Category: Covid-19

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Wastewater surveillance project helps officials detect COVID-19 variants across the state - Columbia Missourian

President Bidens Positive COVID-19 Test Reflects Nationwide Summer Surge

President Joe Biden's recent positive COVID-19 test mirrors a growing wave of summer cases across the United States driven by increased travel, indoor gatherings due to extreme heat, and the emergence of new variants, according to NBC News. Despite the United States no longer tracking cases, CDC data suggests rising infections in 45 states. Experts emphasize the need to rethink vaccine timing, while those at risk, like Biden, are advised to consider antiviral treatments like Paxlovid.

Coverage Gap Leaves 1 in 5 Working-Age Adults in Non-Expansion States Without Affordable Health Insurance

Nearly 20% of uninsured working-age adults in the 10 states that have not expanded Medicaid under the Affordable Care Act fall into a "coverage gap," earning too much for Medicaid but not enough for marketplace subsidies, according to Stateline. An analysis from the Center on Budget and Policy Priorities revealed that this issue disproportionately affects people of color and contributes to broader community health crises. Some states, like Mississippi, are reconsidering Medicaid expansion to address this critical gap and access federal funds.

FDA Authorizes Sales of Tobacco-Flavored e-Cigarettes

The FDA has granted marketing authorization for six tobacco-flavored Vuse Alto e-cigarette products from R.J. Reynolds, recognizing a potential benefit for adult smokers switching from traditional cigarettes, according to The Hill. However, the agency underscores that this does not imply the products are safe or FDA approved and highlights the ongoing risks of tobacco use. Last year, the FDA banned other Vuse flavors due to youth popularity, and it continues to face scrutiny over its handling of e-cigarette regulations.

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What Were Reading: COVID-19 Surge; Medicaid Nonexpansion States Lack Affordable Insurance; Tobacco-Flavored e-Cigarettes - AJMC.com Managed Markets...

President Biden did not wear a face mask in public a couple of times after the White House announced he had tested positive for COVID-19. The White House said the Democratic incumbent was experiencing "mild" symptoms while the president's physician said Biden would self-isolate "in accordance with CDC guidance for symptomatic individuals."

What does the CDC guidance say? What does the White House say?

After the announcement on Wednesday, Biden emerged bare-faced from the motorcade after he arrived at the airport in Las Vegas, where he had made several appearances, and boarded Air Force One. He also was not wearing a mask, which medical professionals have said can help slow the spread of disease, as he stepped off the plane hours later at Dover Air Force Base in Delaware. Biden was surrounded by Secret Service agents and aides on both ends of the trip.

White House press secretary Karine Jean-Pierre said in Wednesday's announcement that Biden, 81, was experiencing "mild" symptoms and would stick to prearranged plans to travel to his home in Rehoboth Beach, where he would isolate.

Biden's physician, Kevin O'Connor, DO, said in a separate statement that Biden had a runny nose, dry cough, and a feeling of "general malaise." He said Biden was being treated with nirmatrelvir-ritonavir (Paxlovid) "and will be self-isolating in accordance with CDC guidance for symptomatic individuals."

What the CDC Says

The CDC encourages people recovering from COVID-19 or any other respiratory illness to wear masks as part of an overall strategy to reduce transmission, but masks are not mandated.

The CDC recommends that people "stay home and away from others" if they're feeling sick. They say people can resume normal activities when symptoms have started to improve and the person no longer has a fever.

The CDC describes masks as an "additional strategy" for preventing disease spread, but it generally leaves it up to individuals to decide whether to use them. It calls masks "especially helpful" when someone is sick and suggests they be used as a precaution during recovery.

What the White House says

The White House has not responded to an emailed request for comment about why Biden chose not to wear a mask.

How Is Biden Doing?

O'Connor said Thursday that Biden is still experiencing mild upper respiratory symptoms from COVID-19. The president does not have a fever and his vital signs remained normal. He's being treated with with nirmatrelvir-ritonavir.

Quentin Fulks, the principal deputy manager of Biden's reelection campaign, said Thursday that Biden was "feeling fine" and was making calls and doing work. Fulks spoke at a news conference on the sidelines of the Republican National Convention in Milwaukee.

White House national security spokesperson John Kirby told reporters during a separate Zoom briefing that Biden was "being kept up to speed as appropriate by his leadership team, and certainly that includes on the national security front."

