COVID may be with us for a long time. What kind of testing do we need?

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(NEW YORK) — Throughout the pandemic, periodic surges in demand for COVID-19 testing — typically during a spike in cases or prior to holiday travel — have put strain on the nation’s testing capacity.

During these times, it can be difficult for people to quickly learn if they are positive for the virus — and to isolate if they are.

Testing is something the U.S. has struggled to get right from the get-go, from strict rules and problems with the initial test kits to how to manage supply and demand during peaks and lulls. In 2021, America grappled with how to manage the volume of tests needed in a fully reopened country with schools and workplaces requiring regular testing, pressures exacerbated during the highly contagious omicron variant hitting ahead of the holidays.

This presents a real problem because experts believe a successful COVID-19 testing regime — along with vaccinations — is the key to building a new normal.

Over the course of the pandemic, the number and types of tests have proliferated, turnaround times for results have varied and other questions arose, including which test should be used and when and where should they be administrated.

So how can the U.S. increase access to tests, and what kind of infrastructure is needed if COVID is going to be an endemic disease, meaning it is always circulating within the population but at low rates. What kind of testing system is needed to prevent further outbreaks fueled by variants including delta and omicron?

Testing experts told ABC News the answer is decentralizing the system and delivering tests to patients directly, setting up community sites with reliable rapid molecular testing and being able to test people for multiple diseases at one time — including COVID.

The tests we have now

Currently, the U.S. has two different types of viral tests used to diagnose COVID-19: antigen tests and molecular tests.

Antigen tests, also known as rapid tests, look for antigens, or proteins, from the coronavirus and return results usually within less than an hour. Molecular tests, also known as PCR tests, are run in a laboratory for viral material and typically return results within three days.

PCR tests are mostly administered at government-run sites, urgent care centers, doctor’s offices and pharmacies, many of which have seen long lines amid the surge fueled by the omicron variant. At-home antigen tests have soared in popularity in recent weeks as way to avoid lines and quickly determine whether or not a person is infected.

How quickly the omicron variant continues to spread will determine whether the U.S. has enough testing capacity for now, the experts say.

“Certainly we have a lot of testing and I think, currently, in the country we can provide well north of two or three million [lab] tests in a day when you consider everything that’s available,” Dr. William Morice, chair of the Department of Laboratory Medicine at Mayo Clinic, told ABC News.

Currently, the U.S. is performing an average of 1.7 million COVID-19 tests per day, according to data from the Centers for Disease Control and Prevention (CDC). However, experts say we should be performing more tests than that.

Dr. Peter Chin-Hong, an infectious diseases specialist at the University of California, San Francisco, told ABC News that the U.S. needs to be performing many more tests — upwards of 2 or 3 million per day — so infected people can get the treatment they need more quickly, avoid being sent to the hospital and contact tracing can occur.

“Use of testing, it’s not as much to show how many cases we have, but it’s actually used for diagnosis ” Chin-Hong said. “When people use testing early on, they can get better bang for their buck with early therapies and prevent them from going to the hospital.”

He continued, “A PCR test can trigger contact tracing, early therapy. There are a lot of other domino effects of testing that’s simply just more than ‘I have another case in my community.’ It actually ends up potentially saving hospital resources.”

Morice believes that if cases continue to rise, then the supply could be strained. The U.S. is recording an average of more than 668,000 infections per day (as of Jan. 7) — the most ever since the pandemic began, although this figure is partially due to a backlog of data reporting over the holidays.

“When the virus is not prevalent and less common in communities, the testing that we’ve had, for example here in Seattle, has been quite adequate,” Dr. Geoffrey Baird, chair of the Department of Laboratory Medicine and Pathology at UW Medicine, told ABC News. “I think we have plenty of testing available if we were just testing people who have symptoms.”

He continued, “But when you have to test asymptomatic people before traveling, before gatherings, before school or before sports, that ends up getting difficult to so support because the absolute number of tests needed can get very, very large.”

The experts say that infectious disease modelers didn’t predict the emergence of the omicron variant or how quickly it would spread — especially as people traveled over the holidays — leading to increased demand for testing.

Dr. Brian Rubin, professor and chairman of the Pathology and Laboratory Medicine Institute at the Cleveland Clinic, told ABC News that at his lab, there have been about 50% more positive tests in 2021 than the year before.

During the previous winter surge, the clinic never had more than 1,000 positive tests per day. In late 2021, as many as 1,700 tests per day come back positive, he said. With as many as 4,000 to 5,000 tests being run every day, this puts a great amount of strain on hospitals, laboratory personnel and testing supplies.

The system we need

Rubin believes the key to building up a robust testing program is to decentralize the system the U.S. has even further, meaning more at-home testing without the need of a healthcare provider to order or perform the test.

“Anything we can do to automate that,” he said. “Decentralizing is going to be the key. How do we not call their doctor to order the test, get them to swab themselves, et cetera.”

He added, “If we can get really reliable testing into the hands of individuals so you can test at home without leaving your home, we can handle it.”

Although most at-home tests currently on shelves are pretty reliable, some at-home tests are known to produce an abundance of false positives.

He envisions a system in which the U.S. uses Amazon or an Amazon-like service to deliver test kits to people’s homes on a grander scale than what is already available.

