Coronavirus Files: COVID funds hit another stumbling block as FDA deliberates on boosters

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Pandemic response neglected poor Americans

Communities in lower-income U.S. counties suffered twice the COVID-19 death rate of wealthier American counties according to a new Poor People’s Pandemic Report, writes Ed Pilkington at The Guardian. 

The gap was even worse during major surges, rising to a three-fold difference in deaths between the poorest and richest 10% of counties during the omicron winter wave.

Because CDC has not been tracking income distribution alongside death rates, the report fills an important hole in the national pandemic picture, writes Pilkington. The Poor People’s Pandemic data, from more than 3,000 U.S. counties, are accessible online.

Vaccination rates didn’t explain the disparities, the authors found, but the large number of people in poor counties who don’t have health insurance was a likely contributor.

“The findings of this report reveal neglect and sometimes intentional decisions not to focus on the poor,” said Bishop William Barber, co-chair of the Poor People’s Campaign, which produced the report in collaboration with the UN Sustainable Development Solutions Network.

Counties with high death rates included those largely comprising communities of color (such as Hancock, Georgia) as well as some with primarily white populations (Robertson, Kentucky).

New report outlines COVID's impact on 'Black America'

Race continues to be a major factor in pandemic impact. A new report from the Black Coalition Against COVID notes that hospitalization rates for Black people was much higher than other populations during the omicron surge, Usha Lee McFarling reports for STAT.

“The juxtaposition — that for some, the pandemic is over, yet the hospitalization rate for Black people is higher than it’s ever been — is stark,” said Dr. Marcella Nunez-Smith of Yale University’s School of Medicine.

The report also details higher rates of children being orphaned, children missing time in the classroom, food insecurity, and pandemic-linked anxiety, depression, and substance use disorders among Black people, compared to white Americans.

All of this is a “predictable result of structural and social realities,” the report says, rather than any biological or genetic factors related to race.

Researchers are also studying how media reports of racial disparities influenced attitudes during the early pandemic, and a recent study in the journal Social Science & Medicine reached a “disturbing conclusion,” writes Ed Pilkington at The Guardian.

The study found that when white U.S. residents were made aware of racial disparities through media reports, they were less afraid of the virus, felt less empathetic towards vulnerable populations, and were less supportive of safety precautions.

That leads the study’s authors to the unsettling suggestion that publicizing racial disparities could, paradoxically, contribute to a “vicious cycle wherein raising awareness reduces support for the very policies that could protect public health and reduce disparities.”

COVID boosters could become annual affair

The FDA’s vaccine advisory committee met last week to discuss a path forward for COVID-19 booster shots, leading to a new FDA plan to seek annual vaccines with at least 80% efficacy against severe disease and death, reports Poynter’s Al Tompkins in his Covering COVID-19 newsletter.

The challenge is to design a booster by spring to defend against the most likely prevailing variant in the coming fall. Trevor Bedford of the Fred Hutchinson Cancer Research Center told the panel that a dangerous new variant like omicron could emerge as often as every 18 months, or as rarely as once a decade.

Ultimately, the committee found there was no existing framework in place to choose when to offer a COVID-19 booster, and which variant to target, writes Andrew Joseph in STAT’s play-by-play of the meeting.

“We’re in uncharted territory,” said acting committee chair Dr. Arnold Monto of the University of Michigan.

Pfizer and Moderna are both trialing omicron-specific vaccine formulas, the effects of which could inform future decisions. The committee will likely convene again in May or June to make more specific plans for fall boosters, reports Scott Hensley at NPR.

Committee members also questioned the FDA’s recent move, made without their input, to authorize second booster shots for Americans 50 and older now. That decision has sown considerable confusion, as Yasmeen Abutaleb and Lena H. Sun report at The Washington Post, because the agency didn’t go so far as to recommend older adults get the shots.

That call was based in part on data from Israel, where second boosters were made available to elderly individuals and health care workers months ago. Two studies from Israel indicated that a fourth dose, compared to three shots, increased protection against severe disease by 73% and death by 78%, reports Yaron Kelner at Haaretz.

However, in one of the studies, fewer than 1% of people in either the three-dose or four-dose group experienced severe symptoms. And the added protection against infection from the additional dose quickly fizzled, dropping to just 29% within 10 weeks.

The European Medicine Agency, relying on the same Israeli data, decided against authorizing a fourth dose, Tompkins notes.

The FDA’s Dr. Peter Marks clarified that the recently authorized additional booster was intended as a stopgap to protect vulnerable groups, and not a signal of an ongoing booster strategy.

Marks also said that once the FDA makes the switch to vaccines targeting a new variant, all vaccines would be changed, including those for the initial series of shots. That means Americans won’t be forced to deliberate the merits of protection from different variants when choosing a booster shot.

According to a STAT-Harris Poll, 60% of U.S. adults would get a second booster if it was recommended, and an additional 22% would do so if there were a new variant or surge in their area.

COVID spending bill hits another snag

Early last week, the Senate appeared poised to approve $10 billion in funds for COVID-19 vaccines, therapeutics and research, only to hit another roadblock over the Biden administration’s plan to relax pandemic-era immigration restrictions.

