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Coronavirus Files: Inequities in treatment access persist; scientists test next-gen vaccines

Coronavirus Files: Inequities in treatment access persist; scientists test next-gen vaccines

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Even free treatments and tests prove too costly for some

One San Diego woman told NPR she paid $424 for a pair of COVID tests for her adult children.

New York Times reporter marshaled every ounce of journalistic resourcefulness she had to find a doctor that would write a prescription for the antiviral Paxlovid and a pharmacy that could fill it, at a total cost of $256.54 for a telehealth appointment plus Uber delivery to get the “free” drug for her elderly, high-risk mother who couldn’t drive to a clinic or pharmacy.

Add to those costs the time and effort required to find an available testing location, schedule appointments and arrange drug delivery. If it took a savvy NYT reporter seven hours to track down the elusive meds, many less privileged people would lack the time or know-how to even try.

Even when access is easy, the cost of masks and tests can multiply quickly. “For some, the added financial burden is an irritation — but still affordable,” reports Phil McCausland at NBC News. “To others, the prospect of paying $1 for a single disposable mask or $24 for a test kit is an economic impossibility.”

The Biden administration’s new efforts to hand out four free rapid tests per household and three N95 masks per person won’t do much to assuage the inequity, though the government has promised that the first 20% of each day’s shipments will go to people in vulnerable ZIP codes.

“Four tests per address might not be enough for larger households with multiple generations or extended families living under one roof,” notes Ben Leonard at Politico.

Already, some families have resorted to sharing nasal swabs to achieve group results, a practice Rachel Gutman at The Atlantic notes is probably inaccurate and also, “to put it scientifically, gross.”

And when the test-order website went live, some apartment-dwellers have found they couldn’t order the tests because they share an address with others in their building. And a phone number, for those without internet access, was not immediately available.

“It’s good, but it’s really just a drop in the bucket,” epidemiologist Dr. Eric Feigl-Ding of the Federation of American Scientists told NBC’s McCausland.

Insurers are also gearing up to pay for members’ rapid tests, but getting the costs refunded may require navigation of complex reimbursement systems.

“Many people do not have easy access to printers or fax machines, required by some insurers for reimbursement,” notes the Kaiser Family Foundation’s Policy Watch. “Even if the cost is eventually reimbursed, many families could face financial barriers if their insurer requires upfront payments.”

The free masks will be distributed at pharmacies and clinics, requiring those desiring them to have time and transportation to pick them up.

These problems are heaped on top of ongoing pandemic inequities. The CDC recently released a report on access to COVID treatment, finding that patients of color who tested positive for COVID-19 were less likely to receive monoclonal antibody treatments than white people.

The latest analysis of booster shots from the Kaiser Family Foundation, based on CDC data that only tracks race and ethnicity for people 65 and older, found that white people were getting boosters at a slightly higher rate, but a recent uptick among eligible Black and Hispanic people was narrowing the gap.

And the authors of a new perspective in Nature Medicine point out that the neurological symptoms of long COVID, such as brain fog and insomnia, are likely to be a greater burden for Black, Indigenous and Latino communities. However, they add, data remains scarce.

“There must be more equity in COVID-19 research,” write the authors, “which in turn requires a dismantling of structural barriers that perpetuate disparities in clinical care.”

What will the next COVID shots look like?

While it’s not certain that people will need COVID shots beyond the current boosters, or require ongoing vaccination similar to annual flu shots, scientists are busily developing next-generation shots and inexpensive formulas as they aim to vanquish existing or even future variants.

World Health Organization advisers said an omicron-specific vaccine might be necessary. Pfizer says its omicron-specific version, which should also defang other circulating variants, will be ready to deploy by March.

Both Pfizer and Moderna have suggested seasonal booster shots might be part of the ongoing battle against COVID.

While their messenger RNA vaccines were the fastest to make early in the pandemic, there may be other options for those boosters.

