Category: Corona Virus Vaccine

A recent study published in the Journal of Internal Medicine investigates the correlations between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and benign prostatic hyperplasia (BPH).

Study:SARSCoV2 infection correlates with male benign prostatic hyperplasia deterioration. Image Credit:Fotoluminate LLC/ Shutterstock.com

SARS-CoV-2, the causal agent of the coronavirus disease 2019 (COVID-19), can infect extrapulmonary systems. Prostate epithelial cells express both angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2), thus suggesting that SARS-CoV-2 can infect the lower urinary tract in males.

Metabolic syndrome and diabetes mellitus are known risk factors for lower urinary tract symptoms (LUTS) that can impact the prostate. SARS-CoV-2 is known to cause new-onset metabolic complications, which could aggravate LUTS.

BPH can cause urinary tract infections (UTIs), retention of urine (ROU), bladder stones, and hematuria. Like COVID-19, BPH is prevalent among aging males, with an estimated incidence of 80% in adults 70 years of age and older; therefore, COVID-19 patients may be more likely to develop BPH complications. Currently, there is limited evidence on the relationship between COVID-19 and LUTS.

In the present study, researchers explore the correlations between COVID-19 and BPH. Relevant data were retrieved from a patient record database of the Hong Kong Hospital Authority.

Patients on monotherapy with long-acting alpha-1 adrenoreceptor blockers (AARBs) for LUTS in 2021 and 2022 were included. Individuals with a history of urolithiasis or prostate cancer in the past five years or ROU in the past year were excluded.

Subjects with a positive SARS-CoV-2 polymerase chain reaction (PCR) test were included in the COVID-19 group, while those without a positive PCR test were in the control group. The study outcomes included the incidence of BPH complications such as UTI, bacteriuria, hematuria, and ROU, as well as the addition of a 5-alpha reductase inhibitor (5ARI) as a combination therapy for LUTS.

Data on UTI, hematuria, and ROU were based on clinical diagnosis codes in the database, whereas bacteriuria was determined based on positive urine cultures. Propensity scores were calculated using logistic regression, and propensity score matching was performed to adjust/balance potential confounders.

A chi-squared test compared the outcomes between SARS-CoV-2-infected and control groups. Sub-group analyses were performed by age groups and COVID-19 severity.

COVID-19 severity was defined based on medications such as interferons, antivirals, or steroids, hospitalization, intensive care requirement, and intervention, including oxygen therapy or extracorporeal membrane oxygenation.

A total of 192,435 males received AARB monotherapy. After exclusions, there were 176,006 subjects, including 10,651 individuals who tested positive for SARS-CoV-2 infection.

After propensity score matching, 17,986 individuals were retained for analyses, with each group comprising 8,993 subjects. There were significant differences in outcomes between COVID-19 and control groups, with the COVID-19 group associated with a higher incidence of ROU, hematuria, bacteriuria, and 5ARI use.

The incidence of BPH complications was significantly higher across most age groups, except those of a younger age. There were significant differences in the incidence of bacteriuria and ROU in individuals 50 years of age and older, as well as UTI incidence and 5ARI use in patients 60 and older. The incidence of ROU, hematuria, and 5ARI use did not differ by COVID-19 severity.

The incidence of bacteriuria and UTI was significantly lower in patients with asymptomatic or mild COVID-19. Furthermore, in sub-group analyses by COVID-19 supportive medical therapy, hematuria incidence was consistently higher after excluding patients on heparin therapy. Likewise, the incidence of bacteriuria and UTI remained higher after excluding patients prescribed steroids.

SARS-CoV-2 infection was associated with an increased incidence of BPH complications and 5ARI use in males treated for baseline LUTS. The strong positive correlation suggests significant urological manifestations of COVID-19; therefore, it is crucial for urologists and clinicians to be aware of this additional burden.

Sub-group analyses revealed a significantly higher incidence of BPH complications among patients of an older age. Notably, there were no differences in the incidence of hematuria or urinary retention and 5ARI use by COVID-19 severity, thus indicating that these urological manifestations may occur even in patients with mild or asymptomatic COVID-19.

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Norways 86-year-old King Harald V has tested positive for the coronavirus and has mild symptoms

October 22, 2023, 11:19 AM ET

2 min read

HELSINKI -- Norways 86-year-old King Harald V, who has been in frail health in the past few years, has tested positive for the coronavirus and has mild symptoms, royal officials said on Sunday.

