POST 244. April 4, 2022.CORONAVIRUS. “Here’s a scary thought: America’s ability to face the pandemic’s next phase may depend on a handful of senators.”…. “When the end of the COVID-19 pandemic comes, it could create major disruptions for a cumbersome U.S. health care system made more generous, flexible and up-to-date technologically through a raft of temporary emergency measures.”

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“After five surges, and with vaccines and treatments widely available, it’s human nature to want to believe the job is done,” writes Dr. Ranney, an emergency medicine physician and academic dean at Brown University School of Public Health in Providence, R.I. “In reality, our healthcare system is in no better shape today than it was two years ago — and, in fact, it might be in worse condition.”..

“Our healthcare infrastructure should be a concern of national security. We need supply chains that work; staffing that is adequate not just during times of calm but also during moments of crisis; data systems that allow us to identify the surges before they overwhelm us; and a public health environment that not just preserves beds for emergencies but also allows us to prevent and treat disease and injury before they become a disaster,” Dr. Ranney said.” (G)

“When the end of the COVID-19 pandemic comes, it could create major disruptions for a cumbersome U.S. health care system made more generous, flexible and up-to-date technologically through a raft of temporary emergency measures.

Winding down those policies could begin as early as the summer. That could force an estimated 15 million Medicaid recipients to find new sources of coverage, require congressional action to preserve broad telehealth access for Medicare enrollees, and scramble special COVID-19 rules and payment policies for hospitals, doctors and insurers. There are also questions about how emergency use approvals for COVID-19 treatments will be handled.

The array of issues is tied to the coronavirus public health emergency first declared more than two years ago and periodically renewed since then. It’s set to end April 16 and the expectation is that the Biden administration will extend it through mid-July. Some would like a longer off-ramp…

MEDICAID CHURN

Medicaid, the state-federal health insurance program for low-income people, is covering about 79 million people, a record partly due to the pandemic.

But the nonpartisan Urban Institute think tank estimates that about 15 million people could lose Medicaid when the public health emergency ends, at a rate of at least 1 million per month.

Congress increased federal Medicaid payments to states because of COVID-19, but it also required states to keep people on the rolls during the health emergency. In normal times states routinely disenroll Medicaid recipients whose incomes rise beyond certain levels, or for other life changes affecting eligibility. That process will switch on again when the emergency ends, and some states are eager to move forward…

TELEHEALTH STATIC

Millions of Americans discovered telehealth in 2020 when coronavirus shutdowns led to the suspension of routine medical consultations. In-person visits are again the norm, but telehealth has shown its usefulness and gained broader acceptance.

The end of the public health emergency would jeopardize telehealth access for millions enrolled in traditional Medicare. Restrictions predating COVID-19 limit telehealth mainly to rural residents, in part to mitigate against health care fraud. Congress has given itself 151 days after the end of the public health emergency to come up with new rules….

TESTS, VACCINES, TREATMENTS, PAYMENTS & PROCEDURES

Widespread access to COVID-19 vaccines, tests and treatments rests on legal authority connected to the public health emergency.

One example is the Biden administration’s requirement for insurers to cover up to eight free at-home COVID-19 tests per month.

An area that’s particularly murky is what happens to tests, treatments and vaccines covered under emergency use authorization from the Food and Drug Administration.

Some experts say emergency use approvals last only through the duration of the public health emergency. Others say it’s not as simple as that, because a different federal emergency statute also applies to vaccines, tests and treatments. There’s no clear direction yet from health officials….

But hospitals could take a financial hit. Currently Medicare pays them 20% more for the care of COVID-19 patients. That’s only for the duration of the emergency.” (A)

“Here’s a scary thought: America’s ability to face the pandemic’s next phase may depend on a handful of senators.

The talks between Senate Majority Leader Chuck Schumer and Sen. Mitt Romney (R-Utah) entered their most urgent stage yet on Wednesday, as the two spearhead an effort to allocate $15.6 billion to fight the pandemic. The Democratic leader and Republican centrist convened a larger group on Wednesday afternoon to see if there is a real chance at a bipartisan bill before the April 9 congressional recess; the meeting broke without a deal but a vow to keep talking.

Lawmakers already disagreed on how, exactly, to claw back cash from unused pots of money that Congress dispensed earlier in the pandemic, which they want to use to bankroll the new funding. But there’s also a more philosophical divide that is proving more complicated: The two parties don’t agree on how urgent it is to come up with more money during the current coronavirus lull. With those underlying problems, it’s a big question mark if Schumer and Romney can get the needed 10 Republican senators to sign on.

