(NEW YORK) — As evidence mounts that the omicron variant is less deadly than prior COVID-19 strains, one oft-cited explanation is that viruses always evolve to become less virulent over time.
The problem, experts say, is that this theory has been soundly debunked.
The idea that infections tend to become less lethal over time was first proposed by notable bacteriologist Dr. Theobald Smith in the late 1800s. His theory about pathogen evolution was later dubbed the “law of declining virulence.”
Simple and elegant, Smith’s theory was that to ensure their own survival, pathogens evolve to stop killing their human hosts. Instead, they create only a mild infection, allowing people to walk around, spreading the virus further afield. Good for the virus, and, arguably, good for us.
But over the past 100 years, virologists have learned that virus evolution is more chaotic. Virus evolution is a game of chance, and less about grand design.
In some cases, viruses evolve to become more virulent.
Continued virus survival, spread and virulence are all about the evolutionary pressures of multiple factors, including the number of people available to infect, how long humans live after infection, the immune system response and time between infection and symptom onset.
Unfortunately, that means it’s nearly impossible to predict the future of the pandemic, because viruses don’t always evolve in a predictable pattern.
There have been thousands of identified COVID variants, each with unique mutations. But most new variants emerge and then quickly die out, unable to compete with the reigning dominant variant.
Some variants, however, have clear “advantages to continued survival, such as those that evade the immune system and spread easily,” said Dr. Abir Hussein, associate medical director for infection presentation and control at University of Washington Medical Center.
Experts warn that it is important to assess the severity of omicron in the context of existing immunity through vaccines and prior infections.
“It is difficult to determine with new variants like delta and omicron if variants are evolving to be more or less virulent. This is because these variants emerged at a time when we had a good deal of immunity to SARS-CoV-2 in certain countries,” said Andrew Pekosz, a professor of microbiology at Johns Hopkins University Bloomberg School of Public Health.
People who are vaccinated or recently infected will have milder symptoms if they experience a breakthrough infection or a reinfection, studies show.
“This is not because the variant is less virulent, but because your immune system was primed from prior vaccination and infection,” said Pekosz.
Experts say omicron should not be taken lightly or thought of as a less lethal form of COVID. Even if less deadly, the omicron variant is also significantly more transmissible, leading to more deaths overall.
The U.S. Centers for Disease Control and Prevention predict that 22,000 more people could die of COVID-19 over the next two weeks.
People who are unvaccinated remain significantly more at-risk, with officials estimating they are 17 times more likely to be hospitalized and 20 times more likely to die of COVID-19 compared to people who are vaccinated.
“The available COVID vaccines provide immunity for a range of variants and continue to be the first line of defense,” said Dr. John Brownstein, chief innovation officer at Boston Children’s Hospital and an ABC News contributor.
As for the future of the pandemic, experts say new variants may emerge in the future, but they won’t be easy to predict.
Jess Dawson, M.D., a masters of public health candidate at Johns Hopkins Bloomberg School of Public Health, is a contributor to the ABC News Medical Unit.
Ben Hasty/MediaNews Group/Reading Eagle via Getty Images
(NEW YORK) — High school athletics are feeling the impact of the omicron surge, from paused games to restricted fans, amid a winter season that coaches and administrators already anticipated would pose challenges for indoor, close-contact sports.
Amid record COVID-19 cases in the U.S., schools are revisiting coronavirus protocols and guidelines to safely keep students playing in person. Teams have had to limit out-of-state travel due to transmission risks, or postpone in-league games due to cases. The Los Angeles school district, the second largest in the country, returned from winter break in person this week with a pause on all sports competitions due to surging cases.
Despite omicron, school officials are optimistic districts won’t experience the same level of disruption as last school year — when some programs saw abbreviated seasons, if any at all — thanks to measures like vaccination and social distancing.
“It has not risen to the level that high school sports across the nation are being disrupted to the point where they can’t go on,” Karissa Niehoff, executive director of the National Federation of State High School Associations, the national leadership organization for high school sports and performing arts activities, told ABC News. “There’s never been an expressed need for shutdown because people know how to deal with it now.”
Readjusting schedules and protocols
Before the Los Angeles Unified School District returned to the classroom Tuesday following winter break, more than 65,000 public school staff and students had tested positive for COVID-19, for a positivity rate over 14%, according to district data. The school district temporarily paused all athletic competitions this week as it monitors cases, with student athletes allowed to practice outdoors while wearing a mask.
