As flu hits Va. hard and Dan River Region in COVID-19 surge, potential increases for so-called ‘tridemic’ –

A surge in the RSV cases in the US which can be fatal is causing severe strain on the healthcare system

For the last two winters, COVID-19 ended up being the main worry for health systems across the commonwealth.

And while another uptick is expected — the Pittsylvania-Danville Health District is currently in a surge, the only Virginia locality in such a designation — others signs point to a potential tridemic this season.

In addition to COVID-19, the flu is already hitting the commonwealth hard, according to the Centers for Disease Control and Prevention. Even early in the season, Virginia is pegged in the highest level for active cases.

In fact, it’s been 13 years since flu has had such a severe impact this early, according to a Friday report from the University of Virginia’s Biocomplexity Institute.


Virginia is experiencing a high level of flu, according to the Centers for Disease Control and Prevention.

The reason can be sourced to a few factors. First, the lack of flu activity from the last two years means fewer people have immunity, meaning a larger part of the population may have no shields against it.

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“Public health restrictions, along with behavioral changes such as masking and social distancing, are effective against a variety of respiratory diseases, including flu and COVID-19,” UVa researchers wrote in Friday’s report. “In the first year of the pandemic, flu virtually disappeared, while last year’s season was very mild.”

For both years, a so-called twindemic was feared — meaning COVID-19 and flu cases stressing health care facilities — but never came to pass.

This year, Virginia may not be so lucky.

“Lack of exposure over the past two years may create an immunity deficit which in turn may lead to a particularly bad flu season,” UVa officials said. “Indeed, that may already be happening this season.”

Low vaccination rates also are factor. As of late last month, only about 18% of Virginia residents had received an annual flu shot, UVa reported. Breaking down those figures, only 40% of seniors and 19% of children from 6 months old to 4 years of age were vaccinated against the flu, two of the age groups most impacted by severe effects. 

Also, there’s been a lackluster response to the COVID-19 booster shot, even with a somewhat strong start, according to UVa. Both flu and COVID-19 immunization levels lag well behind rates from 2021.

The third illness in the tridemic is respiratory syncytial virus, commonly known as RSV, which is surging throughout the nation and state.

“Mercifully, COVID-19 largely spared children from its worst affect, with most severe disease and death occurring among seniors,” researchers wrote in Friday’s UVa report. “By contrast, flu and RSV are most severe in both the very young and the very old.”

Some spikes in flu and RSV are causing stress for pediatric health centers in some areas.


The Pittsylvania-Danville Health District is the only area currently experiencing a surge of COVID-19 cases, according to the University of Virginia’s Biocomplexity Institute.

As far as COVID-19, more than half of the health districts in Virginia area are experiencing increases in cases. Danville and Pittsylvania County are the only areas in what’s defined as a surge, meaning cases have doubled based on a 100,000 population scale.

However, the city and county are still in the lowest community level for COVID-19, according to the CDC. Neighboring Halifax County is listed in medium, meaning people at high-risk for illnesses are recommended to wear masks in public spaces.


Danville and Pittsylvania County are in the lowest community levels for COVID-19, according to the Centers for Disease Control and Prevention.

More than four-quarters of the nation remains in a low risk level for COVID-19.

“With three serious respiratory viruses spreading in Virginia, it is important we all do our part to stop the spread,” UVa scientists said. “Practice basic respiratory hygiene and get vaccinated when eligible.”

Disney drops COVID-19 vaccination from many TV shows – Los Angeles Times

Walt Disney told a string of its TV shows Friday that it will no longer require cast and crews to be vaccinated against COVID-19 as hospitalizations wane.

Productions, including the first-responder drama “9-1-1,” will no longer require workers in front of and behind the camera in the most high-risk areas of their sets to be vaccinated, said people with knowledge of the matter who were not authorized to speak publicly.

The use of vaccination mandates was agreed to by unions and producers as part of the so-called Return to Work agreement last year. About a dozen shows are affected and other protocols including masking and testing will remain in place, a person close to the matter said. Disney may still require vaccines for some productions.


Disney declined to comment. SAG-AFTRA said in a statement that producers have always had the option of whether to impose the mandate.

The Burbank-based entertainment giant is among the first major studios to remove vaccination mandates from such a large number of shows, in a sign of the declining risk of virus outbreaks that caused costly production shutdowns. Some other studios also are no longer mandating vaccinations for cast and crew.

Vaccine mandates have been controversial in some quarters of Hollywood. Some actors have strongly opposed mandatory vaccinations, sparking a rift within SAG-AFTRA.

The union’s president, Fran Drescher, celebrated the decision on social media Saturday.

“We as a nation must be very careful that fear does not turn into fascism,” Drescher said in a video posted to Twitter on Saturday. “When cards must be presented to identify whether you are included or excluded, we stand at a tipping point of an America I no longer recognize. I must applaud Disney for taking the position not to vaccine mandate their sets any longer.”

Drescher, who said she is vaccinated, has been lobbying against the use of the vaccine mandates even though the board of the union she leads has supported its use. The union previously estimated about 25% of productions required vaccinations.

The Return to Work agreement allowed producers to require workers in high-risk zones, typically where actors are without masks in front of the cameras, to have current vaccinations against COVID-19.

“All companies signatory to the Return to Work Agreement have always had the authority to choose to implement — or not implement —vaccine mandates on productions at their discretion, so long as they are in compliance with the requirements of the agreement,” SAG-AFTRA spokesperson Pam Greenwalt said in a statement.

