Saving Lives: Study Finds That Paxlovid Reduces Risk of COVID-19 Hospitalization and Death by 90% SciTechDaily
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CNN
When the US Covid-19 public health emergency ends this month, coronavirus tests will still be available, but there will be changes to who pays for them.
Questions remain about exactly what those coverage changes will look like, but the guarantee of free testing will be lost for many and some costs may shift to become out-of-pocket.
There are still ways to take advantage of the benefits provided by the public health emergency before it expires May 11.
For the past two years, the federal government has required private insurance companies to cover up to eight Covid-19 tests each month. Packs of home tests can be found at pharmacies and other local retailers, and costs may be covered upfront or reimbursed by insurance plans.
The Biden administration launched COVIDtests.gov in January 2022 to allow US households to order free Covid-19 test kits to be delivered to home. The site is still up and running, with four free tests available to any household that hasnt ordered since December.
Also, the US Food and Drug Administration has extended the expiration date for many home tests beyond what is printed on the box. Check the agencys website before throwing them out.
People should go out and ensure that they have tests available, because what we know about Covid is its quite pernicious, and clearly, people can get it more than once, said Mara Aspinall, a professor at Arizona State Universitys College of Health Solutions and a testing and diagnostics expert.
Its critical that people have the ability to test and then isolate or stay at home if they test positive.
Once the public health emergency ends, Covid-19 tests both home tests and laboratory tests will be subject to cost sharing, in which costs of services are divided between the patient and their insurance plan.
Private insurers will no longer be required to cover the costs of testing. The federal government has encouraged continued coverage, but each company will ultimately be able to make their own decision. So far, details on those plans are scarce.
The Blue Cross Blue Shield Association told CNN that its evaluating the best way to keep members informed of changes. Moving into the next phase, coverage may include reasonable limits on tests.
As COVID-19 becomes endemic, each Blue Cross and Blue Shield company is looking at how best to support access to diagnostic testing for COVID-19, just as is done for all other diagnostic testing, said David Merritt, senior vice president of policy and advocacy for the Blue Cross Blue Shield Association. We are committed to protecting patients from unnecessary costs, while ensuring they receive the care they need, when they need it.
Aetna told CNN that it did not have any details to share. Cigna, Humana and UnitedHealthcare did not respond to multiple requests for comment.
Medicare Part B beneficiaries will continue to have coverage for lab tests when ordered by a provider, but the same will not apply for home tests.
For those on Medicaid plans, all tests will continue to be covered for free until the end of September 2024.
The US Centers for Disease Control and Prevention will also continue to support uninsured individuals and socially vulnerable communities pending resource availability, according to a roadmap outlined by the US Department of Health and Human Services.
There may be other avenues to free or cheap testing, too perhaps through state and local governments or other programs.
Recently, for example, the North Carolina Department of Health and Human Services announced the expansion of a program that now allows all state residents to order free tests through June.
The Rockefeller Foundation, a private philanthropic organization, has also extended a public-private partnership program that works with states to get free tests to at-risk communities.
The testing phenomenon during Covid changed many times, Aspinall said.
It was a core focus at the beginning, but the priority then shifted to vaccines, she said. The initial Omicron wave brought a renewed interest in testing, and long waits for lab-based tests drove people to home tests.
It put power and privacy in an individual consumers hand, Aspinall said.
Millions of households took advantage of free Covid-19 tests provided by the federal government in the months after it launched, and a recent CDC report shows that the program helped to get kits to many who otherwise wouldnt have tested and improved equity in testing overall.
About 60% of US households ordered a test kit from COVIDTests.gov, and nearly a third of all US households reported using at least one of those tests by April or May last year.
Nearly a quarter of people who reported using the government-provided tests said that they probably would not have tested for Covid-19 if not for the free kits, according to the report suggesting that more than 13 million people took a Covid-19 test who otherwise wouldnt have. More than 1 in 5 people who used their free tests reported at least one positive result.
Overall, use of the free test kits was similar across racial and ethnic groups. This is a considerable difference from other home test kits, where use was highly inequitable, according to the report. Black people were more likely than White people to use tests provided through COVIDTests.gov but 72% less likely than White people to use other at-home test kits.
