The study, published on Thursday in the journal Science, adds to our understanding of long COVID, the lingering and often debilitating symptoms experienced by some people. One significant finding revealed shifts in proteins the body produces in response to inflammation that may persist months after infection. Another detected blood clots and tissue injury.

“We identified common patterns in long COVID patients not recovered at six months after acute infection,” compared to healthy patients, wrote the team, a collaboration of scientists from New York City’s Icahn School of Medicine at Mount Sinai, Switzerland, Sweden and London.

There is tremendous need to diagnose and find effective ways to treat long COVID, a constellation of symptoms that include exhaustion, migraines, brain fog and nausea that are not explainable using conventional lab tests.

At a hearing in Washington D.C. this week, senators at the Senate Committee on Health, Education, Labor and Pension agreed that the government must become more involved in long COVID research and support. Sen. Tim Kaine, D-Va., said he has been struggling with symptoms of long COVID for four years.

On March 15, a demonstration is planned at Lincoln Memorial to raise awareness and urge greater funding, preventative measures, research, and treatment strategies.

Although long COVID’s prevalence is difficult to estimate, surveys suggest it may afflict 5.3% to 7.5% of people infected by the virus.  It’s not known why some people develop long COVID and others don’t. But vaccines offer protection. One dose of vaccine reduces risk by 21%, two doses reduce risk by 59%, and three or more doses reduce risk by 73%, according to a recent study.

What causes long COVID? One possibility is that, long after it fends off infection, the immune system is still fighting. It turns on — but doesn’t turn off.

Experts don’t know why. UC San Francisco research suggests that viral genetic material remains embedded in tissues, long after infection. Or perhaps COVID triggers an autoimmune response when the body mistakenly attacks itself. There is mixed evidence for the effectiveness of the antiviral drug Paxlovid in preventing long COVID.

There is a desperate need for a diagnostic test and treatment for long COVID. Currently, doctors are treating the symptoms, rather than the underlying cause.

The new findings are important because “they demonstrate dysfunction, which is important to patients,” said Jaime Seltzer, scientific director at the nonprofit MEAction, which advocates for patients with long COVID and myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS.

“Secondly, they point the way to potential treatments, and even possibly mechanisms” of disease, she said.

This paper builds on our understanding of long COVID by connecting the changes that occur during an acute infection to longer-term abnormalities in markers of blood cell function, said Dr. Michael Peluso, an infectious disease physician at Zuckerberg San Francisco General Hospital, who is studying the biological mechanisms that drive long COVID and the infection’s long-term impact on health.

“It suggests that there is a relationship between the virus, its immune effects, and changes in certain blood coagulation pathways,” he said.

Although the study represents another step forward in understanding the science of long COVID, it will not immediately change the approach to diagnosing or treating the condition, said Peluso.

“We need more investment in larger studies to build upon these findings, as well as clinical trials to test whether altering some of the abnormalities that have been found here could result in symptomatic benefit,” he said.

In the new study, scientists analyzed changes in the blood of 113 patients who either fully recovered from COVID-19 or developed long COVID, as well as healthy people.

Specifically, they measured levels of 6,596 different proteins in study participants over a year, then sampled the blood again six months and a year later.  Proteins act like keys that fit in multiple locks on the surface of cells. Changes in proteins mean that cellular processes are altered.

Immune dysfunction is also suspected to be driving the symptoms in those with other persistent infection-linked illnesses, such as ME/CFS and Lyme Disease, said Seltzer. It’s the body’s way of adapting, she said.

There are caveats. With only 113 patients, the study was relatively small. Many participants were so sick that they needed hospitalization, which could have influenced results. Finally, it only studied changes within a year of infection; three to five years later, there may be different markers in the blood, said Seltzer. Patients’ immune systems may not be able to stay overactive indefinitely.

These features suggest potential interventions, wrote Wolfram Ruf of the Center for Thrombosis and Hemostasis in Germany, in a commentary that accompanied the report. Perhaps anti-inflammatory drugs would help. Anti-coagulants might reduce the risk of dangerous blood clots.

“Eventually, the hope is that some of these findings can translate into the clinic, but we are still a ways away from that,” said Peluso. “We need to keep up the momentum to get answers for the tens of millions of people with this disabling condition.”

