August 9, 2022: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

Contributors: Clint Haines, MS; Noelle Huhn, MSPH; Amanda Kobokovich, MPH; Aishwarya Nagar, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; Marc Trotochaud, MSPH; and, Rachel A. Vahey, MHS

MONKEYPOX VIRTUAL BRIEFING Johns Hopkins University will host a live virtual briefing on monkeypox on Wednesday, August 10 from 10:30 am to 11:30 am EDT. Johns Hopkins faculty experts will discuss topics ranging from prevention, transmission, treatment, vaccine distribution and availability, and ways to reduce stigma in the outbreak response. Registration is available here. To watch the live briefing on August 10, please go to: https://hub.jhu.edu/monkeypox-briefing/.

OMICRON-ADAPTED VACCINES The European Medicines Agency (EMA) announced today that it has started a rolling review of an Omicron-adapted vaccine developed by Pfizer and BioNTech. This update follows a large push from national governments for vaccine companies to develop a variant-adapted version of SARS-CoV-2 vaccines to protect individuals against more transmissible variants, including the Omicron subvariants BA.4 and BA.5. Pfizer and BioNTech expect to begin clinical trials later this month using an enhanced vaccine candidate targeting the original strain identified in Wuhan, China, in late 2019 and the Omicron BA.4 and BA.5 subvariants, which are the dominant drivers of outbreaks in Europe. The companies said they would be able to begin delivering doses as early as October. The EMA’s rolling review constitutes an ongoing process in which the agency will assess data as it becomes available. Notably, US FDA officials previously said they anticipate an updated Pfizer-BioNTech vaccine to be available as early as September, and the agency has indicated that it would approve the variant-adapted vaccine while trials are ongoing. However, both the EMA and FDA will still require clinical data from this month’s trial to guide their decisions on the companies’ candidate targeting BA.4/5. Pfizer and BioNTech also are testing vaccine candidates encoding for Omicron BA.1 and BA.2. Both the US and European Union are hoping to use updated SARS-CoV-2 vaccines for fall booster campaigns.

The Biden administration on July 29 announced an agreement to purchase 66 million doses of a version of Moderna’s Omicron-adapted vaccine booster, with intentions to distribute the shots this fall and winter. In July, Moderna announced that its bivalent Omicron (BA.1) booster (mRNA-1273.214) elicited higher neutralizing antibody responses than the currently available booster and said it is simultaneously developing a booster specific to BA.4/5 (mRNA-1273.222). The US government previously purchased 105 million doses of a Pfizer-BioNTech bivalent vaccine for use later this year, although it is unclear which version of the companies’ booster candidate is covered under the agreement.

US EMERGENCY DECLARATION The Biden administration is deliberating whether to once again extend the COVID-19 public health emergency, which facilitates federal assistance for pandemic-related healthcare coverage and access to vaccines and treatments. The deadline to announce a decision is August 15, if the US Department of Health and Human Services is to give states 60 days’ notice before allowing the declaration to expire. If approved, the proposed extension could last into 2023, beyond the November elections and into the pandemic’s fourth year. Reportedly, debate surrounding the declaration has grown more contentious, with some officials pushing for the declaration to expire in October after the expected rollout of updated booster vaccines. The US government has repeatedly renewed the emergency declaration since first instituted in January 2020.

US PANDEMIC VIEWS According to a national survey conducted July 12-18 by the Annenberg Public Policy Center, the majority of Americans (54%) say they rarely or never wear a mask indoors around people outside their household to help prevent COVID-19, and 41% say they have returned to their normal, pre-pandemic lives. Among these individuals, the majority are aware of the risks of infection but say they have adjusted to the “new normal,” with a growing number having returned to pre-pandemic routines and activities. In another poll from Axios and Ipsos conducted July 15-18, 29% of respondents said they believe the pandemic is over. The results varied by political affiliation: 48% of Republicans said the pandemic is over, compared with only 9% of Democrats. Despite this, 4 of 5 respondents agreed with the statement, "We will never fully be rid of the coronavirus in my lifetime." Although the number of new COVID-19 cases has risen significantly with the emergence of the BA.5 Omicron subvariant, reported mask use continues to decline and these polls suggest growing numbers of US residents are returning to their pre-pandemic lives, with limited precautions.

POST-COVID SYMPTOMS IN CHILDREN Researchers led by the CDC COVID-19 Emergency Response Team published a report on post-COVID-19 symptoms and conditions in children in the August 5Morbidity and Mortality Weekly Report (MMWR). The researchers compared the symptoms of 781,419 children with confirmed COVID-19 to 2,344,257 children without COVID-19 from March 1, 2020, to January 31, 2022. Children with confirmed COVID-19 were more likely than were those without COVID-19 to develop certain post-COVID conditions, including blood clots in the lung (adjusted hazard ratio [aHR]=2.01), heart muscle inflammation (1.99), venous blood clot (1.87), acute renal failure (1.32), type 1 diabetes (1.23), blood clotting or bleeding disorders (1.18), type 2 diabetes (1.17), and abnormal heart rhythms (1.16). Additional symptoms were associated with COVID-19, including smell and taste disorders and malaise or fatigue. Still, the incidence of these conditions remained uncommon in the post-COVID pediatric population. Notably, children who had COVID-19 reported lower rates of respiratory, mental health, muscle, and sleeping disorders than those without COVID-19. Reasons for the observation are thought to include the fact that the general population for this study was selected from patients with a healthcare encounter possibly related to COVID-19. As a result, the general population may have been less healthy than patients with COVID-19 at baseline.

LONG COVID DIAGNOSIS & TREATMENT Post-COVID-19 symptoms and conditions, which can linger for months or years in both children and adults, are often referred to as long COVID. However, there is no test for the condition, and there is little agreement around a standard definition for the condition, which is estimated to affect 1 in 5 to 1 in 8 COVID-19 patients. Treatments typically involve symptom management, but researchers are beginning to hone in on the condition’s pathology and begin clinical trials on medicines that target the immune system, blood clots, or lasting fragments of the virus itself. Some researchers are examining the similarities between long COVID and an older condition known as ME/CFS, or myalgic encephalomyelitis/chronic fatigue syndrome. The US government recently released a set of reports that sketch out an action plan to address long COVID, including calling for the establishment of a new office at the US HHS, new funding, and additional focus on the condition from the private sector. Though the full impact of the COVID-19 pandemic is hard to predict, it is becoming increasingly clear that individuals with long COVID may face health challenges for years to come.

