Each household can get four free Covid-19 tests, and some older tests are still good; plus a Covid 'refresher'

U.S. Government photo illustration

Just in time for the cold and flu season the federal government has relaunched its at-home Covid-19 test program. Every U.S. household is eligible for four free test kits sent directly from the U.S. Postal Service, but some older tests might also still be good, too. The easiest way to order kits is through covidtests.gov. "Officials say the tests are able to detect the latest variants and are intended to be used through the end of the year," reports Fenit Nirappil of The Washington Post. "The return of the free testing program comes after Americans navigated the latest uptick in covid cases with free testing no longer widely available."

Keep in mind many antigen tests have extended expiration dates, so tests purchased or received earlier could still be usable, reports Meryl Davids Landau of National Geographic. Check the chart available here to see if yours is still effective.

As temperatures dip and holiday seasons approach, people will spend more time inside. "Experts say free coronavirus testing proved to be an effective public health tool, allowing people to check their status before attending large gatherings or spending time with older or medically vulnerable people at risk of severe disease even after being vaccinated," Nirappil reports. "It also enables people to start antiviral treatments in the early days of infection to prevent severe disease."

If you have forgotten some of the testing details, Landau gives a brief Q & A "refresher."

Swab the throat or the nose? It turns out nasal samples concentrate more of the virus and are therefore more likely to yield a positive diagnosis.

Can you get sick within days of SARS-CoV-2 exposure? A recent study in France confirmed what people are feeling, that those exposed to Omicron develop symptoms earlier than they did after exposure to the original SARS-CoV-2 strain. . . . It’s possible that the incubation period is shorter due to the mutations.

How long should you isolate if testing positive for Covid? Whether a person has a positive test or is likely to have the disease based on symptoms and exposure, it’s crucial they go home and immediately isolate from everyone, including people with whom they live. . . . This isolation should continue for a minimum of five days, which starts the day after the positive test or the appearance of symptoms, according to the Center for Disease Control.

When is masking after isolation necessary? Once in public, the individual must wear a high-quality mask until 10 days have passed since symptoms began or testing positive. Remember: the first day is day zero. This is important because the sick person could be contagious for a full 10 days.

Who should take the antiviral drug Paxlovid? Those who are most likely to face hospitalization and death should talk with their healthcare provider about taking the antiviral medicine, Paxlovid, which continues to be effective against current strains.

Should you get the new vaccine? The Federal Drug Administration and CDC recently approved new Covid vaccines for people six months and older. The benefits of vaccination outweigh side-effect risks for all these age groups, the CDC noted.

How else can you protect yourself? Avoiding crowds and masking remain extremely effective protection measures, but most people don’t need to do them 24/7.

Embracing vaccines sooner rather than later can mean healthier months ahead

The timing of vaccines matters.
(Wall Street Journal illustration, from IStock images)

Covid, flu and respiratory syncytial virus (RSV) -- the vaccine season is upon us. To get the maximum protection from having to face a needle, start with a game plan. "Doctors generally suggest getting your flu and Covid shots before the end of October and say it's OK to get both those shots at the same time," reports Sumathi Reddy of The Wall Street Journal. "The most important thing, doctors say, is to get vaccinated. If you're in a doctor's office or a drugstore and can get your shots, it usually makes sense to do it."

Over the summer, there was a "bump" in Covid cases, and if you've been recently infected, putting off getting a booster for three to six months is wise. John Wherry, director of the Institute for Immunology at the University of Pennsylvania, told Reddy, "If your level of antibodies is quite high, the booster does very little good. You're kind of wasting your shot."

For Covid shots, "Sooner rather than later is good. . . especially if you are a senior or immunocompromised," Reddy reports. "The newly approved booster targets the dominant strains now circulating. Covid-19 test positivity rates have hovered around 14% for the past month, according to CDC data, up from 4% in June. Covid boosters from Pfizer and Moderna have already rolled out. The Novavax booster is expected later this fall."

Recommendations for the flu vaccine include getting it in September or October. Reddy adds, "Flu cases usually start ticking up in November and peak in January before trailing off at the end of March, says Wherry. . . . If you get sick with the flu before you've been vaccinated, you should still get the vaccine about a month later, he says. That's because the flu vaccine typically protects against four types or strains of influenza."