LOS ANGELES — With COVID-19 rising this winter, it’s getting more complicated to discern whether you are infected.

Dr. Elizabeth Hudson, regional chief of infectious diseases at Kaiser Permanente Southern California, said she has noticed it’s sometimes taking longer after the onset of symptoms for rapid tests to return a positive result.

It used to be that someone might test positive for the coronavirus one or two days after the onset of symptoms using a rapid test, Hudson said. Now, positive results might not show up until the fourth day after symptoms start.

What is causing the lag?

The delay in accurate test results is probably a result of people having accumulated immunity from COVID-19 over the years, whether from vaccinations or previous infections, Hudson said.

“It’s actually pushing back the time that people’s COVID tests are coming up positive. So some people are testing at Day 1 and Day 2 and saying, ‘Oh, it’s negative, I don’t have COVID,’” Hudson said. “If they probably tested themselves a couple of days later, there’s a pretty good chance that it actually would turn out to be COVID.”

People who initially test negative for COVID-19 despite having symptoms and don’t retest later “could be getting a false sense of security” that they don’t have the illness when they actually do and are contagious, Hudson said.

What are the recommendations for testing?

Test immediately if you have symptoms of COVID-19, the U.S. Centers for Disease Control and Prevention says. If you take an at-home rapid test, also referred to as an antigen test, a positive result is usually reliable.

But a negative test does not always mean you don’t have COVID-19.

It can take a few days for virus levels to reproduce in quantities high enough to be detected by a rapid test.

If you test negative and have COVID symptoms, the CDC suggests taking a second test 48 hours later. In the meantime, because you are ill, officials say you should stay home and away from other people or mask up if you need to be around others.

Another option is heading to your medical provider to take a PCR test, which generally means going into a medical facility and having your test processed by a lab. “That test is much more sensitive. And that [positive test result] would come up sooner,” Hudson said.

But most people rely on taking at-home tests. And if that second at-home test is negative, experts recommend taking another one four days after the onset of symptoms.

“They should really, probably on Day 4, retest themselves if they’re doing the home antigen test,” Hudson said.

Generally, at-home rapid COVID-19 tests detect a coronavirus infection at least 80% of the time, according to the Food and Drug Administration.

By contrast, a lab-based PCR test generally detects the virus 95% of the time. But PCR tests can take a day or longer to process, while rapid test results are available within 15 minutes.

What if you’re asymptomatic but have been exposed?

You should get tested five days after you were last exposed to someone who was infected with COVID-19, the CDC says.

If the test is negative, take another at-home test two days later, or a PCR test as soon as you can. If the second at-home test result is negative, take a third at-home test two days after the second.

Are there other times when it’s helpful to test?

Testing before an event or visiting someone who is at higher risk can be helpful, the CDC says. Sometimes, a rapid test can detect an infection before symptoms have begun. It’s also possible a rapid test can detect an infection for someone who is asymptomatic.

“Test as close to the time of the event as possible, at least within one to two days,” the agency says. “If you use an antigen test, follow recommendations for repeat testing to be confident in a negative result.”

Where we stand with COVID

Coronavirus cases are up. But the number of people becoming seriously ill remains lower than last year, when hospitals were deluged by a “tripledemic” of COVID, flu and respiratory syncytial virus, or RSV.

Nationally, there were 34,798 new coronavirus-positive hospital admissions for the week that ended Dec. 30, a 20% jump over the prior week and the highest one-week total in nearly a year. Last winter peaked at 44,542 new hospital admissions for the week ending Dec. 31, 2022.

California recorded 3,516 new coronavirus-positive hospital admissions for the week that ended Dec. 30, a 7% increase from the previous week, according to data from the CDC. The state’s peak last winter was 5,260 new hospital admissions for the final week of 2022.

Since Oct. 1, the CDC has reported an average of about 1,400 COVID-19 deaths a week nationally. Over the same time period last year, there were about 2,400 weekly COVID-19 deaths.

