(NEW YORK) — Black New Yorkers were hit disproportionately hard during the omicron wave compared to white New Yorkers, according to a new analysis from the city’s Department of Health & Mental Hygiene published Wednesday.
Black New York City residents were hospitalized for COVID-19 at a rate more than two times greater than white residents.
For example, during the week ending Jan. 1, 2022, Black people were being hospitalized at a rate of 120.45 per 100,000 while white people were hospitalized at a rate of 47.14 per 100,000 that week, according to city data.
This is a much larger gap than seen during previous waves such as the delta wave in fall 2021 or the winter wave of 2020-21.
“This finding represents the impact of multiple points of failure in our system to adequately safeguard the health of Black New Yorkers,” the authors wrote. “It mirrors extensive national evidence documenting racial inequities in COVID-19 outcomes affecting Black persons across the United States.”
The report also found COVID-19 hospitalizations were much higher in New York City neighborhoods with a high percentage of Black residents.
For example, in the Bronx ZIP code 10469, which is about 53% Black, the hospitalization rate during January 2022 was about 274 per 100,000.
By comparison, the Manhattan ZIP code 10075, which is 87% white, had a hospitalization rate of 112 per 100,000 for the same period.
To address why there are such disparities, and how to narrow the gap, the NYC DOHMH also detailed structural racism that has played a role in why Black New Yorkers experienced worse outcomes.
One of these factors is that Black New Yorkers were at greater risk for COVID-19 exposure because they were less likely to be able to work from home since the start of the pandemic.
Additionally, the report also noted that Black residents are more likely to live in “multi-generational homes without adequate space for quarantine and isolation” which increases the risk of being exposed to the virus.
There have also been inequities in making such Black New Yorkers get vaccinated or boosted.
At the start of the omicron wave — Dec. 11, 2021 — only about 50% of Black residents were fully boosted compared to about 60% of white residents and a citywide rate of about 70%.
What’s more, by that same date, about 10% of Black New Yorkers had received a booster shot compared to about 25% of white New Yorkers “in part because fewer had completed their primary vaccination to be eligible for an additional dose,” the report states.
There were also delays in diagnosing Black residents with COVID-19.
The report found about 1 in 4 Black New Yorkers were not diagnosed until five days or longer after symptoms appeared compared to about 1 out of 4 other New Yorkers who took four or more days to get diagnosed.
“These extended times from COVID-19 symptom onset to diagnosis are driven in part by structural barriers such as decreased access to COVID-19 testing or time off work to seek testing,” the authors wrote.
However, there were some bright spots in the report. To close racial gaps, the city’s Taskforce for Racial Inclusion and Equity initiative identified 74 ZIP codes where vaccination rates needed to be boosted.
By February 2022, 73 of those ZIP codes had at least 70% of residents fully vaccinated compared to 14 ZIP codes as of July 2021.
“While the drivers of health inequities are complex and rooted in centuries of structural racism and disinvestment, the Health Department is committed to identifying solutions to protect and promote health today while also building long-term strategies to address structural factors,” the authors wrote.
(TALLAHASSEE, Fla.) — Florida’s state Senate on Thursday passed a bill that bans abortions after 15 weeks, the same gestational limit currently being reviewed by the U.S. Supreme Court.
The bill, HB 5, which passed the state House in February, is expected to move quickly to the desk of Republican Gov. Ron DeSantis, who has previously said he is supportive of a ban after 15 weeks.
If signed by DeSantis, the bill will go into effect July 1.
The bill does not make exceptions for rape or incest, but does allow for exceptions if the fetus has a fatal abnormality or in cases when the mother is at risk of death or “substantial or irreversible physical impairment.”
Those exceptions would require written certification from two physicians.
Currently, abortions are allowed in Florida up to 24 weeks of pregnancy.
Abortion rights advocates argue that banning abortion after 15 weeks will further harm patients who need care the most, including people of color, people of limited economic means and people who lack health insurance.
Dr. Sujatha Prabhakaran, chief medical officer at Planned Parenthood of Southwest and Central Florida, told ABC News that doctors like herself are “scared and sad” about the bill’s potential impact.
“The biggest impact of the bill is going to be hurting our patients’ access to the care that they need,” said Prabhakaran, also a practicing OB-GYN in Sarasota, Florida. “We know that when there are these restrictions, it doesn’t mean that the need for the care goes away, it just means that it makes it even harder for patients to access the care.”
HB 5’s passage in the Senate comes as the Supreme Court is reviewing a similar Mississippi law that bars abortion after 15 weeks.
In the case, Mississippi, Dobbs v. Jackson Women’s Health, the state of Mississippi is arguing to uphold a law that would ban most abortions after 15 weeks of pregnancy, while Jackson Women’s Health, Mississippi’s lone abortion clinic, argues the Supreme Court’s protection of a woman’s right to choose the procedure is clear, well-established and should be respected.
Since the Roe v. Wade ruling and the 1992 Planned Parenthood v. Casey ruling that affirmed the decision, the court has never allowed states to prohibit the termination of pregnancies prior to fetal viability outside the womb, roughly 24 weeks, according to medical experts.
If the Supreme Court rules in Mississippi’s favor and upholds the law — as is expected because of the court’s current conservative makeup — the focus will turn to states, more than half of which are prepared to ban abortion if Roe is overturned, according to the Guttmacher Institute, a reproductive rights organization.
Because the states that plan to ban abortion are focused in specific geographic regions, including the South, the expected effect is that women will have to travel much longer distances, at a greater cost and inconvenience, to seek abortion care, according to Elizabeth Nash, interim associate director of state issues at the Guttmacher Institute,
“If you’re thinking about the average abortion costing $550, and then somebody trying to navigate a trip of several hundred miles, you’re adding hundreds of dollars to the cost and you’re asking that person to pull that money together very quickly,” she told ABC News in January. “That is an insurmountable burden for so many.”
Prabhakaran said she and other doctors in Florida are already seeing patients from states as far away as Texas, which last year enacted a law that bans abortions after six weeks of pregnancy.