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Biden Has COVID and Didn't Wear a Mask. CDC Guidelines Say He Doesn't Have To. - Medpage Today

DARLENE SUPERVILLE, Associated Press

1 day ago

President Joe Biden walks to his car after stepping off of Air Force One at Dover Air Force Base in Delaware, Wednesday, July 17, 2024. Biden is returning to his home in Rehoboth Beach, Del., to self-isolate after testing positive for COVID-19. (AP Photo/Susan Walsh)

REHOBOTH BEACH, Del. (AP) President Joe Biden did not wear a face mask in public a couple of times after the White House announced he had tested positive for COVID-19. The White House said the Democratic incumbent was experiencing mild symptoms while the presidents physician said Biden would self-isolate in accordance with CDC guidance for symptomatic individuals.

What does the CDC guidance say? What does the White House say?

After the announcement on Wednesday, Biden emerged bare-faced from the motorcade after he arrived at the airport in Las Vegas, where he had made several appearances, and boarded Air Force One. He also was not wearing a mask, which medicals professionals have said can help slow the spread of disease, as he stepped off the plane hours later at Dover Air Force Base in Delaware. Biden was surrounded by Secret Service agents and aides on both ends of the trip.

White House press secretary Karine Jean-Pierre said in Wednesdays announcement that Biden, 81, was experiencing mild symptoms and would stick to prearranged plans to travel to his home in Rehoboth Beach, where he would isolate.

Bidens physician, Dr. Kevin OConnor, said in a separate statement that Biden had a runny nose, dry cough and a feeling of general malaise. He said Biden was being treated with the drug Paxlovid and will be self-isolating in accordance with CDC guidance for symptomatic individuals.

The Centers for Disease Control and Prevention encourages people recovering from COVID-19 or any other respiratory illness to wear masks as part of an overall strategy to reduce transmission, but masks are not mandated.

The CDC recommends that people stay home and away from others if theyre feeling sick. They say people can resume normal activities when symptoms have started to improve and the person no longer has a fever.

The CDC describes masks as an additional strategy for preventing disease spread, but it generally leaves it up to individuals to decide whether to use them. It calls masks especially helpful when someone is sick and suggests they be used as a precaution during recovery.

The White House has not responded to an emailed request for comment about why Biden chose not to wear a mask.

OConnor said Thursday that Biden is still experiencing mild upper respiratory symptoms from COVID-19,. The president does not have a fever and his vital signs remained normal. Hes being treated with the drug Paxlovid.

Quentin Fulks, the principal deputy manager of Bidens reelection campaign, said Thursday that Biden was feeling fine and was making calls and doing work. Fulks spoke at a news conference on the sidelines of the Republican National Convention in Milwaukee.

White House national security spokesperson John Kirby told reporters during a separate Zoom briefing that Biden was being kept up to speed as appropriate by his leadership team, and certainly that includes on the national security front.

___

Associated Press writers Mike Stobbe in New York and Will Weissert in Washington contributed to this report.

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Biden has COVID-19 and didnt wear a mask. The CDCs guidelines say he doesnt have to - KTLA Los Angeles