Now, however, Covid-19 cases are a third of what they were a year ago, and hospitalizations and deaths are about as low as theyve ever been. Testing rates have dropped significantly, too.
Along with the decreased transmission, the volume of testing may have dropped as people better understand what the course of an infection looks like, Aspinall said.
She estimates that people may use an average of one or two tests per incident, down from an average of five or six.
While Covid-19 remains a public health priority, the federal government says we are in a better place in our response than we were three years ago, and we can transition away from the emergency phase.
Still, experts agree that continued monitoring is key. Advancements in technologies like wastewater surveillance have helped supplement dwindling testing data, but testing will continue to be an important tool for individuals to keep themselves and their loved ones safe and healthy.
The public health emergency may be over but Covid is not over, Aspinall said.
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Free Covid-19 tests aren't guaranteed after May 11, but there's still ...
COVID-19 cases in the United States()DeathsRecoveriesActive cases
Date
# of cases
# of deaths
Sources: Official reports from state health officials
In November 2019, COVID-19 infections had first broken out in Wuhan, China.[45][46] China publicly reported the cluster on December 31, 2019.[3] After China confirmed that the cluster of infections was caused by a novel infectious coronavirus[3] on January 7, 2020, the CDC issued an official health advisory the following day.[47] On January 20, the World Health Organization (WHO) and China both confirmed that human-to-human transmission had occurred.[48] The CDC immediately activated its Emergency operations center (EOC) to respond to the outbreak in China.[49] Also, the first report of a COVID-19 case in the U.S. was publicly reported,[3] though the All of Us study (released in 2021) showed five states already had cases weeks earlier.[50] After other cases were reported, on January 30, the WHO declared a Public Health Emergency of International Concern (PHEIC) its highest level of alarm[51] warning that "all countries should be prepared for containment."[52][53][d] The same day, the CDC confirmed the first person-to-person case in the U.S.[55] The next day, the country declared a public health emergency.[56] Although by that date there were only seven known cases in the U.S., the HHS and CDC reported that there was a likelihood of further cases appearing in the country.[56]
The Trump administration evacuated American nationals from Wuhan in January.[57] On February 2, the U.S. enacted travel restrictions to and from China.[18] On February 6, the earliest confirmed American death with COVID-19 (that of a 57-year-old woman) occurred in Santa Clara County, California. The CDC did not report its confirmation until April 21,[58] by which point nine other COVID-19 deaths had occurred in Santa Clara County.[59] The virus had been circulating undetected at least since early January and possibly as early as November.[60] On February 25, the CDC warned the American public for the first time to prepare for a local outbreak.[61][62] The next day, New York City saw the sickening of its "patient zero", Manhattan attorney Lawrence Garbuz, then thought to be the first community-acquired case.[63][64][65] Another case known as "patient zero" in Los Angeles is a man named Gregg Garfield, who spent 64 days in the Burbank Hospital, on a ventilator for 30 days, with a 1% chance to live. Contracting the virus from a ski trip, Garfield was able to return to the slopes, although with fingers and toes amputated.[66] In February, Vice President Mike Pence took over for Secretary Alex Azar as chair of the White House Coronavirus Task Force.[67]
By March 11, the virus had spread to 110 countries, and the WHO officially declared a pandemic.[32] The CDC had already warned that large numbers of people needing hospital care could overload the healthcare system, which would lead to otherwise preventable deaths.[68][69] Dr. Anthony Fauci said the mortality from COVID-19 was ten times higher than the common flu.[70] By March 12, diagnosed cases of COVID-19 in the U.S. exceeded a thousand.[71] On March 16, the White House advised against any gatherings of more than ten people.[72] Three days later, the United States Department of State advised U.S. citizens to avoid all international travel.[73]
By the middle of March, all fifty states were able to perform tests with a doctor's approval, either from the CDC or from commercial labs. However, the number of available test kits remained limited.[74] As cases began spreading throughout the nation, federal and state agencies began taking urgent steps to prepare for a surge of hospital patients. Among the actions was establishing additional places for patients in case hospitals became overwhelmed.[75]
