Health

(NEW YORK) — Despite being among the first eligible for COVID-19 booster shots, many nursing homes are struggling to boost residents and staff, experts say.

Nationally, about 72% of residents are boosted in each nursing home, according to data from the Center for Medicare & Medicaid Services.

But in about one-third of U.S. states, booster rates for residents are less than the national average among nursing homes, and three states have yet to crack an average of 60% of residents boosted in each facility.

Booster shots have been shown to be more protective against omicron and other COVID-19 variants. And nursing home residents continue to be among the most vulnerable people in terms of potential for severe illness and death — nearly 151,000 people in nursing homes have died since the beginning of the pandemic, CMS data shows.

While significantly higher than the 44% of Americans who have received a booster, experts say levels in nursing homes are lower than they’d like to see. Ideally, they should match the rate of vaccination — currently 87% of residents fully vaccinated per facility.

When it comes to booster uptake among nursing home staff members, the numbers are even lower than residents.

Only about 39% of staff members per facility have received booster shots, the CMS data shows, and more than half of states have rates below the national average of nursing homes.

“People may feel like, ‘Well, you got two shots and there’s no value’ or even ‘You had two shots and you had COVID already,'” Dr. Cindy Prins, an associate professor of epidemiology at the University of Florida College of Public Health and Health Professions, told ABC News. “I think we need to remember that our immunity can wane, especially in our older folks, and they need to keep getting that renewed protection and the booster will give them that.”

In three states, less than 60% of nursing residents are boosted on average

It’s well known that nursing home residents are among the highest at risk for severe COVID-19 complications due to their ages, likelihood of underlying conditions and the fact that they live in congregate settings.

“The other caveat to understand is that, in those that are over the age 65, sometimes it’s a little more difficult for them to develop responses to vaccines,” so getting a booster helps them mount an immune response, Dr. Katherine Baumgarten, medical director for infection prevention at Ochsner Health System in New Orleans, told ABC News.

Yet some nursing homes have been struggling to boost their residents. In three states — Florida, Arizona and Nevada — not even 60% of residents per facility on average have been boosted.

Florida has the lowest rate in the country at about 55%. By comparison, South Dakota has the highest rate at 87.56%.

The Florida Department of Health did not reply to ABC News’ request for comment on why rates are low.

“It’s absolutely something to be concerned about. That’s unacceptable,” Dr. David Grabowski, a professor of healthcare policy at Harvard Medical School, told ABC News. “With omicron and with potential new variants, having the most vulnerable individuals — these residents in nursing homes that have been the hardest hit by the pandemic — to have them not fully protected is really unfortunate.”

A February 2022 preprint study from France found nursing home residents who received a booster shot of the Pfizer-BioNTech vaccine had high levels of neutralizing antibodies against infection from the delta and omicron variants for at least three months.

Prins said she believes part of the reason booster uptake is low among the resident population in some states is because boosters were not promoted as much as the initial vaccines.

“In Florida, the initial vaccines were very much promoted for our older population,” she said. “It was very strongly put out there that seniors were first and they were going to get vaccinated.”

Prins continued, “But I didn’t see that same messaging with the booster. We haven’t placed the same emphasis on it at the state level that we did with that initial vaccine campaign for seniors.”

There are other theories for why the booster rate among nursing homes residents is lower than public health experts would like it to be.

Grabowski said the initial vaccine rollout was centralized, with the federal government partnering with CVS and Walgreens to distribute the shots to nursing homes.

“When it came time to do the booster rollout, this was really left up to the nursing homes to handle the booster clinics,” he said. “They do a flu vaccine every year for staff and residents and there was some thought that they could do this. Some did but there was also some really slow rollout that highlighted the haves and have nots across nursing homes.”

Grabowski continued, “Nursing homes were dealing with a lot during that period, and this was not something that was prioritized in those facilities and we’ve seen those low rates.”

Booster rollout has been slow among staff

Experts say it’s not just the elderly population in nursing homes who have been slow to get boosted — it’s also staff members.

According to CMS data, 12 states don’t even have an average of 30% of staff with boosters per facility. Florida is once again the state with the lowest rate at 24.52% while California has the highest rate at 68.58%.

Prins said it is possible the low booster rates for nursing home staff are partially due to many being ineligible for a third dose because they completed their vaccine series less than five months ago.