Wastewater COVID-19 levels 'very high' in Arkansas

The CDC says the state is at the viral activity level is very high

Updated: 11:33 PM CDT Jul 18, 2024

JACOB MURPHY SPOKE WITH A LOCAL DOCTOR TO FIND OUT WHAT THIS EXACTLY MEANS. ((JACOB ON CAM)) THE WASTEWATER STUDY IS A WAY TO LOOK AT COVID LEVELS IN AN AREA WITHOUT PEOPLE ACTUALLY GETTING TESTED. THE DOCTOR I SPOKE WITH SAYS THIS IS NORMAL FOR THIS TIME OF YEAR, BASED ON THE COVID PEAKS WE'VE SEEN EVERY SUMMER FOR THE LAST SEVERAL YEARS. ((TAKE PKG)) JOEL FANKHAUSER // DIRECT CARE CLINIC NWA PHYSICIAN "I think this is a pattern we're going to see play out probably indefinitely, unless something happens to change about the nature of how COVID spreads." THE C-D-C HAS RELEASED DATA SHOWING THE CURRENT VIRAL ACTIVITIES OF COVID IN WASTEWATER ACROSS AMERICA. JOEL FANKHAUSER // DIRECT CARE CLINIC NWA PHYSICIAN "They can track essentially, over an area, how many COVID particles are in wastewater." WHICH SHOWS WHAT STATES ARE SEEING HIGH LEVELS.. JOEL FANKHAUSER // DIRECT CARE CLINIC NWA PHYSICIAN "it gives public health officials an idea of the volume of COVID cases" LET'S ZOOM IN ARKANSAS.. THE STUDY SAYS THAT VIRAL ACTIVITY LEVEL THROUGHOUT THE STATE IS VERY HIGH.. JOEL FANKHAUSER // DIRECT CARE CLINIC NWA PHYSICIAN "In the state of Arkansas, there's a peak, roughly summertime and a peak roughly wintertime." WHICH IS SIMILAR TO WHAT THE NATURAL STATE SAW IN 2023 AND 2022. JOEL FANKHAUSER // DIRECT CARE CLINIC NWA PHYSICIAN "I don't know if that's the case across every state in the United States. But in Arkansas, for sure." N-W-A PHYSICIAN JOEL FANKHOUSER SAYS HE HASN'T SEEN A HUGE INCREASE IN CASES LOCALLY. JOEL FANKHAUSER // DIRECT CARE CLINIC NWA PHYSICIAN "The personal health measures that have been introduced over the last several years have been so effective." BUT THAT THE TWO PEAKS, IN THE SUMMER AND WINTER TIME COULD BECOME THE NORM. JOEL FANKHAUSER // DIRECT CARE CLINIC NWA PHYSICIAN "I would expect that we're always going to have these two peaks per year, just because it's happened that way, for the last three years, basically, that we're going to see something roughly now." ((JACOB ON CAM)) I TALKED WITH A COUPLE PEOPLE EARLIER TODAY AT A PARK IN N-W-A AND SOME SAY THEY'RE STILL SEEING PEOPLE GETTING COVID AND ARE WORRIED, WHILE OTHERS AREN'T WORRIED AND HAVEN'T THOUGHT ABOUT COVID AT ALL RECENTLY. THE DOCTOR WE SPOKE WITH SAYS THESE WASTEWATER NUMBERS SHOULDN'T CAUSE CONCERN, BUT YOU CAN NEVER BE SURE AS COVID CONTINUES TO CHANG

Wastewater COVID-19 levels 'very high' in Arkansas

The CDC says the state is at the viral activity level is very high

Updated: 11:33 PM CDT Jul 18, 2024

According to data from the Centers for Disease Control and Prevention, the current viral activity levels of COVID-19 in wastewater throughout Arkansas are considered "very high."It gives public health officials an idea of the volume of COVID cases," NWA physician Joel Fankhauser said. Fankhauser says the rise in activity is common for this time of year in Arkansas. In the state of Arkansas, there's a peak, roughly summertime and a peak roughly wintertime," Fankhauser said. Fankhauser says this data should not cause major concern, but that we could never know as COVID-19 continues to change and develop. I think this is a pattern we're going to see play out probably indefinitely," Fankhauser said. "Unless something happens to change about the nature of how COVID spreads.

According to data from the Centers for Disease Control and Prevention, the current viral activity levels of COVID-19 in wastewater throughout Arkansas are considered "very high."

It gives public health officials an idea of the volume of COVID cases," NWA physician Joel Fankhauser said.

Fankhauser says the rise in activity is common for this time of year in Arkansas.

In the state of Arkansas, there's a peak, roughly summertime and a peak roughly wintertime," Fankhauser said.

Fankhauser says this data should not cause major concern, but that we could never know as COVID-19 continues to change and develop.

I think this is a pattern we're going to see play out probably indefinitely," Fankhauser said. "Unless something happens to change about the nature of how COVID spreads.

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Wastewater COVID-19 levels 'very high' in Arkansas - 4029tv

President Joe Biden walks to his car after stepping off of Air Force One at Dover Air Force Base in Delaware, Wednesday, July 17, 2024. Biden is returning to his home in Rehoboth Beach, Del., to self-isolate after testing positive for COVID-19. (AP Photo/Susan Walsh)

By DARLENE SUPERVILLE

REHOBOTH BEACH, Del. (AP) President Joe Biden did not wear a face mask in public a couple of times after the White House announced he had tested positive for COVID-19. The White House said the Democratic incumbent was experiencing mild symptoms while the presidents physician said Biden would self-isolate in accordance with CDC guidance for symptomatic individuals.

What does the CDC guidance say? What does the White House say?