As of 2017, abortions in Florida represent just over 8% of all abortions in the U.S., according to the Guttmacher Institute.
According to Prabhakaran, a 15-week ban in Florida has the potential to force pregnant people to travel as far as North Carolina and Washington, D.C., for care.
“While abortion is very safe, the the higher the gestational age, the more risk there is potentially to patients who have a complication,” she said, adding that the lack of access also means some patients will continue with high-risk pregnancies while others will seek other care. “What I worry is going to start to happen again is that patients will be taking care from unqualified providers, and that that will put them at risk.”
Elena Hung and her 7-year-old daughter, Xiomara, of Maryland. Xiomara was born with a number of medical conditions affecting her airway, lungs, heart and kidneys. – Elena Hung
(NEW YORK) — When coronavirus shut down the nation nearly two years ago, 7-year-old Xiomara Hung and her family were quick to retreat to their Maryland home in an effort to help curb the spread of the virus and avoid any potential infection.
Like many children across the country, Xiomara and her brother were forced to trade their backpacks for laptops as the virus forced schools online.
However, unlike most students, who are now back to in-person schooling, Xiomara, who was born with a number of medical conditions affecting her airway, lungs, heart and kidneys, has not yet been able to return. Because she is immunocompromised, her parents have been faced with the difficult decision to keep her away from her peers in virtual schooling while the virus is still circulating.
“It’s been really hard,” Xiomara’s mother, Elena Hung, told ABC News. “But in a way, it wasn’t a hard decision. Do we keep her safe and alive, or do we send her to school? The goal is absolutely her to go to school, but I have to weigh that against her safety. There’s no point in going to school, if she’s going to get sick, and she might end up in the hospital.”
The consequences of losing that in-person interaction has been “extremely difficult” as “they are missing out on very important social development.”
Although the omicron surge appears to be steadily subsiding in the U.S., for families like Xiomara’s, the pandemic feels far from over.
“The past two years has been very difficult for us, and even now, more so in 2022, as we are seeing mask mandates lifted, we are seeing fewer protections for people who are disabled and immunocompromised and chronically ill. In so many ways, we feel like we are being left behind as people are trying to return to ‘normal,'” said Hung, who co-founded the organization Little Lobbyists, which aims to advocate for children with complex medical needs.
Across the country, dozens of states and cities, led by both Republicans and Democrats, have moved rapidly in recent weeks to declare an end to COVID-19 restrictions.
“With more New Yorkers getting vaccinated, and the steady decline over the past several weeks in cases and hospitalizations from Omicron, we are now entering a new phase of the pandemic,” New York Gov. Kathy Hochul said in a statement this week upon lifting the mask mandate for schools.
Hochul’s message of a nation moving on in its fight against COVID-19 echoes that of many state and local legislators, as well as President Joe Biden, who, during his State of the Union address Tuesday, declared that “COVID-19 no longer needs to control our lives.”
However, despite the president’s suggestion that “we’re leaving no one behind or ignoring anyone’s needs as we move forward,” many immunocompromised Americans say they indeed feel “left behind.”
“We do lead lives that make us look at life and death differently, but we also have normal life,” Hung said. “Xiomara is a kid, who does all the things that a typical 7-year-old does. Her normal is the same normal. But she can’t accept that normal, if anybody’s going back to school, not wearing a mask.”
‘Immunocompromised patients matter’
With pandemic “fatigue” strong, many Americans have been vocal in their hope to leave COVID-19 behind and return to a long desired sense of normalcy.
Last week, the Centers for Disease Control and Prevention unveiled their new plan for determining COVID-19 risk in communities, and updated its recommendations for mask-use.
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 Wednesday.
The administration has also pledged to take key steps to help individuals who are disabled, including those who suffer from weak immune systems.
“We will continue to address the specific needs of seniors, people living with disabilities and people who are immunocompromised. These are the Americans who need our focus and attention right now,” added Health and Human Services Secretary Xavier Becerra.
However, doctors say those at highest risk should still be wary of taking off their masks.
Across the country, about 2.7% of the population, according to the CDC, are living with weakened immune systems because of a variety of causes, such as active cancer treatment, organ or stem transplant or primary immune deficiency diseases.
For some of these 7 million high-risk Americans, COVID-19 has been “devastating.”
“I see the devastating effects of this viral infection every day as it leads to death and disability of my patients who were previously leading healthy, active lives,” Dr. Jeannina Smith, medical director of the transplant and immunocompromised host service at the University of Wisconsin, told ABC News. “Omicron was not mild for our patients.”
COVID-19 has been the “leading cause of death” in transplant programs at the University of Wisconsin for the last two years, Smith said.
“Immunocompromised patients matter,” Smith stressed. “The new CDC guidelines have absolutely left my patients behind, effectively abandoning them. The goal of the new cutoffs for COVID activity only focus on keeping hospitals from being overwhelmed, with a stated understanding they will not prevent infection. My patients are still dying of COVID despite every medical advance.”
Vaccines have been shown to be less effective for people living with weakened immune systems, putting them at greater risk of serious COVID-19 disease and death compared to the general population.
There are also many Americans with other chronic or long-term conditions, such as diabetes or asthma, who could become quite ill if they were infected.
“COVID-19 remains a threat for most vulnerable Americans — poor, rural patients, minorities, patients that are old or with comorbidities, immunocompromised, or with cancer and the vaccine-hesitant. Many patients will have one or more of these categories,” Dr. Jaime Imitola, the director of UConn Health’s division of multiple sclerosis and translational neuroimmunology, told ABC News.
Getting back to ‘normal’ right now may not be possible for everyone
Vulnerability to infection is a great concern to many immunocompromised Americans. However, many are also anxious about facing increased isolation as states lift mask mandates and other pandemic safeguards.
“Everyone wants to go back to normal but that normal sacrifices our normal,” said Christa Xavier, 30, of Pennsylvania.
