Category: Corona Virus

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This photo provided by Christina Tidmore shows Josh Tidmore Wednesday, Aug. 11, 2021 at Marshall Medical Center South in Boaz, Ala. Healthy and in their 30s, Christina and Josh Tidmore figured they were low-risk for COVID-19, and with conflicting viewpoints filling their social media feeds and social circles, they decided to wait to get vaccinated. On July 20, Josh came home from work with a slight cough they initially thought was sinus trouble. On Aug. 11, he died of COVID-19 at a north Alabama hospital as Tidmore watched a doctor and her team frantically try to resuscitate her husband. (Christina Tidmore via AP)

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This photo provided by Christina Tidmore shows Josh Tidmore Wednesday, Aug. 11, 2021 at Marshall Medical Center South in Boaz, Ala. Healthy and in their 30s, Christina and Josh Tidmore figured they were low-risk for COVID-19, and with conflicting viewpoints filling their social media feeds and social circles, they decided to wait to get vaccinated. On July 20, Josh came home from work with a slight cough they initially thought was sinus trouble. On Aug. 11, he died of COVID-19 at a north Alabama hospital as Tidmore watched a doctor and her team frantically try to resuscitate her husband. (Christina Tidmore via AP)

MONTGOMERY, Ala. (AP) Healthy and in their 30s, Christina and Josh Tidmore figured they were low-risk for COVID-19. With conflicting viewpoints about whether to get vaccinated against the virus filling their social media feeds and social circles, they decided to wait.

On July 20, Josh came home from work with a slight cough initially thought to be sinus trouble. On Aug. 11, he died of COVID-19 at a north Alabama hospital as Christina Tidmore witnessed a doctor and her team frantically try to resuscitate her husband.

She would say, I need a pulse. I would hear, no pulse, Christina Tidmore said through tears. They were trying so hard.

Nobody should go through this. He was only 36 and Im 35 and we have three kids.

She is now imploring young adults not to dismiss the risk and to consider getting vaccinated.

Josh was completely healthy, active, not a smoker. He would have turned 37 on Saturday.

Doctors say they are seeing a spike in cases among young adults and children as the highly contagious delta variant sweeps through unvaccinated populations. Medical officials say there is conflicting information on whether it makes people more severely ill or whether young people are more vulnerable to it, but its clear the contagiousness means more young people and children are getting sick.

There is no question that the average age of people who are being hospitalized is going down, State Health Officer Scott Harris said Friday.

I dont know if its clear that delta is worse in that age group or worse than any of the strains weve seen before. ... But what you have though is one that is just much, much more transmissible. Because seniors are the ones that are predominately the vaccinated population in our state, the most vulnerable are these younger people. So you see them getting infected at much higher rates than we had before.

In the past four weeks, people ages 25 to 49 years, made up 14% of all COVID deaths in the state. And people 50 to 64 years made up about 29%.

The state is also seeing a surge in COVID cases among children, although deaths so far have been rare. The state this week set a record for pediatric hospitalizations with 50 children hospitalized with COVID-19.

In the past four weeks, 6% of cases of COVID-19 in Alabama have been among children under five while 8% have been among children between the ages of five and 17, according to the Alabama Department of Public Health.

I am very concerned that the children of Alabama are experiencing more illness and hospitalizations as a result of COVID-19. Children can and do contract and spread COVID-19 disease. COVID-19 can be a very serious illness in children with at least 6% of children experiencing long-term consequences of this disease, said Dr. Karen Landers, a pediatrician with the Alabama Department of Public Health.

The Alabama Hospital Association said this week that 85% of hospitalized COVID-19 patients are unvaccinated.

Christina Tidmore also had COVID-19 but recovered. She said she and her husband were not anti-vaccine, but heard conflicting information including, she said, from doctors.

Its just a fight out there. This side and that side, and political garbage. ... You dont know who to believe, she said.

A jokester with a heart of gold, Josh loved to help others and to make people laugh, especially kids. He sauntered into Easter and Christmas gatherings wearing an inflatable dinosaur costume and ran around hugging family members. He would cheerfully photobomb beachgoers. He didnt hesitate to rush to help a motorcyclist injured in an accident near the north Alabama church his grandparents founded.

He could make you feel better when nobody else could. He would listen. He genuinely cared about everybody, Christina Tidmore said.

The family is relying on their faith to get through and Christina Tidmore wants to share her husbands story to help people as Josh would have wanted.

If you can try to save your life, then you probably should, she said of vaccinations.

I have lots of feelings and lots of regret and lots of what ifs, she said. you dont want to do that. You dont.

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This story corrects the first sentence in the summary to read Alabama, not Mississippi.

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Follow more of APs pandemic coverage at https://apnews.com/hub/coronavirus-pandemic

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Though young and healthy, unvaccinated father dies of COVID - Associated Press

In the 1980s, doctors at an English hospital deliberately tried to infect 15 volunteers with a coronavirus. COVID-19 did not yet existwhat interested those doctors was a coronavirus in the same family called 229E, which causes the common cold. 229E is both ubiquitous and obscure. Most of us have had it, probably first as children, but the resulting colds were so mild as to be unremarkable. And indeed, of the 15 adult volunteers who got 229E misted up their nose, only 10 became infected, and of those, only eight actually developed cold symptoms.

The following year, the doctors repeated their experiment. They tracked down all but one of the original volunteers and sprayed 229E up their nose again. Six of the previously infected became reinfected, but the second time, none developed symptoms. From this, the doctors surmised that immunity against coronavirus infection wanes quickly and reinfections are common. But subsequent infections are mildereven asymptomatic. Not only have most of us likely been infected with 229E before, but weve probably been infected more than once.

This tiny study made little impression at the time. In the 80s and 90s, coronaviruses still belonged to the backwater of viral research, because the colds they caused seemed trivial in the grand scheme of human health. Then, in the spring of 2020, scientists urgently searching for clues to immunity against a novel coronavirus rediscovered this decades-old research. Before the emergence of SARS-CoV-2, which causes COVID-19, only four known coronaviruses were circulating among humans, including 229E. All four of these coronaviruses cause common colds, and in the most optimistic scenario, experts have told me, our newest coronavirus will end up as the fifth. In that case, COVID-19 might look a lot like a cold from 229Erecurrent but largely unremarkable.