RSV vaccines are approved for seniors and some pregnant women; doctors say opting to have the vaccines sooner is best, Reddy reports, "because activity is picking up, and RSV tends to peak earlier than the other respiratory viruses, says Wherry. There is also a new RSV drug approved to protect infants. Cases are already starting to increase in the Southeast, according to the CDC."

What's going on with the latest Covid-19 vaccines? Here are answers to frequently asked questions.

Updated Covid-19 vaccines from Pfizer/BioNTech and Moderna have rolled out to pharmacies. The Food and Drug Administration approved the mRNA vaccines for everyone 6 months and older. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted 13-1 to recommend that everyone 6 months and older should get the shots, and the CDC endorsed that recommendation.

Lori Robertson and Catalina Jaramillo of FactCheck.org, a service of the Annenberg Public Policy Center at the University of Pennsylvania. Robertson and Jaramillo compiled a list of common questions and answers about the vaccines, and here's a condensed version of their report:

How are these updated shots different from the last one? All of the Pfizer/BioNTech and Moderna Covid-19 vaccines — the originals, the bivalent boosters and the latest updates — use the same mRNA technology to trigger an immune response to the spike protein of SARS-CoV-2, the virus that causes Covid-19. The spike protein is what the virus uses to enter cells.

The difference between the versions of the vaccines is in what type of spike protein they prompt the body to make. The mRNA in the 2023-2024 vaccines instructs cells to make the spike protein of omicron variant XBB.1.5. The variant became a concern at the end of last year, when the CDC projected it made up 40.5% of new CCovid-19 cases in the U.S., a figure that rose to nearly 90% by early March.

Who is eligible to get an updated vaccine? Everyone 6 months of age and older is eligible for these vaccines.The FDA said those age 5 and older can get a single dose of either mRNA vaccine if at least two months have passed since the prior Covid-19 vaccine dose. Unvaccinated people can also get a single dose. Children ages 6 months through 4 years who previously were vaccinated are eligible to get one or two doses, depending on which vaccines they have received and when. Children in this age group who haven’t been vaccinated against Covid-19 can get three doses of the latest Pfizer vaccine or two doses of Moderna’s. . . . Those who are immunocompromised can also receive additional doses.

What evidence supports the use of the updated vaccines? The FDA said it approved and authorized the latest formulas of the vaccines based on its evaluation of manufacturing data and data showing the immune response to these vaccines against prevalent variants is similar to that of previous versions of the vaccines against prior variants.. . . . The FDA is using a similar approach to the annual influenza vaccines, which are tweaked each year to combat the influenza strains expected for that season. Flu vaccines are approved each year without clinical studies because the changes, compared with prior vaccines, are small and because it wouldn’t be possible to test the vaccines each year in people before the flu season.

How effective are they? We don’t have vaccine effectiveness data for the updated vaccines specifically, but data on similar, previous vaccines show they were quite effective at preventing severe disease. And the research. . . .by Moderna and Pfizer/BioNTech shows the updated version increases neutralizing antibodies against the new and emerging variants.

How safe are they? Moderna’s clinical trial for the latest vaccine showed that the percentage of participants reporting mild side effects, such as pain, swelling, headache, fatigue and muscle aches, was similar to or, in many cases, lower than the reporting rates for the prior Covid-19 vaccines. But, the safety evaluation of this formula is based on hundreds of millions of doses of Covid-19 vaccines administered over the past few years.

Are the shots still free, and where can I get one? The vaccines are no longer provided by the federal government for free, but private insurance companies, Medicare and Medicaid, and some CDC programs will cover them.

For more detailed explanations and questions, read the full article here. 

Epidemiologist says the dreaded triple-demic is here, with RSV, flu and Covid-19 cases all rising together

 

Centers for Disease Control and Prevention map

With national rates of influenza, Covid-19 and respiratory syncytial virus (RSV) all rising, the "dreaded and much anticipated triple-demic is finally here," epidemiologist Katelyn Jetelina writes in her newsletter, Your Local Epidemiologist. 

RSV is a common virus that usually causes mild, cold-like symptoms. And while most people recover in a week or two, it can be serious for infants and older adults.

The weekly Centers for Disease Control and Prevention influenza-like illness (ILI) surveillance, which includes a tally of patients that go to the doctor with a fever and a cough and/or a sore throat is a general indication of the climate of respiratory health in the United States. The report does not include laboratory confirmed flu cases. 

The ILI map for the week ending Nov. 26 shows that every state except for four have either a high or a very high ILI activity level. "This level is truly unprecedented; we’ve never seen such high levels of ILI activity at this time of year," she writes. 