Xavier, who suffers from fibromyalgia, was also a former smoker, putting her at increased risk of severe disease. Prior to the pandemic, she worked for 10 years in retail, a career that she has been forced to abandon due to her condition.
“It’s just been extraordinarily difficult to find work that is remote. That’s really tough,” said Xavier.
Now an artist, Xavier feels confined to her home as she fears potential infection with people taking off their masks.
“It basically feels like just being left behind. It’s like everyone is kind of looking at me like, ‘Well, you really should maybe just get back to normal.’ I don’t think anyone really understands what it’s like,” Xavier said. “I could just go outside and within two weeks, I could be dead. … I’m not risking that to go to Target.”
A new KFF poll released this month found that while nearly two-thirds of Americans reported they are worried about the potential economic and social repercussions of retaining COVID-19 restrictions, 61% of those surveyed also said that they are concerned that the move to end mitigation efforts will put immunocompromised people at increased risk.
Even with the Biden administration’s promise that treatments and free high-quality masks will be made widely available to those at high-risk, Xavier said that as mitigation measures drop, she fears a potential viral resurgence should a new variant emerge.
“It felt like it’s just, ‘Well, you guys can wear masks,'” she explained, in reference to the president’s remarks at this year’s State of the Union. “That’s not going to be enough if we have a deadlier variant, or more-contagious variant.”
With 2022 midterm elections approaching, governors have picked up on the fact that Americans are tired of the pandemic’s restrictions, particularly the mask mandates, Xavier argued, which advocates fear may severely affect marginalized communities.
“I think a lot of the politicians … have agendas,” said Xavier. “They want to make it look like things are going awesome, and it kind of feels like immunocompromised people are getting sacrificed.”
COVID-19 must still be monitored closely to keep vulnerable safe, experts say
Health experts fear that the waning omicron surge could be erroneously equated with the end of the epidemic, and thus, the relaxation of COVID-19 safety measures could lead to the emergence of vaccine-escaping variants, potentially leading to another surge of infections.
“There are still emerging threats, like long COVID-19, COVID-19 reinfections and new mutants that will escape the immune system,” Imitola said. “Reducing the restriction will have a domino effect in complacency that will affect the patients that are at higher risk. During this winter, we have seen an increase in the number of cases of COVID in patients that are immunocompromised due to the reduction of mask-wearing and no vaccination and putting the guard down in social gatherings.”
Smith stressed that authorities must continue to monitor a wide array of COVID-19 metrics, not limited to hospital capacity, in order to prevent infections in the vulnerable. In addition to high-quality free masks and equitable access to home testing to identify infection early, Smith advocated for “safe spaces” to be created in grocery stores, pharmacies and schools where everyone is masked to protect the immunocompromised.
Health experts also urge businesses to continue to keep the safety immunocompromised staff in mind, so they can feel comfortable at work and are not forced to work remotely.
“I understand that we are all tired, and I am not asking people to stop their lives,” said Hung, but waiting a little longer before doing away with mitigation efforts might “save someone’s life.”
Immunocompromised Americans are an integral part of the community and workplaces, and their absence would be keenly felt, Xavier added.
“We are not optional members of society,” Xavier said. “You can’t just tell us to shut ourselves away and wear a mask forever. Our ‘normal’ matters just as much as everyone else’s.”
(NEW YORK) — While much of the country is relieved to move into a new phase of the COVID-19 pandemic, millions of families with young, unvaccinated children have looked on with frustration, feeling forced to now raise their guard even higher.
“Just going to the grocery store is less safe now, because we can’t rely on other people protecting him by wearing a mask,” said Rebecca Sanghvi, the mother of a 2-year-old son.
Vaccines for children under 5 years old aren’t expected until sometime in the spring. During his State of the Union address, President Joe Biden said scientists were working hard to get them authorized and pledged to “be ready with plenty of vaccines if and when they do.”
Sanghvi, an instructional coach with the Washington, D.C., Public Schools, her husband and their 5-year-old have led a cautious life during the pandemic to protect their youngest family member.
She knows that there’s a very low chance of her son getting severely sick, but after two years of near-misses, her and her husband can barely afford taking time off work for another quarantine.
They do the necessities, like going to work and attending school, but they don’t dine indoors or go to crowded indoor places, like museums. They don’t see friends indoors. Playdates are at the park, outside.
She wishes the Centers for Disease Control and Prevention had waited for young kids to get access to vaccines before easing the national guidelines for masks, which put 70% of the country in areas where it was no longer required.
“I want to protect my kids. And [masks] seem like not an overwhelming price to pay with all of the unknowns that there are,” Sanghvi said.
Her son is one of about 20 million kids in the U.S. who still can’t get vaccinated — the last age group in the country.
Doctors urge parents to hang on for a few more months
The American Academy of Pediatrics recommends all kids under 5 continue to wear masks — a recommendation that will likely stand until vaccines are available for that group sometime in late spring, said Moira Szilagyi, president of the organization.
The hope is that transmission continues to decrease until then, at least reducing some stress around the virus, and the vaccine could arrive before a potential increase in cases over the summer.
“I share their pain. We see families in our offices and practice settings every day whose children are stuck in this in-between world,” Szilagyi said.
But now is not the time to let your guard down, Szilagyi and other doctors emphasized.
“You should continue to do everything you can to prevent the infection, because we don’t have a great way of telling if your kid will do great or your kid will not,” said Dr. Diego Hijano, a pediatric infectious disease specialist at St. Jude Children’s Research Hospital.
Many parents also worry about their young children developing long COVID, even if the initial infection is mild. But the research is still limited.
Children can get long COVID, experts said, but it’s less common than in adults. When vaccines become available, that is expected to further reduce the risk, as it has for kids ages 5 to 11.
So what are the best ways to stay protected?
In the meantime, experts say that even if other people aren’t wearing masks around kids, they can still be relatively protected if they wear high-quality masks themselves, like surgical masks, N95-equivalent masks made for children, or even cloth masks with at least two layers.
