put people at higher risk of bad outcomes with Covid-19?
More than 40% of US adults have at least one underlying condition that can put them at higher risk of severe complications, according to the CDC.
Those conditions include obesity, chronic obstructive pulmonary disease, heart disease, diabetes, and chronic kidney disease, according to the CDC.
People who have cancer, an organ transplant, sickle cell anemia, poorly controlled HIV or any autoimmune disorder are also at higher risk.
Covid-19 patients with pre-existing conditions — regardless of their age — are 6 times more likely to hospitalized and 12 times more likely to die from the disease than those who had no pre-existing conditions, CNN Chief Medical Correspondent Dr. Sanjay Gupta said.
While young, healthy people are less likely to die from Covid-19, many are suffering long-term effects from the disease.
Treatment & prevention transmission family work/life
What’s the guidance for carpooling or riding with someone from another household?
Unvaccinated people from different households in a car should wear face masks, said Dr. Aaron Hamilton of the Cleveland Clinic.
“You should also wear one if you’re rolling down your window to interact with someone at a drive-thru or curbside pickup location,” Hamilton said.
It’s also smart to keep the windows open to help ventilate the car and add another layer of safety, said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
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Should we clean our cell phones daily?
Yes, that’s a good idea because cell phones are basically “petri dishes in our pockets” when you think about how many surfaces you touch before touching your phone.
You should regularly disinfect your mobile phone anyway, with or without a coronavirus pandemic.
“There’s probably quite a lot of microorganisms on there, because you’re holding them against your skin, you are handling them all the time, and also you’re speaking into them,” said Mark Fielder, a professor of medical microbiology at Kingston University.
“And speaking does release droplets of water just in normal speech. So it’s likely that a range of microbes – including Covid-19, should you happen to be infected with that virus – might end up on your phone.”
Watch the best ways to disinfect your cell phone here.
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Is it safe to go back to the gym?
There are certainly more risks if you’re not fully vaccinated.
Coronavirus often spreads more easily indoors rather than outdoors — especially if you’re indoors for an extended period of time.
Researchers have also found that heavy breathing and singing can propel aerosolized viral particles farther and increase the risk of transmission.
During one fitness instructor workshop, about 30 participants with no symptoms trained intensely for four hours, according to research published by the CDC. Eight participants later tested positive, and more than 100 new cases of coronavirus were traced back to that fitness workshop.
To help mitigate the risk, many gyms are limiting capacity or requiring masks.
And while health experts have recommended staying 6 feet away from others, it’s smart to keep even more distance than that at the gym.
“With all the heavy breathing, you may even want to double the usual 6 feet to 12 feet, just to be safe,” CNN Chief Medical Correspondent Dr. Sanjay Gupta said.
Transmission work/life treatment & prevention
I heard you can get Covid-19 through your eyes. Should we wear goggles, too?
Doctors say wearing eye protection (in addition to face masks) could help some people, but it’s not necessary for everyone.
Teachers who have younger students in the classroom are “likely to be in environments where children might pull down their masks, or not be very compliant with them,” epidemiologist Saskia Popescu said. “There is concern that you could get respiratory droplets in the eyes.”
If you’re a health care worker or taking care of someone at home who has coronavirus, it’s smart to wear eye protection, said Dr. Thomas Steinemann, clinical spokesperson for the American Academy of Ophthalmology.
(Note: Regular glasses or sunglasses aren’t enough, because they leave too many gaps around the eyes.)
But if you’re vaccinated or not in a high-risk situation, wearing goggles isn’t necessary.
While it’s still possible to get Covid-19 through the eyes, that scenario is less likely than getting it through your nose or mouth, Steinemann said.
He said if a significant number of people were getting coronavirus through their eyes, doctors would probably see more Covid-19 patients with conjunctivitis, also known as pink eye (though having pink eye doesn’t necessarily mean you have coronavirus).
Transmission work/life treatment & prevention schools/education myths & misinformation
Should people wear face shields instead of (or in addition to) face masks?
The CDC does not recommend using plastic face shields for everyday activities or as a substitute for face masks. There are a few exceptions, such as for those who are hearing-impaired and rely on lip-reading or those who have physical or mental health conditions that would be exacerbated by wearing a face mask.
Face shields worn in addition to masks could provide an added layer of protection and can also help people stop touching their faces.
If someone must use a face shield without a mask, the CDC says the shield “should wrap around the sides of the wearer’s face and extend to below the chin. Disposable face shields should only be worn for a single use. Reusable face shields should be cleaned and disinfected after each use.”
Transmission treatment & prevention work/life schools/education
Are cancer patients at higher risk of severe complications from Covid-19?
Yes. And the increased risk applies to cancer patients of all ages, the CDC says.
“Having cancer currently increases your risk of severe illness from COVID-19,” the CDC says. “At this time, it is not known whether having a history of cancer increases your risk.”
Researchers found that patients whose cancer was getting worse or spreading were more than five times more likely to die in a month if they caught Covid-19.
But there are steps cancer patients can take to stay as healthy as possible:
Family work/life transmission treatment & prevention
Can central air conditioning spread Covid-19 in public places?
Technically it can, but HVAC (heating/ventilation/air conditioning) systems are not thought to be a significant factor in the spread of coronavirus.
Many modern air conditioning systems will either filter out or dilute the virus. Ventilation systems with highly effective filters are a key way to eliminate droplets from the air, said Harvard environmental health researcher Joseph Gardner Allen.
Filters are rated by a MERV system – their “minimum efficiency reporting value” that specifies their ability to trap tiny particles. The MERV ratings go from 1 to 20. The higher the number, the better the filtration.
HEPA filters have the highest MERV ratings, between 17 and 20. HEPA filters are used by hospitals to create sterile rooms for surgeries and to control infectious diseases. They’re able to remove 99.97% of dust, pollen, mold, bacteria and other airborne particles as small as 0.3 microns.
For context, this coronavirus is thought to be between 0.06 to 1.4 microns in size.
But “HEPA filtration is not always going to be feasible or practical,” Allen said. “But there are other filters that can do the job. What is recommended now by the standard setting body for HVAC is a MERV 13 filter.”
High-efficiency filters in the 13-to-16 MERV range are often used in hospitals, nursing homes, research labs and other places where filtration is important.
“If you’re an owner of a home, building or mall, you want to have someone to assess your system and install the largest MERV number filter the system can reliably handle without dropping the volume of air that runs through it,” advised Erin Bromage, an associate professor of biology at the University of Massachusetts Dartmouth.
“In addition, virtually all modern air conditioning systems in commercial buildings have a process called makeup air where they bring in air from outside and condition it and bring it inside,” Bromage said. “It’s worse in regards to energy, but the more outside air we bring in, the more dilution of the virus we have and then the safer you are.”
Transmission family work/life schools/education
What does asymptomatic mean?
Work/life transmission schools/education
Can you get Covid-19 through sex?
The odds of transmitting coronavirus through sex hasn’t been thoroughly studied, though it has been found to exist in men’s semen.