Hospitalizations for respiratory illness are also on the rise. On Monday, CDC Director Rochelle Walensky said: “Hospitalizations are the highest now than they have been in the past decade.” 

Jetelina points out that while ILI surveillance offers an overall view of respiratory illness in the U.S, surveillance for specific diseases also exist, but is imperfect. 

RSV: CDC data shows that RSV continues to rise, although we may be seeing the first signs of peaking on a national level, Jetelina reports. She adds that this is expected given that the positivity rate for RSV tests have already clearly peaked. 

Flu: "Flu cases are increasing and increasing fast," Jetelina writes. She notes that flu hospitalizations are lagged, but increasing. "We expect hospitalizations to continue to rise in weeks to come," she writes. 

As Inside Medicine reported, for the first time during the pandemic, flu hospitalizations overtook Covid-19 hospitalizations last week. "This may be a one-off occurrence since Covid-19 hospitalizations are increasing now, too, but it is noteworthy," she writes. 

Jetelina adds that epidemiologist are hopeful that the U.S. flu season will follow what has happened in the Southern Hemisphere (Australia specifically) where there has been a high number of flu cases but a moderate level of hospitalizations. 

Covid-19: "Covid-19 is on the rise across the globe due to the combination of seasonal changes, behaviors changes, and the variant soup. In the U.S., all signs point to the beginning of a wave. For example, SARS-CoV-2 in wastewater is rapidly increasing across all regions," she writes. 

"One major concern is the rapid rise in hospitalizations among older adults, which has exponentially increased 28% in the past two weeks," Jetelina writes. "This is partly (or wholly) due to abysmal vaccination rates—only 1 in 3 adults over the age of 65+ have their fall Covid-19 booster. A public health failure. Without a recent booster, many people are technically vaccinated but not protected." 

Bottom line, she concludes: "This viral season is like no other. . . .  I’m especially concerned for hospital systems, kids under 5, and adults over the age of 65, as they are at highest risk." 

She adds, "There’s a lot we can do: mask, test before seeing loved ones, get that airflow moving, stay home when you’re sick. The least you can do for a healthy season is get a flu and fall Covid-19 booster. If you haven’t gotten one yet, it’s never too late." 

Jetelina is a California epidemiologist and biostatistician who says she writes the newsletter on Substack as a way to translate public-health science for everyday use, helping people to make evidence-based decisions. She is also a consultant to a number of organizations, including the CDC. 

It's only November, but flu strains and RSV are already busy

Heading into the holiday season, it's good to remember that this year's flu season is already in full swing with the "triple threat" of influenza, Covid-19 and respiratory syncytial virus (RSV).

RSV arrived early this year, which makes its cycle harder to predict, writes Katelyn Jetelina in her Your Local Epidemiologist newsletter: "Historically, the RSV season lasts five months. It will be interesting to see how the holidays impact RSV patterns. Typically RSV peaks in January, but because it has arrived so early, we are in new viral dynamic territory." The disease poses the greatest threat to infants and seniors.

Centers for Disease Control and Prevention map

This year's dominant flu strain is potent, but there have been some early and limited but encouraging signs, Jetelina reports: "There is good news from the Southern Hemisphere among countries that just concluded their flu season. Chile, for example, found the flu vaccine is a good match for the current strain. They are reporting a 49% efficacy rate," Jetelina reports, "But only 28% of Americans are vaccinated against the flu. This is almost 10 percentage points lower than pre-pandemic rates, which is frustrating."

American hospital systems have already been stressed by Covid-19 and early RSV. Jetelina reminds her readers that people can get infected with more than one virus at a time and taking precautions like staying home when sick and updating vaccinations can keep you and others out of the hospital.

Colorado man tests positive for avian influenza, but CDC says the virus is still a low threat to humans

"Bird flu ranks as a low threat to public health, said the Centers for Disease Control and Prevention, after a Colorado correctional inmate tested positive for avian influenza after culling an infected flock. It was the first U.S. case and the second worldwide of human infection by the H5N1 viruses now circulating among birds globally," Chuck Abbott reports for the Food & Energy Reporting Network.

But, the agency says humans are still at very little risk of contracting the virus, and that the case is the only one they've seen after tracking the health of more than 2,500 people who had been exposed to infected birds. The patient, who is younger than 40, is tired but mostly asymptomatic, and repeated flu tests have come back negative, Abbott reports. The Colorado Department of Public Health theorized that, because the man was in close contact with infected birds, the virus may have been present in his nose without truly infecting him.