But she believes “that does not cover the extent of that lower booster rate” and said the low numbers are “concerning.”

“When you have this kind of facility, the virus gets brought in obviously, and it’s coming in with the people who are most mobile and most often there and that’s going to be your staff members,” Prins said. “[The low number] is absolutely a worry because that puts residents at high risk.”

Since the omicron wave, weekly cases and deaths in nursing homes have declined drastically. However, during the week ending Feb. 20, 2022, there were 620 resident deaths, the highest number since the week ending Jan. 2.

Mandates may be the only way to increase booster rates

The experts say there are a few ways to try and drive booster rates up in nursing homes.

Grabowski said for residents, it would help for the booster rollout to be more centralized with clinics set up by the federal government rather than left up to individual facilities.

However, he believes it will take mandates for booster rates among staff to rise dramatically. As of Tuesday, five states require COVID boosters for nursing home workers: California, Connecticut, Massachusetts, New Mexico and New York.

“The mandates are important here,” he said. ‘I think with boosters, with staff, it’s probably going to take mandates to make sure they go forward with the booster.”

The doctors add that, in addition, it could help to do sit-downs with small groups of nursing home staff to address their concerns and explain why boosters are beneficial. Baumgarten suggested this could include dispelling the ideas that boosters are ineffective or that they don’t reduce the risk of breakthrough infections.

“Nursing homes are a vulnerable population and we want to protect those who are vulnerable,” she said. “Everything that we can do to prevent them from being exposed or at risk for developing COVID important for us to do. If it’s simple enough to get a booster — which it is, they’re readily available, side effects are minimal — we should do that to help protect those around us.”

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(NEW YORK) — Pfizer announced Wednesday it is launching a clinical trial to study the effectiveness of its COVID-19 antiviral pill in young children.

The treatment, Paxlovid, was authorized in December 2020 by the U.S. Food and Drug Administration for emergency use in patients aged 12 and older who have mild-to-moderate symptoms and are at increased risk of severe illness.

The new trial is planning to enroll 140 children between ages 6 and 17 who will be split into two groups.

One group will weigh between 44 and 88 pounds and the other groups will weigh more than 88 pounds.

The group that weighs more than 88 pounds will be given the dose currently authorized for teens and adults while the group that weighs less will be given a smaller dose.

“Since the beginning of the pandemic, more than 11 million children under the age of 18 in the United States alone have tested positive for COVID-19, representing nearly 18% of reported cases and leading to more than 100,000 hospital admissions,” Mikael Dolsten, chief scientific officer and president of worldwide research, development and medical at Pfizer, said in a company statement.

“There is a significant unmet need for outpatient treatments that can be taken by children and adolescents to help prevent progression to severe illness, including hospitalization or death,” Dolsten said.

Children under age 6 will not be included in this study, but Pfizer said research is ongoing to determine the best dose for the youngest of children

Pfizer’s pill was hailed as a game-changer because it was the first COVID treatment that did not require an infusion, making it more convenient to give to patients.

The pill is made up of two medications: ritonavir, commonly used to treat HIV and AIDS, and nirmatrelvir, an antiviral that Pfizer developed to boost the strength of the first drug.

Together, they prevent an enzyme the virus uses to make copies of itself inside human cells and spread throughout the body.

Paxlovid is currently given as three pills twice daily over the course of five days.

Clinical trial data showed the pill reduced the risk of hospitalization and death for COVID patients by 89% within three days of the onset of symptoms compared to a placebo.

According to clinicaltrials.gov, the pediatric trial has three locations including Mississippi, South Carolina and Texas.

ABC News’ Sony Salzman contributed to this report.

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(BALTIMORE) — A Maryland man who earlier this year became the first person to receive a heart transplant from a pig has died, according to the University of Maryland Medicine, where the transplant was performed.

David Bennett, 57, died on March 8, according to University of Maryland Medicine. The hospital did not say what caused his death, noting only that his “condition began deteriorating several days ago.”

“After it became clear that he would not recover, he was given compassionate palliative care,” the hospital said in a statement. “He was able to communicate with his family during his final hours.”

Bennett, a father of two, suffered from terminal heart disease and was deemed ineligible for a conventional heart transplant because of his severe condition, University of Maryland Medicine said in January, at the time the transplant was announced.

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 at the time that 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.”