Seven California counties on Friday joined the CDC’s medium level of coronavirus-positive hospitalizations from the low level: Orange County; Alameda and Contra Costa counties in the Bay Area; and in the Central Valley and Sierra, Stanislaus, Merced, Tuolumne and Mariposa counties. Los Angeles County and the four-county Sacramento area were already in the medium level.

What about JN.1?

A more contagious subvariant may be aiding the spread of COVID-19.

Nationally, the subvariant JN.1 was estimated to account for 62% of coronavirus specimens for the two-week period that ended Saturday; it accounted for 39% of specimens for the prior comparable period.

How can you get a COVID-19 test?

The U.S. government is allowing residents to order free at-home COVID tests through COVIDtests.org. People are able to order four free at-home tests per household. And if they didn’t already place an order between Sept. 25 and Nov. 19, they’re eligible for two separate orders of four tests.

In general, doctors and health plans remain responsible for providing free COVID tests to patients assigned to them, according to the Los Angeles County Department of Public Health.

At-home COVID tests are on sale at pharmacies and online retailers. In California, state law still requires most health plans — those regulated by the state — to reimburse for the cost of eight at-home test kits per month. But residents should check with their health plan on details of reimbursement and whether they need to purchase them through an in-network provider to get fully reimbursed.

There may be some Medicare patients who don’t qualify for free at-home test kits. However, COVID-19 testing is free if ordered by a doctor. And some with Medicare Advantage plans may still be eligible for free at-home COVID tests.

Free tests are available in a number of settings in Los Angeles County, including at libraries, senior centers and food banks. More information can be found at ph.lacounty.gov/COVIDtests or by calling (833) 540-0473.

The CDC has set up a website, testinglocator.cdc.gov, that displays sites that offer free COVID-19 tests for uninsured people who are ill or have been exposed to the virus.

A program funded by the National Institutes of Health, featured at test2treat.org, gives adults who test positive for COVID-19 or flu free access to telehealth care and treatment. That program is expected to run through early summer. Adults who aren’t positive can still enroll to get free tests shipped to them if they are uninsured or underinsured; on Medicare or Medi-Cal; or in the healthcare system of the Department of Veterans Affairs or the Indian Health Service.

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©2024 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.

Tedros Adhanom Ghebreyesus said nearly 10,000 deaths were reported in December, while hospital admissions during the month jumped 42% in nearly 50 countries — mostly in Europe and the Americas — that shared such trend information.

“Although 10,000 deaths a month is far less than the peak of the pandemic, this level of preventable deaths is not acceptable,” the World Health Organization director-general told reporters from its headquarters in Geneva.

He said it was “certain” that cases were on the rise in other places that haven’t been reporting, calling on governments to keep up surveillance and provide continued access to treatments and vaccines.

Tedros said the JN.1 variant was now the most prominent in the world. It is an omicron variant, so current vaccines should still provide some protection.

Maria Van Kerkhove, technical lead at WHO for COVID-19, cited an increase in respiratory diseases across the globe due to the coronavirus but also flu, rhinovirus and pneumonia.

“We expect those trends to continue into January through the winter months in the northern hemisphere,” she said, while noting increases in COVID-19 in the southern hemisphere — where it’s now summer.

While bouts of coughs, sniffling, fever and fatigue in the winter are nothing new, Van Kerkhove said this year in particular, “we are seeing co-circulation of many different types of pathogens.”

WHO officials recommend that people get vaccinated when possible, wear masks, and make sure indoor areas are well ventilated.

“The vaccines may not stop you being infected, but the vaccines are certainly reducing significantly your chance of being hospitalized or dying,” said Dr. Michael Ryan, head of emergencies at WHO.

Three years after more than 3,600 health workers died of COVID-19, occupational safety experts warn that those on the front lines may once again be at risk if the Centers for Disease Control and Prevention takes its committee’s advice on infection control guidelines in health care settings, including hospitals, nursing homes, and jails. In early November, the committee released a controversial set of recommendations the CDC is considering, which would update those established some 16 years ago.

The pandemic illustrated how a rift between the CDC and workplace safety officials can have serious repercussions. Most recently, the giant hospital system Sutter Health in California appealed a citation from the state’s Division of Occupational Safety and Health, known as Cal/OSHA, by pointing to the CDC’s shifting advice on when and whether N95 masks were needed at the start of the pandemic. By contrast, Cal/OSHA requires employers in high-risk settings like hospitals to improve ventilation, use air filtration, and provide N95s to all staff exposed to diseases that are — or may be — airborne.