After the announcement on Wednesday, Biden emerged bare-faced from the motorcade after he arrived at the airport in Las Vegas, where he had made several appearances, and boarded Air Force One. He also was not wearing a mask, which medicals professionals have said can help slow the spread of disease, as he stepped off the plane hours later at Dover Air Force Base in Delaware. Biden was surrounded by Secret Service agents and aides on both ends of the trip.

White House press secretary Karine Jean-Pierre said in Wednesdays announcement that Biden, 81, was experiencing mild symptoms and would stick to prearranged plans to travel to his home in Rehoboth Beach, where he would isolate.

Bidens physician, Dr. Kevin OConnor, said in a separate statement that Biden had a runny nose, dry cough and a feeling of general malaise. He said Biden was being treated with the drug Paxlovid and will be self-isolating in accordance with CDC guidance for symptomatic individuals.

The Centers for Disease Control and Prevention encourages people recovering from COVID-19 or any other respiratory illness to wear masks as part of an overall strategy to reduce transmission, but masks are not mandated.

The CDC recommends that people stay home and away from others if theyre feeling sick. They say people can resume normal activities when symptoms have started to improve and the person no longer has a fever.

The CDC describes masks as an additional strategy for preventing disease spread, but it generally leaves it up to individuals to decide whether to use them. It calls masks especially helpful when someone is sick and suggests they be used as a precaution during recovery.

The White House has not responded to an emailed request for comment about why Biden chose not to wear a mask.

OConnor said Thursday that Biden is still experiencing mild upper respiratory symptoms from COVID-19,. The president does not have a fever and his vital signs remained normal. Hes being treated with the drug Paxlovid.

Quentin Fulks, the principal deputy manager of Bidens reelection campaign, said Thursday that Biden was feeling fine and was making calls and doing work. Fulks spoke at a news conference on the sidelines of the Republican National Convention in Milwaukee.

White House national security spokesperson John Kirby told reporters during a separate Zoom briefing that Biden was being kept up to speed as appropriate by his leadership team, and certainly that includes on the national security front.

___

Associated Press writers Mike Stobbe in New York and Will Weissert in Washington contributed to this report.

Continued here:

Biden has COVID-19 and didnt wear a mask. The CDCs guidelines say he doesnt have to - Boston Herald

The COVID-19 pandemic has been blamed for more than 235,000 deaths in the UK through the end of 2023 one of the highest death tolls in the world.

Todays report confirms what many have always believed that the UK was under-prepared for COVID-19, and that process, planning and policy across all four nations failed UK citizens, Prime Minister Keir Starmer said, referring to England, Northern Ireland, Scotland, and Wales.

The safety and security of the country should always be the first priority, and this government is committed to learning the lessons from the inquiry and putting better measures in place to protect and prepare us from the impact of any future pandemic," he said.

The first report from the inquiry, based on hearings that began in June 2023, was focused only on pandemic preparedness and didn't place blame on any individual.

A second phase looking at the governments response, including the partygate scandal in which then Prime Minister Boris Johnson and his staff broke their own rules by hosting work parties, is due later. A third phase will look into what lessons can be learned from how the nation handled the crisis. The inquiry is due to hold hearings until 2026.

Hallett found that an outdated 2011 pandemic strategy for the flu wasnt flexible enough to adapt to a crisis nearly a decade later and was abandoned almost immediately.

There were fatal strategic flaws underpinning the assessment of the risks faced by the UK, how those risks and their consequences could be managed and prevented from worsening and how the state should respond, Hallett said.

There also was a lack of focus on what was needed to deal with a rapidly transmissible disease, and not enough done to build up a system to test, trace, and isolate infected patients.

Hallett said in her 217-page report that the UK needs to be better prepared for the next pandemic one that could be even deadlier.

The UK will again face a pandemic that, unless we are better prepared, will bring with it immense suffering and huge financial cost and the most vulnerable in society will suffer the most, she said.

Hallett recommended that a new pandemic strategy be developed and tested every three years, and that government and political leaders should be accountable for having preparedness and resilience systems in place. She also said that outside experts should be used to prevent the known problem of groupthink."

Unless the lessons are learned, and fundamental change is implemented, that effort and cost will have been in vain when it comes to the next pandemic," Hallett said. "Never again can a disease be allowed to lead to so many deaths and so much suffering.

Elkan Abrahamson, who represents the nearly 7,000 members of the COVID-19 Bereaved Families for Justice, applauded Hallett for adopting most of its recommendations to prevent a repeat disaster.