DISRUPTIONS TO ROUTINE HEALTHCARE During the early stages of the COVID-19 pandemic, lockdowns prevented many US residents from accessing routine, and sometimes emergency, healthcare. Among households that had a serious illness in the past year, about 1 in 5 respondents to a new poll by NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health said they had trouble accessing care during the pandemic. Some experts are concerned these disruptions, which continue to occur, could have lasting impacts on people’s health as well as the nation’s healthcare system. The poll found the difficulties accessing healthcare hit some racial/ethnic minority populations harder. Among those households with a serious illness in the past year, 35% of Native American households, 24% of Black households, 18% of Latino households, 18% of White households, and 10% of Asian households had difficulty accessing care when they needed it. The survey, conducted from May 16 to June 13, 2022, also examined other problems facing racial/ethnic minorities, including issues concerning finances, housing, neighborhood conditions, and personal safety.

COVID-19 IN ANIMALS A recent report published July 23 in Scientific Data describes a dashboard that monitors COVID-19 cases in animal populations. The online dashboard, called SARS-ANI, is an open-access curated global dataset of SARS-CoV-2 events in animals containing a wide variety of information, including total number of infection events, number of animal species described, number of countries where animal infections have been reported, clinical signs of infection categorized by animal, a SARS-CoV-2 variant breakdown by animal, and more. The majority of animal cases have occurred in mink, with cats and dogs following closely behind. Cases of COVID-19 also have been reported in wild and captive animals, such as deer, gorillas, hippos, hyenas, and marmosets. A separate online dashboard tracking COVID-19 in animals around the world reports that cases have also occurred in certain avian populations, such as swans.

The detection of so many COVID-19 cases in animal populations raises questions about how the pandemic will look in the future. The SARS-CoV-2 virus can mutate in an animal just like it can mutate in humans, so it is entirely possible that SARS-CoV-2 could circulate widely within a population of animals before spilling back into humans to cause a completely new variant through a process known as zoonotic transmission. Additionally, an expansion of the virus into more avian populations could enhance the ability of new variants to be transported and emerge in unexpected places. One of the other concerning aspects of COVID-19 in animals is potential establishment of “viral reservoirs.” Viral reservoirs are animal populations that maintain low levels of circulating virus within their species, which could allow the virus to jump back to humans years or decades after the last human case. One of the reasons smallpox was successfully eradicated was the absence of animal or insect viral reservoirs. The presence of COVID-19 in animals means that a “One Health” approach is needed to properly address the pandemic. One Health focuses on treating the health of humans, animals, plants, insects, and the environment as a connected web.

CHINA China’s tourism-dependent island province of Hainan on August 8 expanded lockdowns amid a growing COVID-19 outbreak during the summer school holiday. The tropical resort of Sanya began an indefinite lockdown on August 6, confining about 80,000 vacationers to their hotel rooms. Tourists who test negative 5 times over 7 days can leave, but many flights to the area have been canceled. Additionally, 4 other cities and 4 counties in Hainan—a total population of about 7 million—began lockdowns of 2 or more days on August 7 and August 8. Hainan reported 471 new COVID-19 cases on August 8, out of a total of 939 new local and imported cases nationwide. It is the province’s largest outbreak since the pandemic began.

In related news, the Chinese autonomous region of Tibet has imposed various restrictions in its capital city Lhasa, as well as in its second-largest city, Shigatse. Residents in the 2 largest cities and other areas will undergo mass testing. Until now, the region had remained COVID-19-free for more than 900 days, the best record of enforcing China’s “zero COVID” policy. The region reported 22 new cases on August 8. The fresh lockdowns came as Hong Kong, a semi-autonomous Chinese city, announced it will reduce mandatory hotel quarantine for international travelers from 1 week to 3 days, followed by 4 days of at-home surveillance, beginning Friday.

NEW ZEALAND & AUSTRALIA According to analysis from the New Zealand Herald, COVID-19 became a leading cause of death in the country, tied with heart disease, in the week ending July 17. During that week, 836 people died nationwide, and nearly 15% of those deaths were attributed to COVID-19. Experts expressed concern that at the same time the nation is experiencing its highest COVID-19 mortality impact, public attention to the pandemic appears to be at its lowest levels. Overall, New Zealand’s cumulative death rate from COVID-19 remains low—at 316 per million population—compared with the US and UK, with 3,062 and 2,753 deaths per million population, respectively. Public health officials predict COVID-19 will continue to be a significant contributor to overall mortality for the foreseeable future—with annual COVID-19 deaths at about 5 times influenza deaths—and could have a significant impact on the country’s life expectancy.

In Australia, modelers with the Actuaries Institute Covid-19 Mortality Working Group estimate that COVID-19 was the primary cause of 7,100 deaths in the country from the beginning of this year through the end of July, making the virus the third most common cause of death this year so far. Only ischemic heart diseases and dementia, which caused about 10,000 deaths each, beat out COVID-19, with deaths from cardiovascular disease (primarily stroke; about 5,500 deaths) and lung cancer (5,400 deaths), following behind.

THAILAND Beginning in October, Thailand will downgrade COVID-19 from a “dangerous” communicable disease, similar to plague and smallpox, to one that “need monitoring,” a group that includes influenza and dengue. In an announcement, Thailand Health Minister Anutin Charnvirakul said the action reflects the readiness of the nation’s public health system, public acceptance of “self-protection behavior,” and the availability of treatments. Thailand’s number of newly confirmed daily COVID-19 cases has remained relatively stable since mid-July. While the number of daily deaths is elevated, officials said they expect to see a decline in both cases and deaths by mid-August.

Is there an advantage to Medicare Advantage Plans?

Stop the Medicare “Advantage” Scam Before Medicare is Dead

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Friday August 05, 2022 · 9:53 AM CDT

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Congress must pass a law to stop the deceptive advertising of Medicare Advantage plans. Only Medicare should be able to call itself Medicare.

Unless you’ve been out of the country for the past few years, you’ve seen the ads on TV featuring Joe Namath, Jimmy Walker, or William Shatner hawking so-called “Medicare Advantage” plans.