But we do know Covid-19 is a highly contagious respiratory illness that can spread via saliva, coughs, sneezes, talking or breathing — with or without symptoms of illness.
So three Harvard physicians examined the likelihood of getting or giving Covid-19 during sex and made several recommendations.
For partners who haven’t been isolating together, they should wear masks and avoid kissing, the authors write.
In addition to wearing masks, people who have sex with partners outside of their home should also shower before and after; avoid sex acts that involve the oral transmission of bodily fluids; clean up the area afterward with soap or alcohol wipes to reduce their likelihood of infection.
Transmission treatment & prevention family myths & misinformation
How can I stay safe in an elevator?
Doctors say getting vaccinated is the best way to prevent coronavirus infection.
If you’re not vaccinated, it’s best to take the stairs if you can. But if you can’t, emergency room physician Dr. Leana Wen offers several tips:
transmission work/life treatment & prevention
How safe are public restrooms?
For those not fully vaccinated, try to avoid public restrooms if you can, said microbiologist Ali Nouri, president of the Federation of American Scientists. But he acknowledged that’s not always possible: “Sometimes when you gotta go, you gotta go.”
Close contact with others is the most significant risk in a public restroom, Nouri said. So if there’s a single-person bathroom available that doesn’t have multiple stalls, using that might be best.
If you do use a multi-stall public restroom, Nouri offers the following tips:
Transmission treatment & prevention work/life
What’s the risk of having a maid service come to clean your house if you’re not home?
“It’s probably safe if you’re not at home,” emergency physician Dr. Leana Wen said. She suggested leaving the windows open to Strengthen ventilation and asking the cleaners to use your own cleaning supplies so they don’t bring items that have been in other people’s houses.
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Can I disinfect my mask by putting it in the microwave?
That’s “not a great idea,” said Dr. Joseph Vinetz, a professor of infectious diseases at Yale School of Medicine. “We have no evidence about that.”
“If there’s a metal piece in an N95 or surgical mask and even staples, you can’t microwave them,” he said. “It’ll blow up.”
To disinfect masks that you can’t wash, Vinetz recommends leaving them in a clean, safe place in your home for a few days. After that, it should no longer be infectious, as this coronavirus is known to survive on hard surfaces for only up to three days.
treatment & prevention work/life myths & misinformation
Is it safe to perform CPR on a stranger?
Doctors strongly recommend performing CPR when someone needs it.
You could be hundreds of times more likely to save that dying person’s life than you are to die from Covid-19 if you contract it after performing CPR, according to a report published by a group of Seattle emergency room physicians in the journal Circulation.
But it’s important to act quickly for CPR to be effective.
“The chance of survival goes down by 10% for every minute without CPR,” said Dr. Comilla Sasson, vice president for science and innovation in emergency cardiovascular care at the American Heart Association. “It’s a 10-minute window to death in many cases.”
If you’re not certified in CPR, performing chest compressions could also buy more time until help arrives. Bystanders should “provide high-quality chest compressions by pushing hard and fast in the middle of the victim’s chest, with minimal interruptions,” the American Heart Association said.
If you’re not sure how “fast” to do to those chest compressions, singing any of these popular songs will help you get the right rhythm.
Transmission work/life family myths & misinformation
I saw other countries spraying down sidewalks and other public places with disinfectant. Why haven’t we done that in the US?
Randomly spraying open places is largely a waste of time, health experts say.
It can actually do more harm than good. “Spraying disinfectants can result in risks to the eyes, respiratory or skin irritation,” the World Health Organization said.
“Spraying or fumigation of outdoor spaces, such as streets or marketplaces, is also not recommended to kill the COVID-19 virus or other pathogens because disinfectant is inactivated by dirt and debris, and it is not feasible to manually clean and remove all organic matter from such spaces,” the WHO said.
“Moreover, spraying porous surfaces, such as sidewalks and unpaved walkways, would be even less effective.” Besides, the ground isn’t typically a source of infection, the WHO said.
And once the disinfectant wears off, an infected person could easily contaminate the surface again.
Treatment & prevention myths & misinformation travel transmission
Can protests increase the spread of Covid-19?
And when people are “shouting and cheering loudly, that does produce a lot of droplets and aerosolization that can spread the virus to people,” said Dr. James Phillips, a physician and assistant professor at George Washington University Hospital.
So doctors and officials say its important to get vaccinated or wear a face mask and try to keep your distance from others as much as possible.
Transmission treatment & prevention work/life
Do I need to wash fruits and vegetables with soap and water?
Treatment & prevention work/life transmission
Should I wash my hands and laundry in very warm or hot water?
Hot water is best for killing bacteria and viruses in your laundry. But you don’t want to use that kind of scalding hot water on your skin.
Warm water is perfectly fine for washing your hands — as long as you wash them thoroughly (like this) and for at least 20 seconds. (To time yourself, you can hum the “Happy Birthday” song twice or sing a couple of verses from any of these hit songs from the past several decades.)
Cold water will also work, “but you have to make sure you work really vigorously to get a lather and get everything soapy and bubbly,” said chemist Bill Wuest, an associate professor at Emory University. To do that, you might need to sing “Happy Birthday” three times instead of twice.
“Warm water with soap gets a much better lather – more bubbles,” Wuest said. “It’s an indication that the soap is … trying to encapsulate the dirt and the bacteria and the viruses in them.”
Treatment & prevention work/life transmission myths & misinformation
Will an antibody test show whether I’m immune and can go back to work or school?
Work/life treatment & prevention transmission schools/education
Can I use vodka as hand sanitizer?
Please don’t. The CDC advises using hand sanitizer that contains at least 60% alcohol.
Vodka typically contains between 35% and 46% percent alcohol.
If the stores are out of hand sanitizer and you want to make your own, the Nebraska Medical Center offers this recipe:
What you’ll need:
In a mixing bowl, stir isopropyl alcohol and aloe vera gel together until well blended.
Add 8-10 drops of scented essential oil (optional, but nice). Stir.
Pour the homemade hand sanitizer into an empty container and seal. Write “hand sanitizer” on a piece of masking tape and attach to the bottle.
Myths & misinformation treatment & prevention
Are smokers or vapers at higher risk? What if I only smoke weed?
This is not a good time to be vaping or smoking anything, including weed.
“Vaping affects your lungs at every level. It affects the immune function in your nasal cavity by affecting cilia, which push foreign things out,” said Prof. Stanton Glantz, director of the Center for Tobacco Research Control and Education at University of California San Francisco.
When you vape, “the ability of your upper airways to clear viruses is compromised,” Glantz said.
Tobacco smokers are at especially high risk. In a study from China, where the first Covid-19 outbreak occurred, smokers were 14 times more likely to develop severe complications than non-smokers.
Even occasionally smoking marijuana can put you at greater risk.
“What happens to your airways when you smoke cannabis is that it causes some degree of inflammation, very similar to bronchitis, very similar to the type of inflammation that cigarette smoking can cause,” said pulmonologist Dr. Albert Rizzo, chief medical officer for the American Lung Association.