People perform the test themselves, including swabbing and analyzing the sample. Once they get results, they scan a barcode or QR code, alerting public health officials of a positive test result rather than the person having to call a doctor or the local health department to inform them. Although some tests already do this, Rubin would like to see all tests have this capability.

At-home tests have a very low likelihood of delivering false positives if a person is symptomatic. So, under Rubin’s proposed system, if the person is symptomatic and gets a positive result, they could stay home and therefore help eliminate long lines at testing sites and free up appointments at clinics.

However, a person who is asymptomatic and gets a positive result from a delivered at-home test would be recommended to get PCR test to confirm they are truly infected with COVID.

Additionally, under Rubin’s system, if someone is a contact of a positive patient, they would be informed and get guidance on whether to get tested or quarantine.

“We have all the pieces for home testing, but how do we make it super elegant and slick and make it as easy as possible,” he said.

The Biden administration is trying to ramp up testing via a similar method: creating a website that will distribute 500 million free at-home rapid COVID tests to Americans, which officials promised will not cut into the current supply of tests on shelves.

Possible setbacks

However there are issues with rapid tests. At-home testing involves multiple steps and requires a clean workspace, meaning people may be performing the tests incorrectly. Additionally, rapid tests are more likely to return false negatives than laboratory tests because they are less sensitive.

This means that rapid tests have to detect enough antigens, or proteins, in the nose to return a positive result. However, laboratory tests, which look for genetic material, can return a positive result even if only trace amounts are detected.

Because of these potential issues, Baird says he is in favor of setting up community testing sites like UW Medicine has done in Washington that use rapid molecular tests.

These are like PCR tests, which are considered the gold standard of testing, but return results within a few hours rather than within a few days.

The UW community sites collect samples, which are then shipped by courier back to the main lab, where they can be quickly analyzed, Baird would like to see a similar system set up by big hospitals across the country.

“The chances of it giving a false negative are very, very low. No test is 100% perfect but it’s as good as you can get and so we’re doing the best we can by making the best possible test as expendable as possible,” Baird said. “I’d be in favor of multiple community test sites like kiosks or trailers or other sites, it can be in retail spaces or something like that.”

Morice said it’s also important to have combination tests that check for multiple diseases such as COVID-19 and the flu, which are currently available — although not at all clinics.

“That will be really important and it’s certainly needed,” he said. “Last year was really anomalous in that we had no influenza whatsoever. Now we’re seeing rates going back up so we’ll need it for that reason.”

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‘We’re all hurting’: Hospital workers plead for vaccination and help amid omicron surge

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(NEW YORK) — When the omicron variant first began sweeping the country, there was some hope that because initial studies indicated it was less severe, it would prove to have less of an impact on the health care system.

However, given its increased transmissibility, the unprecedented explosion of cases is proving otherwise, leaving a record 146,000 coronavirus positive patients hospitalized across the country.

The record-smashing omicron surge, right on the heels of the crushing delta surge of the summer and fall, is pushing many overtaxed hospital systems over the edge — systems facing staffing shortages, patients seeking care for non-COVID-related ailments adding to the burden. The increased pressure also comes despite having 62.6% of the country fully vaccinated and an array of treatments at their disposal.

“Even though they say omicron is probably more mild, I don’t think we’re necessarily seeing that with the unvaccinated,” Dr. Raymond Lee Kiser, a hospitalist and nephrologist at Columbus Regional Health in Indiana, told ABC News. “Here in Indiana, this sort of second wave just superimposed right on top of delta.”

Across the state, a record 3,400 COVID-19-positive patients are currently hospitalized. In mid-November, there were already more than 1,100 patients receiving care.

“There was barely time to breathe before omicron rolled right on over top of us. It really is just like a second surge right on top of the last one.”

On average, more than 18,000 virus-positive Americans are being admitted to the hospital each day, a figure which has more than doubled since early December. In addition, approximately 80% of staffed adult intensive care unit beds are occupied, with more than 23,000 Americans with COVID-19 currently requiring ICU-level care.

Health care workers interviewed by ABC News and officials say the vast majority of those who are severely ill are unvaccinated, leading hospital staff to plead for people to get their shots.

‘Very overwhelming’

Echoing many of her colleagues in numerous health care settings, nurse Becky Bevi, at Columbus Regional Health in Indiana told ABC News she is exhausted.

“Two years later, I’m frustrated,” said Bevi, who has staffed her hospital’s main COVID-19 unit since the beginning of the pandemic. “I feel like this should have been zapped in the first year. Just frustration, tired, exhausted from constantly dealing with it, watching death. It’s just so much and I don’t feel like it’s going to go away anytime soon.”

In Wisconsin, nurse Hilary Krieger, said she often feels overwhelmed, given the constant uncertainty that surrounds the virus.

“It’s hard to explain. It’s lonely. It feels very overwhelming at times,” Krieger said.

In the emergency department at Baystate Health, in western Massachusetts, nurse Thomas Mapplebeck, told ABC News that the staff is burned out.

“We’re working 12- to 14-hour shifts on Sundays up to 16-hour shifts. Breaks are minimal and it’s just that busy, and people are just that sick. Some of us are pushing more than 60 hours a week,” Mapplebeck said.

Nationwide, nearly 30% of hospitals, for which data is available, are reporting that they are experiencing a critical staffing shortage.