The district is also using this week to upgrade its health and safety protocols to be in compliance with stricter protocols from the county health department. Teams with four or more linked cases over a 14-day period are now required to suspend activities for a week.
“We will reevaluate our data and determine next steps before the end of the week,” the district said in a letter sent to families. “Our goal is to resume athletic competitions as soon as possible.”
As of Wednesday, the district did not have an update on its plans, a Los Angeles Unified spokesperson told ABC News.
Other entities have revised protocols amid the surge. In Washington state, all athletes and team personnel in high-risk sports are required to have regular COVID-19 testing regardless of vaccination status “in response to recent sports-related outbreaks,” health officials said. Testing frequency was also increased to three times weekly. Previously, schools were testing unvaccinated students twice a week.
The revised rules came after the state health department traced 200 COVID-19 cases to multiple wrestling tournaments in early December.
In Portland, Oregon, the school district made several changes to its COVID-19 protocols through at least early February to help stem the spread of the virus, including requirements that student-athletes wear masks at all times. For competitions, spectators ages 5 and up also now must show proof of being fully vaccinated or a negative COVID-19 test within 72 hours.
Some schools have recently restricted the number of fans who can be in attendance. In Oahu, spectators are not allowed until further notice “based on the rising number of COVID-19 cases,” the Hawaiian island’s school sports association said.
In Fairfax County, Virginia, school officials are limiting crowds to just family members through Jan. 21 due to the uptick in cases in the community.
“The health department had anticipated the surge, and we’ve taken appropriate measures to try to limit as much of an impact as far as the spread of the virus,” Bill Curran, director of athletic programs for Fairfax County Public Schools, told ABC News.
Successes and challenges
Mitigation strategies have helped keep sports in play with only minor disruptions this year, Niehoff said. The measures have included protocols “big and small,” from widespread vaccination efforts to having multiple, sanitized basketballs at the ready during games, digital ticketing and concessions and frequent communication when potential postponements arise.
“If you’ve got a healthy school and then a school that can’t play, the healthy school goes and finds another healthy school and we get the game on,” she said. “We’ve been creative and supportive and a little safer, because we have a better idea of what we’re dealing with.”
Schools have gotten accustomed to being flexible during the pandemic, though it’s not without its challenges.
In New York City, sports programs this school year have had to react to evolving protocols around vaccination requirements, spectators and travel while seasons were about to start or underway.
For Shawn Mark, head coach of the South Shore boys’ basketball team in Brooklyn, limits on traveling to competitions outside the city have “hurt us.”
“To be the best you got to play against the best,” Mark told ABC News. “Sometimes it’s not always in New York City, you got to go out of town.”
All athletes in the New York City public school system — the largest in the nation — are required to be vaccinated in order to play.
The city’s public school enrollment has also dropped by about 17,000 students this year, according to preliminary data — posing another challenge as athletes have left the public school system or the city altogether, Mark said.
“They want to play, they don’t want any risk of what happened before, where a shutdown happens and then, you know, the season’s over,” he said.
Despite a couple postponements, Mark is optimistic that this season will continue.
Niehoff doesn’t expect schools to see the same level of disruption as last school year, as long as states and districts continue to exercise caution and vaccination numbers trend up.
“We are hearing a success story, obviously concerns as they arise, but they tend to be remediated pretty quickly,” Niehoff said.
Curran is “cautiously optimistic” as cases appear to be quieting down. After playing abbreviated schedules last school year, the school district has returned to its regular sports seasons.
“We are able to offer our program in a pretty meaningful way,” Curran said, noting that the impact on students’ overall health and well-being has been “phenomenal.” “We’ve seen some cancellations of games here and there throughout, but for the most part we’ve been able to keep things moving.”
(NEW YORK) — The U.S. is facing a national blood crisis, the “worst blood shortage in over a decade,” the American Red Cross warns. Despite this urgent need for donations, people who have sex with gay or bisexual men are still facing restrictions on their ability to give blood.
The Food and Drug Administration bars people who have had sex with gay or bisexual men from donating blood for three months following the most recent sexual contact because of fears of HIV in the blood supply.
The agency changed the deferral period from 12 months to three months in November 2020 as blood donations fell and hospitals faced critical shortages during the first year of the COVID-19 pandemic.