“Now you have some airway inflammation, and you get an infection on top of it. So yes, your chance of getting more complications is there.”
Work/life family treatment & prevention
My teenagers aren’t taking this seriously. Any advice?
Coronavirus isn’t just infecting young people. It’s killing young, healthy people as well.
Dimitri Mitchell, 18, admits he had a “false sense of security.” But he was later hospitalized with coronavirus and now wants everyone to take it seriously.
“I just want to make sure everybody knows that no matter what their age is, it can seriously affect them. And it can seriously mess them up, like it messed me up,” the Iowa teen said.
“Four days in, the really bad symptoms started coming along. I started having really bad outbreaks, like sweating, and my eyes were really watery. I was getting warmer and warmer, and I was super fatigued. … I would start experiencing the worst headaches I’ve ever felt in my life. They were absolutely horrible.”
Eventually, the teen had to be hospitalized. His mother said she panic he might “fall asleep and never wake up.”
Mitchell is now recovering, but has suffered from long-term effects.
“I just hope everybody’s responsible, because it’s nothing to joke about,” he said. “It’s a real problem, and I want everybody to make sure they’re following social distancing guidelines and the group limits. And just listen to all the rules and precautions and stay up to date with the news and make sure they’re informed.”
Family transmission treatment & prevention myths & misinformation schools/education
Does this pandemic have anything to do with the 5G network?
No. That’s just a hoax going around the internet.
“The theory that 5G might compromise the immune system and thus enable people to get sick from corona is based on nothing,” said Eric van Rongen, chairman of the International Commission on Non-Ionizing Radiation Protection (ICNIRP).
Learn more about how 5G really works and why this hoax makes no sense.
Myths & misinformation
My ex and I have joint custody of our kids. Is it safe for them to go between two homes?
Ideally, you should limit your children’s potential exposures to coronavirus and work out the safest plan possible with your ex.
The problem: Some state and county family courts might be closed, or open only for emergencies involving abuse or endangerment. So it might be difficult to formally modify pre-existing custody agreements.
But some states may be offering some flexibility during the pandemic. And there may be creative solutions, such as spending more time with one parent now in exchange for extra time with the other parent after the pandemic ends.
Family work/life travel
How do I safely take care of someone who’s sick?
It may be difficult to know whether your loved one has coronavirus or another illness. So it’s critical to play it safe and not infect yourself and, in turn, others. The CDC suggests:
What are the symptoms?
Fatigue, fever, dry cough, difficulty breathing and the loss of taste or smell are some of the symptoms of Covid-19.
Symptoms can appear anywhere from 2 days to 2 weeks after exposure, the CDC says. But some people get no symptoms at all and can infect others without knowing it.
The illness varies in its severity. And while many people can recover at home just fine, some — including young, previously healthy adults — are suffering long-term symptoms.
The stores are out of disinfectant sprays and hand sanitizer. Can I make my own?
Yes, you can make both at home.
“Unexpired household bleach will be effective against coronaviruses when properly diluted” if you’re trying to kill coronavirus on a non-porous surface, the CDC said.
The CDC’s recipe calls for diluting 5 tablespoons (or ⅓ cup) of bleach per gallon of water, or 4 teaspoons of bleach per quart of water.
What you’ll need:
In a mixing bowl, stir isopropyl alcohol and aloe vera gel together until well blended.
Add 8-10 drops of scented essential oil (optional, but nice). Stir.
Pour the homemade hand sanitizer into an empty container and seal.
Write “hand sanitizer” on a piece of masking tape and attach to the bottle.
Work/life Treatment & Prevention
Can I be fired if I stay home sick?
But there are exceptions. Employers who make workers with Covid-19 come in may be violating Occupational Safety and Health Administration [OSHA] regulations, said Donna Ballman, who heads an employee advocacy law firm in Florida.
What happens when workers don't get paid sick leave?
But there is no federal mandate that requires companies to offer paid sick leave, and almost a quarter of all US workers don’t get it, according to 2019 government data. Some state and local governments have passed laws that require companies to offer paid sick leave.
The Family and Medical Leave Act (FMLA) can sometimes protect a worker’s job in the event they get sick, but it won’t certain they get paid while they’re out.
Employee advocates urge businesses to consider the special circumstances of the Covid-19, and some already have
Can managers send a sick worker home?
The Society for Human Resource Management recommends companies “actively encourage sick employees to stay home, send symptomatic employees home until they are able to return to work safely, and require employees returning from high-risk areas to telework during the incubation period (of 14 days).”
If a manager feels an employee’s illness poses a direct threat to colleagues’ safety, the manager may be able to insist the employee be evaluated by a doctor, said Alka Ramchandani-Raj, an attorney specializing in workplace safety.
If traveling on a plane, how do I stay safe?
Since Covid-19 is a respiratory disease, many airlines require passengers to wear face masks during the flight, except for while eating or drinking.
Health experts suggest eating, drinking and using the restroom before getting on the plane, to eliminate the need to take off your mask or go into a cramped lavatory on board.
And always be mindful of where your hands have been, travel medicine specialist Dr. Richard Dawood said.
Airport handrails, door handles and airplane lavatory levers are notoriously dirty.
“It is OK to touch these things as long as you then wash or sanitize your hands before contaminating your face, touching or handling food,” Dawood said.
“Hand sanitizers are great. So are antiseptic hand wipes, which you can also use to wipe down armrests, remote controls at your seat and your tray table.”
Travel family work/life
Should I spray myself or my kids with disinfectant?
No. Those products work on surfaces but can be dangerous to your body.
There are some chemical disinfectants, including bleach, 75% ethanol, peracetic acid and chloroform, that may kill the virus on surfaces.
But if the virus is already in your body, putting those substances on your skin or under your nose won’t kill it, the World Health Organization says. And those chemicals can harm you.
Treatment & Prevention myths & misinformation
I’ve heard that home remedies can cure or prevent the virus. Is that true?
There’s no evidence from the outbreak that eating garlic, sipping water every 15 minutes or taking vitamin C will protect people from the new coronavirus. Same goes for using essential oils or colloidal silver.
Treatment & prevention myths & misinformation
Why was the US been so far behind other countries with testing?
Experts said cuts in federal funding for public health and problems with early testing forced the US to play catch-up.
Problems with public health infrastructure: Two years ago, the CDC stopped funding epidemic prevention activities in 39 countries, including China. This happened because the Trump administration refused to allocate money to a program that started during the 2014 Ebola outbreak.
Former CDC director Dr. Tom Frieden warned that move “would significantly increase the chance an epidemic will spread without our knowledge and endanger lives in our country and around the world.”
Problems with the testing: Malfunctions, shortages and delays in availability have all contributed to the slowdown.
In the first few weeks of the outbreak in the US, the CDC was the only facility in the country that could confirm test results — even though a World Health Organization test became available around the same time.