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Medicare Advantage is not Medicare.

It’s private health insurance being offered to people over 65, with the bill paid for by Medicare.  Once you get on an Advantage plan it’s very difficult to get off, and if you’ve been on for more than a year you may not be able to go back to regular Medicare with a Medigap plan at all.

It’s also one of the most effective ways that insurance companies are using to kill Medicare for All before its even birthed, since almost half of all people who think they’re on Medicare are actually on these privatized plans instead.

Nearly from its beginning, Medicare has allowed private companies to offer plans to seniors that essentially compete with it, but they were an obscure corner of the market and didn’t really take off until the Bush administration and Republicans in Congress rolled out the Medicare Modernization Act of 2003.

This was the GOP’s (and a few corporatist Democrats’) big chance to finally privatize Medicare, one bite at a time.

Bush’s law authorized giant insurance companies to offer for-profit health insurance to people over 65 that competes directly with Medicare and — most egregiously — it lets those companies pretend that they’re offering Medicare by using the brand name “Medicare Advantage.”

Seniors buying Medicare Advantage plans often think — even though they know they’re getting the plan through an insurance company — that they’re somehow still in Medicare or backstopped by Medicare. The reality is they’re neither.

With Medicare Advantage, they’re at the total mercy of the insurance company providing the Advantage plan. They can deny care (and frequently do), refuse to pay for tests, and even refuse to authorize or pay for surgeries and other life-saving procedures.

This is their business model, in fact, just like with regular health insurance. The more they can deny care and claims, the more profit they make.

Most Advantage companies screw their customers just as enthusiastically and aggressively as they do customers of their regular plans, including denials, co-pays, and deductibles. And, because many elderly people don’t have the mental or technical bandwidth to challenge denials of care, the companies get away with it far more easily.

The only real difference is that these companies are paid by Medicare to do this to people, instead of by their customers. And that works out really, really well for the insurance industry, because they regularly lie to Medicare about how sick their customers are so they can make huge profits.

They can pull this off because they don’t get reimbursed directly on a person-by-person, procedure-by-procedure basis (which is how real Medicare works).

Instead, they’re guaranteed payments whether people get sick or not (just like regular health insurance premiums). That’s why the classic strategies of tying people to in-network providers, denying procedures routinely during first-pass authorization attempts, and having high out-of-pocket caps and co-pays are carried over from regular health insurance systems to Medicare Advantage to keep costs low and profits high.

Worse, though, every year, Advantage providers can submit a summary to the federal government of the aggregate “risk score” of all their customers and, practically speaking, get paid ever year a massive additional lump sum for their “increased risk.”

The higher their risk score, the larger the payment. In theory, a plan with mostly very ill people in it should get much larger reimbursements than a plan with mostly healthy people. After all, sick seniors will be costly to keep alive and healthy, while healthy seniors won’t cost much at all.

But profit-seeking insurance companies, being the predators that they are, have found a number of ways to raise their risk scores without raising their expenses. And the more they do this, the faster they drain Medicare’s trust fund straight into their money bins.

For example, many Medicare Advantage plans promote an annual home visit by a nurse or physician’s assistant as a “benefit” of the plan. What the companies are doing, though, is trying to “upcode” their customers to make them seem sicker than they are to increase their overall Medicare reimbursement risk score.

“Heart failure,” for example, can be a severe and expensive condition to treat — or a barely perceptible tic on an EKG that represents little or no threat to a person for years or even decades. So these visiting nurses look for the tiniest tick in an EKG.

Depression is similarly variable; if it lasts less than two weeks, there’s no reimbursement; if it lasts longer than two weeks, it’s called a “major depressive episode” and rapidly jacks up a risk score. So they could ask things like, “Have you ever felt down for three weeks after the death of a friend or relative?”

The home health visits are designed to look for illnesses or codings that can increase risk scores. They very much are not looking for conditions that require medical intervention. This “free home health visit” scam is so profitable that an entire industry has sprung up of companies that send nurses out on behalf of the insurance companies.

In summer 2014, the Center for Public Integrity (CPI) published an in-depth investigative report titled Why Medicare Advantage Costs Taxpayers Billions More Than It Should.

They found, among other things, that one of the most common scams Advantage companies were running involved that very scoring of their customers as being sicker than they actually are, so that their reimbursements were way above the cost of caring for those people.

Here are a few quotes from the report:

• *“Risk scores of Medicare Advantage patients rose sharply in plans in at least 1,000 counties nationwide between 2007 and 2011, boosting taxpayer costs by more than $36 billion over estimated costs for caring for patients in standard Medicare.”

• *“In more than 200 of these counties, the cost of some Medicare Advantage plans was at least 25 percent higher than the cost of providing standard Medicare coverage.”

• *The report documents how risk scores rose twice as fast for people who joined a Medicare Advantage health plan as for those who didn’t.

• *Patients, the report lays out, never know how their health is rated because neither the health plan nor Medicare shares risk scores with them—and the process itself is so arcane and secretive that it remains unfathomable to many health professionals.

• *“By 2009, government officials were estimating that just over 15 percent of total Medicare Advantage payments were inaccurate, about $12 billion that year.”

• *Based on its own sampling of data from health plans, the report shows how Medicare has estimated that faulty risk scores triggered nearly $70 billion in what officials deemed “improper” payments to Medicare Advantage plans from 2008 through 2013.

• *CMS decided, according to the report, not to chase after overcharges from 2008 through 2010 even though the agency estimated through sampling that it made more than $32 billion in “improper” payments to Medicare Advantage plans over those three years. CMS did not explain its reasoning.

• *The report documents how Medicare expects to pay the health plans more than $150 billion this year [2014, the year the study was published].

Companies are almost never nailed for these overcharges, and when they are, they usually pay back pennies on the dollar.

For example, when the Office of Inspector General, Health and Human Services (which oversees Medicare), audited six out of the hundreds of plans on the market in 2007, they found that just those six companies they looked at “had been overpaid by an estimated $650 million” for that one year.

As the Center for Public Integrity states:

“Medicare settled five of the six audits for a total repayment of just over $1.3 million.”

The Centers for Medicare and Medicaid Services (CMS) also, in 2012, decided to audit only 30 plans a year going forward. As CPI noted, “At that rate, it would take CMS more than 15 years to review the hundreds of Medicare Advantage contracts now in force.” And that’s 15 years to audit just one year’s activity!