Senate Democrats insist that every day without action counts, as the country needs to gear up with more therapeutics, testing and vaccines. Schumer said Wednesday that the consequences of failure are “really serious, scary almost.” In remarks on Wednesday afternoon, President Joe Biden said the nation is “running a risk” if Congress doesn’t act quickly, warning testing capacity will be exhausted by the end of June and that vaccine and therapeutic supplies are also dwindling as the year drags on.” (B)

“Senate Democrats and Republicans neared agreement to slash an emergency coronavirus response package to $10 billion from $15.6 billion, as they worked to break a logjam over a stalled package of federal money urgently requested by President Biden for vaccines, therapeutics and preparation against future variants.

The day after Mr. Biden pleaded with Congress to approve the money, senators on Thursday were discussing removing as much as $5 billion in aid for the global vaccination effort as they scrambled to resolve disputes over how to finance the package. Republicans have refused to devote any new funding to the federal pandemic response effort, arguing that unspent money that has already been approved should be used, but the two parties have been unable to agree on which programs should be tapped.

Without that consensus, it was not clear that they would have the votes to move forward in the evenly divided Senate, where 60 votes — including at least 10 Republicans — would be needed.

The package now under consideration would be less than half the White House’s original $22.5 billion request.

At a news conference, the White House communications director Kate Bedingfield said the president had been clear about the urgent need for aid, adding that “we’re very hopeful that Congress is going to come to a solution.”

Asked about the possibility that funding for global efforts could be removed, she avoided saying that Mr. Biden would oppose a package without that aid. But, Ms. Bedingfield noted, “We’re not going to be able to put this pandemic behind us until we stop the spread and proliferation of new variants globally.”..

Under the emerging deal, Mr. Romney, said, most of the $10 billion would be repurposed from the $1.9 trillion pandemic law Democrats muscled through without Republican support last March. But direct funds for state and local governments would likely not be touched, after Democrats balked at this money being clawed back. Mr. Romney said negotiators had discussed taking back some funding from a program that allowed states to give grants to local businesses…

Efforts to tuck the aid into a $1.5 trillion spending package Mr. Biden signed into law earlier this month collapsed when rank-and-file Democrats and governors objected to claiming $7 billion that was supposed to go to state governments to help finance the package. Mr. Biden has warned that without another round of aid from Congress, his administration would be forced to scale back the nation’s pandemic response, jeopardizing its ability to be prepared for another variant or wave of infections.” (C)

“Romney said the $10 billion package would be “entirely balanced by offsets.”..

Republicans have insisted for months that any additional COVID relief funding would have to come out of unused pandemic relief money that Congress approved back in 2020 and 2021.

The $10 billion top line number is significantly less than the more than $22 billion the Biden administration initially requested and less than the $15.6 billion Congress was on the cusp of approving earlier in March…

Half of the new funds will be used for therapeutics, Republican Sen. Roy Blunt, a key negotiator, told reporters Thursday. The other half would be distributed to the Department of Health and Human Services for use with “broad discretion” as to how it will be spent on COVID-centric needs like research.

Blunt said that among the ways the bill is expected to be paid for is by clawing back $2.2 billion appropriated for shuttered performing arts venues, including “zoos and theaters.” The bill would also reprogram more than $2 billion originally intended for aviation manufacturing.

As of Thursday, no legislative text had been written.” (D)

“Gov. Andy Beshear has been toting oversize checks around his state in recent weeks, handing them out to city and county officials for desperately needed water improvements.

The tiny city of Mortons Gap got $109,000 to bring running water to six families who do not have it. The people of Martin County, whose water has been too contaminated to drink since a coal slurry spill two decades ago, got $411,000. The checks bear Mr. Beshear’s signature, but the money comes from the federal government, part of a huge infusion of coronavirus relief aid that is helping to fuel record budget surpluses in Kentucky and many other states.

Therein lies a Washington controversy. The funds, which Congress approved at a moment when the pandemic was still raging, are allowed to be used for far broader purposes than combating the virus, including water projects like those in Kentucky. Most states will get another round of “fiscal recovery funds” — part of President Biden’s $1.9 trillion American Rescue Plan — next month…

The rescue plan set aside $195 billion to help states recover from the economic and health effects of the pandemic. When Mr. Biden made his initial aid request, senior lawmakers in both parties negotiated a plan to pay for it partly by taking back $7 billion from states, as part of a $1.5 trillion spending bill…

Congress specified four broad purposes for the money: to respond to the pandemic’s health and economic impacts; to provide bonus pay to essential workers; to prevent cuts in public services; and to invest in sewer, water or broadband infrastructure. But states can also use the funds to replace lost revenues, which gives them great flexibility in spending the money.