His Majesty the King has been diagnosed with corona and is on sick leave until he is symptom-free. The king has cold symptoms and stays at home, the royal household said in a brief statement.

The Norwegian monarch had also tested positive in March 2022 with mild symptoms. Officials have earlier said Harald had received three COVID-19 vaccine shots but it's not known whether he had received booster shots.

Prime Minister Jonas Gahr Stre wished the king a speedy recovery in a comment to the Norwegian news agency NTB, which said Harald's son and heir to the throne, Crown Prince Haakon, would take over his duties for now.

The aging monarch, who has been seen using crutches in various occasions, has been hospitalized several times in recent years.

In August 2022, he spent three days with a fever at a hospital, and in December the same year, he was again admitted for an infection that required intravenous antibiotics.

In October 2020, the king underwent surgery to replace a heart valve after being hospitalized with breathing difficulties.

Despite health problems, he has been attending major public events in Norway and its Nordic neighbors. In September, Harald attended celebrations in Stockholm marking the 50th anniversary of Swedens King Carl XVI Gustafs accession to the throne.

In May, the monarch, who was released from a hospital just days earlier, appeared on the royal castles balcony in Oslo to salute the thousands of children marching by as the country celebrated its Constitution Day.

The king is Norways head of state but holds no political power, so his duties are ceremonial. Harald ascended to the throne following the death of his father, King Olav, in 1991.

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A vaccine designed to protect against three different deadly coronaviruses shows success in mouse studies, demonstrating the viability of a pan-coronavirus vaccine developed by researchers at the Duke Human Vaccine Institute.

Publishing in the journal Cell Reports, the single nanoparticle vaccine included components of a previous vaccine that was shown to protect mice and primates against multiple variants of SARS-CoV-2, which is the virus that causes COVID-19. In this study, the vaccine protected mice from SARS-CoV-1, another form of SARS coronavirus that can infect humans, and a MERS coronavirus that has led to periodic, deadly outbreaks around the world.

"We are making important progress toward a broadly protective coronavirus vaccine," said senior author Kevin O. Saunders, Ph.D., associate director of the Duke Human Vaccine Institute. "These are pathogens that cause or have the potential to cause significant human infections and loss of life, and a single vaccine that provides protection could slow down or even prevent another pandemic."

Saunders and colleagues built the tri-valent vaccine using a nanoparticle loaded with a key fragment called a receptor binding domain from each of the coronaviruses. The fragment -- a docking site on the virus that enables it to infiltrate the body's cells -- provides enough information for immune cells to build an effective response against actual coronaviruses that enter the body.

In earlier studies in mice and primates, the researchers demonstrated that an earlier iteration of the nanoparticle vaccine was effective against multiple SARS-CoV-2 variants. Human tests are planned next year for a version that carries immunogens to different SARS-CoV-2 strains, including those that have dominated since the original outbreak in late 2019.

The current work expands the components of the vaccine to include an additional SARS-related virus and MERS virus. In lab studies, as well as in mice, the researchers found that the vaccine candidate generated inhibitory immune molecules called antibodies against all three pathogenic human coronavirus types.

Importantly, vaccinated mice did not grow sick when challenged with either SARS-like or MERS-like viruses.

"This study demonstrates proof-of-concept that a single vaccine that protects against both MERS and SARS viruses is an achievable goal," Saunders said. "Given that one MERS and two SARS viruses have infected humans in the last two decades, the development of universal coronavirus vaccines is a global health priority."

In addition to Saunders, study authors include lead author David R. Martinez, who is now at Yale School of Medicine, and Alexandra Schafer, Tyler D. Gavitt, Michael L. Mallory, Esther Lee, Nicholas J. Catanzaro, Haiyan Chen, Kendra Gully, Trevor Scobey, Pooja Korategere, Alecia Brown, Lena Smith, Rob Parks, Maggie Barr, Amanda Newman, Cindy Bowman, John M. Powers, Erik J. Soderblom, Katayoun Mansouri, Robert J. Edwards, Ralph S. Baric, and Barton F. Haynes.

The study received funding support from the National Institute of Allergy and Infectious Diseases, which is part of the National Institutes of Health (U54 CA260543, P01 AI158571).