Throughout March and early April, several state, city, and county governments imposed "stay at home" quarantines on their populations to stem the spread of the virus.[76] By March 26, New York Times data showed the United States to have the highest number of known cases of any country.[77] By March 27, the country had reported over 100,000 cases.[78] On April 2, at President Trump's direction, the Centers for Medicare & Medicaid Services (CMS) and CDC ordered additional preventive guidelines to the long-term care facility industry.[79] On April 11, the U.S. death toll became the highest in the world when the number of deaths reached 20,000, surpassing that of Italy.[80] On April 19, the CMS added new regulations requiring nursing homes to inform residents, their families and representatives, of COVID-19 cases in their facilities.[81] On April 28, the total number of confirmed cases across the country surpassed 1million.[82]
By May 27, less than four months after the pandemic reached the U.S., 100,000 Americans had died with COVID-19.[83] State economic reopenings and lack of widespread mask orders resulted in a sharp rise in cases across most of the continental U.S. outside of the Northeast.[84] A study conducted in May 2020 indicated that the true number of COVID-19 cases in the United States was much higher than the number of confirmed cases with some locations having 624 times higher infections, which was further confirmed by a later population-wide serosurvey.[85][86][87]
On July 6, the United States Department of State announced the country's withdrawal from WHO effective July 6, 2021.[88] On July 10, the CDC adopted the Infection Fatality Ratio (IFR), "the number of individuals who die of the disease among all infected individuals (symptomatic and asymptomatic)", as a new metric for disease severity.[89] In July, US PIRG and 150 health professionals sent a letter asking the federal government to "shut it down now, and start over".[90] In July and early August, requests multiplied, with a number of experts asking for lockdowns of "six to eight weeks"[91] that they believed would restore the country by October 1, in time to reopen schools and have an in-person election.[92]
In August, over 400,000 people attended the 80th Sturgis Motorcycle Rally in Sturgis, South Dakota, and from there, at least 300 people in more than 20 states were infected.[93] The CDC followed up with a report on the associated 51 confirmed primary event-associated cases, 21 secondary cases, and five tertiary cases in the neighboring state of Minnesota, where one attendee died of COVID-19.[94] The U.S. passed five million COVID-19 cases by August 8.[95]
On September 22, the U.S. passed 200,000 deaths, according to data from Johns Hopkins University.[96] In early October, an unprecedented series of high-profile U.S. political figures and staffers announced they had tested positive for COVID-19.[97][98] On October 2, Trump announced on Twitter that both he and the First Lady had tested positive for COVID-19 and would immediately quarantine.[99][98] Trump was given an experimental Regeneron product with two monoclonal antibodies[100][e] and taken to Walter Reed National Military Medical Center,[102] where he was given remdesivir and dexamethasone.[103]
USA Today studied the aftermath of presidential election campaigning, recognizing that causation was impossible to determine. Among their findings, cases increased 35 percent compared to 14 percent for the state after a Trump rally in Beltrami County, Minnesota. One case was traced to a Joe Biden rally in Duluth, Minnesota.[104]
On November 9, President-elect Biden's transition team announced his COVID-19 Advisory Board.[105] On the same day, the total number of cases had surpassed ten million[106] while the total had risen by over a million in the ten days prior, averaging 102,300 new cases per day.[107] Pfizer also announced that its COVID-19 vaccine may be up to ninety percent effective.[108][109] In November, the Trump administration reached an agreement with a number of retail outlets, including pharmacies and supermarkets, to make the COVID-19 vaccine free once available.[110]
In spite of recommendations by the government not to travel, more than 2million people flew on airlines during the Thanksgiving period.[111] On December 8, the U.S. passed 15million cases, with about one out of every 22 Americans having tested positive since the pandemic began.[112] On December 14, the U.S. passed 300,000 deaths, representing an average of more than 961 deaths per day since the first known death on February 6. More than 50,000 deaths were reported in the past month, with an average of 2,403 daily deaths occurring in the past week.[113]