Arkansas, for instance, has awarded $374,000 to a rape crisis center; $6.3 million to the Arkansas Coalition Against Sexual Assault; and another $6.3 million to the Arkansas Alliance of Boys & Girls Clubs. But the bulk of the money has gone toward improving broadband access and addressing the needs of the health care system.

“The Omicron variant came in, cases skyrocketed, hospitals filled up and so we had to utilize a significant amount of our ARPA money for expanding hospital space, home testing and other public health response,” said Gov. Asa Hutchinson, a Republican, using the acronym for the rescue plan. “So that’s obviously the first responsibility, and then we looked at these other needs.”

Other states are using the money in ways that are only tangentially related to Covid-19, but that are permissible under guidelines issued by the Treasury Department.

Alabama devoted $400 million of its allocation, or roughly one-fifth, to building two new prisons, despite a public outcry from advocates for racial justice and civil liberties. Florida devoted $2 billion, nearly one-quarter of its $8.8 billion allotment, to highway construction — a decision that has drawn criticism from the nonpartisan Florida Policy Institute.

“The intended purpose of the American Rescue Plan Act dollars was to ensure that individuals and communities could recover from the pandemic, and I think in many ways there were better uses for this money,” said Esteban Leonardo Santis, the group’s tax and revenue analyst.

Twenty states, including Kentucky, spent a total of $15 billion to build up their depleted unemployment insurance trust funds. Independent analysts say that is effectively a tax break for businesses, which otherwise may have had to make up for the lost revenues. But Mr. Beshear defended it, saying that Kentucky businesses stepped up during the pandemic. A local Toyota plant made face shields, and bourbon distillers manufactured hand sanitizer, he said…”  (E)

“The official in charge of Covid relief tells NBC News’ Lester Holt that programs like PPP were structured in ways that were “an invitation” to fraudsters.

They bought Lamborghinis, Ferraris and Bentleys. And Teslas, of course. Lots of Teslas.

Many who participated in what prosecutors are calling the largest fraud in U.S. history — the theft of hundreds of billions of dollars in taxpayer money intended to help those harmed by the coronavirus pandemic — couldn’t resist purchasing luxury automobiles. Also mansions, private jet flights and swanky vacations.

They came into their riches by participating in what experts say is the theft of as much as $80 billion — or about 10 percent — of the $800 billion handed out in a Covid relief plan known as the Paycheck Protection Program, or PPP. That’s on top of the $90 billion to $400 billion believed to have been stolen from the $900 billion Covid unemployment relief program — at least half taken by international fraudsters — as NBC News reported last year. And another $80 billion potentially pilfered from a separate Covid disaster relief program.

The prevalence of Covid relief fraud has been known for some time, but the enormous scope and its disturbing implications are only now becoming clear…

Justice Department Inspector General Michael Horowitz, who oversees Covid relief spending, told “NBC Nightly News” anchor Lester Holt in an exclusive interview that Covid relief programs were structured in ways that made them ripe for plunder.

“The Small Business Administration, in sending that money out, basically said to people, ‘Apply and sign and tell us that you’re really entitled to the money,’” said Horowitz, the chair of the Pandemic Response Accountability Committee. “And, of course, for fraudsters, that’s an invitation. … What didn’t happen was even minimal checks to make sure that the money was getting to the right people at the right time.”..

No one is sure exactly how much was stolen. An academic paper released last year estimated at least $76 billion in potential fraud, and the authors said that was conservative.” (F)

“As vaccine makers seek authorization for a fourth dose of their Covid vaccines in America, existing delays with vaccination and a lack of federal funding could slow the next booster rollout across the country, experts say.

“We’re way behind the eight-ball,” said Eric Topol, founder and director of the Scripps Research Translational Institute. The rollout of the first round of boosters, authorized in the US last fall, “just fell off the cliff”, with many Americans still not realizing they are eligible or that the booster is recommended.

With a potential second booster on the horizon for vulnerable groups, the Biden administration is still struggling to drum up American public interest in additional shots – and funding from Congress to pay for Covid initiatives.

“We’re out of money pretty much for the pandemic spending, which is terrifying because we don’t know what’s coming around the corner,” said Katrine Wallace, an epidemiologist at the University of Illinois Chicago.