However, it is extremely disappointing that the vulnerable were ignored in the recommendations and there were no proposals for dealing with racial inequality, health inequalities, or the effects of austerity, Abrahamson said.

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Inquiry finds Britain was ill-prepared for COVID-19 pandemic and failed its citizens - The Boston Globe

In this Swedish retrospective cohort study, mechanically ventilated patients with COVID-19 experienced a higher incidence of ICU-acquired infections compared to those with influenza. Staphylococcus aureus was identified as the most common pathogen causing VA-LRTI among patients with influenza and COVID-19, while gram-negative bacteria as a group caused the majority of VA-LRTI in patients with COVID-19. We found an association between ICU-AI and increased risk of mortality in patients treated with corticosteroids. Our data further suggest that corticosteroid treatment in COVID-19 is a risk factor for acquiring secondary bacterial infections in the ICU.

The differing risk of ICU-AI in patients with COVID-19 as opposed to influenza accords with other studies2,11,21,22,23,24. It may be explained by factors such as increased demand on the healthcare system during the COVID-19 pandemic11,25, alterations of immune responses caused by SARS-CoV-221, a high proportion of ARDS in COVID-19, more frequent prone positioning23, and prolonged IMV and ICU stays11,26. Although we noted no difference in ICU LoS between the COVID-19 and influenza cohorts, there was a small difference in time on IMV. Consistent with findings from other studies23,26, more males were observed in critical COVID-19 cases than in influenza cases. This may account for the different incidence rates, as this and other studies suggest that male gender is a risk factor for ICU-AI15,27.

There was no significant difference in the percentage of patients with corticosteroid treatment between the two cohorts. However, the indication for corticosteroid treatment to patients with influenza was airway obstruction and/or sepsis with lower doses and shorter duration than recommended in severe COVID-19. Furthermore, antibiotic treatment on admission has been shown to be a risk factor for ICU-AI2,28,29, and early initiation of antibiotics was high throughout the pandemic, despite the low frequency of co-infections on admission in patients with COVID-19. On the other hand, it is possible that the lower incidence of ICU-AI in the influenza cohort is partly explained by earlier diagnosis and targeted treatment of co-infection, while some co-infections in the COVID-19 cohort might been missed initially and later misinterpreted as ICU-AI.

As the pandemic developed, incidence rates of ICU-AI in patients with COVID-19 increased. A similar pattern, but with slightly lower incidence rates, was seen in a recent Swedish study on VA-LRTI29. The differing incidence rates of ICU-AI during the pandemic can be partly explained by a shift in corticosteroid treatment, for as our study and several others have suggested, corticosteroid treatment is a risk factor for ICU-AI2,15,22,29,30. Moreover, later in the pandemic patients were more critically ill and had more co-infections on admission, possibly affecting the risk of ICU-AI. Nor can we rule out other variables, such as changes in management or staffing at the ICU31, different SARS-CoV-2 strains, or vaccinations32, any of which may have affected the risk of ICU-AI throughout the pandemic.

Other studies have demonstrated the same association between ICU LoS and IMV duration, while reports on mortality are conflicting15,24,29,30,33. Our findings demonstrate an increased risk of mortality with ICU-AI in patients with corticosteroid treatment as compared to patients who have not received corticosteroids. This may in part reflect the higher mortality that occurred in later waves in contrast to the first. Although glucocorticoids have been shown to reduce mortality12,34, later studies have indicated that not all patients with severe COVID-19 may benefit from corticosteroid treatment15,35,36. We did not find any interaction between age and corticosteroid treatment on the risk of ICU-AI, but it cannot be ruled out that certain patient categories might be affected differently by corticosteroid treatment. Further riskbenefit studies of the association between corticosteroid treatment, ICU-AI, and outcome in hospitalized patients are needed.

The microbial pattern we observed in VA-LRTI is consistent with that seen elsewhere11,14,22,29,30. Although we found a larger discrepancy between the two cohorts than other studies observed11,23,24,37, this may have been due to the small number of patients with influenza and ICU-AI. A shift in the microbial pattern was observed between early and late VA-LRTI, with an increase in more difficult-to-treat microbes in later stages, consistent with findings reported in other studies11,29,30. Possible explanations for this are alterations in lung microbiota38, increase of biofilm-active bacteria39, as well as an overuse of antibiotics2. We noted a change throughout the pandemic towards more broad-spectrum antibiotic treatment on admission in patients with COVID-19. Broad-spectrum antibiotics are a risk factor for ICU-AI28 and may possibly facilitate the development of more complicated infections. Although the rate of MDRO was comparatively low23,40, there is a risk of decreasing antibiotic susceptibility with the overuse of antibiotics41,42.