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Single vaccine protects against three deadly strains of coronavirus - Science Daily

Study design

In this study, an open-label, non-randomized, two-arm, blank-controlled, investigator-initiated trial was designed to assess the efficacy and safety of the intranasal spray cocktail A8G6 in preventing SARS-CoV-2 infection among close contacts with COVID-19 patients. The clinical trial was conducted at 6 designated quarantine hotels in Yuzhong District, Chongqing, China from November 27, 2022 and was completed on December 12, 2022.

Recruited participants in the treatment group self-administrated a three doses of 0.7mg (140l) A8G6 nasal spray per day for 7 treatment days. The drug was supplied by Chongqing Mingdao Haoyue Biotechnology Co., LTD (Chongqing, China), stored at 28C. In the blank control group, participants did not receive any treatment. After enrollment, SARS-CoV-2 infection was confirmed by a reverse transcription polymerase chain reaction (RT-PCR) test of oropharyngeal swab. During this trial, with the adaption of the anti-COVID-19 policy, not only RT-PCR, but also rapid antigen tests were used to confirm the SARS-CoV-2 infection status.

The trial was carried out in accordance with all applicable national and local regulatory requirements. Data and Safety Monitoring Board of The Second Affiliated Hospital of Chongqing Medical University oversaw trial conduct and documentation. The protocol has been approved by the Chinese clinical test registration center (the world health organization international clinical trials registered organization registered platform (ICTRP), the registration number: ChiCTR2200066416) and the Ethics Committees of The Second Affiliated Hospital of Chongqing Medical University (the approval number: 2022127-1).

During November COVID-19 wave in Chongqing, China, when patients had been diagnosed as COVID-19 with the positive RT-PCR test for SARS-CoV-2 (index cases), their close contacts were immediately transferred to the designated quarantine sites. At 6 quarantine sites in Chongqing, healthy adults aged between 18 to 65 years who had a close contact with index cases within 72hours were enrolled into this study. The maximum time interval between exposure to treatment was 72h. All vaccination status is eligible for inclusion. Exclusion criteria included positive RT-PCR at baseline, nasal discomfort, the use of other COVID-19 antibody drugs and drug-drug interference with participants regular medication (additional details about eligibility criteria were described in the appendix).

All study participants were capable of self-administrating the intranasal spray, recording and recalling clinical signs. All participants were provided and voluntarily signed written informed consent before the study.

At six quarantine sites in the Yuzhong District, Chongqing, site investigation was carried out to screen eligible participants. Eligible participants were given the choice to join the A8G6 treatment group or blank control group. For eligible participants that showed no preference in either group, they were randomly assigned to A8G6 treatment group or blank control group. Oropharyngeal swabs were taken for quantitative and qualitative RT-PCR assessments at baseline prior to treatment and though the treatment period and a follow-up period. Subjects with positive RT-PCR results before treatment were excluded. The SARS-CoV-2 viral load was present by viral genome copies per mL log10 values with the conversion of the open reading frame of 1ab (ORF1ab) and nucleocapsid (N-gene) cycle threshold (Ct) values (RT-PCR was conducted by Yuzhong District Center for Disease Control and Prevention, in Chongqing, China. Conversion of Ct values to viral genome copies was calculated according to the manufacturers instructions of 2019-nCoV viral RNA kit produced by BioPerfectus Technologies, catalog number: JC10223-1N).

Subjects demographic data, health and COVID-19 vaccination status were recorded at the baseline visit (Day 0). The use of nasal spray, rapid antigen tests or RT-PCR test for COVID-19 were recorded every day during the study participation. When participants in both groups were diagnosed with SARS-CoV-2 infection, the related symptoms and symptomatic treatment for COVID-19 were reported until the trial completed. In the treatment group, all participants were requested to self-report and record the adverse events. Due to the relaxation of COVID-19 control and policy starting from December 4, 2022, some participants returned to home for further isolation. The follow-up visits were adjusted to retrospective telephonic visit according to a questionnaire form from that day.

The primary endpoint analysis included all participants in both the treatment and control groups. The primary endpoint was to assess the efficacy of the intranasal spray A8G6 for post-exposure prophylaxis of COVID-19. In this study, we compared the COVID-19 incidence of the close contacts between the A8G6 treatment individuals and the blank-controlled individuals. We also compared the time from enrollment to SARS-CoV-2 infection between the two groups. The secondary efficacy analysis included the quantitative data of SARS-CoV-2 RNA (log10 copies per mL) at baseline of the positive COVID-19 and the time to conversion of SARS-CoV-2 RNA from positive to negative (viral clearance).