“It will be at least some defense — and enough to make it worthwhile,” said Szilagyi.
Doctors also recommend “cocooning” children with vaccinated people — surrounding them with family and friends who are up to date on their vaccines and boosters.
“If you can get parents, siblings, grandparents on board — that’s the first step because that’s the best way to protect the kid in the house,” Hijano said.
And playing outside without masks is relatively safe, said Hijano, who has young kids.
Traveling has also been proven to be low risk, particularly road trips, and outings to the movie theater, where the seats are relatively spaced out, can be a good activity, he said.
And in the next few weeks, watch for continued improvements in the pandemic’s trajectory.
“Clearly, when masks come off, then that will increase the risk, particularly for unvaccinated children under 5,” said Dr. Dan Barouch, a virologist at Beth Israel Deaconess Medical Center.
“But that is somewhat counterbalanced by the fact that the overall number of cases is much, much reduced compared with where we were a month or two ago and the severity of illness with omicron is lower than the severity of illness with delta or the prior variants,” he said.
Barouch, too, recommended continued mask-wearing and avoiding public indoor gatherings until things improve, as did Dr. Robert Frenck, a vaccine researcher at Cincinnati Children’s Hospital.
“There’s no data to show that the masks are dangerous. There’s no data to show that kids can’t recognize emotion. In fact, there’s data to show kids can recognize emotion because they pick up most of the emotion out of the eyes,” Frenck said.
He urged people to respect one another’s decisions around masks.
“A parent should be allowed to make their decision about a mask,” he said. “And they should feel no recrimination by anyone because they made the decision for their child.”
(NEW YORK) — When the first coronavirus vaccines were shipped out across the country more than a year ago, millions of Americans waited eagerly for their turn to get a shot, hoping that it would lead to a return to normal.
In the spring of 2021, after every adult became eligible for the vaccine, over 2 million people a day were getting their first dose. However, in recent months, with most of those willing to get their shots now inoculated, vaccination rates have plummeted.
The number of Americans who are receiving their first COVID-19 vaccine now stands at a pandemic low, with fewer than 80,000 Americans initiating vaccination each day. Further, since December, the rate of people getting boosted has also fallen significantly, dropping from 1 million booster shots administered a day to less than 140,000.
“Dropping of local vaccine mandates and the end of the omicron surge are likely contributing to a stalling out in first time vaccines and boosters,” said John Brownstein, Ph.D., an epidemiologist at Boston Children’s Hospital and an ABC News contributor. “Unfortunately, at this point, there are not many tools left in the toolbox to encourage people to be up to date.”
Although there are certainly fewer unvaccinated than vaccinated people in the U.S., tens of millions of Americans remain unvaccinated and unboosted. Across the country, more than 58 million eligible Americans remain unvaccinated, while 87.6 million Americans — about half of those currently eligible to be boosted — have yet to receive their supplemental dose.
Amid the declining interest, some scientists and health officials say it is possible Americans could need an additional booster this fall, or seasonal boosters in the future, to address waning vaccine immunity or new coronavirus variants.
“The potential future requirement for an additional boost or a fourth shot for mRNA or a third shot for J&J is being very carefully monitored in real time, and recommendations, if needed, will be updated according to the data as it evolves,” White House chief medical adviser Dr. Anthony Fauci during a press briefing last month.
The experts interviewed by ABC News are concerned about how to convey that message while maintaining trust as well as how additional doses might further exacerbate inequities in access and care around the country.
Since the fall, immunocompromised Americans have already had the option to receive a fourth mRNA dose. However, for the general public, the benefit of additional doses still is not clear.
In an interview with Bloomberg TV last week, Fauci said that the Centers for Disease Control and Prevention is studying data on a “month-by-month basis,” and should durability rates continue to fall, officials will have to decide whether to begin offering a fourth dose, particularly to those at higher risk, such as the elderly.
However, even if data emerges indicating the need for a fourth dose, convincing Americans to get another shot may present a new set of challenges.
“I think we can expect to see less uptake of fourth doses than we saw of third doses,” Dr. Shira Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center, told ABC News. “A change in the messaging around the goal of the vaccination program would help a lot.”
Some people point erroneously to the increase in breakthrough infections as a reason to not get vaccinated, she said.
Thus, experts say, it is important for public health experts to emphasize the benefit of vaccination, and how dramatically reducing the risk of developing severe illness or dying if infected.
In December, a period of omicron dominance, unvaccinated people were 14 times more likely to die of COVID-19 compared to people who received the one-shot Johnson & Johnson shot or two shots of Pfizer and Moderna vaccines.
Health experts also caution that if a fourth dose is eventually needed, it will be important for health officials to outline what the purpose of an additional dose would be.
“Are we trying to prevent all infections, or are we trying to prevent severe disease?” Doron asked. “Public messaging that is honest about the waning effectiveness for infection and focuses on a need for additional doses only when effectiveness against severe disease has waned, and only for those populations in whom that has happened, might help restore trust and increase vaccine uptake.”
Evidence exhibiting protection against severe illness and death, will ultimately be paramount, Brownstein added.
“Clinical data, combined with real-word evidence, must show that additional shots provide critical protection against severe illness and death,” he said.
Experts are particularly concerned about the continued growing racial disparity in the current booster drive, and the impact such gaps in uptake could have on populations that are already at increased risk of severe COVID-19 outcomes.
Black and brown Americans are currently lagging in the booster effort, with only 39.5% of eligible Hispanic/Latino Americans boosted, and 43.8% of eligible Black Americans boosted. Asian Americans lead every race/ethnicity group, with 58.9% of the eligible population boosted.
“Vaccine rollouts have highlighted critical inequities in access and education, leading to concerning differences in vaccination rates across race and ethnicity,” Brownstein explained.
If additional shots are needed in the future, experts worry about deepening inequities.
“A fourth shot strategy is likely to only further inequities in protection unless accompanied with direct efforts to bring the entire population up to date,” Brownstein added.