Mapplebeck shared his harrowing experiences caring for coronavirus patients over the course of the last two years in the hospital’s 20-bed emergency room.

“We have patients of all age brackets with no medical history, unable to breathe, their bodies unable to compensate and overcome their symptoms. For some, we take over their breathing for them, we transport them to the trauma center where despite all efforts, they die,” Mapplebeck said. “We have 40-year-olds that are trying to walk to the bathroom and get short of breath and collapse and they need resuscitation.”

Sicker, faster

Kaila Sizemore, a nurse at Columbus Regional Health, explained that patients appear to be getting sicker, more quickly, compared to previous surges. While the disease was somewhat “more progressive” during the first wave, Sizemore said, now patients suddenly need oxygen and to be transferred to the ICU.

“It’s just how quickly and unexpectedly I think that people change has kind of been hardest for me,” she added.

At Maine’s Northern Light Health, this state’s latest surge is the “worst” the staff has ever seen.

“The numbers are crazy,” said Melissa Vail, assistant vice president of Ambulatory Care Management. “Our staff is scared. I don’t know that we have ever seen anything like this and I don’t know that we will ever see anything like it.”

Northern Light nurse Allison Leary has also been caring for a growing number of COVID-19-positive children.

“It’s challenging taking care of little people … little kids, and it’s sometimes very emotionally draining and intense,” said Leary.

Nationwide, pediatric hospital admissions have surged to a record high, with an average of 830 children admitted to the hospital with COVID-19 each day.

“I’m saddened by the fact that we’re seeing more kids with it now,” Leary said.

Vast majority of those critically ill are unvaccinated

According to health officials, the vast majority of those who are critically ill in the hospitals continue to be the unvaccinated.

“The sickest of the sick that we are seeing now with the patients that are not vaccinated. COVID patients that come in and go home are the ones typically that are vaccinated. They get fluids, medications if needed, and then go home to recuperate,” said Mapplebeck, the nurse from Baystate. “This vaccine doesn’t put an invisible shield around you like a superhero. It’s meant to jumpstart your immune system. So when and if you do become sick with COVID, your body is ready to fight, which gives you a fighting chance.”

Kiser added that he has witnessed a dichotomy between those who are vaccinated and unvaccinated. The course for the vaccinated patients, is much milder, he said, typically only requiring a few days of medications, and often, they are able to go home without any oxygen therapy. In addition, the patients who end up getting transferred from the medical floor to the critical care unit are “almost exclusively” unvaccinated.

“If it weren’t for that group of people … I don’t think we would feel sort of as physically and emotionally crushed as we do right now,” Kiser said.

Mapplebeck, Kiser, of Columbus Regional Health, and others stressed that people should get vaccinated in order to help decrease the number of people who need hospital beds, and give those who are really sick a chance to get the care they truly need.

“Nobody wants to go get a shot, but you know, do this. If you’re not going to do it for yourself. Do it for your community. All the hospitals are just struggling right now. All the health care providers are struggling. We’re all hurting,” pleaded Kiser.

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Family speaks out after man receives pig heart in 1st of kind transplant

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(NEW YORK) — A 57-year-old man who underwent a first-of-its-kind heart transplant involving a genetically-modified pig heart is in a “much happier place” after the transplant, according to his son.

David Bennett Sr., of Maryland, suffered from terminal heart disease and was deemed ineligible for a conventional heart transplant because of his severe condition, according to University of Maryland Medicine, where Bennett underwent the transplant.

On New Year’s Eve, University of Maryland Medicine doctors were granted emergency authorization by the Food and Drug Administration to try the pig heart transplantation with Bennett, who had been hospitalized and bedridden for several months.

Bennett said he saw the risky surgery as his last option.

“It was either die or do this transplant. I want to live. I know it’s a shot in the dark, but it’s my last choice,” he said the day before the surgery, according to University of Maryland Medicine. “I look forward to getting out of bed after I recover.”

Bennett was so sick before the transplant that he was on an extracorporeal membrane oxygenation (ECMO) machine — which pumps and oxygenates a patient’s blood outside the body — and had also been deemed ineligible for an artificial heart pump, according to University of Maryland Medicine.

“His level of illness probably exceeded our standards for what would be safe for human heart transplantation,” said Dr. Bartley P. Griffith, a professor in transplant surgery at the University of Maryland School of Medicine.

It was Griffith who surgically transplanted the pig heart into Bennett. He and a team of researchers have spent the past five years studying and perfecting the transplantation of pig hearts, according to University of Maryland Medicine.

Pig hearts are similar in size to human hearts and have an anatomy that is similar, but not identical.

So far, Bennett’s body has not rejected the pig heart, which experts said is the biggest concern after a transplant.

Xenotransplantation, transplanting animal cells, tissues or organs into a human, carries the risk of triggering a dangerous immune response, which can cause a “potentially deadly outcome to the patient,” according to University of Maryland Medicine.

“It is a game-changer,” Dr. Muhammad Mohiuddin, professor of surgery at the University of Maryland School of Medicine, who oversaw the transplant procedure with Griffith, said. “We have modified 10 genes in this in this pig heart. Four genes were knocked out, three of them responsible for producing antibodies that causes rejection.”