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

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,” University of Maryland Medicine said at the time of the transplant.

Dr. Bartley P. Griffith, a professor in transplant surgery at the University of Maryland School of Medicine, and the doctor who surgically transplanted the pig heart into Bennett, said he is “devastated” by his death.

“He proved to be a brave and noble patient who fought all the way to the end. We extend our sincerest condolences to his family,” Griffith said in a statement. “Mr. Bennett became known by millions of people around the world for his courage and steadfast will to live.”

Bennett’s family said in a statement they are “profoundly grateful” to Griffith and the rest of the medical team that performed the transplant on Bennett, who had been a patient at University of Maryland Medicine since October 2021.

“Their exhaustive efforts and energy, paired with my dad’s insatiable will to live, created a hopeful environment during an uphill climb. Up until the end, my father wanted to continue fighting to preserve his life and spend more time with his beloved family, including his two sisters, his two children, and his five grandchildren, and his cherished dog Lucky,” the family said in a statement. “We were able to spend some precious weeks together while he recovered from the transplant surgery, weeks we would not have had without this miraculous effort.”

“We have felt the prayers of the world during this time and humbly ask that those prayers continue to be offered on behalf of the medical teams, technology companies, research labs, grant writers and innovative initiatives of the future,” the family continued. “We hope this story can be the beginning of hope and not the end. We also hope that what was learned from his surgery will benefit future patients and hopefully one day, end the organ shortage that costs so many lives each year.”

Experts said at the time of Bennett’s transplant, that though it is groundbreaking, 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.

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(NEW YORK) — Officials in every U.S. state and jurisdiction have now ended, or announced an end, to their indoor universal masking requirements.

Over the last month, states from coast to coast have moved to end mask mandates as coronavirus cases have plummeted. By the end of March, there will be no more statewide or school mask mandates in effect.

Although some districts may opt to still mandate mask use, many schools have already decided to drop the requirement.

On Tuesday, Hawaii, the nation’s lone indoor mask holdout, became the last state to end its universal mask mandate, effective March 25 at 11:59 p.m.

“We’re committed to moving the state forward and learning to live with COVID,” Gov. David Ige said during a press conference.

Although the Hawaii Department of Education wrote in a press release that face coverings will still be required indoors in Hawaii schools, State Epidemiologist Sarah Kemble later clarified in a press conference that the department’s recommendations are “guidance” for schools to take into consideration, as they create their own policies and requirements.

Officials in Washington, D.C., also announced on Tuesday that they are recommending that most people no longer wear masks indoors or outdoors at educational facilities, unless COVID-19 community levels are high.

If COVID-19 community levels are medium, people who are immunocompromised or at higher risk for severe COVID-19 are encouraged to wear a mask, or respirator, indoors, the new guidance states.

However, for many students, the change will not go into effect immediately, as D.C. public school officials said on Tuesday that they are still considering next steps.

“For the immediate future, masks are still required indoors at all DC Public Schools for students, staff, and visitors. We will engage our union partners on next steps and continue to communicate with the DCPS community about any decisions that are made,” Lewis Ferebee, chancellor of D.C. public schools, wrote in a tweet following the announcement.

The moves came shortly after Puerto Rico announced that it too would drop its universal requirement on Monday.

In addition, on March 11, Oregon and Washington will end their universal and school mask mandates, while California will also drop its school mask requirement.

The mass ending of mask requirements comes after the Centers for Disease Control and Prevention updated its recommendations for mask use and unveiled their new plan for determining COVID-19 risk in communities.

Under the new risk levels, approximately 90% of the U.S. population now lives in areas deemed to have low or medium threats to their local hospitals, and thus can stop wearing masks.

“Americans in most of the country can now be mask-free,” White House coronavirus response coordinator Jeff Zients said in a briefing on the plan last week.

Many health officials have cautioned, however, that should there be a viral resurgence, mask requirements may have to return.

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(TALLAHASSEE, Fla.) — There is growing pushback among the health care community over Florida’s decision to advise against vaccinating healthy children for COVID-19, with an increasing number of health officials coming forward to strongly criticize the move.

On Monday, Florida Surgeon General Dr. Joseph A. Ladapo announced his state would become the first in the country to make such a formal recommendation.