As health officials plan for the months and years ahead, Doron suggested there are several potential ways to proceed, including switching to an annual vaccination should a seasonal pattern with COVID-19 emerge or waiting for continued signs of waning effectiveness and recommending a fourth dose then, particularly to those at high risk.
“Any determination that additional booster doses are needed will be based on data available to the agency,” a representative from the FDA told ABC News in a statement.
Regardless of how officials decide to move forward, experts say it will be essential to convince Americans of the importance and benefits of vaccines, and thus, that low COVID-19 vaccination rates could not only undermine recovery prospects, but potentially also lead to another surge of infections in the advent of a new variant.
“The case for a fourth shot needs to be incredibly compelling, if we expect the American public to get on board,” Brownstein said. “The focus should continue to be on primary care providers and frontline health care workers to continue to educate the public on the value of vaccines.”
(ATLANTA) — The gap in COVID-19 vaccination uptake between rural and urban Americans is continuing to widen, a federal report published Thursday found.
As of Jan. 31, 2022, 75.4% of people aged five and older living in urban counties have received at least one dose of the vaccine, according to the Centers for Disease Control and Prevention.
By comparison, just 58.8% of those living in rural areas had been given at least an initial shot — a nearly 17% difference.
However, a previous report by the federal health agency found that, in April 2021, the gap was smaller with 45.7% of urban residents given at least one dose of the COVID vaccine compared to 38.9% of rural residents.
This means that in the span of nine months, disparities based on geographic location have more than doubled.
The authors say the large gap is likely due to less access to health care and increased vaccine hesitancy in rural areas.
“Addressing barriers to vaccination in rural areas is critical to achieving vaccine equity, reducing disparities, and decreasing COVID-19-related illness and death in the United States,” the authors wrote.
According to the new report, 46 states had higher COVID vaccine uptake in urban areas than in rural areas with just one state — Arizona — having higher coverage in rural areas.
Three states: Delaware, New Hampshire and Rhode Island, and Washington, D.C., have no rural counties so differences in vaccination coverage could not be evaluated.
In both rural and urban counties, women were more likely to be vaccinated than men.
Data showed 77.4% of urban women and 61.4% of rural women had received at least one dose by the end of January compared to 73.2% of urban men and 55.7% of rural men, respectively.
This is similar to the CDCs report looking at April 2021 vaccination rates, which also showed more women getting vaccinated.
Among all age groups, vaccination uptake was higher in urban counties with the largest difference being among 12-to-17-year-olds.
The report showed just 38.7% of rural teenagers had received at least an initial vaccine dose compared to 64.9% of urban teenagers.
However, the researchers found that there was relatively no difference in the percentage of people in rural or urban areas who received booster or additional doses, both being similarly low.
About 50.4% of fully vaccinated urban residents had received a booster shot as of Jan. 31, 2022 as had 49.7% of rural residents.
The CDC authors noted Americans living in rural counties tend to be aged 65 or older and have more pre-existing conditions.
This puts them at high risk of severe COVID-19 complications and is why rates of death from the virus are higher in rural areas than in urban areas.
Dr. Matt Feeley, part of ABC News’ Medical Unit, contributed to this report.
(NEW YORK) — In the early days of the coronavirus pandemic, as hospitals became overrun, a group of doctors began touting an anti-parasitic medicine called ivermectin as a viable treatment for COVID-19, one going as far as calling it a “miracle cure” for the coronavirus, despite experts in the medical community urging caution and warning that science so far did not support its use in the treatment of COVID-19 outside of a clinical trial.
“There is a drug that is proving to be a miraculous impact, and when I say miracle, I do not use that term lightly,” Dr. Pierre Kory, a critical care physician, said at a congressional hearing in December 2020. “And I don’t want to be sensationalized.”
Major health institutions like the FDA and CDC issued warnings urging against the use of ivermectin as a COVID-19 treatment, even as a group called the Front Line COVID-19 Critical Care Alliance, co-founded by Kory, and another group called America’s Frontline Doctors, continued to promote the drug on their websites, on social media and at speaking engagements — making ivermectin one of the most controversial topics related to the pandemic.
The drug, commonly used for livestock and pets in an animal-grade formula, is also FDA-approved in a human formula to treat parasitic infections and skin conditions such as scabies. In 2020, as the medical community was furiously looking for ways to treat coronavirus patients, and vaccines still seemed like a distant dream, a study in Australia suggested that ivermectin could “stop the SARS-CoV-2 virus growing in cell culture” in a laboratory.
But what happened in that test tube didn’t prove that the drug could heal a person sick with COVID-19 or prevent COVID-19 in people, and the university website where the study is posted warns that “whilst shown to be effective in the lab environment, ivermectin cannot be used in humans for COVID-19 until further testing and clinical trials have been completed to establish effectiveness of the drug.”
Ivermectin advocates often cite “dozens” of studies that show benefits of ivermectin in combating COVID-19, but a closer look at the studies shows that some of them have been retracted for flawed or fabricated data and analysis, while many randomized trials have shown no benefits. There have been some small studies that did suggest positive effects of ivermectin on treating COVID-19 patients, but no large, rigorous, randomized controlled trial has shown that COVID-19 is effective at treating or preventing COVID-19, medical experts say.
The general consensus in the medical community now is that there’s not enough data to recommend ivermectin for routine use as a COVID-19 treatment, said Dr. Adrian Hernandez, professor of medicine and vice dean and executive director of Duke Clinical Research Institute, who is leading a nationwide clinical trial on potential treatments for COVID-19. And doctors point out that there are side effect risks with any pharmaceuticals, so using the medication for unintended purposes may be dangerous.
And even with the arrival of highly effective treatments and vaccines, support for ivermectin has continued among some vaccine skeptics, including Kory, who have championed the drug as a COVID-19 cure and a key part of early treatment, and have urged Americans to stock up on it.
In August, prescriptions for ivermectin jumped to nearly 25 times the normal rate, to 88,000 per week, up from just 3,600 per week before the pandemic, according to the CDC.