The only other recent bird flu case happened in England in December, and officials say the patient had "very close, regular contact with a large number of infected birds, which they kept in and around their home over a prolonged period of time," reported the BBC. Here's the CDC's guidance on how to minimize the risk of contracting avian influenza.

More than 36 million domestic birds, mostly chicken and poultry, have died from the bird flu or from cullings of infected flocks over the past three months. The Agriculture Department transferred $263 million to the Animal and Plant Health Inspection Service last week, in addition to $130 million in mid-March. "APHIS works with state and local officials to identify outbreaks and carry out response plans that include quarantines, cullings of birds, disposing of dead birds, and sanitizing infected premises," Abbott reports.

Bird flu now found in 21 domestic flocks in 12 states; first domestic cases in two years

Just as the coronavirus pandemic seems to be waning among humans, the bird flu is picking up.

"Highly pathogenic avian influenza was identified in three more states — Missouri, Maryland, and South Dakota — said the Agriculture Department. Since the first case was confirmed on February 8 on a turkey farm in southern Indiana, HPAI has been found in 21 domestic flocks in 12 states," Chuck Abbott reports for the Food & Environment Reporting Network. "Nearly 1.9 million birds, mostly chickens and turkeys, have died, either from the disease or from exterminations intended to prevent the spread of it. Agricultural officials act quickly and ruthlessly because 'high path' bird flu can wipe out a flock swiftly. This year’s outbreaks are the first appearance of HPAI in domestic flocks in two years."

The last time there was a bird flu outbreak, it killed more than 50 million chickens and turkeys between December 2014 through June 2015. The deaths represented 12 percent of egg layers and 8% of meat turkeys in the U.S., Abbott reports.

"Avian influenza is highly contagious and can be spread by migratory waterfowl and their droppings, but also through contact with infected poultry and by contaminated equipment and clothing of farmworkers. Wild birds are seemingly unaffected by HPAI. The virus is not considered a health risk for humans."

Pandemic roundup: Studies suggest how to hire more rural nurses; how to persuade the unvaccinated; issue is divisive

New York Times map; click the image to enlarge it.

Here's a roundup of recent news about the pandemic and immunization efforts:

Covid-19 hospitalizations are hitting crisis levels in the South, making it more difficult to maintain care or even find beds for the sickest patients. One in four hospitals now has more than 95% of its intensive-care beds occupied, up from one in five last month. In June, when cases were at their lowest level, fewer than one in 10 hospitals had dangerously high occupancy rates. Read more here.

One in 500 Americans have died from Covid-19. See how different states, ages, and ethnicities compare. Read more here.

A truck driver from rural Tennessee, now on last-resort life-support for Covid-19, urges others who are hesitant about getting vaccinated: "Before you say no, seek a second opinion." He says a daily diet of conservative talk radio that downplayed the pandemic and emphasized personal freedom helped convince him not to get vaccinated. But, he says, people should also consider personal responsibility, and how they don't want to infect loved ones. Read more here.

Bob Enyart, a conservative radio host who bashed the coronavirus vaccine, has died from Covid-19. He also had successfully sued the state of Colorado over mask mandates and capacity limits in churches last year. "Enyart is at least the fifth conservative radio talk-show host to have died of Covid-19 in the last six weeks after speaking out against vaccinations and masking," Timothy Bella reports for The Washington Post. "The Denver host’s comments are another example of talk radio being an often overlooked space for coronavirus misinformation. In the weeks and months leading up to their deaths, all five men had publicly shared their opposition to science-based health efforts when coronavirus infections were spiking." Read more here.

Related: "Politically motivated denial of Covid-19 vaccine effectiveness tracks with a dramatic politicization of trust in science itself," Wake Forest University philosophy professor Adrian Bardon writes for The Conversation. "In a survey conducted in June and July, Gallup found that the percentage of Republicans expressing a 'great deal' or 'quite a lot of' trust in science is down, shockingly, from 72% in 1975 to only 45% today. Over the same period, confidence in science among Democrats is up from 67% to 79%." Read more here.

A recent Harris poll found that one-third of vaccinated Americans surveyed reported cutting ties in some way with friends or family who remain unvaccinated. Only 12% of Republican respondents said they had done so, compared to 28% of Democrats. And 59% of Republican respondents said they had not done so because vaccination is a personal choice, compared with 25% of Democrats. A communications scientist who studies the effects of media and health campaigns suggests more effective ways to persuade the unvaccinated.