Safety endpoints was adverse event types and the incidence rate of adverse events among all participants of the A8G6 treatment group during the study. An adverse effect was defined as any abnormal signs or symptoms and harmful results caused by the study drug.

The sample size in this clinical trial was determined on the basis of statistical power calculations. We proposed greater than 90% power to detect a 20% relative difference between the A8G6 treated and control group at a two-sided alpha level of 0.05 (ie., a 20% prevention efficacy of A8G6). The formula is as follows:

$$n={frac{2pq({Z}_{1-frac{alpha }{2}}+{Z}_{1-beta })}{{delta }^{2}}}^{2}$$

which p is the proportion of participants develop COVID-19 in A8G6 treated group, q is in the control group, is the difference between two group, is two-sided alpha level, and 1- is statistical power. In this clinical trial, we assume that q is 0.1, 20% relative reduction of A8G6 treated group is 0.08. Assuming a dropout rate of 20%, at total of 5160 participants will be recruited.

The primary efficacy endpoints including COVID-19 incidence and time to confirmed SARS-CoV-2 infection. The COVID-19 incidence was analyzed using the KaplanMeier method and log-rank test, and the time to confirmed SARS-CoV-2 infection was analyzed using Wilcoxon rank-sum test. The secondary efficacy endpoints including viral load when confirmed SARS-CoV-2 infection and the time to negative conversion of SARS-CoV-2 determined by RT-PCR. The viral load when confirmed SARS-CoV-2 infection was analyzed using Wilcoxon rank-sum test, negative conversion of SARS-CoV-2 and remission time were conducted using KaplanMeier method and log-rank-test. Safety was assessed in participants in the full analysis set who received A8G6 nasal spray treatment during the 8-day quarantine period.

Database from the Service Platform for COVID-19 Prevention and Control created by Yuzhong District Center for Disease Control and Prevention were authorized for us to use and analyze. Data including demographic and clinical characteristics of the cohorts, endpoints in this clinical trial were collected from an applet of WeChat (a social media platform in China), called Yuzhong Information Exchange. All data were summarized with descriptive statistics (number of subjects (%), median (IQR), meansd). The credible interval for nasal spray was calculated with the use of a beta-binomial model with prior beta (1, 1) adjusted for the treatment duration time. Continuous variables were compared with the MannWhitney U-test, and Categorical variables were conducted using 2 test or Fishers exact test. A P value of <0.05 was considered statistically significant. Statistical analyses were performed using R software, version 3.6.0.

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Researchers from Penn's Perelman School of Medicine found that traces of the COVID virus in longterm patients inhibit the development of serotonin.

A new study led by researchers from Penn's Perelman School of Medicine found that a decrease in serotonin levels is linked to the development of prolonged symptoms in individuals with COVID-19.

According to the study, traces of SARS-CoV-2 in the guts of long COVID-19 patients cause inflammation that prevents the development of serotonin, which is critical to recovery.

Patients with long COVID-19 experience long-term symptoms like brain fog or fatigue in the months or years following the initial COVID-19 infection. According to the CDC, nearly 7.5% of Americans who are infected with COVID-19 experience long-term symptoms.

Many aspects of the basic biology underlying long COVID have remained unclear. As a result, we are lacking effective tools for the diagnosis and treatment of the disease, Maayan Levy, Assistant Professor of Microbiology and senior author of the study, said.

The new study found that the remaining virus in patients with long COVID-19 triggers patients immune system to release interferons, proteins that continue to fight the virus. This, in turn, affects patients absorption of the amino acid tryptophan, which is critical to the development of serotonin.

Serotonin, commonly referred to as the happy hormone, is responsible for memory, happiness, body temperature regulation, sleep, sexual behavior, and hunger. A lack of serotonin is correlated with depression, anxiety, mania, and other health conditions.

Because of the study results, researchers are looking into new ways of treating long COVID-19 by examining serotonin. This novel approach marks a breakthrough in developing treatments for long-term symptoms.

Our findings may not only help to untangle some of the mechanisms that contribute to long COVID, but also provide us with biomarkers that can help clinicians diagnose patients and objectively measure their response to individual treatments, Levy said.