On December 24, following concerns over a probably more easily transmissible new SARS-CoV-2 variant from the United Kingdom, later called Alpha, the CDC announced testing requirements for American passengers traveling from the UK, to be administered within 72 hours, starting on December 28.[114][115] On December 29, the U.S. reported the first case of this variant in Colorado. The patient had no travel history, leading the CDC to say, "Given the small fraction of US infections that have been sequenced, the variant could already be in the United States without having been detected."[116]
On January 1, 2021, the U.S. passed 20million cases, representing an increase of more than a million over the past week and 10million in less than two months.[117][118] On January 6, the CDC announced that it had found at least 52 confirmed cases of the Alpha variant, and it also stressed that there could already be more cases in the country.[119] In the following days, more cases of the variant were reported in other states, leading former CDC director Tom Frieden to express his concerns that the U.S. will soon face "close to a worst-case scenario".[120] It was believed the variant had been present in the U.S. since October.[121]
On January 19, the U.S. passed 400,000 deaths, just five weeks after the country passed 300,000 deaths.[122] On January 22, the U.S. passed 25million cases, with one of every 13 Americans testing positive for COVID-19.[123] On January 29, a nationwide requirement for use of face masks on public transit and other forms of public transportation was issued by the CDC and the federal Transportation Security Administration, to go into effect on February 1.[124][125] (Subsequently, extended, the federal mask mandate for public transportation remains in effect in April 2022.)[125][126]
On February 22, the U.S. passed 500,000 deaths, just five weeks after the country passed 400,000 deaths.[127] By March 5, more than 2,750 cases of COVID-19 variants were detected in 47 states; Washington, D.C.; and Puerto Rico.[128] In the first prime time address of his presidency, on March 11, Biden announced his plan to push states to make vaccines available to all adults by May 1, with the aim of making small gatherings possible by July 4.[129] On March 24, the U.S. passed 30million cases, just as a number of states began to expand the eligibility age for COVID-19 vaccines.[130] Experts began warning against public relaxation of COVID-19 mitigation measures as vaccines continue to be administered, with CDC director Rochelle Walensky, warning of a new rise in cases.[131]
By April 7, the Alpha variant had become the dominant COVID-19 strain in the U.S.[132] On April 12, the U.S. reported its first cases of a new "double mutant" SARS-CoV-2 variant from India, later called Delta, in California.[133] By April 25, the country's seven-day average of new infections was reported to be decreasing, but concerns were raised about drops in vaccine demand in certain parts of the U.S., which were attributed to vaccine hesitancy.[134][135][136] On April 29, the CDC estimated that roughly 35% of the U.S. population had been infected with the virus as of March 2021, about four times higher than the official reported numbers.[137]
On May 4, Biden announced a new goal of having 70 percent of all adults in the U.S. receive at least one COVID-19 vaccine shot by July 4, along with steps to vaccinate teenagers and more inaccessible populations.[138] The country ultimately did not reach that goal, with only 67 percent of the overall adult population having done so by July 4.[139] On May 6, a study by the Institute for Health Metrics and Evaluation estimated that the true COVID-19 death toll in the U.S. was more than 900,000 people.[140] On May 9, Dr. Fauci confirmed that the U.S. death toll was likely undercounted.[141]
On May 13, the CDC changed its guidance and said that fully vaccinated individuals do not need to wear masks in most situations.[142] Some states ended their mask mandates shortly after, while others maintained the mandate. The CDC was criticized for the confusion resulting from the announcement, as it did not remove existing state and local mandates. The guidance also did not remove the federal mask mandate on public transportation.[143] On June 15, the U.S. passed 600,000 deaths, though the number of daily deaths had decreased due to vaccination efforts.[144]
By June, COVID-19 cases rose again, especially in Arkansas, Nevada, Missouri, and Wyoming. The rising numbers were believed to be attributable to the Delta variant.[145] By July 7, the Delta variant had surpassed the Alpha variant to become the dominant COVID-19 strain in the U.S., according to CDC data.[146] By August the Delta variant accounted for 99 percent of all cases and was found to double the risk of hospitalization for those not yet vaccinated.[147]