The bipartisan deal was already for much less than the $22.5 billion the White House had requested. It cut $5 billion in funding for global aid, which many experts say is crucial to block development of new variants that could impact U.S. citizens. The deal also eliminated support for tests, vaccination and treatment of uninsured people.

The $10 billion left in the bill would send $9.25 billion to the Biomedical Advanced Research and Development Authority, including at least $5 billion to purchase therapeutics. This budget would also be used to purchase tests and vaccines.

The remaining $750 million was earmarked for the Public Health and Social Services Emergency Fund to cover research, development, and manufacturing of new vaccines.

The purse was based entirely on unspent funds from previous measures, including unused money originally funneled towards grants for shuttered entertainment venues, small business loans, and other sources. Katie Lobosco and Tami Luhby at CNN have all the details.

The Senate initially planned to pass the bill quickly, which would require unanimous agreement to proceed to a vote.

But the Biden administration announced on April 1 that it planned to lift border restrictions known as Title 42 that, for the past two years, have allowed border agents to expel migrants to prevent COVID-19 spread.

Several Democrats had pushed the White House to make the change, especially in light of the rollback of travel restrictions, write Caroline Simon and Suzanne Monyak at Roll Call.

The reduced restrictions, expected to take place in late May, are expected to lead to a large influx of migrants and asylum-seekers.

Some Democrats as well as Republicans were displeased with the announcement. Several GOP senators said on April 5 that they wouldn’t vote to proceed on the COVID relief funds without progress toward a vote on border restrictions as well.

Lawmakers cited “mixed messages from the Biden administration as it seeks to remove a pandemic mitigation measure while simultaneously demanding billions of dollars to address the continuing spread of the virus,” report Mike DeBonis and Rachel Roubein at The Washington Post.

Senate Republican leader Mitch McConnell said, “There will have to be an amendment on Title 42 in order to move the bill.”

COVID-19 plus diabetes hits harder

People with diabetes are very vulnerable to the coronavirus but haven’t received much attention during the pandemic, writes reporter Andrew Jacobs at The New York Times.

Jacobs cites studies suggesting that 30% to 40% of COVID deaths in the U.S. were among people with diabetes, but this “sobering figure has been subsumed by other grim data from a public health disaster that is on track to claim a million American lives sometime this month.”

More than 37 million people in the U.S. have diabetes, according to the CDC, with 20% of those unaware they have it.

Diabetes impairs both the immune system and the cardiovascular system, putting people at higher risk for COVID complications.

“It’s hard to overstate just how devastating the pandemic has been for Americans with diabetes,” said Dr. Giuseppina Imperatore of the CDC.

The disease also contributes to COVID’s racial disparities. Uncontrolled diabetes, which seems to create the greatest danger, is more prevalent among people of color, Jacobs notes.

Researchers and clinicians hope the pandemic’s toll will bring more attention to the disease.

Sadly, the pandemic may also swell the ranks of people with diabetes, writes Clare Watson at Nature.

A study of more than 180,000 U.S. veterans who survived COVID found that their risk of developing type 2 diabetes within the year following infection went up by 40%.

Post-COVID diabetes occurred even in people with no other risk factors for the disease and a mild case of COVID, though more severe COVID-19 amplified the diabetes risk.

It’s not clear how COVID-19 influences diabetes risk. Some researchers have suggested that the virus could damage the pancreas, leading to impaired insulin production. But a lab study failed to substantiate that idea, writes Watson.

The veterans in the study were mainly older, white men, so it’s not certain the results will apply to other populations. It’s also not yet known if the diabetes risk continues beyond one year.

From the Center for Health Journalism

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April 20, 10 a.m. PT. Sign-up here!

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The National Fellowship helps journalists and their newsrooms report deeply and authoritatively on the health, welfare and well-being of children, youth, families and communities. Fellows learn from nationally renowned health experts, policy analysts and community health leaders, from top journalists in the field and from each other. The National Fellowship offers five days of informative and stimulating discussions (July 10 to July 14), plus reporting grants of $2,000–$10,000, engagement grants for new community journalism partnerships and five months of expert mentoring.

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What we're reading

• “Millions of people could lose health insurance coverage when the COVID-19 emergency ends,” by Ken Alltucker, USA Today
• “The U.S. still doesn’t know how to track a pandemic,” by Betsy Ladyzhets, FiveThirtyEight
• “America is staring down its first So what? wave,” by Katherine J. Wu, The Atlantic
• “Back-to-office pressure is creating a crisis for long COVID patients,” by Jamie Ducharme, Time
• “Into the wild: Animals the latest frontier in COVID fight,” by Laura Ungar, AP News
• “Why the WHO took two years to say COVID is airborne,” by Dyani Lewis, Nature

Events and Resources

• April 13, 7 p.m. PT: Science writer Carl Zimmer of The New York Times will speak at the University of Idaho on “Writing the Pandemic: Journalism in the Age of COVID-19.” The presentation will be livestreamed.
• April 20, 9 a.m. PT: Knowable Magazine hosts a conversation on “A Path to COVID-19 Vaccine Equity.”
• Covering COVID-19’s origin story? See an overview and a list of sources from Bara Vaida at the Association of Health Care Journalists.

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