“Let me just say very clearly that ivermectin is not a recommended treatment for COVID-19,” U.S. Surgeon General Vivek Murthy said in August. “It is not a recommended drug to prevent COVID-19.”
At your doorstep within days
Despite the warnings from health agencies about unproven COVID-19 treatments, several physicians groups have partnered with telemedicine platforms and pharmacies to offer easy access to drugs like ivermectin. But the easy access comes at a cost, with a telemedicine visit and the cost of the prescription typically ranging from $90-$300.
ABC News was able to obtain 28 pills of ivermectin for a total of $339, including a $90 telemedicine consultation fee and a charge of $249 from an online pharmacy — which included a $25 shipping fee for overnight delivery — after filling out an application and providing a medical history through a telemedicine platform, and having a brief conversation with someone who claimed to have no knowledge about the drug or COVID-19.
It was an unusual process for obtaining a medicine: Georgia-based ABC News Senior National Correspondent Steve Osunsami first spoke with a woman who said she was calling from Alabama and described herself as a technical nurse, while a Florida-based nurse practitioner — who didn’t speak with Osunsami but had a license to practice in Georgia — sent the prescription for the pills to a New York pharmacy that then shipped the pills to Georgia.
Osunsami began the process by registering online, after which he was contacted by the woman in Alabama. “Which one of the medications are you interested in?” she asked Osunsami, who told her he was interested in ivermectin. The woman then asked him if he had high blood pressure or allergies, and took some additional information.
“All right, that’s all the information I need,” the woman said. “So let’s send this to the pharmacy.”
Asked if there was anything else to know about the drug, the woman directed Osunsami to the pharmacy that would fill his prescription.
“I don’t have any medical knowledge as far as medicine or even about COVID,” said the woman. “I don’t have any medical knowledge at all. I’m so sorry, but I really don’t.”
But no matter, because the prescription was already on its way.
Osunsami was not asked if he wanted a consultation with a doctor or a pharmacist. He did receive some guidance including how to use the medicine and what side effects to look out for with the drug.
‘Millions of dollars being made’
One year after his congressional testimony, Kory doubled down on the anti-parasitic drug, calling ivermectin the “single greatest solution to the pandemic” in a blog post earlier this month — even though top health agencies have said ivermectin is not yet proven to be effective against the coronavirus.
And just days ago, Kory launched his own telemedicine platform that offers ivermectin as part of its treatment protocols. For $250, his website offers a 15-minute “‘Meds on Hand’ Treatment Kit” consultation with a nurse practitioner through text or telephone — and for a premium of $950, you can even arrange a personalized visit with Kory himself. The website doesn’t say whether the platform sends the drugs to a pharmacy or it sells them directly. It says ivermectin is part of their treatment protocol.
The website offers ivermectin and a few other drugs like hydroxychloroquine, a once-promising COVID-19 treatment that had its FDA emergency authorization revoked after it failed to show a benefit in large studies, as part of its COVID-19 treatment protocols.
Neither Kory, representatives for his new telemedicine platform, or members of the Front Line COVID-19 Critical Care Alliance responded to ABC News’ multiple requests for comment regarding promoting the use of drugs for the treatment of COVID-19 that have not been proven to be effective treatments for the disease.
Critics say that at least one other group is capitalizing on the interest in ivermectin — apparently by leveraging a network of doctors available to write the prescriptions.
ABC News obtained an email sent by Encore Telemedicine, an entity that was connecting patients to telemedicine services for people seeking consultation through the physicians group America’s Frontline Doctors. In the email, Encore Telemedicine sought to entice physicians to “become part of an ivermectin ‘COVID-19 project'” with the potential to receive “tens of thousands of dollars per month” from prescribing ivermectin and hydroxychloroquine.
“We can send you as many patients per day at $30 per patient per encounter as you would like,” the email stated. “We have physicians making tens of thousands of dollars per month.”
Neither Encore Telemedicine nor America’s Frontline Doctors responded to ABC News’ requests for comment. Encore Telemedicine’s website has been down for several months.
The booming online industry of telemedicine offering unproven COVID-19 treatments like ivermectin has caught the attention of lawmakers, who have launched an investigation into America’s Frontline Doctors and SpeakWithAnMD.com, a telemedicine platform.
In a letter sent by the House Subcommittee on the Coronavirus Crisis to America’s Frontline Doctors, House investigators refer to Encore Telemedicine, the company that ABC News obtained the email from, as the parent company of SpeakWithAnMD.com.
The House probe, launched in October, is investigating the entities for allegedly “spreading misinformation and facilitating access to disproven and potentially hazardous coronavirus treatments, such as hydroxychloroquine and ivermectin.”
“Attempts to monetize coronavirus misinformation have eroded public confidence in proven treatments and prevention measures and hindered efforts to control the pandemic,” Rep. James E. Clyburn (D-S.C.), chairman of the House Subcommittee on the Coronavirus Crisis, wrote in a letter to Dr. Simone Gold, the leader of America’s Frontline Doctors, over the fall.
“We think there are millions of dollars being made by various groups selling misinformation,” Clyburn told ABC News. “[We’re] doing what we think is necessary to try to get to the bottom of this.”
(NEW YORK) — The United States marked a new stage in the government’s response to the COVID-19 pandemic when President Joe Biden announced in his State of the Union address Tuesday that “COVID-19 no longer need control our lives.”
The World Health Organization declared a global pandemic in March 2020 due to rapid spread of COVID-19 all across the globe.
However, as many experts believe the virus that causes COVID-19 will never be eradicated, the world must at some point transition away from “pandemic” and toward an “endemic” phase.
Pandemics are a widespread, rapid spread of disease, with exponentially rising cases over a large area. Endemic viruses, meanwhile, are constantly present and have a fairly predictable spread. That predictability allows health care systems and doctors to prepare and adapt, reducing loss of life.
For a pandemic to reach an endemic phase, it would need to be “a situation where you have a background level” of disease, said Dr. Daniel McQuillen, president of the Infectious Diseases Society of America and a senior physician in the division of infectious diseases at Beth Israel Lahey Health in Massachusetts.