Some test kits that were sent around the country were flawed — a move that put the US behind about “four to five weeks,” says Dr. Rob Davidson, executive director of the Committee to Protect Medicare.
Treatment & Prevention
Did Dean Koontz predict this outbreak in the book “The Eyes of Darkness” almost 40 years ago?
No. There are some interesting coincidences in the 1981 fiction novel, which says “a severe pneumonia-like illness will spread around the globe” around the year 2020. Modern editions of the book call the biological strain “Wuhan-400,” and the current coronavirus outbreak started in Wuhan, China.
But there are important differences between the book and reality. The original version of the book called the strain the “Gorki-400,” in reference to a Russian locality, before it was later changed to the “Wuhan-400.” In the book, the virus was man-made, while scientists believe the novel coronavirus started in animals and jumped to humans. And in the book, the virus had a 100% mortality rate. Early estimates of the mortality rate for this coronavirus outbreak range from 2-4%.
myths & misinformation
Type 1 diabetes mellitus (T1DM) is a lifelong condition that occurs when the body stops producing sufficient amounts of insulin. As it is a chronic condition, a person living with T1DM will have a diabetes care team of healthcare providers to help them manage their condition and maintain their health.
T1DM occurs when damage to beta cells in the pancreas, likely due to an immune reaction, means the body can no longer produce enough insulin. This hormone helps regulate blood sugar levels — without it, a person’s blood sugar can increase, which can result in various health issues.
To help an individual control the condition, a person living with T1DM will likely have a dedicated team of health experts with varying specialisms. These individual medical professionals work together to provide a holistic care experience and ensure that a person’s T1DM is well-managed.
This article explores the medical professionals that may comprise a person’s interprofessional care team, how a person can prepare for their first visit, and the resources and support available.
Interprofessional care describes how different health professionals work together to help manage a condition or disease and provide people with the highest quality of care. A diabetes care team will involve many different healthcare professionals to provide services and treatment and refer the individual with T1DM to other health experts when necessary.
The benefits of having a care team and health professionals collaborating can include:
The primary care physician is normally a person’s first point of contact when having health issues. A primary care physician may be the first person to diagnose T1DM. A primary care physician provides a person with routine medical care. This may include performing physical exams, ordering laboratory tests, and prescribing medication.
A primary care physician may also coordinate a person’s T1DM treatment with the other health professionals that are a part of the diabetes care team. The Centers for Disease Control and Preventions (CDC) recommend that a person with diabetes should visit their doctor every 3 months if they are not meeting their treatment goals or every 6 months if they are.
An endocrinologist is a doctor who specializes in medical conditions that relate to hormones. Doctors consider diabetes an endocrine disorder as it impacts the pancreas, which is one of the eight major glands, and how much insulin it produces. With T1DM, a person does not produce enough insulin or any insulin at all. Insulin is necessary to regulate the amount of sugar in the blood.
A doctor will usually refer a person to an endocrinologist.
Eye doctors refer to medical experts that specialize in eye care. An ophthalmologist is a medical professional licensed to practice eye medicine and surgery. An optometrist is a person who is trained to examine the eyes and looks for vision defects or abnormalities. An optometrist may refer a person to an ophthalmologist if a person with T1DM requires further treatment or investigation.
Diabetes can affect the health of the eyes. Increased blood sugar levels can damage the blood vessels in the eye and cause eye conditions such as:
As many diabetic eye conditions typically present without any noticeable symptoms, it is vital that people with diabetes attend yearly eye exams.
A podiatrist is a doctor who specializes in treating the foot, ankle, and other structures of the leg. Diabetes can affect the legs in a few different ways. Diabetes can cause nerve damage, known as diabetic neuropathy, which can cause a person to experience tingling and pain or may lose feeling in their feet.
Diabetes may also increase the risk of a person having an infection in their feet from cuts and sores. If these infections worsen, a person may need a toe, foot, or partial amputation to prevent the infection from spreading.
According to the American Podiatric Medical Association (APMA), including a podiatrist in a diabetic care team can reduce the risk of having to amputate the lower limb by up to 85%. Additionally, it may lower the risk of hospitalization by 24%.
A pharmacist is a medical professional that specializes in not only dispensing medication but also providing advice on health issues and medications. This ensures that people use medicines effectively, correctly, and safely.
A pharmacist can provide important information and education on the medications a person with T1DM may have to take.
An increase in blood sugar can reduce the amount of saliva that the salivary glands produce in the mouth. This can increase the risk of infections as there is a reduction in saliva flow. The buildup of glucose in the mouth can also provide a suitable environment to let bacteria grow. People with diabetes have a higher risk of developing:
A registered nurse is a nurse that works in the doctor’s office and helps coordinate a person’s healthcare needs. Registered nurses may spend more time with a person with T1DM and provide support information on how to self-manage diabetes.
A registered dietitian is a person that specializes in nutrition and food. They can help a person with T1DM establish a healthy diet and advise on the type of food and drink that will help them manage their blood sugar. Diet and nutrition are very important to help keep blood sugar levels stable and prevent potential diabetes problems.
Certified diabetes care and education specialists (CDCES) are qualified professionals that educate people with diabetes and provide support tips on how to self-manage diabetes. They are either registered nurses, registered dietitians, or clinical nurse specialists and may assist in creating a self-management plan to help a person with T1DM navigate their day-to-day life.
CDCES normally have accreditation from organizations, such as the Association of Diabetes Care and Education Specialists, to show they have the necessary training.
People with diabetes are more likely to experience mental health issues such as anxiety, depression, and stress. A person can ask their primary care physician to refer them to a mental health professional if they require additional support.
A fitness professional is a person who specializes in physical activity and may help a person with T1DM find exercises and activities that are safe and ensure that they maintain a moderate weight. Fitness professionals may include:
Mark narrowly survived a rare and life-altering illness followed by a long recovery. He is CEO at Sparrow Bioacoustics.
Healthcare has historically been an inconvenient and expensive service to access. Even basic or primary care has numerous barriers—not the least of which is booking appointments, taking time off work, waiting in waiting rooms, etc. The effects are magnified if you happen to feel ill or are symptomatic.
At the same time, millions of people in the U.S. live in medically underserved areas in states like California, Texas and Illinois, making this process almost insurmountable. It has long been held that the future of healthcare includes more of it being available from the comfort of your home—reserving in-person clinical visits for more serious cases.
A big part of this is the idea that patients should be able to collect their own health data whenever they need it, have control over it and be able to share it with medical professionals in a secure and reliable way. Patient-gathered health data (PGHD) is defined as “data created, recorded, and gathered by and from patients” often involving technology such as wearable devices. It’s the kind of information you would expect to be gathered during a physical exam.
Outside The Doctor’s Office
Back in 2011, Dr. Gregory Abowd gave a keynote to the American Medical Informatics Association on the future of PGHD. He predicted that most of the information that a doctor might use to determine how a patient is doing would be collected outside of that doctor’s office.