On August 1, the U.S. passed 35million cases.[148] By early and mid-August, hospitals in some states with low vaccination rates began to exceed capacity.[149] One-quarter of the U.S. population resides in eight statesAlabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Nevada, and Texasbut, by mid-August, these states together had a half of COVID-19 hospitalizations in the nation.[150] By the end of the month, the ICUs of five of thoseAlabama, Arkansas, Florida, Georgia, and Texaswere over 90% full.[151]
On September 8, the U.S. passed 40million cases.[152] By September 15, one in every 500 Americans had died from COVID-19.[153] By September 20, COVID-19 had killed over 675,000 Americans, the estimated number of American deaths from the Spanish flu in 1918. As a result, COVID-19 became the deadliest respiratory pandemic in recent American history.[154] The Associated Press called the new numbers a "colossal tragedy" because, despite a century of advances in science, the country failed to take full advantage of vaccines.[155] On October 1, the U.S. passed 700,000 deaths.[156] On October 18, the U.S. passed 45million cases.[157] On November 26, Biden announced that the U.S. will restrict travel from South Africa and seven other African countries due to concerns over a new variant from the area, called Omicron.[158]
At the beginning of January 2022, the number of cases per day exceeded 1,000,000.[159] As of February 1, fatality rates were 63% higher in the U.S. than other large wealthy countries, due in part to far lower vaccination rates compared to those countries.[160] On March 9, the Biden administration advised Congress of a lack of funding for testing, therapeutics and vaccines, but Republicans continued to block new spending on the pandemic so Democrats removed an emergency aid package from a proposed spending bill.[161] On March 20, Dr. Anthony S. Fauci warned of an "uptick" in cases like Europe has seen recently, stating the U.S. should "be prepared for the possibility that we might get another variant".[162]
In April 2022, it was reported by CNN that COVID-19 numbers reached pandemic lows across the US, resulting in many testing sites closing their doors. With testing sites seeing as low as single digits per day, Director of Public Health Services Division of the Haywood County Health and Human Services Agency in North Carolina Sarah Henderson suggested that she expected most counties to see closures soon, if they hadn't already. "We were seeing an excess of 100 patients at our testing site in the first few days [of January], which doesn't sound like a lot, but our community is very small," Henderson said. "The last couple of weeks, we have seen single digits every day. I certainly won't speak for other counties, but I think we're probably heading in that direction where if they're not closing down, they're decreasing hours and staff."[163]
On April 18, 2022, the federal transportation mask mandate, which had been extended to May 3 by the Biden administration on the advice of the CDC, was ended nationwide by U.S. District Judge Kathryn Kimball Mizelle, a Trump-appointed federal judge in Florida.[164] The Justice Department challenged the ruling several days later, yet masks remained optional on airplanes, buses, and subway systems, except when required by local mandates.[165]
The first annual National COVID Week of Remembrance & Action was held from April 2430, with mayors and other political officials declaring the week of remembrance in their respective jurisdictions as part of a national movement led by a collection of COVID advocacy groups.[166][167] According to data compiled by NBC News, the U.S. death toll reached 1,000,000 on May 4, 2022, the largest recorded death toll in any single country, followed by Brazil, with about 660,000 deaths.[168] The White House confirmed the 1 million mark with a presidential proclamation on May 12, ordering flags to be flown at half-staff at all federal facilities through sundown on May 16.[169]
In June, the United States concluded the approval process for the vaccination of children under five years of age, with the first vaccines expected to be administered on June 21.[170] On June 12, the U.S. dropped COVID testing requirements for inbound international air travelers, while vaccination requirements largely remained in place for inbound travelers using any mode of cross-border transportation.[171]
The number of cases for the months of January through June 2022 was about 2.4 times the number for the same period in 2021, and the number of COVID-attributed deaths likewise averaged 0.74 times the number in 2021.[159] Nonetheless, as of July 14, only 21 states have active COVID-19 emergency orders in place,[172] and there are no state-level mask requirements still in force.[173]
The number of cases for July and August 2022 was 3,672,358 and 3,154,320 respectively, with 11,963 and 15,943 COVID-attributed deaths, respectively. The totals for these two months reflect about 1.6 times the number of cases and 0.81 times the number of deaths from the same months in 2021.[159]
