Coronavirus Files: Widespread masking remains unlikely as holidays fuel viral surges

Published on
December 12, 2022

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Viral infections skyrocket, impacting kids and hospitals

The flu virus took full advantage of family gatherings over the Thanksgiving holiday.

Over the week that ended Nov. 26, hospitalizations for flu nearly doubled, reports Richard Franki at WebMD. The number of positive flu tests that week, more than 34,000 nationwide, is the most ever reported, with records going back to 1997, reports Keren Landman at Vox — though that figure is in part explained by higher testing rates.

The CDC’s map of flu-like illness rates, normally a woodsy mix of green hues in autumns past, is now a patchwork of purple and red.

RSV and COVID are also going strong. Pandemic protection measures flattened both RSV and the flu in recent years, so the population lacks immunity, creating an ideal opportunity for them to come back strong.

Children in particular, and the pediatric hospital units that serve them, are suffering from the “tripledemic,” write Sallie Permar and Robert J. Vinci at STAT. Families are struggling to find children’s fever medicines, with drug store shelves nearly bare, reports Laurel Wamsley at NPR.

Most people do have some immunity to COVID this season. A recent preprint estimates that some 94% of the U.S. population has been infected by the virus at least once. That, plus vaccinations, should provide some measure of protection against the worst outcomes — but COVID hospitalizations still rose in Thanksgiving’s wake, reports Erin Prater at Fortune Well. The BQ.1 and BQ.1.1 variants currently circulating have a greater ability to escape prior immunity than previous variants, notes Michael DePeau-Wilson at MedPage Today.

New York City is experiencing a high rate of new COVID cases and COVID hospitalizations, report Corina Knoll and Sarah Cahalan at The New York Times, but it’s Los Angeles County — the nation’s most populous — that’s currently staring down the possibility of a new mask mandate.

LA County’s Department of Public Health has set two trigger points for the return of masking requirements. The first such trigger, 10 or more weekly hospital admissions for COVID per 100,000 residents, has already been met, report Luke Money and Rong-Gong Lin II at the Los Angeles Times. If the county hits the second mark — 10% or more of hospital beds occupied by COVID patients — it could prompt the return of a mask mandate in early January, said LA County Public Health Director Barbara Ferrer.

While LA County, and the CDC, have already encouraged people to mask up to avoid the stew of circulating respiratory viruses, public enthusiasm for a return to face coverings is decidedly low, report Cahalan and Knoll.

“Three years in, it is extraordinarily difficult to mandate,” said Dr. Sara Cody, public health director for Santa Clara County.

Women, Black and Asian people left out of COVID trials

Amid a collection of 122 COVID trials, researchers generally failed to recruit participants who mirrored the general population, according to a new JAMA Network study.

Women were underrepresented among the pool of more than 176,000 participants, as were Black and Asian people. 

Better representation is important because doctors can’t be confident in treatments only tested on groups with skewed demographics.

Women may have been under-included because they are less likely to become seriously ill with COVID-19 than men, notes Arielle Dreher at Axios.

In contrast, Latino and Hispanic people were overrepresented. That may reflect the preponderance of trials in states like Florida, Texas and California, which have large Hispanic and Latino populations, reports Annalee Armstrong at Fierce Biotech.

The Pew Research Center recently released a poll on attitudes towards clinical trial participation, and found that Black and Hispanic individuals were a little less likely to say such trials are important than white or Asian people. In focus groups, some people of color pointed to past mistreatment of communities of color in medical research as reason to avoid being a “test case.”

The JAMA study authors suggest several potential solutions to spur more representative trials. Some people may be more likely to participate if they had adequate transportation, child care, or time off work.

While federally funded studies are required to ensure racial representation, those run by companies are not. The authors suggest that tax breaks or patent extensions could be offered as incentives to companies to encourage them to make the extra effort to recruit diverse participants in their trials.

Omicron booster authorized for kids as young as 6 months

The bivalent booster that targets the omicron variant has been authorized for children under 5, the FDA announced Thursday.

Eligibility depends on which shots kids got previously. Those who received two doses of Moderna’s original-formula vaccine can already get that company’s bivalent booster.

Children who are midway through Pfizer’s three-dose regimen for that age group can receive a bivalent booster for their third shot.

But those who already completed Pfizer’s primary series will have to wait. The FDA has not yet received data to support a fourth, bivalent shot for those children, but expects to have the data in hand by January, reports Spencer Kimball at CNBC.

The bivalent boosters, which target omicron BA.5 and were authorized for adults in late summer, are already a bit out of date now that BQ.1 and BQ.1.1 are the dominant strains in the U.S.

But a recent CDC study supports the idea that these boosters enhance protection compared to the original, monovalent shots alone. The longer it had been since a person’s previous shot, the more benefit the booster provided.

Congress poised to terminate military vaccine mandate

Republicans are expected to succeed in ending the COVID-19 vaccine requirement for military service members as part of the annual military spending bill, reports The Hill.

The White House and Defense Secretary Lloyd Austin oppose the change, notes Rachel Roubein at The Washington Post. National Security Council spokesman John Kirby said the mandate is still “very much a health and safety readiness issue for the force.”

Conservatives have argued that the mandate, put in place in August 2021, slowed military recruitment and forced more than 8,000 service members to depart. About 98% of the military’s 1.2 million members have been vaccinated already, reports Connor O’Brien at Politico, and he notes the bill, as it stands now, would not reinstate those discharged over the issue.

Austin said there are no “hard data” that indicate the COVID vaccine mandate hurt recruiting, reports Reuters.

Up to 17 other vaccines are required for service members, depending on their position and risk level.

Democrats are willing to cede the issue to get the bill passed. While the White House has called the change “a mistake,” President Joe Biden has not indicated he would veto the bill if it the mandate is dropped, report Nathaniel Weixel and Joseph Choi at The Hill.

What we’re reading

  • “For the uninsured, COVID care has entered a new stage of crisis,” by Noah Weiland and Sarah Kilff, The New York Times
  • “China’s COVID wave is coming,” by Katherine J. Wu, The Atlantic
  • “With COVID-19 climbing, how do schools keep students on track?” by Aziah Siid, Word In Black
  • “Do we still need to quarantine with COVID?” by Jennifer Henderson, MedPage Today
  • “Ex-FDA vaccine inspectors call for better training,” by Erin Banco, Politico

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