Mohiuddin and Griffith said they are now closely monitoring Bennett to make sure his body continues to accept the new heart.

“He’s awake. He is recovering and speaking to his caregivers,” said Griffith. “And we hope that the recovery that he is having now will continue.”

Speaking of the possibility of rejection, Griffith added, “The pig heart will be attacked by different soldiers in our body, different immune players can take it out and we have designed a treatment plan, in addition to the humanized, genetically-edited heart, to try to account for that.”

Bennett’s son, David Bennett, Jr., told “Good Morning America” the transplant provided his father a “level of hope.”

“Hope that he could go home and hope that he could have the quality of life that he’s so much desired,” Bennett, Jr said. “He’s in a much better place and a much happier place right now following this transplant procedure. He is happy with where he is at. Happy with the potential to get out of the hospital.”

While the type of transplant Bennett received is groundbreaking, experts said it does not minimize the ongoing need for human organ donations.

Around 110,000 people in the United States are on the organ transplant waiting list, and more than 6,000 patients die each year before getting a transplant, according to the Department of Health and Human Services.

“Whether it’s 3-D printing or growing organs in a lab setting or donations, we desperately need more organs,” said ABC News chief medical correspondent Dr. Jennifer Ashton, a board-certified OBGYN.

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Nursing homes struggle with low booster rates, staffing issues as omicron spreads

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(NEW YORK) — As the omicron variant causes a surge in coronavirus cases, many long-term care facilities are facing challenges not seen in months, officials from around the country tell ABC News.

Many nursing homes are struggling with low booster rates and a growing staffing crisis, said industry executives and health care advocates.

“Nursing homes are on high alert right now,” said Terry Fulmer, president of the John A. Hartford Foundation, a nonprofit that works to improve care for older adults. “Omicron is highly transmissible and is spreading through communities like wildfire.”

In the week ending Jan. 2, nursing homes and long-term care facilities reported close to 15,000 cases across the country, three times the infection rate from just a month ago when facilities were reporting under 5,000 cases, data released by the Centers for Disease Control and Prevention shows.

Cases among staff members have shot up at an even higher rate, with facilities reporting upwards of 34,000 cases in the week ending on Jan. 2, compared to just over 5,600 a month ago.

In Sussex County, New Jersey, the National Guard was deployed last week to assist nursing home staff with infection control protocols and other duties as multiple facilities saw COVID-19 outbreaks.

“The staff at these facilities have been particularly hard hit by the latest COVID variant,” County Commissioner Anthony Fasano said in a statement. “We believed it was prudent to get them the help they needed before there was a crisis.”

In California, after more than 5,000 new cases were reported in skilled nursing facilities, the state’s public health officer, Tomas Aragon, announced that boosters will be mandatory for health care works and that visitors will require additional testing.

According to the CDC data, the recent spread of the virus among long-term care residents is occurring primarily among unvaccinated and twice-vaccinated residents, while the infection rate remains low for residents that have received a booster shot.

For most adults, two doses of currently authorized COVID-19 vaccines dramatically reduce the risk of being hospitalized or dying of the virus. But elderly adults, whose immune defenses fade with age, may still be at higher risk of serious illness from COVID-19, especially if it’s been more than five months since their last shot.

As of Jan. 2, more than 87% of residents at nursing homes nationwide had received two shots, and nearly 62% had been boosted, according to the CDC data.

For industry advocates, increasing the number of residents and staff getting boosters is a priority.

“We have been urging long-term care providers to get ready and to get ahead of the surge by ramping up their booster efforts,” said Cristina Crawford, a spokesperson for the American Health Care Association/National Center for Assisted Living.

Hartford told ABC News that she’s especially concerned that the rate of booster shots among staff is lagging behind.

“We have to increase our efforts to get boosters into the arms of both residents and staff,” she said.

In Ohio, where around 40% of nursing home staffers remain unvaccinated and the 21-day case average is above 14,000, omicron has “exacerbated” the growing staffing crisis, said Pete Van Runkle, executive director of the Ohio Health Care Association.

“Cases in long-term care in Ohio are about four times as many with omicron as during the height of delta,” Runkle told ABC News.

“The biggest problem with the incredibly high transmissibility is staff missing time from work,” he said.

The good news, said Runkle, is that despite the rising number of cases, nursing homes are reporting “very few” COVID-related deaths compared to last winter’s surge.

Across the country, death rates among long-term care residents and staff have remained flat throughout the spread of omicron. Nationally, facilities have reported 405 deaths among residents in the week ending Jan. 2, compared to 485 deaths in the week ending Dec. 5, according to data released by the CDC.

Pennsylvania state Health Care Association CEO Zach Shamberg said the good numbers are the result of a multi-pronged approach.

“This is a complete 180 from what we have seen last year and is a credit to providers and front-line workers who are doing everything they can to mitigate the spread of the virus now that they better understand the virus, have PPE and tests, and most importantly, access to a vaccine and boosters that help provide an additional level of protection for residents and workers,” Shamberg said.

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San Francisco reducing COVID testing hours because of staff shortages

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(SAN FRANCISCO) — The San Francisco Department of Public Health said it is reducing hours at some COVID-19 testing sites due to staffing shortages.

The decision comes despite warnings from experts about the importance of COVID testing to keep up with the surge of the highly transmissible omicron variant.