The agencies are once again at odds. The CDC’s advisory committee prescribes varying degrees of protection based on ill-defined categories, such as whether a virus or bacteria is considered common or how far it seems to travel in the air. As a result, occupational safety experts warn that choices on how to categorize COVID, influenza, and other airborne diseases — and the corresponding levels of protection — may once again be left to administrators at hospitals, nursing homes, and jails or prisons.

Eric Berg, deputy chief of health at Cal/OSHA, warned the CDC in November that, if it accepted its committee’s recommendations, the guidelines would “create confusion and result in workers being not adequately protected.”

Also called respirators, N95 masks filter out far more particles than looser-fitting surgical masks but cost roughly 10 times as much, and were in short supply in 2020. Black, Hispanic, and Asian health workers more often went without N95 masks than white staffers, which helped explain why members of racial and ethnic minorities tested positive for COVID nearly five times as often as the general population in the early months of the pandemic. (Hispanic people can be of any race or combination of races.)

Cal/OSHA issued dozens of citations to health care facilities that failed to provide N95 masks and take other measures to protect workers in 2020 and 2021. Many appealed, and some cases are ongoing. In October, the agency declined Sutter’s appeal against a $6,750 citation for not giving its medical assistants N95 masks in 2020 when they accompanied patients who appeared to have COVID through clinics. Sutter pointed to the CDC’s advice early in the pandemic, according to court testimony. It noted that the CDC called surgical masks an “acceptable alternative” in March 2020, “seemed to recommend droplet precautions rather than airborne precautions,” and suggested that individuals were unlikely to be infected if they were farther than 6 feet away from a person with COVID.

This is a loose interpretation of the CDC’s 2020 advice, which was partly made for reasons of practicality. Respirators were in short supply, for example, and physical distancing beyond 6 feet is complicated in places where people must congregate. Scientifically, there were clear indications that the coronavirus SARS-CoV-2 spread through the air, leading Cal/OSHA to enact its straightforward rules created after the 2009 swine flu pandemic. Workers need stiffer protection than the general population, said Jordan Barab, a former official at the federal Occupational Safety and Health Administration: “Health workers are exposed for eight, 10, 12 hours a day.”

The CDC’s advisory committee offers a weaker approach in certain cases, suggesting that health workers wear surgical masks for “common, often endemic respiratory pathogens” that “spread predominantly over short distances.” The draft guidance pays little attention to ventilation and air filtration, and advises N95 masks only for “new or emerging” diseases and those that spread “efficiently over long distances.” Viruses, bacteria, and other pathogens that spread through the air don’t neatly fit into such categories.

“Guidelines that are incomplete, weak, and without scientific basis will greatly undermine CDC’s credibility,” said a former OSHA director, David Michaels, in minutes from an October meeting where he and others urged CDC Director Mandy Cohen to reconsider advice from the committee before it issues final guidance next year.

Although occupational safety agencies — not the CDC — have the power to make rules, enforcement often occurs long after the damage is done, if ever. Cal/OSHA began to investigate Sutter only after a nurse at its main Oakland hospital died from COVID and health workers complained they weren’t allowed to wear N95 masks in hallways shared with COVID patients. And more than a dozen citations from Cal/OSHA against Kaiser Permanente, Sharp HealthCare, and other health systems lagged months and years behind health worker complaints and protests.

Outside California, OSHA faces higher enforcement obstacles. A dwindling budget left the agency with fewer workplace inspectors than it had in 45 years, at the peak of the pandemic. Plus, the Trump and Biden administrations stalled the agency’s ongoing efforts to pass regulations specific to airborne infections. As a result, the agency followed up on only about 1 in 5 COVID-related complaints that employees and labor representatives officially filed with the group from January 2020 to February 2022 — and just 4% of those made informally through media reports, phone calls, and emails. Many deaths among health care workers weren’t reported to the agency in the first place.