“The Florida Department of Health is going to be the first state to officially recommend against the COVID-19 vaccines for healthy children,” Ladapo said at the end of a 90-minute roundtable discussion in West Palm Beach, Florida, hosted by Gov. Ron DeSantis, aimed to close the curtain on the “COVID theater once and for all.”

However, criticism swiftly followed, coming from many of the nation’s leading health officials.

The American Academy of Pediatrics, and its Florida chapter, called the decision “irresponsible,” reasserting that the COVID-19 vaccine is still the nation’s “best hope for ending the pandemic.”

“The Surgeon General’s comments today misrepresent the benefits of the vaccine, which has been proven to prevent serious illness, hospitalizations and long-term symptoms from COVID-19 in children and adolescents, including those who are otherwise healthy,” American Academy of Pediatrics Florida Chapter President Lisa Gwynn said in a statement Monday.

“The evidence is clear that when people are vaccinated, they are significantly less likely to get very sick and need hospital care. There is widespread consensus among medical and public health experts about the life-saving benefits of this vaccine,” Gwynn said.

The American Academy of Pediatrics, alongside the Centers for Disease Control and Prevention, have also been vocal in their support of pediatric COVID-19 vaccinations, stressing to parents that real-world data has demonstrated that vaccines are safe and effective at protecting children against severe disease, as well as against potential long-term consequences from the virus.

“Children can get sick from COVID, and some get very sick,” AAP President Dr. Moira Szilagyi said. “The virus is still circulating in Florida. … It is irresponsible to advise parents not to vaccinate their children against this virus.”

The Infectious Diseases Society of America also issued a strong statement in opposition to the move, which the organization described as “disturbing.”

“The Florida Surgeon General’s decision to recommend against COVID-19 vaccination for healthy children flies in the face of the best medical guidance and only serves to further sow distrust in vaccines that have proven to be the safest, most effective defense against severe COVID-19 disease, hospitalization and death,” Dr. Daniel P. McQuillen, president of the Infectious Diseases Society of America said in a statement on Tuesday, further suggesting that Florida’s decision “put politics over the health and safety of children.”

“Vaccinating eligible children against COVID-19 not only protects them, but it also protects their classmates, friends and vulnerable family members from a virus that has left nearly 1 million people in the United States dead in its two-year wake,” McQuillen added.

Among the other voices in the chorus of concerns is Dr. David R. Nelson, president of UF Health and senior vice president for health affairs at the University of Florida, where Ladapo is a professor.

In a statement released Tuesday, Nelson pointed to the widespread support for COVID-19 vaccinations in children among health experts.

“UF Health and the UF College of Medicine note that while children are generally at lower risk than adults for more serious consequences of COVID-19, the risk is not zero, and the vaccine has been shown to be safe and effective, with a very low risk of adverse outcomes,” Nelson said.

Nelson noted that although at times, there can be a “significant disagreement” in the public discourse surrounding COVID-19, “the principle of scientifically sound, evidence-based medical decisions” remains critical.

“Vigorous intellectual discussion around competing opinions is at the heart of the marketplace of ideas we celebrate and is a time-honored way to advance truth. That is no less the case here,” he wrote.

Nelson also underscored the fact that Ladapo’s role as the state’s surgeon general is entirely separate from his faculty position at the University of Florida College of Medicine.

White House press secretary Jen Psaki also denounced the state’s decision, telling reporters that Florida’s decision was “absolutely not” a good policy.

“It’s deeply disturbing that there are politicians peddling conspiracy theories out there and casting doubt on vaccinations, when it is our best tool against the virus and the best tool to prevent even teenagers from being hospitalized,” Psaki said during a press briefing Monday.

However, the Florida Department of Health doubled down on their support of the surgeon general’s announcement, telling ABC News in a statement that “healthy children likely have no benefit from receiving the currently available COVID-19 vaccine.”

“It is essential for health care practitioners to analyze existing data on the COVID-19 vaccine alongside parents when deciding to vaccinate children,” Ladapo said in a statement Tuesday. “Based on currently available data, the risks of administering COVID-19 vaccination among healthy children may outweigh the benefits. That is why these decisions should be made on an individual basis, and never mandated.”

ABC News’ Dr. John Brownstein and Sasha Pezenik contributed to this report.

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(NEW YORK) — Two studies published Monday show how COVID-19 infection is associated with higher rates of brain tissue abnormalities.