“On Monday, some SFDPH-affiliated sites will temporarily reduce testing hours due to challenges beyond our control,” the department tweeted Sunday. “Please check your health system first for testing. Do not go to the ER for tests.”

In a statement released Monday, SFPDH said it expects testing capacity will only be reduced “by about 4%, or approximately 250 tests per day out of the current 7-day average of 6,000 tests per day at SFDPH-affiliated sites.”

Additionally, only four sites are being impacted by reduced hours and the department insists the change is temporary.

It’s unclear how many workers are out sick. San Francisco Mayor London Breed revealed last week that more than 400 city employees were out due to either COVID-19 infections or isolation after potential exposure.

It comes as San Francisco is recording an average of 1,245 new cases per day, which is the highest ever since the pandemic began and a 1,600% increase from one month ago, city data shows.

Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco, told ABC News he is worried the reduced hours will mean that COVID-19 cases are missed.

“It’s going to have a terrible impact,” he said. “It reminds me of early March 2020 when we didn’t have enough testing. Of course we have a lot more tests numerically, but the proportion seems to be the same because the percentage of those needing testing is definitely not met by the number of available tests.”

Matt Haney, a member of the San Francisco Board of Supervisors, said reducing the hours of operation at COVID-19 testing sites is unacceptable.

“It was already hard to get a test in San Francisco and now it just got harder and that’s unacceptable,” he told ABC News. “Our department of public health had expanded capacity at a number of sites. But it wasn’t enough. Now they’re cutting back because of staffing shortages.”

Testing capacity has been stretched to an all-time high, according to SFDPH.

Haney, however, argued that testing sites need to make sure they are consistently meeting demand.

“The level of demand for tests exceeds anything we had seen,” he said. “Health officials also feel the private providers need to do more testing. I think all of those things are true, yet our residents need our public health department to step up and get the job done.”

Haney wants to call a hearing on testing to get more answers on why it’s been so difficult for residents to get tests.

“You may have heard that people are calling 911 to get tested,” he said. “When people get exposed or they’re not feeling well, if the county tells them go to get a test and then they can’t get tested, that’s freaking them out and they’re calling 911 — and our 911 lines are overwhelmed because what people are being told to do can’t be done.”

There are ways to prevent the staffing shortages from having a large impact, according to Chin-Hong, such as deploying the National Guard to sites, which Gov. Gavin Newsom did over the weekend.

“There are also some creative strategies like utilizing student volunteers who are in health professions, like medicine, nursing, pharmacy, to go out,” he said. “They have some medical background. It’s kind of an all hands on deck perspective. It doesn’t take a lot of training to do a swab; people do that at-home after all.”

He also recommended that testing sites become more diverse and be expanded to offices, community centers and banks.

 

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US hospitals strained with influx of patients amid latest COVID-19 surge, staffing shortages

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(NEW YORK) — Explosive COVID-19 surge strains hospitals and schools around the nation
The number of hospitalized Americans who are positive for COVID-19 soared to more than 138,000.

For nearly two years, day after day, under exhausting and often dangerous conditions, health care workers across the country have continued to care for the nation’s sickest Americans who have fallen victim to coronavirus.

As the highly infectious omicron sweeps through the country, the United States is now facing its most significant coronavirus infection surge to date, putting additional pressure on an overtaxed health care system.

“We have seen an incredible proliferation of the virus in hospitals, such that we went from a place where virtually no county in the country was at risk of exceeding its capacity to well over half are now. I don’t like to make predictions, but things could get very bad in the coming couple of weeks,” Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital in Boston, told ABC News.

Although preliminary global studies indicate that the omicron variant may cause less severe illness than prior variants, health officials say that the sheer numbers of infections caused by the new variant could still overwhelm the health care system.

The burden on the health care system is made worse by nationwide staffing shortages and hospital capacity at elevated levels as many other patients seek care for non-virus related reasons.

“Due to the tsunami of omicron cases, the volume is affecting our health and community service,” said Dr. Rebecca Weintraub, assistant professor of Global Health and Social Medicine at Harvard Medical School. “While we are very lucky hospitalizations have decoupled, the vast spread is alarming.”

Late last month, Dr. Anthony Fauci, chief medical adviser to the White House, pointed to the disparity between cases and hospitalization as a “strong” indicator that omicron is less severe, as the U.S. has not experienced a concomitant increase in the relative percentage of hospitalizations.

Even so, Fauci warned that there will still be many virus-positive Americans who will seek medical care, creating further strain on hospitals.

“Even if you have a less of a percentage of severity, when you have multi-multi-multi-fold more people getting infected, the net amount is you’re still going to get a lot of people that are going to be needing hospitalization. And that’s the reason why we’re concerned about stressing and straining the hospital system,” Fauci told ABC News’ George Stephanopoulos during an appearance on This Week, earlier this month.

Experts say the baseline for hospitalizations is already higher than it was a year ago, with hospitals described by some experts as “relatively quiet” last winter for ailments other than COVID-19, which provided a “much bigger buffer zone,” to care for the most critically ill. In addition, hospitals were already struggling with patients from the delta wave.

“We entered this wave, with hospitals at a higher capacity than they were in previous waves, from non-COVID [health issues],” Faust explained. “That’s the real problem.”