Some advocates, including the HRC, say the FDA is moving too slowly on removing the restriction, saying that it’s an outright ban on the ability of people, particularly gay and bisexual men, to donate blood.
“Just like other individuals throughout the country, many people have sex on a regular basis, including with partners and spouses,” said Sarah McBride, the press secretary of the LGBTQ advocacy organization the Human Rights Campaign.
“It really amounts to being an effective ban, based on a person’s identity rather than an actual factor on the science,” she added.
In 2015, the guidance changed from a lifetime ban to a 12-month deferral, and the FDA determines the guidance used by all U.S. blood collection organizations.
Restrictions on blood donations from gay and bisexual men, who are considered to be at high risk for HIV or AIDS transmission, date back to the 1980s.
Gay and bisexual men undergo individual risk assessments instead of time-based bans in countries around the world, recently including Greece and France, according to international reports. Italy, Israel, and several other countries have similar requirements.
In 2020, ABC News broke the story that several major blood donation organizations — including the American Red Cross, Vitalant, and OneBlood — announced that they are working together to study and provide data to the FDA to determine if eligibility based on an individual’s risk can replace the current time-based deferral system while maintaining the safety of the blood supply.
Vitalant told ABC News in a new statement that researchers are halfway toward its goal of enrolling 2,000 participants across eight cities: Washington D.C., San Francisco, Orlando, New Orleans/Baton Rouge, Miami, Memphis, Los Angeles, and Atlanta. They encourage gay and bisexual men who are 18 to 39 years old to participate in the research.
The FDA, in a statement to ABC News, said that this study could generate data that will help the agency determine if a donor’s individual risk assessment and questionnaire would be just as effective in reducing the risk of HIV in the blood supply as the time-based deferrals the FDA already has in place.
The FDA also said it does not have a specific timeline for when these studies will be completed but that it is “committed to gathering the scientific data that can support alternative donor deferral policies that maintain a high level of blood safety.”
The America Red Cross said that there is no clear data that would suggest that changing this blood donation policy would significantly increase the number of blood donations, but the organization says it does not intend to discriminate against the LGBTQ community.
“We believe blood donation eligibility should not be determined by methods that are based upon sexual orientation and we’re committed to achieving this goal,” the American Red Cross said in a statement to ABC News.
However, according to the organization, doctors are now being forced to decide which patients receive blood transfusions and who is forced to wait due to the shortage. The organization says that “a lack of blood and platelet donations are critically needed to help prevent further delays in vital medical treatments.”
“Donors who are excluded solely on their membership in a group … doesn’t encourage safe sexual behaviors in the integrity of the population,” McBride, from HRC, said. “We want people to be engaged in safe sex practices. And we want to ensure that our blood supply is safe and sufficient.”
ABC News’ Tony Morrison contributed to this report.
(NEW YORK) — Kids who have recovered from COVID-19 may have an increased risk of developing diabetes, according to a new study from the Centers for Disease Control and Prevention.
The study, which looked at databases with information for over 2.5 million patients under 18, found that children diagnosed with COVID-19 were about 2.5 times more likely to receive a new diabetes diagnosis a month or more after infection.
The health care data, taken from the first full year of the coronavirus pandemic, showed that other, non-COVID-related infections were not found to be associated with increased risk of diabetes diagnosis, leading researchers to look for reasons for this possible link between COVID and diabetes diagnoses.
A possible link between COVID-19 and an increased risk of diabetes has also been found in adults. In June, two studies were released that showed the virus’s ability to infect pancreatic beta cells, decrease insulin secretion and effectively yield Type 1 diabetes.
In Type 1 diabetes, the body completely stops making insulin, requiring daily insulin injections, via shots or an insulin pump, to stay alive.
In Type 2 diabetes, the body continues to make insulin but develops insulin resistance, meaning the cells do not respond to insulin correctly.
The CDC’s new study on children ages 18 and under, released Friday, included cases of both Type 1 and Type 2 diabetes in its analysis.
The new concern for kids comes as the United States continues to see its most significant COVID-19 infection surge yet, which is heavily impacting children.
Last week alone, 580,000 children tested positive for COVID-19, nearly three times more than two weeks prior, according to a weekly report from the American Academy of Pediatrics and the Children’s Hospital Association.
Here are three things for parents to know about kids, COVID-19 and diabetes.