Michaels, who is now on the faculty at the George Washington University School of Public Health, said the CDC would further curtail OSHA’s authority to punish employers who expose staff members to airborne diseases, if its final guidelines follow the committee’s recommendations. Such advice would leave many hospitals, correctional facilities, and nursing homes as unprepared as they were before the pandemic, said Deborah Gold, a former deputy chief of health at Cal/OSHA. Strict standards prompt employers to stockpile N95 masks and improve air filtration and ventilation to avoid citations. But if the CDC’s guidance leaves room for interpretation, she said, they can justify cutting corners on costly preparation.

Although the CDC committee and OSHA both claim to follow the science, researchers arrived at contradictory conclusions because the committee relied on explicitly flawed trials comparing health workers who wore surgical masks with those using N95s. Cal/OSHA based its standards on a variety of studies, including reviews of hospital infections and engineering research on how airborne particles spread.

In decades past, the CDC’s process for developing guidelines included labor representatives and experts focused on hazards at work. Barab was a health researcher at a trade union for public sector employees when he helped the CDC develop HIV-related recommendations in the 1980s.

“I remember asking about how to protect health care workers and correction officers who get urine or feces thrown at them,” Barab said. Infectious disease researchers on the CDC’s committee initially scoffed at the idea, he recalled, but still considered his input as someone who understood the conditions employees faced. “A lot of these folks hadn’t been on hospital floors in years, if not decades.”

The largest organization for nurses in the United States, National Nurses United, made the same observation. It’s now collecting signatures for an online petition urging the CDC to scrap the committee’s guidelines and develop new recommendations that include insights from health care workers, many of whom risked their lives in the pandemic.

Barab attributed the lack of labor representation in the CDC’s current process to the growing corporate influence of large health systems. Hospital administrators prefer not to be told what to do, particularly when it requires spending money, he said.

In an email, CDC communications officer Dave Daigle stressed that before the guidelines are finalized, the CDC will “review the makeup of the workgroups and solicit participation to ensure that the appropriate expertise is included.”

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

U.S. men dying nearly 6 years before women is now the largest life expectancy gap between sexes since 1996, according to new research led by Harvard T.H. Chan School of Public Health and UC San Francisco.

The life expectancy gender gap of 5.8 years in 2021 was a jump from 4.8 years in 2010, when the gap was at its smallest in recent history.

The pandemic, which took a disproportionate toll on men, was the biggest contributor to the widening gap from 2019 to 2021 — followed by unintentional injuries and poisonings (mostly drug overdoses), accidents, and suicide.

“There’s been a lot of research into the decline in life expectancy in recent years, but no one has systematically analyzed why the gap between men and women has been widening since 2010,” said first author Brandon Yan, a UCSF internal medicine resident physician and research collaborator at Harvard Chan School.

Life expectancy in the U.S. dropped in 2021 to 76.1 years — falling from 78.8 years in 2019, and 77 years in 2020.

The shortening lifespan of Americans has been attributed in part to so-called “deaths of despair.” The term refers to the increase in deaths from such causes as suicide, drug use disorders, and alcoholic liver disease, which are often connected with economic hardship, depression, and stress.

“While rates of death from drug overdose and homicide have climbed for both men and women, it is clear that men constitute an increasingly disproportionate share of these deaths,” Yan said.

Using data from the National Center for Health Statistics, Yan and fellow researchers from around the country identified the causes of death that were lowering life expectancy the most. Then, they estimated the effects on men and women to see how much different causes were contributing to the gap.

Before the COVID pandemic, the largest contributors were unintentional injuries, diabetes, suicide, homicide, and heart disease.

But during the pandemic, men were more likely to die of the virus. That was likely due to a number of reasons — including differences in health behaviors, as well as social factors, such as the risk of exposure at work, reluctance to seek medical care, incarceration, and housing instability.

“We have brought insights to a worrisome trend,” Yan said. “Future research ought to help focus public health interventions towards helping reverse this decline in life expectancy.”

A federal judge in Miami sentenced Jonathan Grenon, 37, and Jordan Grenon, 29, to 12 years and seven months in prison, while Mark Grenon, 66, and Joseph Grenon, 36, each received five years, according to court records. A jury found all four guilty in July of conspiring to defraud the United States and deliver misbranded drugs. The Grenons represented themselves but declined to speak during the two-day trial.