For example, Novavax, which submitted the last of its data to the FDA earlier this month, is a protein-based vaccine that is based on more traditional technology, and may be more palatable to some mRNA vaccine skeptics or those worried about the side effects of the earlier shots.

And the Texas-based developers of CORBEVAX made waves recently when their traditional, protein-based shot was given emergency authorization in India. The developers are sharing their recipe (unlike Pfizer and Moderna) so that manufacturers around the world can produce it, for an estimated cost of $1–1.50 per dose.

CORBEVAX would be slow to pivot to new variants, though; the advantage still goes to mRNA formulations there.

Then there’s the tantalizing hope for a universal COVID-19 vaccine, one that would block all variants, past, present and future — and perhaps even related coronaviruses that cause more garden-variety colds.

“This crucial work is a long shot,” writes Umair Irfan at Vox in a nice summary of the strategies under development and the diverse challenges in the way. “It could take years of sustained effort, but some researchers are confident that universal vaccines will emerge.”

In fact, researchers from the Walter Reed Army Institute of Research are already making good progress with their candidate. Their approach is to link together several different versions of the virus’ spike protein, instead of just one version of the spike like other vaccines. The idea is that the immune system should respond by creating a panoply of antibodies for different kinds of spikes, conferring broad protection.

The vaccine looked promising in a study of monkeys, and early trials with people reportedly went well.

“We want a pan-coronavirus vaccine so that you have it on the shelf to respond to the next viral pandemic,” NIH’s Dr. Anthony Fauci told NBC. “Ultimately, you want a vaccine that covers everything.”

Future projections continue to tempt reporters

“By month 25 of the COVID-19 pandemic, we all probably should have learned not to try to anticipate what the SARS-CoV-2 virus is going to do next,” writes Helen Branswell at STAT. Yet as her article and others show, we just can’t resist gazing into that crystal ball.

U.S. cases may have peaked, and if you squint at the graphs, hospital admissions might be at a plateau, or even dipping in some areas. But that doesn’t mean we can wave goodbye to omicron and its devastating consequences.

“The higher a wave crests, the longer and more confusing the path to the bottom will be,” writes Katherine J. Wu in The Atlantic. “We need to prepare for the possibility that this wave could have an uncomfortably long tail — or at least a crooked one.”

If people see a small drop in infections as reason to stop masking or start partying, that could slow the decline.

“It’s not like you get to the top of Everest, have a small party and then start your ascent down and take off your oxygen mask,” Dr. Craig Spencer of New York-Presbyterian told The Guardian’s Eric Berger. The downslope is just as slippery as the road up.

Whenever omicron rates do crash, or fizzle out, we could be in for a lull in the pandemic, Branswell writes. That’s because by then, so many people will have acquired immunity one way or another.

The next step could be progress towards an endemic state, in which the virus causes disease but not massive surges or major disruptions to day-to-day life — but most of Branswell’s sources weren’t ready to go that far.

Alternatively, the virus could throw another curveball in the form of some other, unanticipated variant that eludes the immunity built up from vaccines and past infections. Nobody knows.

Branswell and Wu joined the Center for Health Journalism last week to discuss how they navigate the confusing and ever-changing morass of COVID information — check out their tips here.

From the Center for Health Journalism

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What we're reading

  • “They promised quick and easy PPP loans. Often, they only delivered hassle and heartache.” By Lydia DePillis and Derek Willis, ProPublica
  • “Inside the student-led COVID walkouts,” by Pia Ceres, Wired
  • “What the omicron wave looks like at one Brooklyn E.R.,” by Joseph Goldstein, The New York Times
  • “The pandemic’s true death toll: millions more than official counts,” by David Adam, Nature
  • “Coronavirus infections inside U.S. immigration detention centers surge by 520% in 2022,” by Camilo Montoya-Galvez, CBS News
  • “COVID deaths and cases are rising again at U.S. nursing homes,” by Meg Kinnard and Bryan Gallion, AP News
  • “People are hiding that their unvaccinated loved ones died of COVID,” by Andrea Stanley, The Atlantic

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