That future may be hard to imagine with intensive-care units filling up yet again during this Delta surge. But the pandemic will end. One way or another, it will end. The current spikes in cases and deaths are the result of a novel coronavirus meeting naive immune systems. When enough people have gained some immunity through either vaccination or infectionpreferably vaccinationthe coronavirus will transition to what epidemiologists call endemic. It wont be eliminated, but it wont upend our lives anymore.

With that blanket of initial immunity laid down, there will be fewer hospitalizations and fewer deaths from COVID-19. Boosters can periodically re-up immunity too. Cases may continue to rise and fall in this scenario, perhaps seasonally, but the worst outcomes will be avoided.

We dont know exactly how the four common-cold coronaviruses first came to infect humans, but some have speculated that at least one also began with a pandemic. If immunity to the new coronavirus wanes like it does with these others, then it will keep causing reinfections and breakthrough infections, more and more of them over time, but still mild enough. Well have to adjust our thinking about COVID-19 too. The coronavirus is not something we can avoid forever; we have to prepare for the possibility that we will all get exposed one way or another. This is something were going to have to live with, says Richard Webby, an infectious-disease researcher at St. Jude. And so long as its not impacting health care as a whole, then I think we can. The coronavirus will no longer be novelto our immune systems or our society.

Endemicity as the COVID-19 endgame seems quite clear, but how we get there is less so. In part, that is because the path depends on us. As my colleague Ed Yong has written, the eventuality of endemic COVID-19 does not mean we should drop all precautions. The more we can flatten the curve now, the less hospitals will become overwhelmed and the more time we buy to vaccinate the unvaccinated, including children. Letting the virus rip through unvaccinated people may get us to endemicity quickest, but it will also kill the most people along the way.

The path to endemic COVID-19 will also depend on how much the virus itself continues to mutate. Delta has already derailed summer reopening plans in the U.S. And with so much of the world still vulnerable to infection, the virus has many, many opportunities to luck into new variants that may yet enhance its ability to spread and reinfect. The good news is this virus is unlikely to evolve so much that it sets our immunity back to zero. Our immune responses are so complex, its basically impossible for a virus to escape them all, says Sarah Cobey, an evolutionary biologist at the University of Chicago. For example, levels of antibodies that quickly neutralize SARS-CoV-2 do indeed drop over time, as happens against most pathogens, but reserves of B cells and T cells that also recognize the virus lie in wait. This means that immunity against infection may wane first, but the protection against severe illness and death are much more durable.

Read: Your vaccinated immune system is ready for breakthroughs

Protection against severe illness and death was, in fact, the original goal of vaccines. When I spoke with vaccine experts as the trials were under way last summer, they universally told me to temper expectations. Vaccines against respiratory viruses rarely protect against full infection because they are better at inducing immunity in the lungs than in the nose, where respiratory viruses gain their first foothold. (Consider: The flu shot is 10 to 60 percent effective depending on the year.) But the extraordinary efficacy from the initial clinical trials raised expectations, Ruth Karron, the director of the Center for Immunization Research at Johns Hopkins University, told me. With the Pfizer and Moderna vaccines 95 percent effective against symptomatic infection, eliminating COVID-19 locally, like measles or mumps in the U.S., suddenly seemed possible.

Then came the less pleasant surprise: new variants, like Beta, Gamma, and now Delta, that erode some protection from vaccines. We now are where we thought we would be a year ago, Karron said. The vaccines still protect against serious illness very well, as expected, but herd immunity again seems out of reach. The virus will continue to circulate, but fewer people will get sick enough to be hospitalized or die. Highly publicized outbreaks among vaccinated people, such as in Provincetown, Massachusetts, already show this pattern playing out. And entire countries with high vaccination rates, such as the U.K., Iceland, and Israel, are also seeing spikes with only a fraction of their pre-vaccine deaths.

The timing and severity of reinfections and breakthrough infections once COVID-19 becomes endemic depend on how quickly the protective effects of immunity against the virus wanes. And that, in turn, depends on a combination of two factors: first, how quickly our immune systems get rusty against SARS-CoV-2, and second, how quickly this coronavirus evolves to disguise itself. The immunological machinery is simply harder to rouse against an old enemy. But a reinfection or breakthrough infection does reinvigorate the immune response. A breakthrough case acts like a booster for the vaccine, as Laura Su, an immunologist at the University of Pennsylvania, told my colleague Katherine J. Wu. In the 229E study, the doctors also found that the volunteers who did not get infected the first time were more likely to be infected when exposed a year later, compared with volunteers who got sick the first timesuggesting that more recent illness is more protective.

The virus itself will also change with time. As more people gain immunity via either infection or vaccination, the coronavirus will try to find ways to evade that immunity too. This is a natural consequence of living with a circulating virus; the flu also mutates every year in response to existing immunity. But in the endemic scenario, where many people have some immunity, the coronavirus will not be able to infect as many people nor replicate as many times in each person it infects. Im very confident that the rate of adaptation is going to be set by the prevalence of SARS-CoV-2 in the world, Cobey says. You might think of viral replication as buying lottery tickets, in which the virus accumulates random mutations that very occasionally help it spread. And the fewer lottery tickets the virus has, the less likely it is to hit the mutation jackpot. The appearance of troubling new variants may slow down.

Reinfections with the four common coronaviruses are likely driven by a combination of our immunity fading and the viruses themselves evolving. Putting together everything we do know, a pattern starts to emerge: We are likely first exposed to these common coronaviruses as children, when the resulting disease tends to be mild; our immune systems get rusty; the virus changes; we get reinfected; the immune response is updated; the immune system gets rusty again; the virus changes again; we get infected. And so on.