On September 18, 2022, in an appearance on 60 Minutes, president Joe Biden declared his belief that the COVID-19 pandemic was "over" in the United States.[174][175] This assessment met some debate in the medical community: at the time, the UnitedStates had roughly 400 deaths from the disease per day, and when extrapolated to 150,000 per year is three times the fatality rate of a bad flu season.[176]
The number of cases for the months of July through September 2022 was about 0.86 times the number for the same period in 2021, and the number of COVID-attributed deaths likewise averaged 0.42 times the number for the same period in 2021.[159]
In October, new variants BQ.1 and BQ.1.1 from the dominant BA.5 appeared to be spreading quickly, but comprised only a small proportion of overall variants. Although variant XBB was of concern internationally, it was rare in the United States.[177] Recommendations for receiving vaccination booster shots are mixed: while populations at risk of severe disease and death should stay up-to-date, healthy, middle-aged-and-younger populations are rarely at risk of severe illness, and most have adequate immunity. Although the newest bivalent boosters target the recent BA.4 and BA.5 variants and their risks are low, some experts recommend new strategies to develop vaccines with broader effectiveness.[178]
In a survey of vaccination booster intake (after completing a primary series), about 15% reported receiving the updated booster. The rates varied racially with 19% among White, non-Hispanic people, about 11% among Hispanic people, and about 7% among non-Hispanic American Indians, Alaska Native people, Black people, and those of multiple races, leading to concerns of vaccination access inequity.[179]
In the months leading up to November, deaths from COVID-19 substantially decreased, attributed to high levels of population immunity (through vaccination or prior infection), and improvements in early treatment for patients at risk for severe disease. The CDC recommended vaccinations, treatments for immunocompromised individuals and to reduce severity of the disease, and continuing to wear masks in public.[180] Nonetheless, Dr. Anthony Fauci stated that the Biden administration felt that there was "enough community protection that we're not going to see a repeat of what we saw last year at this time," referring to the emergence of the Omicron variant.[181]
A study of vaccine effectiveness found that U.S.-authorized bivalent mRNA boosters to those having already received 2 to 4 monovalent vaccinations provided significant additional protection against symptomatic SARS-CoV-2.[182] Concerns of a surge in Beijing caused the Biden administration to require U.S. visitors from China, Hong Kong, and Macau to provide proof of COVID-19 negative test results.[183] At the end of the year, the CDC reported that the COVID Omicron XBB.1.5 variant became much more prevalent and represented about 41% of new cases in the U.S. Scientists at Columbia University warned that the rise of subvariants could "result in a surge of breakthrough infections as well as re-infections."[184]
On January 11, 2023, the Biden administration decided to renew the COVID-19 public health emergency amid a winter surge of cases related to highly transmissible Omicron subvariants. With relief measures such as automatic Medicaid re-enrollment being decoupled from the emergency declaration, some commentators believed this signaled the final extension of the emergency declaration.[185]
Although some states had already ended emergency SNAP benefits enacted during the pandemic, the USDA announced that emergency allotments for the remaining 32 states, the District of Columbia, Guam, and the U.S. Virgin Islands would end after the February 2023 distribution. Leaders of some anti-hunger organizations believed that the end of the $95-per-month additional benefit would strain local food pantries and food banks.[186] South Carolina, which ended emergency food grants after the January 2023 distribution, and the 17 other states which terminated pandemic food supplements prior to the federal end date were all states with Republican-controlled state legislatures.[187]
On January 31, 2023, President Biden announced the end to the COVID-19 emergency declarations by May 11, 2023.[188] By February 23, eighteen states had already cut payments for more than 10 million people, and Congress had decided to end the program early, exchanging additional benefits for a new permanent program that provides extra money to low-income families to replace school meals during the summer.[189]
On April 10, 2023, President Biden signed into law a resolution terminating the national emergency, effective immediately.[190][191] This national emergency was separate from the public health emergency, which will remain in effect until May 11, 2023.[190]
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