Things haven’t improved since that 2014 investigative report from CPI. In September 2019, Senator Sherrod Brown of Ohio and five Democratic colleagues sent a letter to President Donald Trump’s CMS administrator, Seema Verma.

“The recent HHS Payment Accuracy Report exposes that taxpayers have overpaid Medicare Advantage plans more than $30 billion dollars over the last three years,” Brown wrote. “This report comes on the heels of a 2016 Government Accountability Office (GAO) report and a 2013 GAO report on [Medicare Advantage] plan overcharges and the failure of the Centers for Medicare and Medicaid (CMS) to recoup billions of dollars of improper payments from Advantage plans.”

With a tiny slice of these huge profits, Advantage companies then will pay small parts of dental, vision, hearing or even give people a bit of cash every month. It’s pure marketing, though: in exchange for what sounds like a deal, customers must put up with fewer diagnostics, regular denials of care, co-pays, and deductibles.

The National Bureau of Economic Research (NBER) compared Medicare Advantage with traditional Medicare and found the Advantage programs to be mind-bogglingly profitable: “MA insurer revenues are 30 percent higher than their healthcare spending. Healthcare spending for enrollees in MA is 25 percent lower than for enrollees in [traditional Medicare] in the same county and [with the same] risk score.”

In other words, they are paid more and deliver less, keeping the balance as their profit. And it is hundreds of billions of dollars.

According to that NBER study, people with Medicare Advantage got 15 percent fewer colon cancer screening tests, 24 percent fewer diagnostic tests, and 38 percent fewer flu shots.

And it’s causing real disasters for real people.

A fellow I’d known decades ago recently bubbled back into conversation among a few of us who’d hung out together in New York back in the 1970s. Sam, I’ll call him, had turned 65 and hadn’t had employer-provided health insurance in years. He spent a few hours trying to figure out how to sign up for Medicare and then gave up, totally confused, figuring he’d try again in a few months.

Unfortunately, his prostate intervened. When Sam started experiencing pain urinating, he visited a local “doc in a box” urgent care clinic, where they gave him a PSA test. The result was shocking: his PSA was so high that it was a virtual certainty he had prostate cancer, and possibly it had even metastasized, a situation that is the second-leading cause of cancer death in American men.

Telling him that he’d be facing hefty doctor and hospital bills regardless of the outcome, the urgent care clinic signed him up for a Medicare Advantage plan offered by an affiliate that almost certainly paid them a commission for the sign-up. Sam was excited, though, because he now had insurance, and it was a “no dollar” plan that didn’t cost him a penny.

Sam then got on the phone to find a urologist who specialized in cancer. He found that the best worked out of Memorial Sloan Kettering Cancer Center in New York, and, telling them he was “on Medicare,” he made an appointment to see one of their top docs. A month later, when his appointment finally opened up, the person who was checking him into the system told him that he’d have to pay cash because his Advantage plan didn’t include Sloan Kettering.

In fact, more than a third of all Medicare Advantage plans nationwide do not include any of the National Cancer Institute centers, and none of the Advantage plans offered in the New York City area include the nation’s most famous one, Memorial Sloan Kettering Cancer Center.

Shocked, Sam contacted Medicare to see if he could transfer from Medicare Advantage to regular Medicare. This all happened in fall 2020, so they told him that he could make the change during the “open enrollment period” of October 15 to December 7. He made the change and called Sloan Kettering back.

This time, they wanted to know what Medigap policy he’d signed up for to fill in the 20 percent of billing that Medicare doesn’t cover. That sent Sam back to the internet and, ultimately, to an insurance agent, who told him that while Medigap plans can’t refuse you because of preexisting conditions when you first sign up when you turn 65, if you shift from Medicare Advantage back to traditional Medicare after that first enrollment, particularly if you’re older or sick, they can simply refuse to cover you.

Reporter Mark Miller wrote for the New York Times in February 2020 about Ed Stein, a 72-year-old man with bladder cancer and a Medicare Advantage plan that didn’t cover the cancer docs in his area who specialized in his type of cancer. He tried to shift back to traditional Medicare to cover what promised to be complex and expensive surgery and chemotherapy.

As Miller wrote:

“That was when he ran up against one of the least understood implications of selecting Advantage when you enroll in Medicare: The decision is effectively irrevocable.”

And when those customers get really, truly sick they’re sometimes in for a world of hurt.

The New York Times did an exposé of the problem last year, in an article titled “Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds.” It tells the story of “Kurt Pauker, an 87-year-old Holocaust survivor in Indianapolis” who’d bought an Advantage policy from Humana:

“In spite of recommendations from Mr. Pauker’s doctors, his family said, Humana has repeatedly denied authorization for inpatient rehabilitation after hospitalization, saying at times he was too healthy and at times too ill to benefit.”

This is not at all uncommon, the Times notes:

“Tens of millions of denials are issued each year for both authorization and reimbursements, and audits of the private insurers show evidence of ‘widespread and persistent problems related to inappropriate denials of services and payment,’ the investigators found.”

If you have “real” Medicare with a Medigap policy to cover the 20% Medicare doesn’t, you never have to worry.

Your bills get paid, you can use any doctor or hospital in the country who takes Medicare, and neither Medicare nor your Medigap provider will ever try to collect from you or force you to pay for what you thought was covered.

Neither you nor your doctor will ever have to do the “pre-authorization” dance with real Medicare: those terrible experiences are part of the past.

But if you have Medicare Advantage — which is not Medicare, but privatized insurance that came about because of George W. Bush’s 2003 law to privatize Medicare — you’re on your own.

As the Times laid out:

“About 18 percent of [Advantage] payments were denied despite meeting Medicare coverage rules, an estimated 1.5 million payments for all of 2019. In some cases, plans ignored prior authorizations or other documentation necessary to support the payment. These denials may delay or even prevent a Medicare Advantage beneficiary from getting needed care…”

If Congress and the Biden Administration really want to continue to allow giant insurance companies to exploit and rip off consumers and drain the Medicare Trust Fund, there’s probably not a lot we can do, given that almost half of all seniors now have so-called Advantage plans. Unwinding this scam will be very, very difficult at this point.

But — at the very least — let’s stop the egregiously deceptive advertising.  Only Medicare should be able to call itself “Medicare.”