In the best case, COVID-19 will follow the same pattern, with subsequent infections being mild, says Stephen Morse, an epidemiologist at Columbia University. If the burden of disease is not high, we take [the virus] very much for granted, he says. Still, these colds are not completely benign; one of the common-cold coronaviruses has caused deadly outbreaks in nursing homes before. In a less good scenario, COVID-19 looks like the flu, which kills 12,000 to 61,000 Americans a year, depending on the seasons severity. But deaths alone do not capture the full impact of COVID-19. A big question mark there is long COVID, says Yonatan Grad, an immunologist and infectious-disease researcher at Harvard. There are still no data to prove how well the vaccines prevent long COVID, but experts generally agree that a vaccinated immune system is better prepared to fight off the virus without doing collateral damage.

The transition to endemic COVID-19 is also a psychological one. When everyone has some immunity, a COVID-19 diagnosis becomes as routine as diagnosis of strep or flunot good news, but not a reason for particular fear or worry or embarrassment either. That means unlearning a year of messaging that said COVID-19 was not just a flu. If the confusion around the CDC dropping mask recommendations for the vaccinated earlier this summer is any indication, this transition to endemicity might be psychologically rocky. Reopening felt too fast for some, too slow for others. People are having a hard time understanding one anothers risk tolerance, says Julie Downs, a psychologist who studies health decisions at Carnegie Mellon University.

With the flu, we as a society generally agree on the risk we were willing to tolerate. With COVID-19, we do not yet agree. Realistically, the risk will be much smaller than it is right now amid a Delta wave, but it will never be gone. We need to prepare people that its not going to come down to zero. Its going to come down to some level we find acceptable, Downs says. Better vaccines and better treatments might reduce the risk of COVID-19 even further. The experience may also prompt people to take all respiratory viruses more seriously, leading to lasting changes in mask wearing and ventilation. Endemic COVID-19 means finding a new, tolerable way to live with this virus. It will feel strange for a while and then it will not. It will be normal.

Read more:

How We Live With the Coronavirus Forever - The Atlantic

Dr. James E. Eddie Black of Phoebe Putney Health System Medical. He is Phoebes health system Medical Director for Emergency Services. Contributed

Many are alarmed at the sheer increase of cases in such a short amount of time. In Georgia, the number of hospitalized children ages 0 to 4 has nearly quadrupled over the last two weeks, from 8 to 31, according to the state Department of Public Health. Among school-aged children 5 to 17, the number has almost doubled, from 28 to 50.

The situation is even more dire in other parts of the Southeast. In Dallas, earlier this week there were no more pediatric ICU beds available for children, and Louisianas childrens hospitals reached capacity earlier this month. In Florida, which is currently logging about one-fifth of the countrys COVID hospitalizations, about 54 children were being admitted per day in early August.

What were seeing is that a low-frequency event, which is needing to be hospitalized, is happening a lot more frequently because so many kids are being infected in our communities right now, said Dr. Stephen Thacker, associate chief medical officer at Memorial Health University Medical Center in Savannah.

One-two punch

Previous COVID variants didnt hit young people as hard. With many patients delaying routine medical care and elective procedures, some childrens hospitals were able to act as a relief valve for the health care system at large, lending staff, equipment and sometimes even space to adult hospitals overflowing with COVID-19 patients.

In May, when the government authorized emergency use of the Pfizer-BioNTech vaccine for adolescents ages 12 to 15, health authorities hoped the shots would protect young people before they returned to school.

Siblings Jared McCauley, 14, second from left, and Maya McCauley, 15, second from right, wait to receive the Pfizer COVID-19 vaccine during a free vaccination event held by the Gwinnett, Newton, Rockdale County Health Department at Discovery High School in Lawrenceville, Wednesday, August 18, 2021. (Alyssa Pointer/Atlanta Journal Constitution)

Credit: Alyssa Pointer

Credit: Alyssa Pointer

But vaccination rates lagged. And last month, things began to shift.

The highly contagious delta variant, first identified in India in late 2020, began to sweep across the country as many Americans, vaccinated and not, traveled and mingled more freely without masks or other COVID precautions. That included children, who, after being cooped up for the better part of a year, were particularly vulnerable to highly contagious illnesses like respiratory syncytial virus. RSV typically spreads in colder months and can cause pneumonia and bronchiolitis in small kids.

That one-two punch of COVID and respiratory viruses like RSV is stretching many pediatric health systems to the brink.

Hospitals around the country are reporting 1,963 pediatric patients hospitalized with confirmed and suspected COVID-19 cases, according to the federal Department of Health and Human Services, a record number for the pandemic.

Severe illness from COVID-19 is still uncommon in children about 1.3% of COVID cases among Georgia kids have resulted in hospitalizations, according to the Childrens Hospital Association.

But doctors are still trying to understand the long-term impact of the virus on children, including Multisystem Inflammatory Syndrome in Children, a rare ailment thats dogged some kids who had COVID-19.

And even though only a small percentage of children suffer severe cases, enough kids have become infected that pediatric hospitals have been filling up.

On Tuesday there were 22 patients hospitalized with COVID in the hospitals run by Childrens Healthcare of Atlanta, a spokeswoman said. As recently as June, there were none.

Childrens Healthcare of Atlanta. CONTRIBUTED

At Savannah Memorial Healths childrens hospital, doctors and nurses were treating eight pediatric and neonatal coronavirus patients on Tuesday, including a pair of newborns.

Statewide, 135 kids under 18 were hospitalized with confirmed or suspected cases of COVID-19, according to the most recent information hospitals reported to HHS. Georgia had the nations fourth-highest number of children currently hospitalized with COVID-19, after Texas, Florida and California.

Many of the children hospitalized, and particularly those who need intensive care, have chronic underlying conditions like diabetes or are immunocompromised. But a sad, growing trend in hospitals is that the childrens siblings and parents are also infected with COVID 19, doctors say.

Thats one of our biggest concerns that were seeing right now, said Dr. Brian Griner, who owns a pediatrics and internal medicine practice in Valdosta. Whenever you have small ones (who catch COVID), that easily takes care of the whole family in one fell swoop, including the parents.

Many, but not all, are families in which the parents and older children are not vaccinated.

Rolling the dice

The rise in hospitalizations comes as the number of positive COVID-19 tests has surged.