1. Not all kids with COVID will get diabetes.
Sanjoy Dutta, Ph.D., vice president of research for the Juvenile Diabetes Research Foundation, a nonprofit organization focused on Type 1 diabetes research and advocacy, said parents should be aware that the new research shows an association between COVID-19 and diabetes, but does not identify how the virus could or whether it actually does increase the risk of diabetes in kids.
“I would not necessarily go about raising the alarm bell right now that it is increasing Type 1 diabetes,” said Dutta. “There is no mechanism yet to suggest that it is doing it or how it is doing it.”
The study did not include information about who may have had preexisting conditions that could lead to diabetes and did not include laboratory data confirming the new diagnoses.
The study also did not include people without commercial health insurance, which excludes over one-third of children in the U.S.
2. Getting vaccinated remains important.
The study’s findings highlight the importance of getting vaccinated against COVID-19, according to the CDC.
Currently, all children ages 5 and older are eligible to receive the Pfizer vaccine. Children ages 12 and older, and certain immunocompromised children ages 5 to 11, are also now eligible to receive a third dose of the Pfizer vaccine.
Pediatricians say the safety of the vaccine is far more proven than the uncertainty of potential complications from COVID-19 for kids.
“We have never had a vaccine that we’ve ever given, going back 100 years, that long-term suddenly something showed up that didn’t show up within the first two to three or four months,” Dr. Stanley Spinner, chief medical officer and vice president of Texas Children’s Pediatrics and Texas Children’s Urgent Care, told ABC News earlier this month. “So we are very comfortable about the safety long-term of these vaccines.”
“What we don’t know is what the long-term effects of COVID can be to kids, even when they get over it now,” he continued. “Parents need to know that if your child gets COVID and seems to be OK with it, great, but what’s going to happen maybe six months or a year or five years down the road, because we definitely don’t know.”
3. There are warning signs of diabetes to look for.
The CDC is urging parents, pediatricians and caregivers to be aware of the warning signs of diabetes.
Symptoms of diabetes include thirst, hunger, frequent urination, unexplained weight loss, blurry vision and fatigue, according to the CDC.
Dutta added that parents should watch for unusual behavior patterns in their kids.
“Any unusual pattern of change in behavior in a short window of time is what I would look out for as a sign of needing to consult a doctor,” he said. “It’s not intentional, but it’s very easy to overlook some of the signs of a disease.”
Concerned parents should contact their child’s medical provider, or in the case of an emergency, seek immediate help. A delay in diagnosis can lead to diabetic ketoacidosis, a serious complication of diabetes that can be life-threatening, according to Dutta.
A diabetes diagnosis can typically be made through a blood test.
ABC News’ Sony Salzman and Robert Rowe, a resident in the ABC News Medical Unit, contributed to this report.
(ATLANTA) — After weeks of health experts urging Americans to upgrade their masks to protect against the omicron COVID-19 variant, the Centers for Disease Control and Prevention said Wednesday that it was planning to update its mask guidance to “best reflect the multiple options available to people and the different levels of protection they provide.”
In a statement provided to ABC News on Wednesday, the agency said the goal is for Americans to have “the best and most updated information to choose what mask is right for them.”
The move by the CDC would be the first significant update to its mask guidance since last July when it urged all Americans to return to wearing masks, after the delta variant proved so transmissible that research found even vaccinated people could transmit the virus.
While vaccinated people are considered infectious for a shorter period of time than someone who is unvaccinated, and they are considerably less likely to end up hospitalized, the CDC urged everyone to return to masking indoors to prevent community cases from rising.
Since the arrival of omicron, however, health experts have urged caution with the usual cloth masks and cities like Los Angeles and New York have already recommended mask upgrades to their residents.
CDC would not say how soon it planned to update its online guidance, although one administration official said the goal was by week’s end. The Washington Post first reported that CDC was considering the update to its guidance.
Dr. Rochelle Walensky, the agency’s director, told reporters on Wednesday that the overall recommendation won’t change that “any mask is better than no mask” and that a mask should fit well.
The best mask, she told reporters, is “the one you can keep on all day long that you can tolerate in public indoor settings and tolerate where you need to wear it,” Walensky said.
“I recommend you get the highest quality mask that you can tolerate and that’s available to you,” Dr. Anthony Fauci, the nation’s top infectious disease expert and President Joe Biden’s senior medical adviser, told CNN on Tuesday.
One problem with pushing higher grade masks is that they can be costly, harder to find and – in the case of surgical N95s – somewhat uncomfortable to wear. The CDC also warns customers against counterfeit masks that aren’t as effective.