Pfizer-BioNtech asked the US Food and Drug Administration (FDA) on 15 March for another round of boosters for those 65 and up, while Moderna went a step further and asked on 17 March for more boosters among those 18 and up to give the FDA “flexibility” in considering who would benefit from additional shots, including vulnerable younger people, the company said.

The doses in question would be the original formulation of the vaccines. Omicron-specific vaccines are still in the trial phase, but scientists believe updating the vaccines as the virus evolves could broaden immune responses to future variants.

A $15bn funding package for testing, treatment, vaccines and more was cut unexpectedly from an omnibus spending bill in Congress on 9 March.

Health officials spoke to Democratic senators about the urgent need for Covid funding in a meeting on Wednesday, Politico reports, but the plan may meet with opposition: Republicans, who were not at the meeting, say the White House’s $22.5bn request must be accompanied with equal cuts to government spending elsewhere.

There is enough funding to give fourth doses of the vaccines to immunocompromised people, who already qualify for the shots, and for those over 65, if the shot is authorized for them in coming weeks, the coronavirus response coordinator, Jeff Zients, said at a White House briefing on Wednesday.

But wider booster campaigns would not have funding under the current budget shortfalls, and first- and second-shot campaigns could also be affected in the longer term.

The funding collapse may also affect future research on updated vaccines and treatments. “Maybe we will see a new variant that’s escaped all of these, and we need a new vaccine,” Wallace said. Without funding to create and then distribute the updated vaccines, “that is going to be an issue”.” (H)

“Pfizer’s new COVID-19 treatment came with a catch when it debuted late last year: Supplies were limited, and it can take months to make the tablets.

Company leaders say they are expanding production and expect big gains in the next several months. That could help if another wave of cases develops.

The U.S. government distributes Paxlovid, the first pill authorized to treat the coronavirus. White House coronavirus response coordinator Jeff Zients said Wednesday that the government will have 1 million treatment courses available this month. He expects that to more than double in April.

Pfizer Chief Global Supply Officer Mike McDermott says there is “an ample amount” of Paxlovid available for high-risk patients who need it.

Physicians also have several other treatment options, including a less effective capsule treatment from Merck that U.S. regulators say should be considered only if other options aren’t available or appropriate.

Dr. Raymund Razonable of the Mayo Clinic said Paxlovid supplies would have to increase if another surge materializes that’s as big as the one caused recently by the omicron variant.

Why does it take so long to make Paxlovid?

The short answer: It’s a complex drug that involves chemical reactions that need time to develop.

Pfizer’s manufacturing experts compare Paxlovid to a complicated Lego model where key parts are made at different locations and then brought together and combined.

The initial building blocks can take up to three months to make. Some chemical reactions need days to develop at a controlled temperature and pressure.

“If you put it all in together very quickly, it can all go wrong,” said Charlotte Allerton, Pfizer’s head of medicine design.

Those initial building blocks are shipped to another location that makes the main part of the drug, the active ingredient. Tack on another three months for that process.

Then the ingredient heads to an additional location that turns it into tablets and packages the medicine. That can take six weeks. Add another week for quality checks and testing.

Paxlovid production involves more than 20 different sites in over 10 countries.” (I)

“The federal program that reimburses pharmacies, clinics, doctors, hospitals and other providers for testing and treating the uninsured for Covid-19 stopped accepting new claims last week due to insufficient funds. And it will cease taking new claims for vaccinating the uninsured on April 5.

The end of this program — which launched in the early days of the pandemic — makes it tougher for the nation’s 31 million uninsured residents to contend with Covid-19. While some access to free services continues, many uninsured Americans will now have to shell out money to get a coronavirus test or receive treatment if they are sick.

Vaccinations should still be provided free of charge since the federal government pre-purchased all the vaccines, said Jennifer Tolbert, associate director for the Program on Medicaid and the Uninsured at the Kaiser Family Foundation. Providers have been able to apply for reimbursement for administering the shot.

The federal program’s cessation is expected to hit more than just the uninsured, especially if the US experiences another Covid-19 surge.

“Some patients will end up not getting these lifesaving vaccines, treatments or being able to identify if they have had any type of exposure, which is going to harm these vulnerable individuals and impact our nation’s safety and protection against Covid-19,” said Audrey Richardson, policy analyst at Families USA, a consumer health advocacy group.” (J)

“The next wave of Covid-19 is coming, and in some parts of the United States, it’s already here. Are you ready?