Highly localized surges a pain point for many communities

An ABC News analysis of federal data found that in recent weeks, total hospitalizations — COVID-19 and non-COVID-19 related — have seen an uptick. The number of COVID-19-positive Americans who are hospitalized is now nearing a pandemic high, with more than 138,000 Americans hospitalized, and an average of 17,000 being admitted to hospitals each day.

Most of the patients who are requiring intensive care are still unvaccinated, according to top health officials, including U.S. Centers for Disease Control and Prevention Director Rochelle Walensky.

Experts say there is no overarching experience for how COVID-19 is now affecting the country, as surges are asymmetric, and the impact of COVID-19 will look different for every community.

“Ground conditions matter beyond belief,” Faust said, explaining that while one area can see an uptick in COVID-19 infections, hospitals may not become overwhelmed, because they have adequate staffing or a highly vaccinated and younger population, hospitals in other areas with lower vaccination rates and fewer resources could find themselves completely overwhelmed.

“There are places where incidental infection is a higher proportion of admissions than others. The reverse is true in other areas. And there are places with higher vaccination rates than others. When an unvaccinated person gets admitted to the hospital, they are going to be sicker and require more care and take up more resources. Every place is different,” Faust added.

Even within a state, the timing of surges is also highly localized, experts say, varying by areas and even by hospital. Thus, even if hospital capacity nationwide or on the state level looks relatively stable, “micro surges,” seen in individual facilities or communities may still be occurring and threatening care.

Even virus-positive patients who are not admitted primarily for COVID-19 are adding a strain

Nationwide, it remains unclear as to how many patients are being admitted to the hospital for coronavirus-related care, and how many patients are coincidentally tested positive for the virus, after they were admitted for other reasons and subsequently checked for positivity as a routine check.

In New York, state officials reported on Friday that 42% of COVID patients were admitted for non-COVID reasons, and in Florida, Gov. Ron DeSantis cited data from three of the state’s major hospitals, which reported that half, or more, of their COVID-19 positive patients are getting treated for other conditions, not the virus.

However, some experts and hospital officials have cautioned that the proportion of patients seeking care specifically for COVID-19 likely varies widely community by community. In addition, health officials say a COVID-19 diagnosis can cause additional strain on a health system, as virus-positive patients in many hospitals are required to be treated differently.

In a series of tweets last week, Dr. Ashish Jha, dean of the Brown University School of Public Health, stressed that both patients “with COVID-19” and those admitted “for COVID-19,” have an impact on care, utilization, and can stress the health care system.

Patients, who may have come in for another ailment, such as a broken leg, and are found to be positive for the virus must stay in a COVID-19 isolation room, explained Jha, who added that there are already a limited number of such rooms available.

In addition, every time a health care worker enters a room with a COVID-19 positive patient, they must be wearing full PPE, which in turn, prolongs wait times for many patients.

“Admissions with COVID is still very disruptive to the health care system, at a time when it can’t afford more disruption,” Jha said.

Federal data shows the emergency department visits with diagnosed COVID-19 cases are currently at their highest point of the pandemic — a figure that has more than doubled over the last month.

“People are in the ER for hours and days, creating gridlock for new patients that need emergency services every day,” said Dr. Jay Bhatt, an internist and adjunct faculty at the UIC School of Public Health and an ABC News Med Unit contributor.

Other hospital officials have noted that even if patients are admitted for a reason other than COVID-19, a COVID-19 infection on top of another condition may only exacerbate an individual’s original illness.

At Cincinnati Children’s Hospital Medical Center, hospital officials told ABC News that they have seen their COVID-19 positive patient totals “skyrocket” in recent weeks. Some of these patients happen to test positive while admitted for other concerns, while others are primarily sick with COVID-19.

“Even the children who are not admitted primarily for COVID have hospital courses that are further complicated because of COVID. Having cancer, heart issues, appendicitis, and COVID is never a good thing,” one hospital representative said.

A growing shortage of hospital staff ‘wreaking havoc’ on the health care system

Surge after surge, nurses, doctors and respiratory technicians have led the fight against the virus, many forced to leave their families for weeks to months at a time in order to avoid a total collapse of the health care system during the pandemic.

Since the onset of the pandemic, the already existing staffing shortage has only grown worse, and now experts say they are concerned there will not be enough front-line workers to care for the influx of patients in need as many of them are forced into isolation and quarantine after testing positive.

“I am worried we don’t have enough health care workers to care for patients flooding hospitals,” said Bhatt. “[The] unprecedented numbers of sick clinical staff [are] wreaking havoc on hospitals and health systems as they do their best to care for patients in this current surge. I have not seen a workforce issue as serious as this, and is deeply concerning.”

As of January 2022, there have been at least 819,000 coronavirus cases among health care personnel, and more than 3,100 virus-related deaths.

Late last month, the CDC shortened the isolation time for COVID-19-positive health care workers in anticipation of the potential shortages that might occur amid the latest surge.

Many health care workers say they are exhausted as they train to keep their facilities running.

“There are wait times in the emergency department that are running six to eight hours, in the trauma center. [In the] emergency room sometimes it runs greater than 24 hours. So you know we … the nursing staff is tired, we have burned out. We’re working 12- to 14-hour shifts, on Sundays up to 16-hour shifts,” Thomas Mapplebeck, a nurse in the Emergency Department at Baystate Health told ABC News.