These effects were subtle and it’s possible many of the people who experience them will heal on their own without medical intervention. But these findings could help explain the cognitive decline experienced by some COVID-19 survivors.

Because the studies evaluated patients who became sick with COVID-19 before vaccines were widely available, it’s not clear if this tissue damage happens among vaccinated people. Experts are hopeful vaccines would offer some protection against neurological damage, as they do help reduce the risk of other types of tissue damage.

The first study, published Monday in the journal Nature, looked at more than 400 people ages 51 to 81 who tested positive for COVID-19 from the U.K. Biobank study, comparing MRI scans taken prior to infection against those taken an average of five months after infection.

Researchers from the University of Oxford found that even people with mild COVID-19 symptoms had signs of slightly reduced brain size and subtle tissue damage — especially in the region of the brain associated with sense of smell.

“The fact that this study demonstrates a loss in brain volume over several months is concerning and could imply accelerated brain aging,” said Dr. Leah Croll, a vascular neurology fellow at New York University Langone Health.

Added Croll, “We need more time to understand what this actually means for patients. There is not enough meaningful clinical data here to know if the imaging findings truly match up with changes in cognitive functioning.”

The second study, published in Neurology, found evidence of damaged neurons and glial cells, which are fundamental cells in the brain.

Researchers from Northwestern Medicine studied 64 people, some of whom had been hospitalized with COVID-19, and others who hadn’t been hospitalized but later experienced long-haul symptoms.

They didn’t use MRIs, but rather looked for biomarkers, or molecular signatures, of brain damage.

“There were two markers of brain damage, or rather a marker of direct damage to nerve cells and another marker that indicates there is increased inflammation in the central nervous system or brain itself,” said Dr. Barbara Hanson, a researcher at the Northwestern Medicine Neurology COVID-19 research lab.

The study found evidence of brain inflammation that correlated with symptoms of anxiety reported by COVID-19 long-hauler patients.

Researchers hope the finding will bring some relief to COVID long-haulers, who often express frustration that their neuropsychiatric symptoms are dismissed.

According to Hanson, about a third of people with COVID-19 develop some form of long-COVID symptoms — many of them neurological symptoms like decreased memory, headache and dizziness.

Hanson predicted that COVID-19-related neurological symptoms could become even more prevalent in the decade to come.

But two years into the pandemic, it’s not clear yet if people will grapple with lifelong symptoms, or if they will eventually heal, experts said.

“It’s too soon for us to know if this damage will last or if people can recover from it over time,” Croll said.

Dr. Pooja Sharma is a family medicine resident at Emory University in Atlanta. Sony Salzman is the coordinating producer of ABC’s Medical Unit.

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(NEW YORK) — New York City dropped several of its COVID-19 mandates on Monday, including mask and vaccine requirements.

Restaurants, bars and other indoor public areas — including gyms and entertainment venues — will no longer be required to ask people for proof of vaccination under the “Key to NYC” vaccine passport program.

Additionally, masks will be optional for public school students aged 5 and older.

When announcing the changes Friday, Mayor Eric Adams said it was time to drop restrictions because COVID-19 cases and hospitalizations are declining and more than 75% of New York City residents are fully vaccinated.

“Two years ago, we were the epicenter of the COVID virus, and two months ago we became the epicenter again under omicron,” he said during a press conference in Times Square. “New Yorkers stepped up. They heard the call and they responded. We did the masking, we did the social distancing, we did the vaccinations and boosters shots.”

Although he acknowledged “COVID is still here,” he said “we are beating it back” and added that the next phase of the pandemic response will focus on reviving New York City’s economy.

“The overall restriction is being removed. This is about giving people the flexibility that is needed to continue to allow not only safety, but we have to get our economy back on track,” Adams said. “It’s time to open our city and get the economy back operating.”

However, other COVID restrictions will remain in place.

Any settings with children under age 5, including daycares, will still require masks, and K-12 schools will still have daily screenings to check for any students exhibiting symptoms.

In addition, anyone using public transit — including trains, buses, taxis and ride-share services — must wear masks.

Some indoor businesses have said they will keep their mask and vaccine requirements in place.

The Broadway League, which operates all Broadway theaters, said its guidance on masks and proof of vaccination for audience members will last until at least April 30, 2022.

Adams also said Friday the city will neither be lifting its municipal employee vaccine mandate nor reinstating any unvaccinated workers who were fired.