DPH said it saw a 117% increase in the number of cases among Georgia children aged 5 to 17 this week versus last, and an 111% increase for kids under age 4.

Experts attribute that in part to low vaccination rates among young people.

Only one in five Georgians between the ages of 12 and 17 is fully inoculated, according to federal data.

Meanwhile, many of those unvaccinated children are now attending in-person schools, which in many places dont require masks.

Schools in metro Atlanta reported nearly 4,000 infections since the start of fall semester as of Friday, and at least 19 Georgia school districts have temporarily shut down, shifted to online learning or moved to a hybrid of in-person and digital instruction within days of starting the school year.

The exterior of Discovery High School in Lawrenceville, which hosted a vaccination event on Wednesday, August 18, 2021. (Alyssa Pointer/Atlanta Journal Constitution)

Credit: Alyssa Pointer

Credit: Alyssa Pointer

Sarah McCool, a clinical associate professor at the Georgia State University School of Public Health, said her biggest concern among schools is the threat of continued transmission.

We already have high community transmission in the Atlanta area, and it is just going to exacerbate transmission, she said. You are still rolling the dice.

Dr. Hugo Scornik, a Conyers pediatrician who leads the Georgia chapter of the American Academy of Pediatrics, said schools need to encourage vaccination of teachers, staff and all eligible children and have proper procedures in place for quarantining students who may have been exposed to COVID-19.

All kids need to wear a mask in school, and schools need to have procedures to enforce mask use and social distancing amongst the kids, he said.

Thacker, the Savannah physician, sees the next two weeks as particularly crucial for the states pediatric health system. Modeling suggests rising case numbers are likely, but Thacker said hes encouraged by a recent uptick in vaccination rates.

I hope that our communities are hearing that message around vaccination, he said. I think theres a chance for us not to be in the boat that we see other states in.

Staff writers J. Scott Trubey, Helena Oliviero and Ariel Hart contributed to this article.

The rest is here:

Ga. hospitals stretched with influx of kids battling COVID-19, other viruses - Atlanta Journal Constitution

This is an updated version of an article first published on Nov. 13, 2020.

The Delta-variant-driven wave of coronavirus infections is driving a new surge in testing and that could mean more surprise medical bills.

Congress wrote rules last spring to make most coronavirus testing free for all Americans. But patients, with or without insurance, have found holes in those coverage programs.

Federal law does not, for example, require insurers to cover the routine testing that a growing number of workplaces and schools are mandating. Some doctors and hospitals have tacked unexpected fees onto coronavirus testing bills, leaving patients with surprise charges ranging from a few dollars to over $1,000.

In the past year, Ive collected patients bills related to coronavirus. As part of that project, Ive read through more than 100 patient stories about coronavirus tests. Many patients are happy to report no charge at all, while others have been billed large unexpected fees or denied claims related to coronavirus tests.

[Have a bill you want to share? Submit it here.]

The surprise bills have hit uninsured Americans as well as those with robust coverage. The health data firm Castlight estimates that 2.4 percent of coronavirus test bills leave some share of the charge to consumers, which means there could be millions of patients facing fees they did not expect.

These are some simple steps you can take to lower your chances of becoming one of them.

Many states, counties and cities/towns now have public testing facilities. Very few patients have reported surprise medical bills from those testing sites (although its not impossible). You can typically use your state health department website to find public testing options.

If a public test site isnt an option where you live, you might consider your primary care doctor or a federally qualified health clinic. The largest surprise coronavirus test bills Ive reviewed tend to come from patients who are tested in hospitals and free-standing emergency rooms. Those places often bill patients for something called a facility fee, which is the charge for stepping into the room and seeking service.

Patients are finding that these fees can pop up even when they dont actually set foot in the facility. Multiple patients at one Texas emergency room had $1,684 facility fees tacked onto their drive-through coronavirus tests. A patient in New York faced a $1,394 charge for her test at a tent outside a hospital. The majority of the bill was the facility fee. The investigative news site ProPublica has reported on how facility fees can sometimes cost as much as 10 times the coronavirus test itself.

If you get your test at a primary care provider, or at a public test site, you shouldnt have to worry about that type of billing. They typically do not charge facility fees for coronavirus tests or any other types of care.

When patients receive a surprise medical bill related to a coronavirus test, often the charges they face are not for the test itself, but for other services that the patient may not have known about.

Some of these make sense: Many bills for coronavirus tests have fees for the doctor visit that went along with it. Others make less sense, like the bills that include screenings for sexually transmitted diseases. Those extra fees appear to be a bit more common in emergency rooms, or when health providers send their samples to outside laboratories. But they can happen at public testing sites, too: One Connecticut doctor regularly tested patients for dozens of illnesses at a town drive-through. The patients thought they were simply getting coronavirus tests.

To avoid those extra charges, ask your provider what diseases they will screen for. It can be as simple as saying: I understand Im having a coronavirus test. Are there any other services youll bill me for? Having a better understanding of that up front can save you a headache later, and you can make an informed decision about what care is actually needed. If your providers cant tell you what theyll bill for, that may be a signal you want to seek care elsewhere.

Uninsured patients have faced coronavirus bills upward of $1,000, according to billing documents reviewed by The New York Times.

That type of billing is legal: Health care providers are not required to provide free coronavirus tests to Americans who lack health insurance. But they do not necessarily have to bill patients directly. The federal government has set up a provider relief fund: Health providers can seek reimbursement for coronavirus testing and treatment provided to those without coverage. Once again, it pays to ask ahead of time how providers handle uninsured patients and whether they submit to the fund. Unfortunately, they are not required to do so and could continue to pursue the debt.

You should also be aware that 17 states have authorized their state Medicaid plans to cover coronavirus test costs for uninsured Americans. This means your state government can pay the bill instead of you. You can find out if you live in one of these states here.

New federal laws regulate how health providers and insurers can bill patients for coronavirus tests. Understanding how they work can help you push back on charges that may not be allowed.

The new laws state that health insurers must cover coronavirus tests ordered by a doctor without any cost to the patients. This means that standard deductibles and co-payments youd face for other services do not apply.