Staffing shortages are also preventing some people from receiving the critical care they need, added Bhatt, who said that some patients in need of hospice are struggling to receive placement because of the shortages.

The unknown of what’s to come

Many health officials and experts have tried to forecast what Americans can expect from the virus in the months and weeks to come, and when COVID-19 will finally enter an endemic phase. However, Faust explained he is reluctant to make predictions as there is still so much unknown surrounding the virus.

“Five weeks ago, we’d never heard about omicron because it didn’t exist as far as we know, and now we were in the worst part of this pandemic,” Faust said.

With many younger Americans becoming infected, Faust said it is possible intenstive care unit bed capacity may not be overrun. It is also possible the virus could reach the millions of Americans who are still unvaccinated, as well as many at-risk people who remain vulnerable for severe illness.

An additional roadblock for some hospitals has been delays in returning patients to nursing rooms, further exacerbating the shortage of beds.

“Patients who are ready for discharge are having trouble getting back to long-term care, nursing home facilities, short-term rehab and home without social support as resources are strained and this creates a logjam that strains the system and workforce even further,” Bhatt said. “We can’t have situations where we are having trouble getting patients back to the community so that others that really need hospital care can get it. We can and need to do better.”

The worst-case scenario, said Faust, will be if nursing homes see significant spikes.

“If that happens in places that are already on the edge, we will see horrifying scenes that we’ve been warning against for a long time,” Faust said.

Health officials have stressed it will be critical for Americans to modify their behavior by wearing masks, avoiding mass gatherings and getting vaccinated.

“I hope people can do their part to get vaccinated, decrease the number of people who need hospital beds so that these other folks who are really sick have a chance to get the care that they need,” said Dr. Jeff Pothof, an emergency medicine physician at UW Health in Madison Wisconsin. “It’s really bad right now,” he added.

Benjamin Rader, a research fellow at Boston Children’s Hospital, contributed to this report.

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CDC warns about rabies linked to bats after three Americans die in recent weeks

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(ATLANTA) — The Centers for Disease Control and Prevention issued a warning Thursday about the risk of rabies after three Americans — including a child — died from the disease over a six-week period last year.

All three patients contracted rabies after being exposed to bats.

This brings the total number of rabies cases in 2021 to five, which officials say is concerning considering there were no cases reported in the U.S. in 2019 and 2020.

“We have come a long way in the United States towards reducing the number of people who become infected each year with rabies, but this recent spate of cases is a sobering reminder that contact with bats poses a real health risk,” Dr. Ryan Wallace, a veterinarian and rabies expert in the CDC’s Division of High-Consequence Pathogens and Pathology, said in a press release.

The deaths occurred between Sept. 28, 2021 and Nov. 10, 2021 with one case each in Idaho, Illinois and Texas, according to a report published by the CDC.

Two of the deaths were described as “avoidable exposures.” One involved a bat roost in a person’s home and the other involved a patient picking up the bat with bare hands.

None of the three patients, all male, received post-exposure shots that can prevent the rabies virus from infecting a person and causing symptoms to develop.

According to the CDC, one patient refused the shots due to a “long-standing fear of vaccines” and the other two did not realize they were at risk for rabies due to their exposures.

Once a person starts to develop rabies symptoms, which include fever, vomiting, difficulty swallowing, confusion and hallucination, it means the disease has progressed to the point where it is almost 100% fatal.

All three patients died between two and three weeks after their symptoms began.

In its report, the CDC suggested that the uptick in rabies deaths is because people may not be aware of the risks of the disease.

The CDC also warned people to never touch or handle bats, which are the leading cause of rabies in people — accounting for 70% of infections in the U.S. Raccoons, skunks, and foxes are other common causes in the U.S.

Infected bats spread the virus through their saliva, typically from a bite. However, the saliva can also enter the body through a cut or break in the skin.

If a person has come into contact with a bat, the CDC recommends calling the state or local health department so the animal can be trapped for testing. They should also immediately wash wounds with soap and water

The person should also not delay speaking to a health care professional or seeking urgent medical to determine whether or not they need post-exposure shots. Post exposure shots are highly effective in preventing death if given soon after exposure.

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Only 1 in 10 adults eating enough fruits and vegetables, CDC finds

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(ATLANTA) — Most American adults are not getting enough of their fruits and vegetables, according to a new study from the Centers for Disease Control and Prevention, with even greater disparities found for those living in poverty.

The report, published Thursday, found that only 10% of adults are eating the recommended daily serving of vegetables, and slightly more — 12.3% — are consuming enough fruit.

The recommendations are based on dietary guidelines from the U.S. Department of Agriculture and Health and Human Services, which advise that adults incorporate 2 to 3 cups of vegetables and 1 1/2 to 2 cups of fruit into their diet each day. Eating sufficient fruits and vegetables “can help protect against some chronic conditions that are among the leading causes of mortality in the United States,” the study noted.

Researchers identified notable regional and demographic differences.

Some 16% of Connecticut adults met fruit recommendations while only 8% of West Virginia adults did. Meanwhile, 16% of Vermont adults met fruit recommendations but only 6% of Kentucky adults did.

Women met the recommendations more often than men, while people over 50 met them more often than their younger counterparts, researchers found. Additionally, Black people reached the vegetable goal less often than white or Hispanic people.