Prosecutors called the Grenons “con men” and “snake-oil salesmen” and said the Bradenton family’s Genesis II Church of Health and Healing sold $1 million worth of their so-called Miracle Mineral Solution. In videos, it was pitched as a cure for 95% of known diseases, including COVID-19, Alzheimer’s, autism, brain cancer, HIV/AIDS and multiple sclerosis, prosecutors said.

What the Grenons were selling was actually chlorine dioxide, officials said. When ingested, the solution becomes a bleach that is typically used for such things as treating textiles, industrial water, pulp and paper, according to the Food and Drug Administration. Authorities said it is the same as drinking bleach and can be fatal.

A Miami federal judge ordered the church to stop selling the substance in 2020, but that was ignored.

Jonathan and Jordan Grenon were arrested in Bradenton, just south of the Tampa Bay area. Mark and Joseph Grenon fled to Colombia, where they were arrested and extradited back to the U.S.

Besides the fraud convictions, Jonathan and Jordan Grenon were also convicted of violating federal court orders requiring them to stop selling Miracle Mineral Solution in 2020. U.S. authorities agreed to drop those same contempt charges against Mark and Joseph Grenon as a condition of their extradition from Colombia.

It’s the end of an era for a once-critical pandemic document: The ubiquitous white COVID-19 vaccination cards are being phased out.

Now that COVID-19 vaccines are not being distributed by the federal government, the U.S. Centers for Disease Control and Prevention has stopped printing new cards.

The federal government shipped more than 980 million cards between late 2020, when the first vaccines came out, through May 10, according to the latest available data from the CDC.

Federal and local health officials don’t expect the discontinuation of the cards to be a particularly big change, since the days of keeping them tucked in purses and wallets to ensure entry into festivals, bars and restaurants are largely over. If you’ve held on to your card, it’s still valid as proof of vaccination. Otherwise, people who need their COVID-19 immunization records will need to request them just like any other vaccine.

In many cases, the clinic, pharmacy or health department that provided the shot can provide those records. Every state and some cities have an immunization registry, though rules vary on when records are included and options for obtaining copies of your records. Records from the mass vaccination sites held early in the pandemic also should be available in those registries, depending on state laws. There is no national registry for immunization records.

For example, Texas requires patients’ written consent to be included in the registry, San Antonio Metropolitan Health District spokesman David Andres Alegria said. Other places, including Wyoming and Philadelphia’s city-specific record system, require vaccine providers to log all vaccinations.

Many states offer digital vaccination records for individuals either online or through an app. Users can save a certificate or a QR code that proves they are vaccinated. And some websites will even track and alert patients when they’re due for another one.

“One of the positives (during the pandemic) was having increased autonomy on your patient record, especially the immunization record,” said Jeff Chorath, who manages the immunization information system in Washington state. Washington offers two digital options for obtaining vaccination records — a comprehensive list of all of a person’s vaccinations noted in the state database and one specific to COVID-19 vaccines.

Other states don’t have the same options, so it might take longer to get your records. There could also be gaps in state databases; for example, if you were vaccinated by a federal health provider, those records may be tracked in a separate system.

As for your old card — if you still have it — maybe don’t mail it off to the Smithsonian quite yet. You should save it like any other health record, Wyoming Department of Health nurse consultant Heidi Gurov said.

“It’s always good to keep those in a safe spot,” she said.

Four million people in the U.S. have received the latest COVID-19 vaccine since it was approved last month, CDC director Dr. Mandy Cohen said Wednesday, and a total of 10 million doses have been shipped to providers.

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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

WASHINGTON — The Biden administration announced Wednesday that it is providing $600 million in funding to produce new at-home COVID-19 tests and is restarting a website allowing Americans to again order up to four free tests per household — aiming to prevent possible shortages during a rise in coronavirus cases that has typically come during colder months.

The Department of Health and Human Services says orders can be placed at COVIDTests.gov starting Sept. 25, and that no-cost tests will be delivered for free by the United States Postal Service.