There is one important exception in those laws: Insurers do not have to cover routine coronavirus testing ordered by a school or workplace. If your job mandates that you get tested each week, for example, it is up to your health plan whether it wants to pay those bills.

For that type of testing, youll want to be especially careful about where you get tested, and ask more questions about the fees you may have to pay. Some employers are already directing their workers to be tested at public sites, in part to reduce the possibility of surprise charges.

For the coronavirus tests that insurers do have to cover, there is still a bit of a gray area. The law requires insurers to cover any other services that are necessary to get the coronavirus test, but doesnt define what makes the cut. Most experts agree that a doctor visit fee is a pretty clear example of a service that ought to qualify, and that patients facing those types of bills ought to appeal to their insurer for coverage. Other services, like a flu test or even an X-ray conducted alongside a coronavirus test, present a murkier situation. If youre facing fees like those, you might want to enlist your doctor to tell the insurer why the additional care was needed.

One last thing to know about the federal laws is that they require insurers to fully cover out-of-network coronavirus tests. This can be especially important for patients who go to an in-network doctor but unknowingly have their sample sent to an out-of-network laboratory, a situation Ive seen many times. Your health plans typical rules for out-of-network care should not apply to the coronavirus test. They can, however, be applied to other parts of the test experience (the doctor visit fee, for example), so it is safer to stick with in-network providers whenever possible.

One other issue to look for is what billing codes your doctor used for the test visit. Many of the surprise bills Ive reviewed involve doctors who charge a visit fee, then send the test to an outside laboratory that submits its own claim. The health plan might apply a co-pay to the doctors visit because its not clearly linked in billing records to the coronavirus test. In this case, you may need to work with your health provider to get your visit recoded to show a coronavirus test occurred.

Nearly everything I know about coronavirus test billing comes from reading the bills that hundreds of Times readers have sent describing their experiences. If you receive a bill related to coronavirus testing and treatment, we ask that you take a moment to submit it here. It will help me continue to report on the types of fees patients face, and can help identify areas of the country where patients are facing unusually high fees.

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Will You Have to Pay for a Coronavirus Test? Here's How to Avoid a Surprise Bill - The New York Times

JERUSALEM Last spring, Israels remarkably swift vaccination campaign was seen as a global model. Coronavirus infections plummeted, an electronic pass allowed the vaccinated to attend indoor concerts and sporting events, and distancing rules and mask mandates were eventually scrapped.

Israel offered the world a hopeful glimpse of the way out of the pandemic.

No longer.

A fourth wave of infections is rapidly approaching the levels of Israels worst days of the pandemic last winter. The daily rate of confirmed new virus cases has more than doubled in the last two weeks, making Israel a rising hot spot on the international charts.

Restrictions on gatherings and commercial and entertainment venues were reinstated this week, and the government is considering a new lockdown.

I believe we are at war, Israels coronavirus commissioner, Prof. Salman Zarka, told a parliamentary committee on Wednesday.

Scientists are still assessing how Israels pandemic response plunged from shining example to cautionary tale, and the stunning reversal has provided a crucial test for Israels new prime minister, Naftali Bennett, who staked a claim for leadership partly on the strength of his manifesto, How to Beat a Pandemic.

But some experts fear that Israels high rate of infections among early vaccine recipients may indicate a waning of the vaccines protections over time, a finding that contributed to a U.S. decision Wednesday to begin offering booster shots to Americans starting next month.

The vaccine may be less effective at preventing infection with the highly contagious Delta variant, now the primary version of the virus in Israel. And the first cohort to be vaccinated was an older group whose immune systems may have been weaker to begin with.

By June, Israelis, convinced the worst was over, had abandoned social distancing and other precautions.

Everyone went about the business of trying to put the memory of a very difficult year and a half behind them, said Prof. Ran Balicer, chairman of an expert panel that advises the Israeli government on Covid response.

At that point in time, he said, the paradigm for many was that Israel is the most vaccinated country in the world, that vaccinated people rarely become infected, that even more rarely do they become severely ill and that basically, with very few precautions in place, the population was very close to herd immunity, all things considered. That was not a mistake.

The problem, he said, was that what was true for the original virus did not necessarily hold true for future variants coupled with waning immunity.

The vast majority of Israels older population had received two doses of the Pfizer-BioNTech vaccine by the end of February, and by now about 78 percent of the population 12 and older are fully vaccinated.

The vaccine is still believed to help prevent severe illness in those who do become infected, though some Israeli data suggests the possibility of an increased risk of severe disease among those who received early vaccinations. The number of deaths in Israel has climbed in the past month as the infection rate increased.

Seeing infection levels dropping in the spring, and determined to reboot the economy, Israel retired its electronic pass system, eased travel bans and lifted all other restrictions. The last to go was the indoor mask mandate on June 15.

Days earlier, however, a family had returned from a Greek vacation to the central city of Modiin, a middle class commuter hub between Tel Aviv and Jerusalem. More than 90 percent of its residents 12 and over are vaccinated, according to its mayor, Haim Bibas, making it one of Israels most vaccinated cities.

But the family included a child too young to be vaccinated, and who should have spent at least 10 days in home quarantine pending a negative PCR test, according to the regulations at the time.

Aug. 19, 2021, 5:19 a.m. ET

Instead, the parents sent the child to school. Ultimately, about 80 students were infected with the Delta variant.

The child wasnt to blame, Mr. Bibas said, indirectly pointing a finger at the parents.

A second outbreak occurred almost simultaneously in similar circumstances in a school in the north.

The Delta variant has since taken over in Israel, and now mainly comes from within the country.

Professor Balicer had warned in May that despite the early success, Israels pandemic was not over. There was the continuous risk of variants that could be more impervious to the vaccine. Out of a population of nine million, about a million eligible Israelis have so far opted not to get vaccinated at all. And among the fully inoculated, Israeli scientists have found growing evidence of waning immunity, particularly among the older population who were vaccinated first.

Data published by Israels Ministry of Health in late July suggested that the Pfizer shot was just 39 percent effective against preventing infection in the country in late June and early July, compared with 95 percent from January to early April. In both periods, however, the shot was more than 90 percent effective in preventing severe disease.