The major strengths of our study are the large sample size of patients on IMV due to COVID-19 and our detailed examination of the medical charts for each case. There are however some important limitations to consider: First, the retrospective nature of the study. Second, the small comparison group, due to the relatively few patients on IMV as a result of influenza, especially during the COVID-19 pandemic. The inclusion period for the two cohorts also differed somewhat, possibly affecting the prevalence of MDRO. Third, most patients receiving corticosteroid treatment were hospitalized after the first wave, so it is possible that there were coinciding changes in management that further affected the risk of ICU-AI. Fourth, most samples from the lower respiratory tract were not taken with protected brush. This may have resulted in some colonization cultures and contaminations being included for analysis.

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Intensive care unit-acquired infections more common in patients with COVID-19 than with influenza - Nature.com

Victoria Pickering / Flickr cc

The proportion of COVID-19 deaths in central Europe in 2020 and 2021 would have been up to 18% to 27% higher if death certificates listing the virus as a contributing condition had coded it as the cause of death, estimates a newstudy published in PLOS One.

University of Warsaw-led researchers examined 187,300 death certificates from Austria, Bavaria (Germany), Czechia (Czech Republic), Lithuania, and Poland mentioning COVID-19 in 2020 and 2021. They performed a two-step analysis of cause-of-death association indicators (CDAIs) and contributing CDAIs to estimate the statistical strength of associations between COVID-19 and other conditions.

"Excess deaths reported to causes other than COVID-19 may have been due to unrecognised coronavirus disease, the interruptions in care in the overwhelmed health care facilities, or socioeconomic effects of the pandemic and lockdowns," the authors noted. "Death certificates provide exhaustive medical information, allowing us to assess the extent of unrecognised COVID-19 deaths."

A total of 15,700 death certificates listed COVID-19 as a contributing condition, and three of four recorded a statistically significant COVID-19 complication or pre-existing condition as the cause.

Unrecognised coronavirus deaths were equivalent to the entire surplus of excess mortality beyond registered COVID-19 deaths in Austria and the Czech Republic, and its large proportion (2531%) in Lithuania and Bavaria.

"In Austria, Bavaria, Czechia, and Lithuania the scale of COVID-19 mortality would have been up to 1827% higher had COVID-19 been coded as the underlying cause of death," the researchers wrote. "Unrecognised coronavirus deaths were equivalent to the entire surplus of excess mortality beyond registered COVID-19 deaths in Austria and the Czech Republic, and its large proportion (2531%) in Lithuania and Bavaria."

The undercount may be attributable to a lack of COVID-19 testing, atypical disease course, misclassification, or deaths from other causes such as cardiovascular disease and cancers that may have risen as strained healthcare systems prioritized COVID-19 patients or fallen owing to the reduction of risk factors such as air pollution, traffic, or other infectious diseases.

"Finally, mortality may have increased due to harmful behaviours typical of the socioeconomic instability experienced by some groups during the pandemics, lockdowns and economic slowdown, such as abuse of noxious substances, suicides and accidents," the researchers wrote.

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US COVID-19 activity continues to rise steadily - University of Minnesota Twin Cities

A Boston Children's Hospitalledstudyreveals that COVID-19 vaccine uptake lagged among US children with more social vulnerability, lower socioeconomic status (SES), and greater household composition and disability (HCD) as of July 2022.

The study, published today in Pediatrics, also identified longer travel times to vaccination sites for rural, uninsured, White, and Native American families.

The researchers mined the Centers for Disease Control and Prevention's (CDC's) Vaccine Tracking System in July 2022 to estimate vaccination-site accessibility by geocoding the sites, measuring travel times to the nearest site, and weighting population demographics to arrive at nationally representative vaccination estimates for October 2021 to July 2022.

The team also compared COVID-19 county-level vaccine coverage by Social Vulnerability Index scores, SES, HCD scores, minority status and language (MSL), and housing and transportation types. HCD concerns the number of people living in a household, and disability refers to the disability of anyone in the household.

Children from marginalized and minoritized communities have also faced disparate impacts across the COVID-19 care continuum.