Twelve manufacturers that employ hundreds of people in seven states from California to Maryland have been awarded funding and will produce 200 million over-the-counter tests to replenish federal stockpiles for government use, in addition to producing enough tests to meet demand for tests ordered online, the department said.

The new effort is meant to guard against supply chain issues that sparked some shortages of at-home COVID tests made overseas during past surges in coronavirus cases. But it also illustrates the political balance President Joe Biden is trying to strike as he seeks reelection next year between trumpeting his administration having led the country through the worst of the pandemic while also trying to trying to better prepare for the continued effects of a virus that persists.

Dawn O’Connell, assistant secretary for preparedness and response at HHS, said that though some portions of the public may be tired of the pandemic and its implications, at home-testing remains a key way to slow the spread of new cases.

“Whether or not people are done with it, we know the virus is there, we know that it’s circulating. We know, if past is prologue, it’ll circulate to a higher degree and spread, and cases will go up in the fall and winter seasons,” O’Connell said. “Anticipating that that would be true again, or something similar, we want to make sure the American people have these tools.”

O’Connell said the website will remain functional to receive orders through the holidays and “we reserve the right to keep it open even longer if we’re starting to see an increase in cases.”

“If there is a demand for these tests, we want to make sure that they’re made available to the American people for free in this way,” O’Connell said. “But, at this point, our focus is getting through the holidays and making sure folks can take a test if they’re going to see Grandma for Thanksgiving.”

The tests are designed to detect COVID variants currently circulating, and are intended for use by the end of the year. But they will include instructions on how to verify extended expiration dates, the department said.

The initiative follows four previous rounds where federal officials and the U.S. Postal Service provided more than 755 million tests for free to homes nationwide.

It is also meant to complement ongoing federal efforts to provide free COVID tests to long-term care facilities, schools, low-income senior housing, uninsured individuals and underserved communities which are already distributing 4 million per week and have distributed 500 million tests to date, the department said.

O’Connell said manufacturers would be able to spread out the 200 million tests they will produce for federal use over 18 months. That means that, as demand for home tests rises via the website or at U.S. retailers when COVID cases increase around the country, producers can focus on meeting those orders — but that they will then have an additional outlet for the tests they produce during period when demand declines.

She also said that each winter since the pandemic began “as people move indoors into heated spaces” cases rise and added that also “there’s always an opportunity or chance for another variant to come” but “we’re not anticipating that.”

“That’s not why we’re doing this,” O’Connell said. “We’re doing this for the fall and winter season ahead and the potential for an increase in cases as a result.”

HHS Secretary Xavier Becerra said that the “Biden-Harris Administration, in partnership with domestic manufacturers, has made great strides in addressing vulnerabilities in the U.S. supply chain by reducing our reliance on overseas manufacturing.”

“These critical investments will strengthen our nation’s production levels of domestic at-home COVID-19 rapid tests and help mitigate the spread of the virus,” Becerra said in a statement.

A pre-pandemic common cold coronavirus infection may help set the stage for long COVID, according to Boston researchers who have been looking to explain why some patients end up facing the long-lasting, debilitating symptoms.

The researchers from Brigham and Women’s Hospital and Massachusetts General Hospital teamed up with experts in immunology and virology to look for clues about long COVID in blood samples from patients with autoimmune rheumatic diseases.

The team found that among these patients, those who developed long COVID were more likely to have expanded, pro-inflammatory antibodies specific to a coronavirus that causes the common cold.

A person’s viral history, especially prior infection and expansion of antibodies against a pre-pandemic coronavirus, could prime the immune system for developing long COVID, according to the researchers.

“Our study offers evidence and explanation for why some of our patients may be experiencing the persistent and wide-ranging symptoms of long COVID,” said co-corresponding author Zachary Wallace, of the Division of Rheumatology, Immunology and Allergy at Massachusetts General Hospital.

“Identifying a biomarker that helps us better understand current and previous infections could shed light on an inappropriate immune response that leads to some cases of long COVID,” Wallace added.

Up to 45% of individuals with rheumatic diseases — which include rheumatoid arthritis and other chronic autoimmune disorders that cause inflammation — experienced persistent symptoms associated with long COVID 28 days after acute infection with SARS-CoV-2.

Patients with rheumatic diseases are also at risk for more severe disease and complications from acute infection.