Since Dr. Abowd’s seminal prediction, wearable devices and specialized connected devices that record vitals or help you manage conditions have flooded consumer markets. At the same time, there are now more ways that people gain electronic access to things like their medical records, test results and X-rays. Up until recently, however, the adoption of PGHD to support clinical decisions by doctors was relatively slow. The pandemic did a lot to move healthcare institutions, medical practitioners and insurers forward on this front. By way of example, over 500 health institutions now support Apple Health Records.
The promise here is that patients will ultimately have greater custody over their medical information, carrying it with them wherever they go. The ability for a patient to transmit this information instead of waiting for in-person visits or forwarding the information to specialists means better access with fewer steps. It also puts the patient in more control, something we are now used to in our consumer lives.
The question remains, however, how will patients record and share things like a lung sound or heartbeat in a way that is medically useful and accessible? The widespread adoption of smartphones has hit an inflection point that is relevant to this question. Analysts today put smartphone adoption in the U.S. at 88%, with almost 75% adoption in the 65 and older demographic. One study stated the average person touches their phone 1,500 times a week. Today, there are no comparable physical technologies that we interact with more. In addition, the evolution of these devices has also been guided by our ability to use them as proxies for our own senses: ultrahigh-resolution video, stereo audio recording, selective noise canceling, physical feedback, geolocation, gyroscopes and more.
These features combine to help us connect our physical reality with the digital one. It means our smartphones can help act as an extension of a doctor’s ability to touch, listen, see and measure us from anywhere. Consumerization and convenience have driven huge changes in how we manage finances, make important decisions and shop; healthcare is next. In fact, a recent study shows that “60% of consumers expect their healthcare digital experience to mirror that of retail.”
People using their personal devices as medical instruments to assess their health does not seem far-fetched, and it is poised to become as normal as using a banking app instead of standing in line. I believe that patient-gathered data applied correctly will invariably fuel intelligent systems that can help both patients and doctors make quicker, sound decisions.
Looking Forward: Merging Home And Work Life
As home-life and work-life seem to increasingly merge, it is impossible to talk about the benefits to the individual without considering the impact on employers and the workplace. If health monitoring can be delivered on-demand at home, the same will become true at work, and you will soon be able to track and correlate the effect work has on your health.
When moving toward this, we need to make sure that the data is owned by the individuals, and in this way, it can be used to advocate and shine a light on a company’s occupational health policies with possible implications on employer liability.
But democratizing elements of the screening and assessment process into the consumer’s control can seem daunting. Could the medical system get overwhelmed with consumers demanding attention because their phones told them they were sick? Will employees gravitate to medical software on their devices to document the effects of work-related stress?
Considering this future, policies on the use of self-collected health data at the workplace need to evolve sharply. At the very least, employers cannot continue to treat health as something people only worry about on their own time. A population’s health is heavily tied to the economy’s health, so people’s ability to be more proactively involved is essential. Embracing forward-looking policies here can have significant positive impacts on workforce health and benefits programs.
It’s easy to argue that consumers should leave the gathering and use of vital signs and other health data to professionals. Anything else would simply be confusing or harmful to the patient; however, many people with chronic illnesses or conditions already manage their own care to a large degree every day. For them, getting the best outcomes depends on being proactive, having the right information and tracking the progression of their conditions themselves.
Businesses can use these examples to bolster their response to employee health, creating policies that will put them at the forefront of patient-gathered data.
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On June 13, a man in New York began to feel ill.
"He starts to experience swollen lymph nodes and rectal discomfort," says epidemiologist Keletso Makofane, who's at Harvard University.
The man suspects he might have monkeypox. He's a scientist, and knowledgeable about the signs and symptoms, Makofane says. So the man goes to his doctor and asks for a monkeypox test. The doctor decides, instead, to test the man for common sexually transmitted diseases. All those come back negative.
"A few days later, the pain worsens," Makofane says. So he goes to the urgent care and again asks for a monkeypox test. This time, the provider prescribes him antibiotics for a bacterial infection.
"The pain becomes so bad, and starts to interfere with his sleep," Makofane says. "So this past Sunday, he goes to the emergency room of a big academic hospital in New York."
At this point the man has a growth inside his rectum, which is a symptom of monkeypox. At the hospital, he sees both an ER doctor and an infectious disease specialist. Again, the man asks for a monkeypox test. But the specialist rebuffs the request and says "a monkeypox test isn't indicated," Makofane says. Instead, the doctor speculates that the man might have colon cancer.
A few days later, he develops skin lesions — another key sign of monkeypox.
On the surface, the monkeypox outbreak in the U.S. doesn't look that bad, especially compared with other countries. Since the international epidemic began in May, the U.S. has recorded 201 cases of monkeypox. In contrast, the U.K. has nearly 800 cases. Spain and Germany both have more than 500.
But in the U.S., the official case count is misleading, Makofane and other scientists tell NPR. The outbreak is bigger — perhaps much bigger — than the case count suggests.
For many of the confirmed cases, health officials don't know how the person caught the virus. Those infected haven't traveled or come into contact with another infected person. That means the virus is spreading in some communities and cities, cryptically.
"The fact that we can't reconstruct the transmission chain means that we are likely missing a lot of links in that chain," Jennifer Nuzzo, an epidemiologist at Brown University, says. "And that means that those infected people haven't had the opportunity to receive medicines to help them recover faster and not develop severe symptoms.
"But it also means that they're possibly spreading the virus without knowledge of the fact that they're infected," she adds.
In other words: "We have no concept of the scale of the monkeypox outbreak in the U.S.," says biologist Joseph Osmundson at New York University. "
Why are so few cases getting detected? Testing. In many ways, the U.S. has dropped the ball on monkeypox testing.
Across the nation, public health agencies are running too few tests — way too few, Osmundson says. "State officials are denying people testing because they're using a narrow definition of monkeypox to decide who receives a test. They're testing in only a very restrictive number of cases."
Take for instance the man Makofane knows. Eventually, after seeing more than four doctors, the man finally finds an activist who's trying to expand testing. The activist connects the man with a doctor who orders a test through a private company (that's working to produce a commercial test.) The result: He's positive. He has monkeypox.
Makofane says the testing situation right now is so "abysmal" in the U.S. that he launched his own study, called RESPND-MI, to figure out the prevalence of monkeypox in New York City and to help friends share information about monkepox.
The CDC would not divulge to NPR how many tests have been performed across the country, nor will the agency say where community transmission is likely occurring in the U.S. (NPR emailed the agency multiple times about these questions but the press person declined to comment or provide an interview.)
On Thursday, the CDC told the New York Times, it has performed 1,058 monkeypox tests. However, it's not clear how many of these tests are duplications for the same person. And several sources involved with monkeypox testing doubt the agency has tested that many cases. One source told NPR that, as of last Friday, the CDC had tested about 300 cases. At that time, about 100 of those tests were positive, giving a positivity rate of more than 30%.
When the outbreak first began last month, the CDC quickly helped to set up testing in about 70 state and local labs across the country. Unlike with COVID, the agency already had a test developed and ready to send to labs.