This means that, while some people would still get infected, it wouldn’t be an unbearable number with devastating consequences that overwhelms the public, hospital systems and providers.
The seasonal flu, or influenza, is an example of an endemic virus. H1N1 influenza has had pandemic spread of variants in the past, such as the Spanish flu in 1918 and swine flu in 2009. Variants of these are now part of respiratory viruses that we encounter regularly.
“There’s not a hard and fast rule for when a pandemic becomes an endemic,” said Dr. Paul Goepfert, a professor of medicine in the University of Alabama at Birmingham’s division of infectious diseases.
Without knowing if there may be another variant on the horizon and without a predictable pattern of disease, it’s still too soon to tell if the nation has reached an endemic phase.
That’s why many Americans are concerned it’s too soon to lift mask mandates. There is still a lot of transmission, and young children and immunocompromised people are still vulnerable.
However, McQuillen said the new guidelines from the Centers for Disease Control and Prevention are a reasonable shift, as they focus on local transmission and capacity.
“We’re going from trying to prevent disease completely to going more to how do we deal with preventing severe illness and hospitalizations and how do we prevent our health care system from getting so swamped that we can’t take care of even normal problems,” he said.
This must be determined at a local level.
“I think [the new CDC guidance] reflects this need to be flexible in how to respond to the pandemic,” said Dr. Natasha Chida, assistant professor in the division of infectious diseases at Johns Hopkins University.
Pandemics are “not a static experience,” she said. Some places in the country still have very low hospital capacity, so they would struggle to handle additional cases and thus would benefit from masking. But when numbers are low, we should “be able to have a normal type of experience,” she said.
Despite the new guidelines, many experts are hesitant to say the nation has entered an endemic phase just yet, as only time will tell if a new variant will arise and cause similar upheaval.
“Endemic is where you are seeing consistently low numbers, the health care system is able to manage it [and] people are able to get the care they need,” Chida said.
While the U.S. is getting close, numbers have dropped before and then new variants emerged, so it’s “too soon to say” if we are in this phase yet, she said.
To prepare for and prevent another wave, McQuillen, Goepfert and Chida each emphasized the importance of building better infrastructure for public health initiatives. This includes equitable vaccine distribution across the globe and increasing supply of treatments and testing — items currently outlined in the White House’s new pandemic policy agenda.
Goepfert also noted the importance of supporting primary care providers, both in allowing them to administer vaccines in their clinics and ease of access to treatment.
“What the pandemic laid bare was that public health has been massively under-resourced for decades, and people suffered because of that,” Chida said.
Now, with more than 75% of Americans vaccinated, experts are hopeful that the country can move toward better control of the disease and toward a new endemic phase — where we can control the disease, and it doesn’t control us.
(NEW YORK) — As the Russian invasion of Ukraine intensifies, children are experiencing devastating consequences of being caught up in the war zone.
At least seven children have been killed, according to United Nations High Commissioner for Human Rights, and several more have been injured during air strikes and blasts.
Dozens of children are hiding in bomb shelters, basements, metro stations and other underground areas while others have fled their homes for neighboring countries.
Psychologists and other experts say there are also mental health concerns these children face and that it’s important they have as much structure as possible to keep a sense of stability in their lives.
And adults can better provide for their children by taking care of their own mental health needs.
“Children are extremely vulnerable to insecurity, not only the physical trauma but the psychological trauma, and it can reverberate and have repercussions for a long time,” Dr. Paul Wise, a professor of pediatrics at Stanford University, told ABC News.
Mental health risks for children in war zones
There are physical risks for children that come with living in war zones, such as breathing in smoke and ash from fires and blasts that can affect the nose and lungs. But there are also mental health risks.
Studies have shown that children and families living in or fleeing war regions have an increased risk of suffering from mental health problems.
“We’ve seen past war situations like what is happening in Ukraine, an increase in depression, anxiety,” Dr. Monica Barreto, a clinical psychologist at Orlando Health Arnold Palmer Hospital for Children, told ABC News.
And while not all children will be traumatized, they may react differently to the traumatic situations they’re witnessing.
“Some children may be more agitated, they may be harder to calm down, just more unsettled,” said Dr. Jack Shonkoff, director for the Center of the Developing Child at Harvard University. “Some children in these circumstances tend to be more withdrawn, they’re not crying as much, they’re not demanding much attention.”
He continued, “Sometimes people might look at that and say, ‘This child is managing pretty well.’ Sometimes that’s a sign of the things to worry about the most because these children are withdrawing, they’re internalizing a lot of what’s going on.”
Taking care of adults’ needs helps children
Shonkoff, who is also a professor of child health and development, said one way to ensure a good outcome for children in a war zone is by making sure the adults are being taken care of too.
“The most important factor that determines how children are going to basically survive and go forward after a war experience is the nature of the adults who are caring for them,” he said. “If the parents and the caregivers are significantly traumatized, they can’t provide that sense of support. The adults’ needs become critically important to protect the children.”
He likens it to a safety presentation on a flight, when flight attendants tell passengers to secure their own oxygen masks before helping others.
“That’s not a way of saying you’re more important than your child. It’s a way of saying if you pass out, your child won’t be OK,” Shonkoff said.
As for babies, he explained they are highly attuned to what’s going on and if adults are not engaging with them, it can hurt the babies’ development.
“If the parent is so traumatized or depressed, they can’t coo back, can’t smile back. That signals danger to the brain even though the baby doesn’t know what’s going on. That can create excessive stress in the body, raise inflammation and blood pressure levels,” Shonkoff said.
Wise adds that children look to adults not only for protection but also for how frightened they should be and “for understanding what’s happening to them in a time of profound insecurity, and children will feel the best protected with a strong, coherent community life and family life.”
Children need as much as structure as possible
The experts say it’s important to make sure that children are provided structure as much as possible while living in war zones to help with their development and well-being.