Experts warn that these early assessments have not been scientifically proven: The small numbers of cases involved, Israels testing policies and a host of other biases could have skewed the results.

Still, as summer approached, infections began to spiral. School was out, families crowded local hotels and up to 40,000 people a day were flying abroad, even as the Delta variant was rampaging across the globe. After many days of zero Covid deaths in June, at least 230 Israelis have died so far this month.

Unlike previous epicenters of infection in Israels crowded, less-vaccinated ultra-Orthodox communities, this scourge primarily took hold in well-vaccinated, middle-class suburbs.

Understandthe State of Vaccine and Mask Mandates in the U.S.

Some experts have accused the new government of having been slow to respond.

The resurgence of the contagion coincided with the swearing in of Mr. Bennetts government in mid-June. After three Israeli lockdowns, Mr. Bennett came in with a new approach, determining that the country had to live with the virus and keep business operating at full capacity. He called the policy soft suppression.

An indoor mask mandate was reinstated on June 25, but compliance was lax. Alarmed medical experts began to urge stricter measures, including curbs on all gatherings. The government advisory panel called twice in July and again on Aug. 1 for the immediate reinstatement of the electronic Green Pass system.

It was only in the last two weeks that a sense of urgency returned, said Prof. Nadav Davidovitch, a public health expert and a member of the advisory panel. What we are doing now, we needed to do in July.

But after the premature euphoria of the spring, virus fatigue has made returning to strict antivirus protocols difficult.

Its a matter of discipline, said Prof. Galia Rahav, the head of the Infectious Disease Unit and Laboratories at the Sheba Medical Center near Tel Aviv. People are sick of masks. They want to live.

Officials worry that many Israelis are still oblivious to the rising danger.

The Israeli public has not yet absorbed that we are in a fourth, significant wave, said Tomer Lotan, director general of the Ministry of Public Security, which is responsible for enforcement. We are still in routine mode, with the feeling that we are vaccinated. Its hard to make the switch in public discourse and say, Listen, we are in a catastrophe.

Israel is now pinning its hopes on booster shots. Beginning with those 60 and older, and quickly expanding the drive to those 50 and above, more than a million citizens have already received a third dose this month. Israeli researchers say there are preliminary signs that new infections among older vaccinated people may have begun to drop.

A preliminary study released Wednesday by Maccabi, an Israeli health-care provider, found that a booster shot of the Pfizer vaccine provided 86 percent effectiveness against infection in people aged over 60, a week or more after receiving the third dose.

A global debate is raging over boosters. The Biden administration announced Wednesday that Americans who received the Pfizer-BioNTech and Moderna vaccines would be able to obtain booster shots eight months after receiving their second doses.

But the World Health Organization contends that available vaccines would be better used to inoculate high-risk people in poor nations where few have gotten the shots and where new variants could emerge.

Most Palestinians in the West Bank and Gaza remain unvaccinated after Palestinian officials rejected a vaccine-exchange deal with Israel in June.

Professor Davidovitch, the Israeli public health expert, got a third shot. But he is now convinced of the necessity of a multilayered strategy, including mask wearing, limiting access to public venues to the vaccinated or those who have recovered from the virus, and measures to strengthen the health care system.

The vaccinations were supposed to solve everything, he said. We now understand that the vaccines are not enough.

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Israel, Once the Model for Beating Covid, Faces New Surge of Infections - The New York Times

Minnesota recorded more than 3,000 new coronavirus cases Tuesday from over 57,000 tests, the most cases and test results reported in a single day since April.

The Minnesota Department of Health no longer reports coronavirus numbers on weekends so Tuesdays statistics are actually from more than one day from Saturday through 4 a.m. Monday. Nevertheless, the 3,054 cases reported Tuesday was an increase of 45 percent over a week ago using the same reporting structure.

The more contagious delta variant is the cause of nearly all new infections in Minnesota. More than 99 percent of new cases, hospitalizations and deaths are residents who are not fully vaccinated.

The U.S. Centers for Disease Control and Prevention says community transmission of the coronavirus is widespread enough that masks are recommended in 80 of the states 87 counties. Seven are in the moderate transmission category and there are none where spread is considered low.

Meanwhile, the test-positivity rate in the state has again exceeded the 5 percent caution threshold.

Masks are important, but health officials maintain that vaccination is the best way to avoid contracting and spreading the coronavirus. Breakthrough infections are rare and much less likely to be severe.

Jan Malcolm, the state health commissioner, said this years summer surge is shaping up to be worse than a year ago, before there were vaccines to protect against the coronavirus.

Even more striking, compared to last year at this time our case rates are 54 percent higher than they were, Malcolm said.

Three more COVID-19 deaths were also reported Thursday. They ranged in age from their 50s to their 70s and all resided in Hennepin County with two in private homes and one in a behavioral health facility.

There have been 7,737 COVID-19 fatalities, including 4,533 deaths in long-term care. About 88 percent of deaths have been seniors.

Hospitalizations continue to rise, with 434 patients requiring care and 115 in critical condition. Fewer than 3 percent of Twin Cities hospital beds are currently available, according to state data.

Since the pandemic began, more than 11 million samples from 4.8 million residents have been screened for the coronavirus. There have been 629,354 infections diagnosed, and of those who tested positive 612,681 have recovered enough they no longer need to be isolated.

There are an estimated 8,500 people with active cases who are recovering at home, roughly double the number just two weeks ago.

Minnesota has administered more than 6 million doses of vaccine and 3.2 million have gotten at least one dose. There are 3 million Minnesotans whove completed their vaccination series.

Vaccinations have climbed considerably in recent weeks, thanks to a combination of concern over the delta variant and a $100 reward being paid by the state to the newly vaccinated. New vaccinations of 12- to 17-year-olds since have increased by about 20,000 doses since a back-to-school vaccination push began earlier this month.

Roughly 70 percent of residents 16 and older have gotten at least one shot.