"We should celebrate that prior investment," Nuzzo says. "That's what preparedness means.
But as the need for testing grew — and the disease became more common than officials initially predicted — the testing system set up by the CDC stopped functioning well, because it actually deters doctors from ordering a monkeypox test.
Providers have to go out of their way to order a test. They have to receive permission and instructions from local or state labs, Nuzzo says. The process is cumbersome and often time-consuming. Sometimes a doctor has to sit on the phone for hours.
"That's really the bottleneck that we're panic about," she says. "We need to cast a wider net with testing to find infections that we're missing. And that's really hard to do if we make it cumbersome and difficult for health care providers to request a test in the course of their busy days."
Nuzzo says the CDC and local health departments need to remove the barriers to testing. "I also want to make testing easier and more widespread so that all clinicians feel that they can test a patient. Any patient with a suspicious rash."
And doctors and nurses need to have a better understanding of what monkeypox actually looks like in patients. It's different from what's in medical textbooks. It can present like many other diseases, including herpes, syphilis and colon cancer.
"Infections have been largely found in men who have sex with men, who may typically seek care at a sexual health clinic," Nuzzo explains. "Those providers may be particularly well-educated now about monkeypox and may be more willing to send a specimen out for testing. But we may not be seeing that level of education and willingness to test with other health care providers, who see different kinds of patients. And that means we may be missing infections in different patient groups."
On Thursday afternoon, the CDC announced they were working to ramp up testing at the main labs that health providers normally use. And the agency is aiming to make testing easier sometime in July.
But Nuzzo says changes to testing need to happen right away. It needs to be easier, right now, for doctors to submit samples to the labs already doing this testing.
"Time is not on our side here," she says. "Every day we delay, we are missing links in the transmission chain and are allowing this outbreak to grow possibly beyond control."
And monkeypox, just like COVID, may become a long-term — perhaps even permanent — problem here in the U.S.
Copyright 2022 NPR. To see more, visit https://www.npr.org.
In the months since physicians showed that it is possible to transplant pig organs into humans, researchers have been calling for US regulators to allow clinical trials to test such procedures thoroughly in people. Last week, during a two-day meeting of an advisory committee to the US Food and Drug Administration (FDA), agency officials and physicians discussed what regulators would need to move forwards. Most attendees agreed that human trials are needed to help answer the most pressing research questions about inter-species transplants, known as xenotransplants.
The data support the initiation of “small, focused” clinical trials with “appropriately selected patients”, says Allan Kirk, a transplant surgeon at the Duke University School of Medicine in Durham, North Carolina, who presented at the meeting.
Researchers have repeatedly transplanted pig organs into non-human primates, such as baboons, with success. But these experiments don’t simulate human trials perfectly. If the ultimate goal is to do transplants in people, human trials are needed, says Caroline Zeiss, a veterinary specialist at Yale School of Medicine in New Haven, Connecticut.
Such trials, she says, would help to answer a slew of questions, including what is the best cocktail of immunosuppressive drugs to provide humans to help their bodies accept a pig organ, and how can physicians manage the risk that transplanted organs might harbour a pig virus. Researchers also want to know which pig breed is best suited for growing transplant organs, and how co-occurring health conditions, such as diabetes, could affect transplantation success.
Physicians see an urgent need for the trials: more than 100,000 people are waiting for organ transplants in the United States alone. Researchers have long hoped that xenotransplantation could help to meet demand and, therefore, save lives. “We have people dying each day waiting for organs,” says Jay Fishman, a specialist in transplant infectious disease at Massachusetts General Hospital in Boston who participated in the FDA meeting.
Although there have so far been no formal human xenotransplant trials, physicians have performed a handful of the procedures in the past year, with the permission of institutional ethics boards. In late 2021, for instance, surgeons transferred genetically modified pig kidneys into two legally dead people who had no discernible brain function and were on ventilators. The kidneys functioned normally over the 54 hours of the test and seemed to produce urine1.
In January this year, a severely ill man became the first to receive a pig heart, during an operation in Baltimore, Maryland. (The man otherwise faced certain death, so the FDA granted a compassionate-use authorization for the procedure.)
The heart recipient recovered from the surgery, and his body did not reject the genetically modified organ, but he died two months later. Physicians later found traces of porcine cytomegalovirus (PCMV) in the pig heart and now think that the pathogen might have contributed to the man’s death. An investigation is under way.
Fishman says it’s thought that the virus doesn’t infect human cells, but it has been linked with reduced survival times for non-human primates that received pig organs2. To get to the bottom of the mystery, more tests and trials are needed, researchers say.
Even though the heart-transplant recipient died, the surgery represents an enormous accomplishment, Kirk says. The science of xenotransplantation, he says, has advanced to the point that there is an answer to the biggest question — can a pig organ support life in a human who would otherwise die? And the answer is yes.
The high-profile transplants have “increased public awareness of the field” and have “made this an optimal time for public conversation” and clinical trials, said Wilson Bryan, director of the FDA’s Office of Tissues and Advanced Therapies in Silver Spring, Maryland, at the meeting.
But there are still many questions that must be answered before xenotransplantation can become standard clinical practice. During the advisory meeting, the FDA sought advice from committee members on how to Strengthen screening for viruses — PCMV can linger silently in infected pigs — and how to reduce the risk of breeding pigs with viral infections. To be more comfortable with human trials, Zeiss said she wants to see validated tests that could eliminate the possibility that PCMV and other viruses are lurking in pigs bred as organ donors.
Companies such as Revivicor in Blacksburg, Virginia, owned by United Therapeutics, have been breeding pigs for use in xenotransplantation. They have been searching for the right combination of genetic modifications for their pigs to help ensure that humans’ immune systems accept organs from the animals. These companies “have been creative making these pigs; hopefully they’ll be creative testing them”, said FDA investigator Deborah Hursh at the meeting.
Other panellists discussed whether it would be possible to develop a standard ‘package’ of immunosuppressive drugs for humans, and genetic modifications for pigs, to ensure success. Fishman said that there probably won’t be one package that works for everyone. Instead, it will need to be tailored on the basis of the organ being transplanted and the recipient’s condition, as is done in human-to-human organ transplants.
Researchers at the University of Alabama at Birmingham and the University of Maryland Medical Center in Baltimore have signalled their desire to begin xenotransplant clinical trials soon. The FDA hasn’t publicly indicated what it will do with the advice collected during the meeting, but a 30 June report from The Wall Street Journal says that the agency is devising plans to allow trials.
Far from the Nashville courtroom where nurse RaDonda Vaught was convicted of homicide for giving a patient the wrong drug, medical experts and talking heads have mostly asked the right questions. Will the case have a chilling effect on the nursing profession? Did software system issues at Vaught’s hospital contribute to the tragedy? Aren’t chronically low staffing levels priming the pump for future mistakes?
All are important, all worthy of examination. But the rush to answer these questions obscures a development, nurses say, that may radically alter the delivery of medical care in our country. It is a sea change hiding in plain sight.