The culprit this time is BA.2, a subvariant of the highly infectious Omicron variant. Nobody knows for sure how much havoc it will cause, but BA.2 has already led to a surge of cases in Europe and is now the dominant version of the coronavirus in the United States and around the world.

Researchers are tracking an uptick in cases in the United States, and they’ve detected a rise in the viral particles recovered from nearly 150 wastewater-surveillance sites. Because people can shed the coronavirus even if they never develop symptoms, pieces of the virus collected in wastewater can serve as advance warning several days before official case counts rise, said Bronwyn MacInnis, who directs pathogen genomic surveillance at the Broad Institute in Cambridge, Mass. Over the past two weeks, Dr. MacInnis’s group has seen a rapid increase in levels of the BA.2 subvariant in the Northeast.

“I don’t think we’re looking at a crazy lockdown scenario in this part of the world with BA.2,” Dr. MacInnis said. “But we can’t be sure that we won’t have another curveball from this virus in the future.”

American health officials have said they are hopeful that BA.2 won’t cause another major surge, in part because so many people were infected by the original Omicron wave this winter and most likely have at least some natural or vaccine immunity to protect them against severe illness and hospitalization.

But other variables could turn the BA.2 wave into a more damaging surge. One concern is that less than 70 percent of Americans over 65 have had a first booster shot, leaving a large group vulnerable, said Dr. Eric Topol, a professor of molecular medicine at Scripps Research in La Jolla, Calif. And for many people who got their booster shots in the fall, immune protection may be waning. Unvaccinated people who are counting on natural immunity from a previous infection by a different variant should know that BA.2 can easily sidestep those fading immune defenses.

And then there’s the question of whether pandemic fatigue will prevent some people from taking reasonable precautions, like wearing masks and social distancing, when Covid numbers start to rise in their area.

“We know how to manage it,” said Dr. Robert Wachter, a professor and the chair of the medicine department at the University of California, San Francisco. “But the big caveat will be that there are lots of parts of the country that will not go back into careful mode. It’s wishful thinking to believe we’re going to stay in a situation as good as we are in now.”” (K)

• A.COVID pandemic’s end may bring turbulence for US health care, By RICARDO ALONSO-ZALDIVAR, https://apnews.com/article/covid-health-business-coronavirus-vaccine-medicaid-fbb66b72937f3517a5d3d1ba8840f339
• B.The next phase of Covid depends on the Senate, By BURGESS EVERETT and MARIANNE LEVINE, https://www.politico.com/news/2022/03/30/covid-pandemic-aid-senate-00021764
• C.Senators near a deal to slash the stalled Covid aid package to $10 billion., https://www.nytimes.com/live/2022/03/31/world/covid-19-mandates-cases-vaccine#senators-near-a-deal-to-slash-the-stalled-covid-aid-package-to-10-billion
• D.Senators close in on $10 billion COVID relief deal, By Mariam Khan,Allison Pecorin, andTrish Turner, https://abcnews.go.com/Politics/senators-close-10-billion-covid-relief-deal/story?id=83788292
• E.As Biden Pleads for More Covid Aid, States Are Awash in Federal Dollars, By Sheryl Gay Stolberg, https://www.nytimes.com/2022/04/01/us/politics/covid-relief-funds.html?referringSource=articleShare
• F.Billions in pandemic relief funds lost to fraud, By Ken Dilanian and Laura Strickler, https://www.nbcnews.com/politics/justice-department/biggest-fraud-generation-looting-covid-relief-program-known-ppp-n1279664
• G.https://www.washingtonpost.com/opinions/2022/03/28/health-care-system-vulnerable-to-covid-ba2-omicron-surge/
• H.‘We’re way behind’: next US booster rollout faces delays and lack of funds, by Melody Schreiber, https://www.theguardian.com/us-news/2022/mar/27/us-second-covid-booster-delays-funding
• I.Why Pfizer needs time to make its COVID pill, Associated Press, https://www.modernhealthcare.com/supply-chain/pfizer-coronavirus-treatment-paxlovid-timeline
• J.Americans start to feel the impact of federal Covid-19 funds drying up, By Tami Luhby, https://www.cnn.com/2022/04/02/politics/federal-covid-uninsured-tests-vaccines/index.html
• K.A New Wave of Covid-19 Is Coming. Here’s How to Prepare., By Tara Parker-Pope and Knvul Sheikh, https://www.nytimes.com/2022/03/30/well/live/ba2-omicron-covid.html?referringSource=articleShare