For more information about vaccines visit:VaccineConnector.mn.gov. Apply for the $100 vaccine reward at mn.gov/covid19/100.

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3K COVID-19 cases reported in Minnesota, highest level since April. See a map of where transmission is high. - TwinCities.com-Pioneer Press

(RiverStone Health news release)

Billings A Yellowstone County woman in her 40s died on Tuesday at a Billings hospital from COVID-19 related illness. She had not been vaccinated and had no underlying health conditions, according to information received by RiverStone Health.

The pandemic is taking the lives of adults of all ages parents, spouses, siblings, grandparents, aunts and uncles, said John Felton, Yellowstone County health officer and RiverStone Health president and CEO. The tragic death Tuesday marks the third time so far in 2021 that a Yellowstone County resident younger than 50 died of COVID-19 illness. None of those three victims was vaccinated against this deadly virus.

More than four of every five recent COVID-19 patients in Billings hospitals had not gotten vaccinated before they got sick. On Wednesday, Billings Clinic and St. Vincent Healthcare together had 56 COVID-19 patients hospitalized, including 17 in ICU and 12 on ventilators.

COVID-19 cases are increasing. In Yellowstone County, 703 new cases have been reported in the first 17 days of August, compared with 451 new cases in the entire month of July.

Severe illness and death from COVID-19 is highly preventable through vaccination. RiverStone Health will offer these free, walk-in vaccination clinics this month:

Friday, Aug. 20, 11 a.m. 1 p.m., RiverStone Health, Lil Anderson Center, 123 S. 27th St., (four-story building), Pfizer and Johnson & Johnson vaccines will be offered. Aug, 30, 11 a.m. 1 p.m., Rocky Mountain College, in the Bair Family Student Center, with Pfizer and J&J. RiverStone Health Immunization Clinic, 123 S. 27th, in the Lil Anderson Center, is offering appointments for all students back-to-school vaccinations, including the Pfizer COVID-19 vaccine. Vaccinations will be available 8 a.m. to 4:30 p.m. today through Friday, Aug. 20. Call 247-3382 for an appointment. COVID-19 vaccinations and childhood immunizations will still be available after this week, but hours for appointments will be reduced.

More vaccination information is posted at covid.riverstonehealth.org.

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Yellowstone County woman in her 40s dies of COVID-19 illness - KTVQ Billings News

Chimpanzee attempts keeper's COVID-19 protocol by putting on face mask

A chimpanzee in Chongqing, China copied his keeper's COVID-19 routine. Correction: This video previously reported the incorrect species. The animal is a chimpanzee.

Associated Press, USA TODAY

A study by the U.S. Department of Agriculture has found that white-tail deer, the kind some people will see in their backyards, are being exposed to SARS-CoV-2, the virus that causes COVID-19.

The study, not yet peer-reviewed, showed that 40% of deer tested across four states in 2021 were positive for antibodies, meaning they had been exposed to the virus at some point. The positive tests do not necessarily indicate deer had active infections.

The findings raise questions about whether deer are transmitting the virus among themselves and how their interactions with humans could affect spread.

"At the moment, theres no immediate cause for concern but justification for precaution. Just as we socially distance from people who could be infected, we also have to think about socially distancing from some animals who could potentially be infected," Peter Rabinowitz, a physician who specializes in zoonotic diseases and co-directs the University of Washington Alliance for Pandemic Preparedness, told USA TODAY on Wednesday.

"This definitely justifies continued surveillance, so we need to look at more deer populations in more places... how did the deer get infected, how much are they actually shedding virus and infecting other deer, and posing risk to humans?" he said.

The deer were studied in Illinois, Michigan, New York and Pennsylvania. The USDA's Animal and Plant Health Inspection Service tested 481 deer between January 2020 and March 2021, and found 33% were positive for SARS-CoV-2 antibodies. The percentage was highest in Michigan, with 67% of 113 samples testing positive, and lowest in Illinois where 7% of 101 samples were positive.

Biden administration: COVID-19 booster shot for Pfizer, Moderna vaccines will be available Sept. 20

Looking at just the samples tested between January and March this year, 40% of 152 samples tested positive. The agency said the tests on white-tail deer in the four states cannot be extrapolated to U.S. deer populations as a whole, and that none of the deer in the study showed clinical symptoms of the virus.

The USDA said the study came to no conclusions on how the deer were becoming exposed. "Its possible they were exposed through people, the environment, other deer, or another animal species," the USDA said.

But one important factor is that over time, deer have had more contact with humans, Rabinowitz said. Because of where people are living, deer have been coming closer to houses and coming in contact with the foliage near dwellings.

There have been previous known transmissions between humans and animals, including with animals in zoos and farmed mink, among which population the virus spread and mutated, then reinfected humans in some cases.

Researchers already knew white-tailed deer were capable of infection because they have similar receptors as found in humans, Rabinowitz said, so it's not a surprise that deer would show exposure in the wild.

What's concerning, he said, is the potential for the virus to inhabit an "animal reservoir," where the virus spreads and mutates among a new host, in this case, deer, and not cause illness in the host but could reinfect recovering human populations and cause illness.

"Widespread human infections with SARS-CoV-2 combined with human-wildlife interactions create the potential for spillover between people and animals," the USDA said.

There are about 30 million white-tail deer around the continental U.S., found in most states.

People who interact with deer through activities such as hunting and and harvesting game meat should not be worried about getting COVID-19 from those activities, the USDA said, but they should take basic hygiene precautions when processing animals.

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Thomas DeLiberto, assistant director at the USDA National Wildlife Research Center, told the Detroit Free Press that the risk to humans from deer is considered quite low.

"This is a human-adapted pathogen. In its current form, it likes to be in people and the greatest risk to people is transmission from other infected people," DeLiberto said.

Rabinowitz, who also directs the University of Washington Center for One Health Research, said the study demonstrates the importance of studying the relationships between humans, animals and the environment when it comes to viruses like the coronavirus.

"We have to realize that these zoonotic pathogensare moving between humans and animals and the environment. We have to understand those connections better so we canprevent worse outbreaks," he said.