“The overwhelming number of New York City employees did the right thing, and it sends the wrong message,” he said. “We can’t send the wrong message that, when we say something, we’re going to change and vacillate.”

The city is currently recording a seven-day rolling average of 569 COVID cases, the lowest seen since October 2020, according to NYC Open Data.

Additionally, the test positivity rate has also dropped by nearly half from 2.65% to 1.41% over the last 28 days, data from the city’s Department of Health & Mental Hygiene shows.

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(NEW YORK) — As inflation continues to send food prices soaring, more Americans are turning to dollar stores to save on groceries. But can you find healthier options while still cutting costs?

While dollar stores are usually known to carry highly processed, packaged foods, some are beginning to offer nuts, fruits, vegetables and dairy products.

ABC News’ Becky Worley appeared on Good Morning America Monday to discuss what healthy options you may be able to find at a dollar store near you:

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(NEW YORK) — Recently, an update to the national COVID-19 strategy was released, designed to manage the virus so most Americans can return to daily life without disruption.

The country is moving to a new phase in which the COVID-19 threat changes from “pandemic” to “endemic.” That means the virus will likely continue to circulate within the population, but at low rates or seasonally.

The updated strategy should fill us with optimism. But we should couple that with a healthy dose of caution.

“As we move toward a COVID-controlled life, it’ll be ever-important to assess for real-time changes in the virus and its community impact because we know just how unpredictable this virus can be,” said Dr. Atul Nakhasi, an internist at the Martin Luther King Jr. Outpatient Center in Los Angeles.

How can we know if it’s safe to unmask and resume our normal activities? What signals should we look for to determine if we need to resume social distancing? Below are five indicators that may provide us with answers.

1. Case numbers:

In Los Angeles County, where Nakhasi practices, public health officials have developed an alert system designed to signal the risk level of the virus. If the number of new cases stays below 200 per 100,000 people, then the risk level remains low.

Though vaccination plays a key role in keeping case numbers low, it’s not the only way to get there. Most people who become infected with COVID-19 develop some level of immunity to the virus. Widespread infections combined with vaccinations have led one group of scientists to determine that 73% of Americans are, at least for now, immune to omicron, the dominant variant. They say that percentage could increase to 80% by mid-March.

2. Hospitalizations:

If we see hospitalizations continue to decrease and remain stable, that will suggest endemicity. The CDC has pivoted away from case numbers to focus on hospitalizations. That’s because, even if the overall reported number of cases stay low, an increase in hospitalizations could indicate that the virus has mutated and the risk of infection may be increasing rapidly.

“A new phase of the pandemic requires a recalibration of metrics that directly highlight true population impact,” said ABC News contributor and Chief Innovation Officer at Boston Childrens Hospital John Brownstein, P.h.D.

“While cases have uncoupled from severe illness, hospitalization numbers will continue to be a robust indicator that public health can rely on,” he added. “Though not the most timely (measure), hospital capacity will continue to reflect risk levels in communities and help guide decisions on mitigation efforts.”

3. Death rates:

According to Jodie Guest, an epidemiologist at Emory University, one measure of the severity of the virus is death rates. If we see fewer than 100 COVID-19 deaths a day nationwide, according to Guest, the virus has reached the endemic phase. Of course, we will need to keep an eye on variants and particular regions of the country where community spread may be different.

4. Wastewater samples:

Yeah, it’s gross, but the wastewater that flows through our sewer systems can tell us a lot about diseases that might be circulating in the community. In fact, data from the CDC’s National Wastewater Surveillance System showed that 70% of wastewater facilities found that virus levels had decreased compared to two weeks ago — another sign COVID-19 cases are on the decline.

Wastewater samples are especially important because people shed the virus when they are in the early stages of infection. That means we can identify rising infection rates even before people begin to show symptoms.

Dr. Ted Smith, an associate professor of environmental medicine at the University of Louisville School of Medicine, said that “wastewater concentrations are dropping in North America.” Though he cautions that infection rates typically drop in the spring and summer, “the genomics is supportive of a tamped situation.”

5. Outbreak clusters:

If we’ve learned anything at all about COVID-19, it’s that it’s highly contagious. That means public health officials need to be able to identify clusters of outbreaks in schools and workplaces, which likely portend rising levels of disease.