Instead of saying on TV, “You can get Medicare and get dental and vision.” they should have to say, “You can get a private insurance plan for seniors that gives you dental and vision.”

Congress, therefore, needs to act. They should amend the 2003 Medicare Modernization Act to explicitly say that private health insurance plans of all types are forbidden from using the word “Medicare” to describe their plans in any way.

Let’s bring truth in advertising to health care for seniors and stop the destruction of what’s left of real Medicare.

HartmannReport.com

Above is from:  https://www.dailykos.com/stories/2022/8/5/2114705/-Stop-the-Medicare-Advantage-Scam-Before-Medicare-is-Dead

August 4, 2022: Johns Hopkins COVID 19 Situation Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

Contributors: Clint Haines, MS; Noelle Huhn, MSPH; Amanda Kobokovich, MPH; Aishwarya Nagar, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; Marc Trotochaud, MSPH; and, Rachel A. Vahey, MHS

MONKEYPOX OUTBREAK UPDATES The Johns Hopkins Center for Health Security is analyzing and providing updates on the global monkeypox outbreak. Since May, monkeypox outbreaks have been identified in many countries where the virus is typically not reported. To sign up to receive periodic email updates on the outbreak response, to read past updates, and for additional information, visit https://www.centerforhealthsecurity.org/resources/monkeypox/index.html.

EPI UPDATE The WHO COVID-19 Dashboard reports 577 million cumulative cases and 6.4 million deaths worldwide as of August 3.* The global weekly incidence dropped 7.14% from the previous week, falling for the first time since the end of May. Global weekly mortality remained stable, rising only 0.34% over the previous week. However, global weekly mortality has continued to increase since mid-June.

At the regional level, the Western Pacific (+20%) and Africa (+5%) regions experienced increases in new weekly cases, while the number of new cases increased or remained stable in Europe (-35%), Eastern Mediterranean (-12%), South-East Asia (-2%), and the Americas (-2%). In the Western Pacific region, the highest increases were in Japan (+42%) and South Korea (+25%). The number of new weekly deaths increased in the Western Pacific (+44%), Eastern Mediterranean (+26%), South-East Asia (+20%), and Africa (+12%) regions; decreased in Europe (-26%); and remained stable in the Americas region.

*The WHO notes the case and death data for the Africa region are incomplete and will be updated as soon as more information becomes available.

UNITED STATES

The US CDC is reporting 91.5 million cumulative cases of COVID-19 and 1,026,723 deaths. The current 7-day moving average of new daily cases is down slightly over last week, dropping to 119,034 on August 2. The average daily mortality remains relatively stable, at 387 on August 2. Daily mortality has risen since the beginning of June, when it was around 275 deaths per day.**

Both new hospital admissions (-1.7% over the past week) and current hospitalizations (-0.4%) remained relatively stable over the previous week, possibly reflecting the slight decrease in daily incidence.

Community transmission in the US is primarily driven by the Omicron BA.5 sublineage. BA.5 is now projected to account for 85.5% of sequenced specimens. The BA.4 sublineage accounts for about 7.7% of cases, while the newly delineated BA.4.6 accounts for 4.1% of cases and appears to represent a growing proportion of BA.4 sublineages. Together, BA.2.12.1 and BA.2 now account for only about 2.7% of cases. According to the data, Omicron variants represent all new cases in the US.

**Changes in state-level reporting may affect the accuracy of recently reported data, particularly over weekends. In an effort to reflect the longer-term trends, the numbers reported here may not correspond to the most recent dates.

US COVID PLATEAU The US appears to have settled into a persistent pattern of high levels of SARS-CoV-2 transmission—around 120,000 new infections per day, which is likely a massive undercount due to a lack of surveillance—and a relatively steady number of daily deaths—averaging between 350-400 per day. The currently high number of infections disrupt society and the economy and could result in millions more people experiencing long COVID. Although the COVID-19 death rate has dropped due to widespread immunity from vaccination or natural infection or both, as well as improved treatments, the virus is still killing hundreds of people each day, rarely dropping below 300 daily deaths. Some estimates predict 100,000, or more, annual COVID-19 deaths, far higher than the number associated with other respiratory diseases. Most individuals dying from COVID-19 now are those who are elderly, immunocompromised, unvaccinated, have lung or heart conditions, or have a combination of factors. Early treatment, in addition to vaccination, appears to provide good protection from death, even among people at higher risk.

Retooled booster vaccines, tailored to the Omicron subvariants BA.4 and BA.5, might provide additional protection when they become available in late summer or early fall, and the Biden administration is urging US residents who are not up to date on their vaccinations and booster doses—around 70% of the population as of July 21—to get those shots now. Several new studies suggest that people who received 3 or 4 vaccine doses are better protected against infection with Omicron than those who received 2 doses. But at the same time, the US CDC is expected to release updated guidance for COVID-19 community control, including easing quarantine recommendations for people who are exposed to the virus, such as those who are unvaccinated or not up to date on their vaccines; de-emphasizing 6 feet of social distancing; and downplaying the use of regular screening tests in schools. Some wonder how the new guidance—which remains under review but could be released this week—meshes with stubbornly high new infections and deaths. Additionally, no one knows what variant might emerge in the future, or how much existing levels of immunity might wane over time.

LONG COVID RESEARCH & SERVICES On August 3, the Biden administration announced new government initiatives to address the long-term health impacts of COVID-19, often referred to as long COVID, in 2 reports: the National Research Action Plan on Long COVID and Services and Supports for Longer-Term Impacts of COVID-19. The National Research Action Plan outlines what is currently known about long COVID—including defining 2 technical terms, post-COVID-19 conditions (PCC), broadly equivalent to long COVID, and post-acute sequelae of SARS-CoV-2 infection (PASC), focused on the direct effects of the virus—and directs future research toward certain vital areas. The Services and Supports report acts as a guide for those with long COVID to access services and care; additionally, it acts as a guide for healthcare providers seeking more information about how to care for their patients. These reports have been anticipated by the millions of US residents diagnosed with long COVID and their healthcare providers who are searching for answers. An estimated 7 to 23 million US residents have experienced long COVID, often with debilitating and life-interrupting symptoms.