Prior to omicron, Walensky resisted a call for Americans to wear surgical N95 masks for the average American because the agency didn’t want to discourage people from wearing any mask.
Walensky did not wear an N95 mask while testifying on Capitol Hill Tuesday. According to a spokesperson, she wore a disposable mask with a cloth mask on top “to ensure a tight seal.” That would be in keeping with CDC’s current guidance that suggests Americans could opt for two masks for increased protection.
To address the issue of limited supply, the Biden administration says it’s planning to help ramp up production of N95s to make them more available to Americans who want one. Dawn O’Connell, a top official at the Health and Human Services Department, said Tuesday that the government planned to sign a contract within the next month or so that would identify a provider to produce 140 million N95 masks a month.
There are already 737 million N95 masks in the strategic national stockpile available for medical workers.
White House COVID Coordinator Jeff Zients said Wednesday the White House was seriously considering making “high quality masks” available to all Americans, although he did not provide additional details.
ABC News reporter Cheyenne Haslett contributed to this report.
(NEW YORK) — Nearly 2 million new cases of cancer are expected to be diagnosed and some 609,000 people will likely die from cancer in the U.S. in 2022, according to a new report published Wednesday.
The annual report from the American Cancer Society estimates that 1,918,030 Americans will be diagnosed with cancer, equivalent to 5,250 new cases being detected every day. This is up from approximately 1.8 million new cases that likely occurred in 2021.
Both figures — for cases and deaths — are the highest estimates made by the ACS since at least 2007.
Health experts have suggested that people missing cancer screenings and doctor’s appointments due to the COVID-19 pandemic may cause cancer rates to rise in the coming years.
However, Dr. Rebecca Siegel, an epidemiologist at the American Cancer Society and corresponding author of the report, told ABC News that estimates were made based on complete data, which is only available through 2018 for cases and 2019 for deaths.
“We absolutely expect that the pandemic will impact cancer rates because of delays in screenings, and diagnoses because of health care closures, but we were not able to account for that yet,” she said.
She expects future reports will likely reflect the impacts of the pandemic.
Among the findings in the report is that cases of breast cancer have been slowly increasing by about 0.5% every year. In 2022, an estimated 290,560 Americans will be diagnosed with breast cancer, mostly women.
Siegel said this is not because of an increase in screenings that detect the cancer but rather because more women are having fewer children later in life — both of which are linked to an increased likelihood of breast cancer.
“It’s thought to be related to continued declines in the fertility rate, because the higher number of childbirths and the earlier age is protective against breast cancer, and we know that women are having children later and they’re having fewer children,” she said. “So that is likely contributing to this small increase.”
She added that higher body weight also increases the risk of breast cancer and that increasing rates of obesity are likely a contributing factor.
The report also showed disparities when it comes to communities of color. For example, Black women were 40% more likely to die of breast cancer despite having lower rates than white women.
Siegel said this is because minorities have traditionally had less access to high quality health care and that more effort needs to be placed in providing access to disadvantaged communities.
However, the report also had some bright spots. The risk of death from cancer overall has been declining continuously since 1991 with about 3.5 million cancer deaths avoided as of 2019.
“The population-level data seen in this report reflects our experience treating patients. Cancer has become a curable or chronic disease for more Americans,” Dr. Deb Schrag, Chair of Medicine at Memorial Sloan Kettering Cancer Center in New York, who was not involved in the report, told ABC News in a statement.
Additionally, although lung cancer continues to be the leading cause of death in the U.S. — with an estimated 350 deaths per day from lung cancer — the three-year survival rate has increased from 21% in 2004 to 31%.
Siegel said declines in smoking played a role, but the bigger factors are recent improvements in treatment and lung cancer being detected in early stages.
“One finding was that twice as many lung cancers are being detected at an early stage, and that means more patients are having their cancer detected when they’re the most treatable,” Dr. Lauren Byers, a lung cancer expert at MD Anderson Cancer Center in Texas, who was not involved with the report, told ABC News.
Siegel said she hopes the new report encourages people to stay up-to-date on their cancer screenings.
“We have a lot of effective screening tests now to prevent deaths from cancer and so, while none of these tests is perfect, being up to date and talking with your doctor about when you should screen can really help reduce your risk of dying from cancer,” she said.
(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.”
(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.
(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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(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.