A Tulsa pastor is offering to write religious exemptions for cash. In just two days, more than 30,000 people have downloaded the form from his church's website. Meanwhile, an expert says religious exemptions for the coronavirus vaccine could be on shaky legal ground. Read more here and here.

Hospitals nationwide are struggling to hire more nurses, especially in rural areas. A study found that state laws mandating nurse-to-patient staffing ratios helps significantly, but two other popular approaches (mandating public reporting of nurse staffing levels and including frontline nurses on hospital staffing committees) have little or no impact on nurse staffing levels. Read more here.

Rural residents should get their flu shots to avoid stressing the local health-care infrastructure even more than it already is, writes Betsy Huber, president of the National Grange, the nation's oldest agricultural and rural advocacy organization. Read more here.

The coronavirus vaccines have been linked to myocarditis, an inflammation of the heart muscle. But, a cardiovascular specialist says it's an extremely rare and often mild side effect associated with pretty much all vaccines, and that it's far more likely to happen when someone is infected with a virus of any kind (like influenza). Bottom line: unvaccinated people face a higher risk of myocarditis, as well as getting seriously ill or dying from Covid-19. Read more here.

Some have complained that wearing face masks and other personal protective equipment causes people to breathe in too much carbon dioxide and not enough oxygen. A newly published study found that, while PPE usage does increase your carbon dioxide intake, it's still well under federal safety limits. Read more here.

Covid roundup: Pediatric hospitalizations up; Christian broadcasting group's spokesman fired after pro-vax op-ed

Here's a roundup of recent news about the pandemic and immunization efforts:

The number of children hospitalized for Covid-19 has soared over the summer, especially in the least-vaccinated states, leaving some children's hospitals and intensive-care units stretched thin. Read more here and here.

Stillbirths have doubled during the pandemic in Mississippi, the least-vaccinated state. State officials have recorded 72 stillbirths (spontaneous miscarriages after 20 weeks of gestation) among unvaccinated pregnant people who were infected with the coronavirus. Eight infected pregnant people have also died over the past month. Pregnant and recently pregnant people have a higher risk of becoming severely ill from the coronavirus, studies show. Read more here.

The rate of new coronavirus infections among babies and children under age 4 recently surpassed the rate of new cases among seniors. Experts discuss what steps pregnant people and parents can take to be safe. Read more here.

The spokesperson for the National Religious Broadcasters (an association of more than 1,000 Christian new media professionals) was fired at the end of August after encouraging people to get their coronavirus vaccines in a USA Today op-ed and an appearance on MSNBC's "Morning Joe." He was fired for violating the company's policy of staying neutral on vaccination, the CEO said on social media. Read more here.

Crowded jails and prisons drove millions of coronavirus infections, a new study has found. Read more here.

Coronavirus testing, hospital stays and emergency-room visits are about to get much more expensive for many Americans, as major insurers end the temporary waivers that reduced costs. Read more here.

A recent study found that unvaccinated people are 29 times more likely to be hospitalized with Covid-19 than vaccinated people. Many vaccinated people worry about breakthrough infections, but the risk depends on factors such as overall health, where someone lives, and what other risks they take. Vaccinated people who do get infected tend to suffer only mild symptoms, if any. Read more here.

People who have survived a coronavirus infection and then gotten vaccinated have what's called "hybrid immunity," and studies show it's impressively potent—not just against the Delta variant, but possibly future variants as well. Read more here.

Experts say it's especially important to get a flu shot this year: with Covid cases surging across the country, it may be difficult to get treated if you get the flu and it takes a turn for the worse. Also, getting the flu can weaken your immune system and make you more susceptible to coronavirus infection—and getting both viruses one after the other could be dangerous. Read here for more answers to frequently asked questions.

Fully vaccinated people who get a breakthrough coronavirus infection are about half as likely as unvaccinated people to suffer from long Covid, a study has found. Read more here.

A respiratory therapist describes, in seven stages, how Covid-19 typically progresses among hospitalized patients. Read more here.

Experts recommend some tips for coping with pandemic anxiety this fall and winter. Read more here.

The share of American adults willing to get vaccinated rose 5 percentage points in the last month, according to a recent poll. Read more here.

People who were hospitalized for Covid-19 are twice as likely as usual to develop kidney disease afterward, researchers have found. Read more here.