Over the past two decades, health systems in the U.S. have moved steadily toward the “just culture” model of care. In a just culture, caregivers are held accountable for their mistakes, but without scapegoating. The larger emphasis is on identifying and improving the processes, procedures, and training and design flaws that led to the failures in the first place. Many have argued that in a profit-driven health industry, just culture is one of the few effective means of constantly forcing reevaluation and upward evolution in care.
The just culture approach, though, relies heavily on a free flow of information and transparency, with doctors and nurses encouraged to self-report their errors as part of the system-wide effort to improve. From the moment Vaught was criminally charged for the mistakes that killed 75-year-old Charlene Murphey, that model has been fraying at the edges.
In interview after interview, nurses told me they believe their colleagues will be much less likely to self-report errors, or even near misses. “People will die because of this,” says Janie Harvey Garner, founder of Show Me Your Stethoscope, an online nurse advocacy group that helped raise money for Vaught’s legal fees. Nurses also say they’ll think twice about employing the sort of routine shortcuts and workarounds that can be necessary in hospital settings to expedite care to patients, particularly those in critical settings.
“We will not report errors for fear of going to jail,” Leslie Silket said bluntly. Silket, a registered nurse in Northern California with 22 years of experience in major hospitals and clinic settings, told me the case is almost certain to drive more of her peers out of the profession, adding, “This is going to drastically impact the future of nurses and add to the shortage.”
“Every health care system I have worked in promotes a just culture, where there is some mechanism to report errors without fear of retribution,” said Gabe Wardi, a critical care specialist with the University of California, San Diego. “But since this case became publicized, I’ve noticed that a sizeable percentage of nurses have changed how they practice. Patient care will suffer at the expense of self-preservation, and after this case I don’t blame the nurses for protecting themselves.”
Promoting a just culture is not the same as excusing mistakes. RaDonda Vaught made several, experts say. Unable to find the prescribed sedative Versed in the Vanderbilt University Medical Center’s automated medication dispensing cabinet on Dec. 26, 2017, Vaught overrode the system. That was a fairly common practice at the time, her attorney said, because of problems in the medical center’s software system, which impeded communication between the medication cabinets, electronic health record and pharmacy. In subsequently typing in the letters “VE” and selecting the first drug that came up, though, she erroneously selected vecuronium, a powerful paralytic. (Versed is a brand name; Vaught should have been looking for the sedative by its generic name, midazolam.)
Vaught also failed to check the label on the medication, did not heed a bottle cap warning that described the medicine inside as a paralyzing agent, and failed to recognize that Versed is a tablet, but vecuronium a powder. Vanderbilt did not have a bar-code scanner in place in the radiology suite to confirm the patient’s drug order, another potential safeguard against mistake.
After administering the paralytic to Murphey, Vaught—who was working as a “help-all” on that shift, helping with nursing needs across the neurologic intensive care unit as they arose, while also mentoring a student—did not remain with the patient to check for an adverse reaction. Murphey suffocated and was pronounced dead the following day.
“It’s a classic wrong-drug error,” said Bruce Lambert, a patient safety expert and director of the Center for Communication and Health at Northwestern University. “It implicates all sorts of process issues about automated dispensing cabinets, about alerts, about overrides, about safe practices for paralytics, moderate sedation and monitoring, and so on. Those are the main facts.”
Vaught self-reported her mistakes. She took responsibility immediately, and in every interview thereafter. At a Tennessee Board of Nursing hearing last year she said, ”I know the reason this patient is no longer here is because of me. There won't ever be a day that goes by that I don't think about what I did.” The board did not recommend that she lose her license or be suspended. But about a year later, an anonymous tip led to state and federal investigation, the filing of criminal charges, and ultimately Vaught’s conviction in March of criminally negligent homicide and abuse of an impaired adult. Vaught was convicted despite agreement between prosecutors and defense attorneys that the nurse’s mistakes were purely unintentional.
This criminalization of medical errors, though not unprecedented, is incredibly rare. But this April in North Carolina, a grand jury reacted to the 2019 death of a Black jail inmate not by indicting any of the five detention officers who held him down in his cell while he repeatedly exclaimed, “I can’t breathe,” but by indicting the on-call nurse, an employee of a private contractor.
Medical institutions assiduously avoid court cases. Vanderbilt fired Vaught less than a month after Murphey’s death, then settled with Murphey’s family out of court, a deal that forbid the family members from speaking publicly about the agreement or the medication error. The center also did not report that medication error to state or federal officials, as required by law.
The medical center’s CEO has admitted that Murphey’s death was not reported to state regulators, and that the hospital’s response was “too limited.” The hospital has also filed a "plan of correction" with the federal Centers for Medicare and Medicaid Services in order to avoid losing Medicare reimbursement payments. But Vanderbilt has not been penalized for its failures, nor for several of the systemic issues that many argue contributed to the tragic sequence of events. “It’s a classic throwing an individual under the bus to avoid institutional responsibility,” says Lambert. (Reached by Fortune for this piece, Vanderbilt medical officials declined comment.)
Vaught went on trial facing a potential eight years in prison. That she ultimately was sentenced on May 13 to three years’ probation and judicial diversion does nothing, nurses say, to lessen the fact that in the end, she stood alone.
“What do we say? Do we say, ‘Nurses, don’t tell the truth anymore’?” says Garner, the advocacy group founder. “Just like everyone else, nurses have constitutional rights. We have a right not to self-incriminate—which is exactly what RaDonda did, because she was an honest nurse.”
The nursing workforce in the U.S. shrank by 100,000 positions last year, according to a recent study published in Health Affairs. The exodus was driven largely by nurses under age 35 who fled hospital-based jobs. According to the National Council of State Boards of Nursing, there are more than 4.3 million RNs with active licenses in the country, and some 5.1 million RN licenses issued overall. Yet only about 3 million are currently employed as RNs, 1.7 million of them at hospitals.
Nurses, that is, are staying away from their own profession. The ones with whom I spoke believe that chronic short-staffing by medical behemoths, along with COVID fatigue and worry, factor significantly into that issue—but they also think the fear of being held criminally liable for medical mistakes will drive the total higher in 2022. “We have all these checks and balances, but ultimately the end user is always the one who's punished, and we’re scared,” says Shannon Cotton, a medical intensive care unit nurse in San Diego. Or as RN Suzanne Martin put it, “A precedent has been set, and the consequence is prison.”
The history of medicine is filled with great achievement and sorrowful failure. Mistakes happen. A study from Johns Hopkins University a few years ago estimated that more than 250,000 Americans die each year because of medical errors, and while other researchers have questioned the precise number, no one doubts that people die by mistake while under care.
What Vaught’s charges and trial highlight, to nurses, is the profoundly one-sided nature of that unhappy truth. Medical institutions and health systems roll on, but individuals can be ruined. If that is the case, then nurses will act to protect themselves from losing everything, even as it runs counter to so much of what they’ve been trained to do: anything to help a patient.