One big caveat:

As we move into the endemic phase of the virus, many people will be tempted to think COVID is a thing of the past. If only it were so. For one thing, every community is different. Vermont’s vaccination rate is around 80%, while Alabama’s is closer to 50%. Residents of these two states are facing two very different scenarios in the months ahead.

Likewise, even in cities like Los Angeles, Nakhasi warned that “it’s really important for us to recognize the disproportionate impact this virus has had on our under-resourced and vulnerable communities and prioritize their health, well-being, and life as we prepare for the next surge.”

Also, just because fewer of us are getting sick, doesn’t mean we shouldn’t take smart precautions like washing our hands and continuing to get booster shots when recommended.

“We are in an endemic phase when cases, hospitalizations, and deaths have reached a steady state,” said Dr. Megan Ranney, a practicing physician and dean at Brown University’s School of Public Health. “Remember, though, that ‘endemic’ is not the same as ‘not dangerous.'”

Dr. Jay Bhatt is an internist, instructor at UIC School of Public Health and an ABC News contributor.

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(NEW YORK) — As many states relax COVID-19 protocols, birthing practices continue to be impacted by the virus nearly two years after the World Health Organization declared it a global pandemic.

Kyaira White is set to give birth for a second time during the pandemic, with her baby due in late spring.

“I was hoping things would be over,” White, of Ellenwood, Georgia, told ABC News. “I’m just not looking forward to having to have a C-section and have your mask on.”

As a first-time mom, White didn’t know what to expect when she gave birth to her son last year.

“Everything was so new to me,” she said.

Weeks after recovering from COVID-19, she tested positive for the virus upon admission on what she said turned out to be a faulty batch of rapid tests. She said she wasn’t able to see her son in the neonatal intensive care unit for several days until it was sorted out.

“The hospital kind of was just giving me the runaround because they knew I didn’t know anything,” she said.

Much has been learned about the virus in the past two years, particularly around the risk of infection for newborns following delivery, allowing medical associations to update their guidance. However, COVID-19 continues to complicate families’ plans, oftentimes limiting who can be at the hospital and, if a parent tests positive before the delivery, restricting visits to NICUs.

Some hospitals also may still lag on standards of care when it comes to keeping otherwise healthy COVID-positive mothers and their newborns together, which can help foster bonding and breastfeeding, by instead separating them, according to Dr. Lori Feldman-Winter, a professor of pediatrics at the Cooper Medical School of Rowan University and the chair of the American Academy of Pediatrics’ Section on Breastfeeding.

“We understand how to care for mothers and babies during the pandemic, even when mothers present with positive PCRs for COVID,” Feldman-Winter told ABC News. For instance, immediate skin-to-skin contact was something “we weren’t sure about early in the pandemic,” but which the AAP currently recommends, she said.

Varying practices across hospitals means pregnant women should be prepared to advocate for themselves, and that hospitals might need to improve their care practices, according to Feldman-Winter.

“It is shocking, actually, how long it takes to get policies from the AAP into practice,” she said.

Where the latest guidance stands

AAP’s clinical guidance on care for infants born to a mother with a confirmed or suspected case of COVID-19 has remained largely unchanged since May 2021. The organization says that mothers and infants can room-in safely, as long as the mother is well enough.

“The evidence to date suggests that the risk of the newborn acquiring infection during the birth hospitalization is low when precautions are consistently taken to protect newborns from maternal infectious respiratory secretions,” the AAP said.

The Centers for Disease Control and Prevention also note that the latest evidence “suggests that the chance of a newborn getting COVID-19 from their birth parent is low, especially when the parent takes steps (such as wearing a mask and washing hands) to prevent spread before and during care of the newborn.” It advises birth parents to talk to their health care provider about the the “risks and benefits” of rooming-in and shares precautions to take in the hospital. “Having your newborn stay in the room with you has the benefit of making breastfeeding easier, and it helps with parent-newborn bonding,” it says.

The American College of Obstetricians and Gynecologists also advises that COVID-positive mothers and their infants “should ideally room-in according to usual facility policy,” due to the benefits of early and close contact, including “increased success with breastfeeding, facilitation of mother-infant bonding, and promotion of family-centered care.”

“Decision-making around rooming-in or separation should be free of any coercion, and facilities should implement policies that protect an individual’s informed decision,” it says.