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Deer in 4 states have been exposed to the coronavirus, USDA study shows. What does that mean for humans? - USA TODAY

STATEN ISLAND, N.Y. Staten Island families are preparing for the return to school as the coronavirus (COVID-19) delta variant continues to spread, raising the question: Does my child have to quarantine if exposed to the virus?

That answer varies, depending on the situation, according to the Centers for Disease Control and Preventions (CDC) newest guidelines.

The New York State Education Department (NYSED) developed its reopening guidance based on the CDC guidelines and reopening guidance from the American Academy of Pediatrics (AAP).

According to the CDC, students and teachers who are unvaccinated should quarantine if they have been within six feet of someone who has COVID-19 for a cumulative total of 15 minutes or more over a 24-hour period.

However, those who are fully vaccinated do not need to quarantine after contact with someone who has COVID-19 unless they have symptoms, the CDC says. But they should get tested.

Even if they dont have symptoms, they should get tested and continue to wear a mask indoors in public for 14 days following exposure or until they test negative, the CDC says.

If a vaccinated student has been in a classroom, at least three feet from the infected student, and both students were wearing masks the whole time, the exposed student does not have to quarantine, the CDC says.

But if an unvaccinated student was less than three feet apart in a classroom, less than six feet apart elsewhere in school, or either student was unmasked, quarantining is necessary the CDC says.

The CDC suggests 14, 10 or seven calendar days as acceptable quarantines.

Adults may return after seven days if they have tested negative, the CDC says.

Anyone with COVID should isolate at home and not come to school at all, the CDC says. An infected individual should return to school after 10 days have passed since their first symptoms and they have gone 24 hours without a fever.

What to do if you must quarantine:

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When do students, teachers need to quarantine amid coronavirus delta variant? Heres what the CDC says. - SILive.com

Monoclonal antibodies such as those made by Regeneron and GlaxoSmithKline won't work for every Covid-19 patient; mAbs, as they are known, are only available for people age 12 and older and who aren't hospitalized or severely ill.

Regeneron's therapy can also be used for some people who know they were exposed to the virus, but don't yet have a positive test. That protection doesn't last long, though, and it's not a replacement for the vaccine.

"These monoclonal antibodies, Regeneron and others, have proven to radically reduce the chance that somebody ends up being hospitalized and at the end of the day, reducing hospital admissions is got to be a top priority and if you reduce those admissions, people don't go to the hospital to begin with, you know they're going to recover and so that's a really important thing," said DeSantis, a Republican.

The treatments are effective at reducing severe disease; however, some scientists have been critical of the push for these treatments over other, easier prevention methods.

"We know what works to prevent people from contracting this disease in the first place, masking and vaccination. We should be focusing on these preventive measures," said Dr. Leana Wen, an emergency physician and visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health. "It's totally backwards to say that we should be focused on treatment instead of emphasizing prevention, and the steps that we know work to stop Covid-19 in the first place."

Here's what you should know about monoclonal antibodies for Covid-19.

What is a monoclonal antibody?

Monoclonal antibodies are lab-made proteins, that can mimic the immune system's ability to fight off threats like the coronavirus.

When a patient is infected it takes a little while for their body to produce antibodies that can help them fight the infection. These treatments, also known as mAbs, can speed up the body's ability to fight infection.

Two mAbs made specifically to fight the coronavirus are in use in the United States right now.

Can they prevent Covid-19?

It can be given to someone who has been exposed to an infectious person, or it can be given to someone who is at a high risk of exposure, like people who live in a nursing home that has had a recent case.

As prevention, the mAbs are meant to be used in patients who are not fully vaccinated, or in people who are not expected to mount an adequate immune response to a vaccine -- like people who have had an organ transplant and are immunocompromised.

Who can get monoclonal antibody treatments for Covid-19?

The treatments for people infected with Covid-19 are for non-hospitalized adults and pediatric patients 12 years of age and older who have a risk of getting severe Covid-19.

How does someone access the treatment?

The drugs don't come in a simple pill, so they wouldn't typically be available at the average doctor's office, but a doctor can prescribe them.

The mAbs have to be given by an infusion or, if getting an infusion would cause a delay in treatment, the Regeneron treatment can also be given by four subcutaneous injections.

The infusion itself can take about an hour and then patients need to wait for an observation period to make sure there are no side effects.

How effective are the treatments?

In March, Regeneron announced patients who got its treatment within 10 days had a 70% reduced risk of hospitalization and death.

Are there side effects?

How much do the treatments cost?

Are the treatments hard to get?

For months, the government has tried to promote the use of mAbs, yet the US Department of Health and Human Services said as of August 6, the latest date it has figures for,that only about half of the distributed supply has been used.

"At this time, there is plenty of product available for existing and new sites," a spokesperson for HHS told CNN last week.

As coronavirus cases have surged recently, the US has seen a 1,200% increase in orders for monoclonal antibody treatments in the past month, according to HHS. About 75% of the orders are coming from regions of the US that have low vaccination rates.

HHS also said it has seen a recent increase in the number of doctors using the treatments. Earlier in the year, the federal government had sent thousands of doses to states, but many sat on the shelf due to the complicated logistics of administering the treatments.

During the pandemic, health officials have acknowledged that doctors don't always know as much about these treatments, and patients have had to push to get them, or drive long distances to find a center that will administer them.

What's the difference between mAbs and a vaccine?

The protection from an antibody treatments doesn't last as long as a vaccine though. Typically the treatment would only provide protection for about a month.

A vaccine takes a couple of weeks for the immune system to start providing protection, but monoclonal antibodies work right away.

If there's treatment for Covid-19, why do we need vaccines or other prevention methods?

The treatments aren't a cure, and they aren't an option for every Covid-19 patient.

"The antibodies are an important complement to treatment options, but it is not the path out of this pandemic," Wen says. "There's only a small subset of patients who would qualify for monoclonal antibody treatment. Also, it is resource intensive, time intensive to administer.

"The way out of this pandemic is through vaccination and preventive measures to stop you from getting Covid in the first place."

Originally posted here:

Covid-19 antibody treatments work, but they're 'not the path out of this pandemic' - CNN