Levy previously received the National Institute of Health Directors Award, which is granted to scientists undertaking innovative research with a broader impact on pressing biomedical challenges.

There has been some evidence to suggest that SSRIs could be effective in preventing long COVID, and our research now presents an opportunity for future studies to select specific patients for a trial who exhibit depleted serotonin, and to be able to measure response to treatment, Benjamin Abramoff, Assistant Professor of Clinical Physical Medicine and Rehabilitation and senior author of the study, said.

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Penn Medicine researchers find serotonin is linked to long COVID ... - The Daily Pennsylvanian

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A team of UC Davis scientists used dynamic total-body positron emission tomography (PET) to provide the first imaging of the human bodys immune response to COVID-19 infection in recovering patients. Their work, published in Science Advances, could lead to a better understanding of how the bodys immune system responds to viral infections and develops long-term protection against re-infection.

The researchers used the uEXPLORER total-body PET scanner. It is an innovative imaging technology developed at UC Davis in collaboration with United Imaging Healthcare.

Dynamic PET involves injecting very small amounts of radiotracers in the patient, followed by continuous imaging over a period of time. It essentially creates a movie showing the radiotracer kinetics (distribution over time) within the body. Mathematical models can then be applied to extract biologically-relevant information.

Total-body PET scanners enable simultaneous dynamic imaging and kinetic modeling in all body organs. They have significantly higher sensitivity than conventional PET systems. This translates into better image quality while enabling the use of lower radiotracer injection doses.

Dynamic total-body PET is currently the only available technology with acceptable radiation dose that allows noninvasive quantitative measurements of immune cell distribution and trafficking (movement) inside all tissues in living humans, said first author Negar Omidvari, assistant project scientist in the UC Davis Department of Biomedical Engineering.

The study presents the first use of dynamic PET and kinetic modeling to measure CD8+ T cell distribution in humans. CD8+ T cells are specific immune cells with CD8 protein on their surface. During a viral infection, nave (non-customized) CD8+ T cells become activated and cytotoxic. This means they find and kill infected cells. Some of these CD8+ cells develop into antigen-specific memory T cells for long-term protective memory against reinfection.

These cells circulate in the blood but mostly reside and function in non-blood tissues, particularly the lymphoid organs, such as the bone marrow, spleen, tonsils and lymph nodes.

There has been a growing interest in studying the critical role of CD8+ T cells in immune response and memory. However, evaluating immunological changes in non-blood tissue is challenging due to the invasive nature of biopsies. In some cases, it is not even practical in certain anatomical regions of living participants, such as the brain, spinal cord, cardiopulmonary tissue and vascular tissue, Omidvari said. So, the challenge was to find noninvasive quantitative methods for measuring CD8+ T cell distribution and trafficking in the body that are safe to also use in healthy people.

For the study, the researchers enrolled three healthy individuals and five patients recovering from COVID-19 infection. The recovering patients had mild or moderate symptoms and were not hospitalized.

The team injected the participants with a small amount of a radioactive liquid that includes an immunoPET radiotracer (89Zr-Df-Crefmirlimab) that targets human CD8. For each participant, the team took a dynamic 90-minute scan, a 60-minute scan at six hours, and a 60-minute scan at 48 hours after the injection. The recovering patients also did the same set of scans four months later.

The researchers measured the activity of the radiotracer in the blood and non-blood tissue on PET images. They did kinetic modeling to separate the effect of blood circulation on tissue. This allowed them to measure the radiotracer uptake in tissues independent of when the imaging was done and differences in the blood of each participant.

With the total-body PET, the researchers could do a noninvasive measurement of the T cell distribution with remarkable image quality throughout the whole body, in all tissue types. Their study showed a high uptake of CD8+ T cells in the lymphoid organs of all participants. The highest uptake was in the spleen, followed by the bone marrow, liver, tonsils and lymph nodes.

The most significant finding was the increased concentrations of CD8+ T cells in the bone marrow of recovering COVID patients compared to the healthy controls. In the follow-up imaging (acquired at 6 months post infection), these concentrations in recovering patients were slightly higher than those acquired at around 2 months post infection (baseline) in all bone marrow regions.

Bone marrow has been identified as a major pool and the preferred site for proliferation of memory CD8+ T cells following a viral infection. This trafficking of memory T cells to certain tissues like the bone marrow is critical to developing immune memory after viral infection, Omidvari explained.