Those living below or close to the poverty level were the least likely to meet vegetable recommendations, at 6.8%, the study found.

“Additional policies and programs that will increase access to fruits and vegetables in places where U.S. residents live, learn, work, and play, might increase consumption and improve health,” the study stated.

The study was conducted through the Behavioral Risk Factor Surveillance System, which has been collecting information on American fruit and vegetable consumption for over 30 years, and included 294,566 participants.

The survey included data from 2019, before the start of the COVID-19 pandemic. The researchers noted that barriers to healthy foods, such as cost and limited availability and access, “might have worsened during the COVID-19 pandemic.”

Among its recommendations, the CDC advised that states and communities can support community retail programs “to attract grocery stores and supermarkets to underserved communities to improve community food quality,” as well as promote participation in federal nutrition assistance programs that help low-income people buy healthy foods.

Pandemic-related supply chain issues have particularly impacted people in food deserts, Geri Henchy, director of nutrition policy for the Food Research & Action Center, told ABC News.

“People who live in communities that had issues around the availability of quality, affordable produce, those issues have gotten worse during COVID because of the supply chain problems,” she said.

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Henchy also agreed that promoting participation in federal food assistance programs, such as the Supplemental Nutrition Assistance Program, or SNAP, and the Special Supplemental Nutrition Program for Women, Infants and Children, or WIC, will be key, especially after boosts to both during the pandemic.

This past fall, the average SNAP benefit increased by $36.24 per person each month, and the government extended increased fruit and vegetable WIC benefits through March. Those measures should have a positive impact on food and vegetable consumption, though “of course we have a lot of people who are eligible who aren’t in the programs,” said Henchy.

Just over 80% of eligible Americans participate in SNAP, while about half of those eligible for WIC participate, according to the most recent federal data.

ABC News’ Sony Salzman contributed to this report.

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What to know about ‘flurona’

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(NEW YORK) — In the midst of a new pandemic surge, another seemingly new ailment is now grabbing headlines: flurona.

Despite the catchy name, “flurona” is not new. It is a term coined to describe what happens when a person tests positive for the flu and COVID-19 at the same time.

“Both are common, so it is not unexpected that some people would be infected at the same time,” said Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center in Boston.

Flurona is not a new disease, experts stress, nor is it a new variant of COVID-19. The flu virus and COVID-19 virus are from two very different virus families. Scientists are not concerned about the two viruses mixing to create a new virus.

There are many different types of viruses that are capable of infecting people. Viruses that cause the flu and COVID-19 are two examples, but there’s also HIV, the chicken pox virus, rabies virus, the common cold and many others.

It has always been possible for one person to be infected with two or more different viruses at once. And with flu season coinciding with a new COVID-19 surge, there’s a greater chances that a handful of people will test positive for both viruses at the same time.

Doctors call these instances co-infections. Though uncommon, last year’s flu season also saw a handful of cases of flu and COVID-19 in the same person at the same time.

“It has not been a big issue for us because of the low levels of influenza circulating in the community,” Dr. Jonathan Grein, director of Hospital Epidemiology at Cedars-Sinai Medical Center in Los Angeles, told the hospital’s website. Cedars-Sinai said it had recently seen one mild case of the co-infection.

“It’s obviously not good to be infected with two viruses rather than one, but there’s no clear indication that this is a particularly bad combination,” Grein added.

With the flu and COVID circulating at the same time, people can reduce the risk of becoming severely ill with either virus by getting vaccinated against the flu and COVID, wearing a mask in crowded spaces and washing your hands.

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Staff shortages from COVID forcing some health care facilities to limit services

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(NEW YORK) — As U.S. COVID-19 cases continue to surge, some health care facilities have been forced to shut down facilities or departments as staffing shortages worsen.

Holy Cross Health in Fort Lauderdale, Florida, was forced to close labor and delivery units, while keeping open, at least for now, NICU and postpartum units.

“Holy Cross Health has reached critical staffing levels in Labor and Delivery,” the hospital said in a statement to ABC News. “In the best interest of patient safety, the Labor and Delivery unit is on diversion until further notice.”

The Centers for Disease Control and Prevention updated guidance last month for health care workers, reducing their isolation periods to align with “understanding of the disease trajectory,” which affected staffing measures.

Three Aurora Urgent Care facilities in Wisconsin were forced to close last week until at least Jan. 26.

“Managing the COVID surge combined with staffing shortages have contributed to temporary closures at three lower volume urgent care centers in Menomonee Falls, Brookfield and on River Center Drive in Milwaukee,” a representative for Advocate Aurora Health told ABC News in a statement. “This allows those team members to be deployed to busier urgent cares in the area. All other non-urgent care services offered at these three facilities are currently open.”

Pulaski Memorial Hospital in Indiana also told ABC News it’s closing its OB/Maternity department in mid-January due to staffing shortages.

“With so few maternity nurses available, our medical staff and senior leadership felt it best to close the OB/Maternity Department instead of trying to operate at less than optimal staffing levels,” hospital CEO Tom Barry said in a statement. “Over the past several months, we have had significant difficulty recruiting additional staff to our OB/Maternity Department in order to maintain the high-quality standards that all patients deserve and expect from PMH.”

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