While advocates say these actions are a good step forward, many raise concerns that they are inadequate to address the real-time needs of those with long-term symptoms. In a memorandum posted in April, US President Joe Biden emphasized the need for a whole-of-government approach to addressing the research gaps and assistance needs for individuals with long COVID. The memorandum also recommended the US HHS set up an Office of Long COVID Research and Practice but did not provide specifics on how to do so or how such an office would be funded. Relatively little is still known about the incidence of long COVID and any underlying factors that might predispose someone to experience long-term conditions. The US CDC estimated in May that 1 in 5 adults had a health problem that may be attributable to a prior SARS-CoV-2 infection. Aside from incidence, new research suggests long COVID appears to manifest in 3 different forms: nervous system problems (brain fog, fatigue, headaches), respiratory problems (chest pain, shortness of breath), and other myriad symptoms (heart palpitations, muscle aches, changes to skin and hair, etc.). Individuals with long COVID and their advocates hope the new action plans will help improve our understanding of long COVID and effective treatments or cures.

CARDIAC COMPLICATIONS As the COVID-19 pandemic continues, more people around the world are experiencing SARS-CoV-2 infections, some multiple times. Many individuals are able to recover from the disease, due in part to widespread implementation of vaccines and therapeutics. However, research evidence and clinical experience suggest that COVID-19 can drastically alter health after infection. Post-COVID conditions, sometimes called long COVID, can include a wide variety of symptoms and complications, but many experts are showing concern over research suggesting SARS-CoV-2 infection is associated with a higher risk of post-infection cardiovascular problems. In one study published earlier this year using records from the US Department of Veterans Affairs (VA), researchers found individuals with COVID-19 have an increased risk of incident cardiovascular issues, ranging from heart attack, heart inflammation, blood clots, and stroke, within the first year following infection. Unpublished analysis of the VA data from the University of Washington’s Institute for Health Metrics and Evaluation (IHME) predicts that COVID-19 may have led to 12,000 extra strokes and 44,000 extra heart attacks in 2020 and 18,000 extra strokes and 66,000 extra heart attacks in 2021. A preprint study posted to medRxiv on July 7 indicates that risk factors for cardiovascular complications may include prior cardiovascular disease, pre-existing conditions, older age, and hospitalization for COVID-19. Therefore, COVID-19 may be capable of worsening the cardiovascular prognosis of individuals already experiencing poor health.

The mechanism for cardiovascular damage may be related to the virus spike protein binding with human ACE2 to enter cells. ACE2 is a cellular protein that is found on many cell types throughout the human body. This means that the virus can thrive in a wide variety of human tissues. In the cardiovascular system, blot clots that form to heal damage done by the virus may also be responsible for much of the observed complications. Plaques can also accumulate after infection, leading to a higher risk of stroke and heart attack. Additional ongoing research hints that SARS-CoV-2 may also damage the heart by activating the TLR4 immune system signaling pathway. More research is needed, but understanding the mechanisms of injury can help scientists develop preventive and therapeutic strategies. The growing body of evidence suggesting that COVID-19 can have long-term impacts on human health highlights the need for continued measures to prevent infection and heightened awareness of and resources for the management of complications.

NASAL VACCINES Scientists worldwide are hard at work designing the next generation of SARS-CoV-2 vaccines and boosters. When they were first authorized, mRNA vaccines were approximately 95% effective at preventing symptomatic infection, but that efficacy has waned as new viral variants emerge and spread. The currently approved and authorized vaccines continue to remain effective at reducing rates of hospitalization and death, but each novel emerging variant brings fears that it could better escape immunity from vaccination or natural infection. US health officials stated during a recent summit at the White House that the next generation of vaccines should focus on the development of a pancoronavirus vaccine and various delivery mechanisms, including nasal delivery.

A report published July 19 in Science Immunology shows that currently available mRNA vaccines are not very good at eliciting immune responses in the respiratory tract of vaccinated individuals compared to people with previous SARS-CoV-2 infection. However, using an animal model, the study suggests that coupling mRNA shots with an adenovirus vector booster administered intranasally could provide a much higher level of protection against the virus entering the body through mucosal tissue and establishing infection. The Indian biotechnology company Bharat Biotech recently reported the completion of clinical trials using an adenovirus vector intranasal vaccine (BBV154) as a booster dose. The trial included 4,000 participants, and no adverse events were reported. Bharat Biotech is hopeful the Drug Controller General of India will authorize the vaccine this month.

VACCINE EFFECTIVENESS AMONG CHILDREN Since many countries authorized Pfizer-BioNTech’s mRNA SARS-CoV-2 vaccine, marketed as Comirnaty, for the 5- to 11-year-old age group, researchers continue to study the vaccine’s efficacy in that age group, particularly in the wake of the rise of Omicron variant predominance. Recently published studies appear to reinforce evidence that Comirnaty remains highly effective at preventing hospitalizations and severe outcomes from COVID-19, but its effectiveness against symptomatic infection wanes over time and against Omicron subvariant infections. A study in Singapore estimated vaccine effectiveness in 5- to 11-year-old children to be 82.7% against hospitalizations but 65.3% against PCR-confirmed infections during the initial Omicron wave. These approximations are echoed in a preprint out of Canada in which researchers estimated a range of 29-65% effectiveness against Omicron infections but 68-100% effectiveness against hospitalization due to Omicron. Interestingly, another study in the European Union found that vaccine effectiveness was higher among the youngest in this age cohort compared to the oldest. Children aged 5-6 years appeared to be more protected against symptomatic infection compared to those aged 10-11 years, with children aged 7-8 years falling between the 2 groups. Depending on the starkness of this difference moving forward, it could be valuable to investigate the tolerance and protectiveness of higher dosages in older children. Still, these studies taken together demonstrate the continued importance of vaccinating children to protect them against severe disease as we wait for Omicron-specific vaccines to become available.

MONOCLONAL ANTIBODIES Eli Lilly & Co plans to begin commercial sales of its COVID-19 monoclonal antibody treatment, bebtelovimab, to states, hospitals, and other healthcare providers this month. Most COVID-19 therapeutics and vaccines have been distributed at no cost through the US government, but the federal supply of bebtelovimab is running out and the government has no funds to purchase more, unless the US Congress moves to appropriate additional money. The move likely is the first test of how accessible COVID-19 treatments and vaccines will be once they are shifted to a commercial market. Bebtelovimab is available for use under US FDA emergency use authorization (EUA) for the treatment of mild-to-moderate COVID-19 among certain children and adults.