The specificity of the immunoPET tracer combined with the high detection sensitivity of total-body PET provides a new platform for scientists to study the immune response and memory in all organs over the long term in a non-invasive way.

What is fundamentally important about this study is that it showed the potential of total-body PET to assess T-cell distributions across the entire human body, with the image quality necessary for detailed modeling, and with a radiation dose that is low enough to allow its broad application to study the immune response in humans, said Simon R. Cherry, a UC Davis physicist and distinguished professor emeritus of biomedical engineering and radiology. In our case, we were able to characterize the dynamics of this immunoPET tracer in healthy control subjects and in patients with infectious disease (COVID-19), which is an important first.

The team pointed to many potential applications for this method. It could be used to study the immune response during viral infection, immune memory after viral infection, and treatment response evaluation in cancer patients. It might also extend to studies of infectious disease, autoimmune disease and transplant, and can be used for prognosis as well as therapeutic and vaccine developments.

Watch Dr. Negar Omidvari explain the study: video

The studys co-authors from UC Davis are Terry Jones, April L. Ferre, Jacqueline Lu, Yasser AbedlHafez, Fatma Sen, Stuart Cohen, Ramsey D. Badawi and Barbara Shacklett. The other co-authors are Ian Wilson and Kristin Schmiedehausen of ImaginAb Inc. and Pat M. Price of Imperial College.

This work was supported by grants from the National Institutes of Health (NIH) (R01CA206187, R35CA197608), NIHs National Cancer Institute (NCI) (P30 CA0933730) and NIHs The National Center for Research Resources (NCRR) (S10 RR12964, S10 RR026825, S10 OD018223-01A1). It was also supported by James B. Pendleton Charitable Trust and ImaginAb Inc.

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What GAO Found

Most COVID-19 relief funds went to the intended recipients in the intended amounts. In other instances, significant funds went to those who engaged in fraud schemes. Federal fraud schemes consist of five key elements: (1) affected program, (2)participants, (3) types of fraud activities, (4)mechanisms to execute fraudulent activities, and (5) impacts. These elements represent the highest-level components in GAO's Conceptual Fraud Model. The model provides a common language and structure for describing fraud schemesincluding those affecting COVID-19 relief programsto support agency efforts to combat fraud.

Key Elements of an Example of a Fraud Scheme Involving Multiple COVID-19 Relief Programs

Federal agencies did not strategically manage fraud risks and were not adequately prepared to prevent fraud when the pandemic began. While eliminating all fraud is not a realistic goal, resources and requirements exist to support strategic fraud risk management. For example, GAO's Fraud Risk Framework and Antifraud Resource provide leading practices and interactive tools, respectively, to help agencies combat fraud. GAO's 142 recommendations to agencies to align their efforts with fraud risk management leading practices also provide a roadmap for action. GAO has also suggested actions Congress can take, such as reinstating agencies' reporting on fraud risk management and enhancing data analytic capabilities. These congressional actions and agencies' use of GAO resources to strategically manage fraud risk would position them to better prevent fraud in both normal operations and in emergencies.

Since March 2020, Congress and the Administration have provided trillions of dollars in COVID-19 relief funding to help the nation respond to and recover from the pandemic. Agencies across the federal government acted quickly to stand up new programs and greatly scale up existing programs.

The unprecedented demand for benefits and the need to quickly implement or expand programs increased the risk of fraud during the pandemic. There have also been cases of funds paid to those who sought to defraud the government. For example, from March 2020 through June 2023, at least 1,399 individuals or entities were found guilty or liable for fraud-related charges in cases involving federal COVID-19 relief programs.

Managing fraud risk is the responsibility of program managers and includes assessing the potential for fraud and implementing strategies to appropriately mitigate related fraud risks. Better understanding the nature of federal fraud schemes and the resources available to combat them can enhance agency efforts to prevent, detect, and respond to fraud risk during normal operations and emergencies.

This testimony discusses (1) key elements of federal fraud schemes and examples of schemes involving COVID-19 relief funds and (2) actions agencies and Congress can take to better prevent fraud during normal operations and emergencies.

GAO reviewed its prior COVID-19 findings and recommendations on internal controls and fraud risk management practices.

For more information, contact Rebecca Shea at (202) 512-6722 or shear@gao.gov.

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Impact of COVID-19 Vaccinations on Menstrual Bleeding - Cureus