Barreto mentioned videos she’s seen online of Ukrainian families in bunkers trying to provide play and teachers trying to teach lessons.
“Children are no longer in school, they’re no longer in a safe environment,” she said. “Maintaining some of that structure can be very helpful and protective during these times.”
Barreto added that the same recommendations apply for children in refugee camps, making sure they are set up with their families and that some time is provided so they can experience “normality” whether that is playtime or having lessons.
(NEW YORK) — A North Carolina woman who had been unable to eat solid foods for over a decade due to a rare condition underwent a life-changing multiorgan transplant that gave her a new stomach, pancreas and intestines.
Sarah Granados, a mom of three from Gastonia, North Carolina, waited 444 days for the transplant, which took place in November at Indiana Health University Hospital, more than 500 miles away from her home.
“It gave my kids their mom back. It gave my husband back his wife,” Granados, 36, said of the transplant. “It gave me the chance to dream about things I haven’t dreamt about in years because I was too scared to.”
Granados has faced life-threatening medical complications since 2012, when she underwent what was considered a routine surgery to remove her gallbladder because of a potentially cancerous spot.
Though the surgery did not have complications, Granados said doctors believe she was uniquely affected by it because she has Hypermobile Ehlers-Danlos syndrome, an inherited connective tissue disorder that can cause gastrointestinal dysfunction.
After the surgery, Granados said she was unable to eat solid foods and had to be placed on a feeding tube.
Doctors diagnosed her with severe gastroparesis, a disorder that “slows or stops the movement of food from your stomach to your small intestine,” according to the National Institutes of Health.
After spending six years on a feeding tube, Granados underwent a second surgery, a gastrectomy, in 2018 to remove her stomach and part of her small intestines. Complications from that surgery, she said, sent her into intestinal failure and she was diagnosed with intestinal pseudo-obstruction, a rare condition when the intestines appear blocked, according to the NIH.
Granados, whose youngest child was around 4 years old at the time, was then placed on total parenteral nutrition, a lifesaving measure that delivers nutrients intravenously.
“I ran into complications almost immediately,” said Granados. “It was at that time that [doctors] said, ‘You’re either going to need a transplant or your life expectancy is probably only a few years.”
Doctors determined that Granados needed a transplant of her gastrointestinal system, a rare procedure that only occurs in around 100 patients worldwide each year, according to Dr. Richard Mangus, surgical director of the IU Health intestine transplant program and the doctor who performed Granados’ transplant.
Granados went on the transplant list in 2020, during the coronavirus pandemic, and spent much of the time leading up to the transplant in the hospital.
She was hospitalized in North Carolina in November 2021 when she got the call that a donor had been found with a stomach, pancreas and small and large intestines deemed a “perfect match” for Granados.
“At that point I was having conversations with my family about having my lines actually removed and going into hospice because I was ready to be done,” said Granados. “And not because I don’t love my life, and not because I wouldn’t give anything and everything, but because my body was really, really tired and couldn’t stand the thought of living in a hospital anymore.”
“I essentially had to have a perfect donor to make this this match happen,” she said.
Within 24 hours of getting the call, Granados was transported by plane to Indiana Health University Hospital in Indianapolis.
At the same time, Mangus flew to the location of the deceased donor to oversee the removal of the organs.
Once back in Indianapolis, on Nov. 14, 2021, Mangus oversaw a complex, 10-hour transplant procedure that involved several doctors.
“Usually there are a couple of surgeons taking her organs out, while a couple of surgeons are preparing the organs on a separate table, and then when her organs are out, we go ahead and bring the the new organs and put them into her abdomen,” Mangus explained. “We have to connect the blood vessels … and then we have to connect back to the intestinal tract .. and then distally we have to connect into her large intestine as well.”
Granados said she has thought every day since her transplant about the donor, whom she calls her “angel donor.”
“I can’t change that they had an untimely death, but I truly believe that there are angels that are made to save other people,” she said. “And in my case, the doctors were saying there was a one-in-a-million chance, so I’m very fortunate that I got my one-in-a-million.”
Granados continued, “There’s not an hour that goes by that I’m not very keenly aware that I’m now carrying somebody else. It’s a privilege but it’s also something I take very, very seriously.”
Both Granados and Mangus stressed the importance of organ donation, for which there is a critical need in the United States. More than 106,000 people are currently on the transplant waiting list, and 17 people die each day waiting for an organ transplant, according to U.S. government data.
“They ultimately had to be willing to share five organs with me,” Granados said of her own donor, whose identity she does not know but whose family she said she prays she can one day meet.
“I’m making the choice to honor the beauty of organ donation by talking about it,” she said. “Now every person I walk by, I’m like, ‘You have the potential to save a life or I have the potential to save yours.'”
Granados has had to stay in Indianapolis since November as doctors oversee her recovery. She had a brief visit with her husband and kids, now ages 18, 16 and 14, when the hospital allowed them to visit on Christmas Day.
“We had our first official family meal,” said Granados, who was able to sit and eat with her family for the first time in her kids’ memory. “My oldest daughter couldn’t even hardly eat her food because she was crying because she couldn’t believe that we were having a family dinner.”
In late February, Granados was also allowed to drive to North Carolina to again see her kids, whom she surprised at a local park.
“Getting to surprise them and the look on their faces when they realized it was me might be the best moment of my life,” she said, adding that the visit home gave her “the boost and the strength to go back and continue fighting.”
Granados said she is now on a regimen of 33 prescription medications daily as she fights for her body to continue to accept the transplanted organs.
She said that though her fight is far from over and though there are many hard days in the process, she is for the first time in years allowing herself to dream of a future, which includes swimming with her kids, eating meals with them and fulfilling her dream of opening an animal sanctuary.
“I owe it to my angel donor and to my family to live as best as I possibly can, and I think that means sharing hope and sharing joy wherever I possibly can, so that’s what my goal is,” said Granados. “Like I tell my kids, ‘As long as we have air in our lungs, there’s hope.'”