In a research letter published in JAMA, researchers from the Netherlands report that a large proportion of high-risk COVID-19 patients treated with the monoclonal antibody sotrovimab—one of a few such treatments to maintain neutralizing activity against Omicron BA.1—developed spike protein mutations associated with resistance to the treatment. The study included a small sample size and lacked a control group but provides additional evidence that treatment of high-risk patients with a single monoclonal antibody is associated with mutation development. The researchers called for further investigations into combination therapies and continuous genomic surveillance of immunocompromised patients during treatment. As of April 5, sotrovimab was no longer authorized by the FDA to treat patients in the US due to inactivity against Omicron BA.2, which was predominant at the time.

August 2, 2022: Johns Hopkin COVID 19 Situation Report

COVID-19 Situation Report

Editor: Alyson Browett, MPH

Contributors: Clint Haines, MS; Noelle Huhn, MSPH; Amanda Kobokovich, MPH; Aishwarya Nagar, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; Marc Trotochaud, MSPH; and, Rachel A. Vahey, MHS

COVID-19 REBOUND US President Joe Biden once again tested positive for SARS-CoV-2 infection this week, following several days of negative tests last week. His symptoms are reportedly mild, and he returned to isolation after the positive tests. The phenomenon is commonly referred to as “Paxlovid rebound” or “COVID-19 rebound,” and it occurs in COVID-19 patients who take the drug, test negative for SARS-CoV-2 infection, and then test positive again. The phenomenon was not seen as an issue during clinical trials of the drug but appears to be more frequently reported since Paxlovid became widely available, although it remains unclear what proportion of people experience rebound. Typically, the recurrence of COVID-19 symptoms tends to be relatively mild.

President Biden’s rebound case has called attention to the US CDC’s guidance regarding isolation after COVID-19 diagnosis or a positive SARS-CoV-2 test. The CDC currently recommends isolation for a minimum of 5 days after the onset of symptoms or positive test. To end isolation, those who were symptomatic should wait until their fever has subsided for at least 24 hours and other symptoms are improving—and those leaving isolation should wear a mask in public through Day 10. Notably, the CDC indicates that individuals can test before they end their isolation, but the guidance emphasizes that testing is optional (ie, as opposed to recommended) for anyone who “wants to.” Those who elect to test and obtain a positive result should remain in isolation. The isolation and testing protocol implemented for President Biden went “above and beyond” the CDC recommendations, and CDC Director Dr. Rochelle Walensky indicated that the CDC must issue guidance that is feasible for most people to follow. Recent studies have demonstrated that many individuals continue to test positive for 6 days or longer, and most can shed the virus for 8 days or longer, which could enable them to infect others if they end isolation after 5 days. In light of this evidence, some experts have called on the CDC to revisit its guidance to slow transmission, particularly in light of the current Omicron surge.

PUBLIC HEALTH OFFICIAL HARASSMENT Over the course of the COVID-19 pandemic, an increasing number of public health officials in the US have received personal threats and harassment. A study, published July 29 in JAMA Network Open and led by researchers from the Johns Hopkins Bloomberg School of Public Health, set out to examine the share of US adults who thought it was acceptable to threaten or harass public health officials because of business closures and the basis for those beliefs. Overall, the study suggests that 1 in 5 survey respondents feel that threatening or harassing public health authorities is acceptable. From November 2020 to July and August 2021, the share of surveyed US adults who believed that harassing or threatening public health officials over pandemic-related closures rose from 20% to 25% and 15% to 21%, respectively, according to the study. The most significant increases were among respondents who identified as male, Hispanic, and Republican. Increases also were observed among those with higher incomes. The study identified a concerning uptick in support of these attacks among economically advantaged groups, as well as individuals who are historically more trusting of science. Researchers emphasized that restoring trust in public health officials and the entire public health workforce will require tailored approaches to reach diverse groups.

Such harassment and threats can have devastating consequences. In Austria this week, national leaders appealed for solidarity and medical representatives urged greater protections for healthcare providers after a physician who received death threats and harassment from people opposed to COVID-19 vaccination committed suicide.

IMPACTS ON US HEALTH Beyond the immediate health risks of SARS-CoV-2 infection, we are beginning to gain more clarity about the long-term impacts of COVID-19 on US residents’ health. Notably, more than 1 million people in the country have died of COVID-19, and an additional 350 people are dying of the disease each day. But other health indicators have worsened during the pandemic, as people missed routine appointments, changed their habits, felt isolated or stressed, or experienced loss. Overall, deaths and death rates from heart disease and stroke increased in the US over the past 2 years, with some studies suggesting COVID-19 can increase the risk for both, even after recovery. Drug overdose deaths, excessive alcohol consumption, serious mental illness, gun-homicide rates, and hospital-associated antimicrobial resistant infections all increased in 2020.

Additionally, millions of people in the US have post-COVID-19 conditions, also known as long COVID. The US CDC estimates that nearly 1 in 5 individuals who have had COVID-19 continue to report long-term symptoms lasting 3 months or longer. Many of them have left their jobs because they have symptoms, such as fatigue or brain fog, that hinder their ability to perform daily or work tasks. Under federal guidance, people with long COVID can qualify for disability, meaning employers must offer accommodations to their workers. But many people with long COVID say negotiating accommodations or finding support from social assistance programs remains difficult. Some experts advocate for a better definition of the condition to facilitate diagnosis, more robust educational campaigns to warn people of the risk for long COVID, and more support for people with the condition. More than 100,000 US residents are diagnosed with COVID-19 everyday, some for a second or third time, and evidence suggests people who are infected more than once are at greater risk of long-term health consequences. It will be years before we fully understand the disease’s impacts on the public health, employment, and health coverage landscapes.

RACIAL/ETHNIC DISPARITIES IN VACCINATIONS The COVID-19 pandemic has disproportionately affected racial and ethnic populations in the US, with substantial racial and ethnic inequities in COVID-19 mortality persisting, particularly in rural areas. Several recent studies examine racial and ethnic disparities in US COVID-19 vaccine distribution and uptake. According to a study published in the August issue ofHealth Affairs, researchers used CDC data to illustrate that uptake rates for the first COVID-19 vaccine dose were higher among Hispanic and Asian populations than among White and Black populations, while booster uptake was higher among Asian and White populations than among Black and Hispanic populations.