“We have been told time and time again that reporting mistakes is not to be punitive, because we operate in a ‘just culture’ framework,” said Anthony Cosenza, an RN in Pennsylvania. “This case really challenged that idea, and I am not sure many of us trust that to be true any longer.” Under no scenario does that reality play out to the good of patients or the practice of medicine in America.
Carolyn Barber, M.D. has been an emergency department physician for 25 years. Author of the book Runaway Medicine: What You Don’t Know May Kill You, she has written extensively about COVID-19 for national publications, including Fortune. Barber is co-founder of the California-based homeless work program Wheels of Change.
This story was originally featured on Fortune.com
As the number of patients approved to use medical marijuana in Florida continues to climb, some providers are growing increasingly frustrated by what they allege are bad actors in the state’s highly competitive cannabis industry.
One of the issues involves online companies seeking to make it easier for people to qualify for medical marijuana by connecting patients and doctors. The businesses share a portion of fees with physicians, who sometimes conduct patient evaluations through telehealth.
The fee-sharing agreement could run afoul of a state law prohibiting patient brokering. And a separate law requires doctors to meet in person with patients seeking medical marijuana.
The activities are drawing the ire of doctors spending money and time to comply with what is deemed to be one of the nation’s most rigorously regulated medical marijuana programs.
Nearly 2,300 Florida doctors have undergone training that allows them to order medical marijuana, which was broadly legalized by state voters in a 2016 constitutional amendment. A number of physicians belong to practices that focus almost exclusively on cannabis patients. The state has more than 730,000 patients who’ve qualified for the treatment.
Online businesses such as Veriheal are gaining a foothold in Florida and other states by promoting services for patients interested in getting state-issued medical-marijuana cards.
“Veriheal is a health care technology company with a mission to provide personalized cannabis education and wellness to everyone around the world. We do that by connecting patients and doctors online, through our platform, to provide recommendations for living a better life,” the company’s website says.
Veriheal, a corporation registered in Delaware with a physical address in Colorado, charges $199 to hook up patients with doctors and help navigate the process to obtain Florida cards. The money is refundable if patients don’t qualify for the treatment.
According to a complaint filed with the Florida Board of Medicine in February, Veriheal enlisted doctors to participate in its referral program by offering physicians $55 for each patient steered from its website. Doctors wouldn’t receive anything if the patients were deemed ineligible for medical marijuana, according to the complaint.
Critics question the legality of such fee-sharing agreements.
State law says, in part, that it is unlawful to “offer or pay a commission, benefit, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engage in any split-fee arrangement, in any form whatsoever, to induce the referral of a patient or patronage to or from a health care provider or health care facility.”
Aaron Bloom, CEO of DocMJ, filed a petition asking the Board of Medicine for a “declaratory statement” to determine whether a proposed Veriheal fee-splitting agreement violated Florida law, after the company solicited a doctor who works for Bloom’s group.
“The statute is so clearly written that it basically says nobody --- persons, companies, anything --- can pay anything of value for a referral,” Bloom, an attorney, told The News Service of Florida in a phone interview.
The board addressed the issue at an April 8 meeting in Tampa.
“You’ve answered your own question when you referred to it as a split fee,” board attorney Ed Tellechea told Bloom, whose company contracts with 45 doctors throughout the state.
But Tellechea said the board, which can issue sanctions against doctors, lacked authority to punish the online company. The anti-kickback law gives the attorney general’s office and state attorneys the power to prosecute illegal fee-splitting arrangements.
In a series of emails last week, a spokesman for Veriheal said the company could not respond to questions about its Florida activities due to the holiday weekend.
Some doctors working with Veriheal and similar companies also have conducted patient consultations via telehealth. State law requires doctors to be “physically present in the same room as the patient” and to conduct physical examinations when evaluating whether patients are eligible for medical marijuana.
Gov. Ron DeSantis temporarily suspended the face-to-face requirement because of the COVID-19 pandemic, but only for patients who were renewing medical-marijuana certifications with the same doctors they had seen previously.
The executive order expired a year ago, and the state Office of Medical Marijuana Use’s website advises doctors that telehealth is off-limits.
“As of June 27, 2021, the use of telemedicine services to re-certify existing patients in the Medical Marijuana Use Registry is no longer allowed,” the office’s FAQ for physicians says.
But some doctors continued the practice, according to information obtained by the News Service.
For example, Ivan Fields, the CEO of marijuanadoctor.com, had a telehealth visit on March 4 with Ahsan Iqbal, a doctor he was referred to by Veriheal. The session lasted just under five minutes, a recording of the meeting provided to the News Service showed.
Florida law also requires doctors to perform a number of steps before certifying that patients are eligible for medical marijuana. Doctors have to enter information about the patient into a statewide database. The data includes the patient’s qualifying condition, dosage and the amount and forms of marijuana authorized for use.
When Fields asked Iqbal --- whose voice can be heard in the recording but whose camera was off throughout the visit --- about what products he should use, the doctor told him he would receive information from Veriheal or medical-marijuana dispensaries.
“You have nothing to worry about. All my patients get anything at the dispensary,” Iqbal told Fields. “We take care of everything and make it very simple, so you have access to everything possible at the dispensary.”
Iqbal did not respond to an email seeking comment.
Fields, whose company contracts with doctors in 35 locations, never followed up and did not try to obtain a marijuana ID card.
Emails obtained by the News Service showed that Veriheal was continuing to solicit doctors to conduct telehealth certifications as recently as last month and scheduling online patient consultations through June.
For example, a May 4 message from Veriheal to a Florida doctors’ group said Veriheal was “back online for Florida telemedicine for initial consults.”
A May 31 email showed that Veriheal booked a June 2 telehealth appointment for a prospective patient with “Dr. Cannabis Consultants LLC.”
“Step 1: Prepare for your video appointment and complete your consultation,” said part of the message from “Warren” at Veriheal.
In a May 21 press release, Veriheal announced that it had “reasserted its commitment to the Florida medical cannabis market by partnering with over 20 health care providers in the Sunshine State.”
The Florida Department of Health did not respond to questions about the telehealth or patient-brokering allegations. Attorney General Ashley Moody’s office did not say if she was aware of the complaints.
Bloom said he believes the vast majority of doctors “are doing it right and want to do it right.” But he and other industry executives are frustrated that their complaints about alleged rule breakers aren’t getting results.
“We as an industry are trying to stop this ourselves and police it ourselves. And nobody, unfortunately, wants to help us,” Bloom said. “I do think there needs to be a mechanism for the existing government agencies to enforce the law.”
Bloom also is concerned that wrongdoers could undermine the credibility of the medical-marijuana program.
“It’s incredibly frustrating for our doctors. Our doctors, they love the program because they see the amazing benefits and results that their patients are getting,” Bloom said. “What’s particularly confounding to our doctors is that there are so many rules and regulations and this program is under such scrutiny. Every year, the Legislature continuously looks for ways to regulate it. … Why is this issue, a clear violation, ignored?”