The researchers compared immunological changes in patients with rheumatic diseases who recovered from COVID. Specifically, they looked for differences in the immunological fingerprints left behind by previous infections.

The team found an unexpected signal tied to OC43, a coronavirus that causes common cold symptoms. Individuals with long COVID were more likely to have antibody responses specific to this form of coronavirus.

The study is restricted to individuals with rheumatic diseases, and further research is needed to determine if their findings will apply more widely to patients without a pre-existing autoimmune disorder.

“By starting with patients with rheumatic diseases, we may be able to develop biomarkers that help us understand who is at high risk for developing long COVID and strategically enroll individuals into clinical trials to either prevent long COVID or develop therapies to treat it,” said Wallace. “This study represents an important step in that direction.”

The risk of new disease, disability and death remains elevated in some patients as long as two years after catching COVID-19, according to a large study showing the infection’s prolonged heath impact.

People who were never sick enough to be hospitalized for acute COVID still had a higher risk than uninfected people of developing long COVID-related disorders such as dangerous blood clots, diabetes and lung, gastrointestinal and musculoskeletal disease two years later, according to the study published Monday in the journal Nature Medicine.

Some 65 million people globally are estimated to be living with so-called post-COVID-19 condition — a number reported to be steadily increasing in the absence of approved treatments and continuing viral spread. The research from the Clinical Epidemiology Center of the Veterans Affairs St. Louis Health Care System in Missouri shows how longterm ailments that afflict COVID survivors add to the disease burden of the pandemic.

“While many people’s long COVID symptoms improve slowly over time, this can take years, and some symptoms persist even beyond that point,” said Michael Peluso, an assistant professor of medicine at the University of California, San Francisco. “The disability attributed to these post-COVID conditions is sobering.”

Long COVID has been linked to more than 200 symptoms affecting every organ system. Epidemiologist Ziyad Al-Aly and colleagues used the VA’s national databases to compare the incidence of 80 post-acute health problems among 138,818 veterans who survived the first month of a COVID infection during the first year of the pandemic with almost 6 million who weren’t infected during the same period.

Those who weren’t hospitalized for COVID had an increased risk of developing 31% of the 80 ailments after two years of follow up, compared with non-infected controls, while hospitalized COVID patients had a higher chance of developing 65% of them.

“It’s very clear that people hospitalized during the acute phase of a SARS-CoV-2 infection have a really long and arduous road to recovery,” Al-Aly said in an interview. “They have a significantly higher risk of death, even at two years.”

The increase in mortality risk from COVID-19 wasn’t significant beyond six months for non-hospitalized patients, but remained significantly elevated through the two years for those who had been hospitalized, the study found. Most users of the VA health system are older males, which might limit how applicable the study’s findings are to other groups, the authors said.

Lasting Damage

A severe case of COVID may cause long-lasting alterations to the innate immune system, the body’s first line of defense against pathogens, researchers said Friday in a separate study that points to why the disease can cause persistent inflammation and widespread organ damage. Yet another study published Monday found COVID may trigger new-onset hypertension, especially among hospitalized patients.

The VA study measured the burden of disease from long COVID in disability-adjusted life years, or years lost due to disability.

Cumulatively at two years, long COVID contributed a burden of 80.4 disability-adjusted life years for every 1,000 people who caught COVID but weren’t sick enough to be hospitalized, and 642.8 disability-adjusted life years for every 1,000 patients who were hospitalized for acute illness.

The disability burden “is extremely high, even in the non-hospitalized group, and shows the severity of the impact long COVID is having and will continue to have on society,” said Hannah Davis, who co-founded the Patient-Led Research Collaborative, which studies long COVID, after she developed the condition herself in early 2020.

The “timely and very important analysis” from the VA researchers confirms what doctors have heard from patients in the clinic and in smaller studies, UCSF’s Peluso, who’s also studying COVID’s effects, said in an email. More research is needed on the long-term risks associated with COVID, Peluso said.

“It also reinforces the urgency of figuring out exactly what beyond the initial infection causes these post-acute symptoms and sequelae so that we can identify treatments to return people to their regular health sooner and minimize ongoing disability,” he said.

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