Many factors could influence this disparate uptake of COVID-19 vaccines and boosters, including systemic and structural inequalities in vaccine rollout and distribution. A study published July 28 inPLOS Medicine found that healthcare facilities were less likely to serve as vaccine administration locations if they were in urban counties with large populations of Black residents or rural counties with large populations of Hispanic residents. Additionally, racial and ethnic populations may be skeptical about getting vaccinated due to a long history of discriminatory and predatory medical research and practices in the US. According to another recent study published inSocial Science & Medicine, vaccine hesitancy was higher among Black adults than among White adults and US-born Hispanic adults, largely due to lack of trust in the government’s communication about risk, concerns that vaccines were developed too quickly, beliefs that vaccines would give people COVID-19, and fears that vaccines may cause infertility. The study also suggests that foreign-born Hispanic adults were not more hesitant to get vaccinated than US-born White and Hispanic adults, which counters perceptions that immigrants may be less likely to opt for vaccination out of fear of being deported. These recent findings suggest that a concerted effort is needed to combat structural inequities in vaccine rollouts, for COVID-19 and other diseases, as well as to address the misinformation and mistrust that underlines vaccine hesitancy among racially and ethnically diverse communities in the US.

AFFORDABLE HOUSING In order to help prevent the further spread of SARS-CoV-2 in overcrowded housing conditions caused by evictions, the US CDC imposed a nationwide temporary federal moratorium on residential evictions for nonpayment of rent in September 2020. The moratorium ended in August 2021 after the US Supreme Court ruled to end a temporary stay on a lower court ruling seeking to overturn the rule, ending protections that had kept millions of people in their homes during the pandemic. Despite the moratorium, at least 4 corporate landlords attempted to aggressively push nearly 15,000 renters out of their homes between March 2020 and July 2021, according to a US House subcommittee investigation report. During the period covered by the report, the Eviction Lab at Princeton University documented 495,216 eviction actions.

As the pandemic progressed, many renters left urban areas to move to midsize cities—what became known as “Zoom towns”—leaving landlords with no choice but to slash rents to attract tenants. Some renters moved into those lower-priced, but often not rent-controlled, homes, only to have their rents increase immensely over the past year, often by 30-65%. Now, with a shortfall of 1.5 million homes and skyrocketing rents and home prices in communities nationwide, the US Treasury this week announced state, local, and tribal governments will have more flexibility to use COVID-19 funds from the American Rescue Plan to fill financing gaps for affordable housing projects, which could help increase the housing supply for families hit hard with high rent and inflation. The new rules allow the use of rescue funds to finance long-term affordable housing loans that extend at least 20 years and offer affordable units to households earning 65% or less of the area’s median income over the same period; to be directed to 6 additional federal housing programs; and to finance the development, repair, or operation of existing affordable rental housing units.

JAPAN Japan’s current COVID-19 surge, and largest to date, surpassed 200,000 new cases per day, ranking #1 globally in terms of total daily incidence and #6 on a per capita basis. The surge is driven largely by the BA.5 sublineage of the Omicron variant of concern (VOC), and reportedly, individuals younger than 20 years old represent approximately 30% of new cases in July, and those less than 30 years old accounted for approximately half. For comparison, these 2 age ranges comprise approximately 16% and 26% of Japan’s total population, respectively. While Japan reports relatively high vaccination coverage (including boosters) in older adults, it is much lower among younger adults and children. Only one-third of those aged 12-19 years have received their first booster, and only 17% of children aged 5-11 years have received the original 2-dose course of the vaccine. Despite facing the country’s largest surge, Japanese Prime Minister Fumio Kishida indicated that there are no plans to implement national restrictions, and Daishiro Yamagiwa, the government’s COVID-19 response lead, emphasized the importance of balancing COVID-19 protections against economic and social activity. Rather, prefecture governments can issue requests for local populations and businesses to take recommended protective measures, such as voluntary movement restrictions or increased remote work.

Reportedly, the Japanese government is considering changes to its COVID-19 reporting requirements, in an effort to reduce the burden on hospitals and laboratories. Currently, Japan requires all COVID-19 cases to be reported, but potential changes could reclassify COVID-19 under the same category as seasonal influenza. While this shift could ease reporting requirements, it would also limit the ability to identify and quarantine close contacts, which could facilitate further transmission. Additionally, it could eliminate measures for the national government to cover the costs of testing.

Since the onset of the pandemic, Japan’s travel and tourism sector has faced severe impacts. Amid reports of a travel resurgence in many regions, particularly in Europe, Japan has not benefited from a similar windfall. In June, Japan announced decisions to resume international travel, albeit with specific COVID-19 restrictions in place, just in time for the summer travel season. While international travelers would once again be able to enter Japan, restrictions mandate that their activities be part of organized group itineraries, and visitors must remain with designated chaperones throughout their trip. Additionally, travelers also face quarantine measures upon arrival. These measures have reportedly factored into travelers’ decisions, and many have opted for other destinations, including South Korea. Both global and regional travel have been impacted in Japan, and one report indicates that approximately 10% of hotels and travel agencies have shut down over the course of the pandemic. Historically, Japan’s largest tourism market is China, but prolonged national-level quarantine and travel restrictions have resulted in substantial decreases in Chinese tourists.

NEW ZEALAND New Zealand fully reopened its borders on July 31 after more than 2 years of strict pandemic restrictions. The final stage of the country’s phased reopening began in April, when tourists from countries on a visa-waiver list could enter. Now, visitors from all over the world are allowed into New Zealand, including those on student visas and from non-visa waiver countries. Per New Zealand’s Ministry of Health, electronic or paper proof of vaccination is required to enter, as well as a rapid antigen test conducted upon arrival and on the fifth or sixth day post-arrival. Masks are required indoors, including museums, grocery stores, and pharmacies. In a speech on August 1, Prime Minister Jacinda Ardern emphasized the reopening was part of a carefully staged plan to keep people safe. As the nation reopened, the Ministry of Health reported 5,312 new COVID-19 cases. Daily new COVID-19 deaths began to increase in February 2022 and remain elevated at an average of 3 deaths per day.