The guidance deviates when an infant is in the NICU, where there typically is separation following a positive test, Gail Bagwell, president of the National Association of Neonatal Nurses, told ABC News.

“We cannot risk having moms in the NICU that are COVID-positive because the other babies are immunocompromised,” Bagwell said. “That said, our goal is to not separate moms from their babies. It’s a balancing act between the trauma that the baby could experience from not being with its mother to keeping every other child in that NICU safe.”

In practice

Early on in the pandemic, when much wasn’t known about the virus, COVID-positive mothers would often be separated from their newborns in the hospital. That started to shift in summer 2020 with updated CDC guidance that emphasized the mother’s autonomy in the decision, according to Dr. Melissa Bartick, an assistant professor of medicine at Harvard Medical School who studies breastfeeding.

“Unfortunately, a lot of hospitals had this separation policy, and they never changed that policy,” explained Bartick, who said she continues to hear reports of COVID-positive mothers and their infants being separated.

How long hospitals require COVID-positive parents to isolate before being able to visit the NICU may also vary from 10 to 14 days, Bagwell said.

It’s difficult to assess nationally what hospitals’ policies are currently when it comes to COVID-positive mothers due to a lack of tracking. The CDC’s national survey of Maternity Practices in Infant Nutrition and Care does look at room-in policies, though the 2020 survey did not address COVID-19 specifically, Feldman-Winter said.

“It would be useful to have a survey of exactly what hospitals are doing now with respect to infected mothers and infants, and … if they are separating, why they’re still separating,” Bartick said. “That would be useful to know because that should not be a standard of care right now.”

Hospital policies may be impacted by COVID-19 transmission in the area, their interpretations of CDC guidance and their risk tolerance, Bagwell said.

“Some people have lower tolerance for risk and other people have a higher tolerance for risk,” she said.

Whether a hospital is designated as a baby-friendly facility, meaning it has practices that optimize mother-baby bonding, could also impact room-in policies, according to Becky Mannel, clinical assistant professor at the University of Oklahoma Health Sciences Center and director of the Oklahoma Breastfeeding Resource Center.

“Most hospitals, especially if they were hospitals who were really already trying to follow best practice and keep moms and babies together … I would think that most hospitals are back to doing that,” she said. “We still have hospitals that didn’t have that as routine practice, so it’d be really easy for them to use COVID as an excuse to continue doing what they want to do.”

New moms may also be put in a tough spot trying to decide what to do if they test positive for COVID-19, Mannel said.

“If they’re actually not giving you really all of the current recommendations, have you made an informed choice at a time that you’re extremely vulnerable?” she said.

Kimarie Bugg, president of the Atlanta-based breastfeeding advocacy group Reaching Our Sisters Everywhere, said some moms may be able to advocate for themselves, while others might not have enough information.

“They say, ‘OK, fine, I’ll do whatever you say,'” she told ABC News. “It’s inconsistent.”

With her second baby due later this spring, White is optimistic she will have a smoother experience. She hopes she’ll be able to have her mother, in addition to her husband, with her for support — unlike last year, when she was only able to have one support person.

“Some things are definitely changing, but since COVID it’s been really different and painful. People aren’t even able to get into the hospital at all,” Bugg said. “So many grandmothers I know are sitting in the parking lot while their daughter’s in the hospital because they cannot go in.”

Where guidance goes from here

As more is learned about the virus, that could continue to impact guidance and policies, Bagwell said.

“It depends on what we find out,” she said. “As we learn more about this disease, as it goes from the very pandemic type of state that we’re in now to more endemic, like seasonal flu, I would predict that things would again change more.”

For instance, she said, during certain times of year NICU visitors are limited to just parents due to the flu.

The designs of NICUs — often open bays with multiple infants in the same area — also could have an impact on protocols. Even before COVID-19, there was a push for more family centered care in NICUs, such as private rooms with beds, Bagwell said.

“The newer NICUs that are being built are incorporating more of the single-patient room design into their NICU design,” Bagwell said. “Parents are caregivers and they’re the ones that take the babies home, so we want them there 24/7 if possible.”

The behavior of future variants could also impact guidance, Feldman-Winter said.

“It’s always ‘to be continued,'” she said. “That’s why we call the guidance ‘interim guidance,’ which we look at monthly, really, to see if we need to update or reaffirm.”

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