COVID-19 has disproportionately affected marginalized and minority communities across the country, but access to testing, clinical trials, vaccines, and treatments haven't been equitably allocated to socially and clinically vulnerable adults, the study authors noted.

"Children from marginalized and minoritized communities have also faced disparate impacts across the COVID-19 care continuum, including inequities in rates of COVID-19 infection and COVID-19-related hospitalization, ICU admission, complication (eg, multisystem inflammatory syndrome), mortality, and loss of a primary caregiver," they wrote.

More than 15.2 million COVID-19 vaccine doses (271,589 doses of the Pfizer/BioNTech vaccine for children 6 months to 4 years, 6,270 doses of the Moderna vaccine for the same age-group, and 14,956,097 doses of the Pfizer vaccine for children aged 5 to 11 years)were given at 27,526 sites.

In total, 2.0% of the US population and 2.7% of uninsured, 10.5% of rural, 13.2% of American Indian and Alaska Native (AIAN), 2.0% of White, 2.2% of Hispanic, and 1.2% of Black children lived more than 30 minutes from the nearest vaccination site for children 5 to 11 years.

In contrast, 13.7% of the population and 65.9% of rural, 15.3% of uninsured, 25.3% of AIAN, 14.5% of White, 11.8% of Hispanic, and 9.0% of Black children lived more than 30 minutes from the nearest site for children 6 months to 4 years.

Rural children had longer travel times than their urban peers in all demographic subgroups and both vaccine age-groups, with large differences in the accessibility to sites for the younger age-group. Relative to White children, who lived a median of 4.8 minutes away, AIAN children (13.5 minutes) lived farther from the nearest site for younger children, while Asian (2.2 minutes), Hispanic (2.7), and Black (3.4) children lived closer.

For children 5 to 11 years old, the median travel time was 2.3 minutes for White children, 4.1 minutes for AIAN children, 4.1 minutes for Asian American children, 1.3 minutes for Hispanic children, and 1.6 minutes for Black children.

Lower vaccine uptake was linked to higher Social Vulnerability Index scores, lower SES, and greater HCD among children aged 6 months to 4 years (overall incidence rate ratio [IRR], 0.70; SES IRR, 0.66; HCD IRR, 0.38) and 5 to 11 years (overall IRR, 0.85; SES IRR, 0.71; HCD IRR, 0.67). Social vulnerability by MSL, however, was tied to higher uptake (6 months to 4 years IRR, 5.16; 5 to 11 years IRR, 1.73).

"Pediatric COVID-19 vaccine uptake and accessibility differed by race, rurality, and social vulnerability," the authors wrote. "National supply data, spatial accessibility measurement, and place-based vulnerability indices can be applied throughout public health resource allocation, surveillance, and research."

Coordinated responses to emerging pathogens at hyperlocal, regional, and national levels must prioritize health equity.

The lower vaccine coverage among children aged 6 months to 4 years may be attributable to slow "diffusion of innovation" in the weeks after the COVID-19 vaccine became available for this age-group and higher parental hesitation to the vaccine for young children.

And the greater vaccine uptake among children with social vulnerability by MSL could reflect a troubling truth, the authors said: "Greater vaccination among privileged groups even when sites are located within marginalized communities, because of low vaccine confidence and other access barriers, disproportionately impacting marginalized populations," they said. "Moreover, early racial and spatial inequities in the pediatric vaccination rollout may grow further as pandemic-related coverage and reimbursement expansions are rescinded."

They recommend taking evidence-based, "low-tech/high-touch" approaches such as behavioral nudges, reminders, employer and school vaccine requirements, parental education about vaccine importance and safety,and delivery of vaccine messages by trusted community members.

"Our methods and findings may be useful for prioritizing equity in the rollout of promising new interventions like nirsevimab for respiratory syncytial virus,targeting future outbreak response efforts,and surveilling population-level disparities in chronic pediatric conditions," the researchers wrote. Nirsevimab (Beyfortus) is a monoclonal antibody that can reduce the risk of respiratory syncytial virus (RSV) in infants.

"Coordinated responses to emerging pathogens at hyperlocal, regional, and national levels must prioritize health equity, because of distributive justice, because of the many intersections of health and social conditions, and because our health is inextricably linked to the health of those around us more than ever during a pandemic," they concluded.

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Lower COVID vaccine uptake tied to unequal access to vaccination sites - University of Minnesota Twin Cities