The Return to Work agreement was extended last month until January 2023. The agreement provides sick pay as well as requirements for testing, vaccination and masking on film and TV shows.

Dr. Jay Varma Receives Grant to Study COVID-19 Disease Surveillance – Weill Cornell Medicine Newsroom

Dr. Jay Varma, a professor of population health sciences at Weill Cornell Medicine, has received a six-month, $1 million grant from the Bill & Melinda Gates Foundation to assess how countries around the world have been monitoring and reporting COVID-19 infections and outcomes during the pandemic.

“The COVID-19 pandemic heightened awareness of the weaknesses of infectious disease surveillance systems worldwide,” said Dr. Varma, who is also a director of the Cornell Center for Pandemic Prevention and Response, which engages investigators at Weill Cornell Medicine and Cornell’s Ithaca campus in collaborative research. “For example, there were many variations in the reporting of cases, hospitalizations and deaths, and data was not always integrated with other essential information, such as vaccination status or laboratory testing results.”

“Our project will identify opportunities and challenges in integrating, analyzing and publicly reporting disease surveillance data at the local, regional and national levels to inform how we can collectively improve it the next time a pandemic occurs,” he added.  

Dr. Varma’s grant proposal stemmed from discussions with colleagues from his previous positions in public service before joining Weill Cornell Medicine in 2021. After spending more than two decades at the Centers for Disease Control and Prevention, including assignments in Thailand, China and Ethiopia, Dr. Varma most recently served as senior advisor for public health to former New York City Mayor Bill DeBlasio. In this role, he advised the mayor on the city’s policies and practices to control COVID-19 and organized its testing, tracing and vaccination campaigns.

Dr. Varma and his team, which includes co-investigator Dr. Nathaniel Hupert, an associate professor of population health sciences at Weill Cornell Medicine, and their colleagues at Weill Cornell Medicine-Qatar, will assess current disease surveillance systems in World Health Organization (WHO) Member States across all regions of the world by analyzing government websites reporting COVID-19 data since January 2020. They will seek to identify factors associated with the timeliness, completeness and availability of data and evaluate whether data were effectively integrated for driving public health responses. They will also consider economic, political and social factors that may account for differences in how information was reported.

Additionally, the researchers will interview public health officials and local academic partners from countries around the world, to gather insights on factors that assisted or hindered data collection, management and sharing.

“I’m excited to receive this grant from the Bill & Melinda Gates Foundation,” Dr. Varma said. “Integrated disease surveillance is critical for driving public health policy during pandemics. We hope our findings will help countries and the WHO, and possibly set the foundation for building an international consortium of academic institutions that can assist with future pandemic efforts.” 

COVID-19 is still a ‘dangerous global health threat.’ A new international study spells out how we can end it – University of Colorado Boulder

To end the “persistent and dangerous global health threat” of COVID-19, the world must take a “vaccine-plus” approach, which includes improved indoor air ventilation and filtration, and increased masking, testing and treatment. That’s just one of 57 recommendations included in a new study published today in the journal Nature by 386 multidisciplinary experts from more than 100 countries and territories. 

The authors agreed that there are many immediate and near-term actions that government leaders, businesses and the public can take to end the threat without exacerbating socio-economic burdens or putting the most vulnerable at greater risk. These include cross-disciplinary pandemic preparedness and response, addressing pandemic inequities, rebuilding public trust and combatting false information. 

They were also almost unanimous in their consensus that indoor areas with poor ventilation present the highest risks of transmission.

“Unfortunately, COVID-19 is not yet over,” said Jose-Luis Jimenez, co-author of the study, distinguished professor of chemistry at CU Boulder and fellow at the Cooperative Institute for Research in Environmental Sciences (CIRES). “But there are many things we can and should be doing about it here in the U.S. and across the world, and a high priority should be paying attention to and taking action by cleaning our indoor air.”

Jose-Luis Jimenez

Jose-Luis Jimenez, distinguished professor of chemistry at CU Boulder and fellow at the Cooperative Institute for Research in Environmental Sciences (CIRES).

Finding consensus

The findings of the consensus study, led by the Barcelona Institute for Global Health, have been endorsed by over 180 organizations worldwide. They come more than 2.5 years into the COVID-19 pandemic, as SARS-CoV-2 continues to circulate globally at unacceptable levels, threatening public health and straining health care systems.

As of October 2022, more than 630 million COVID-19 cases and over 6.5 million deaths have been reported—although the real death toll has been estimated to be upward of 20 million. In addition, millions of patients with cancer and chronic disease have experienced dangerous healthcare delays, and long COVID-19 continues to elude definitive treatment, posing an ongoing threat to survivors. The virus also continues to mutate and evade immunity. 

Due to the large number of experts consulted, the wide geographical representation and the consensus-building study design, the study may prove to be a model for responding to future global health emergencies, said Jeffrey Lazarus, lead author and coordinator of the study, and researcher at the Barcelona Institute for Global Health.

The panel of experts carried out a Delphi study, a research methodology that challenges experts to garner consensus on answers to complex research questions. The multidisciplinary panel of academic, health, NGO, government and other experts created a set of 41 statements and 57 recommendations across six major areas—communication, health systems, vaccination, prevention, treatment and care, and inequities—directed at governments, health systems, industry, and other key stakeholders.

The highest-ranked recommendations emphasize the need for coordinated strategies by both societies and governments to avoid fragmented efforts and make health systems more responsive to people’s needs. It also highlights a “vaccines-plus” approach, as 97% of the experts agree that vaccines alone are insufficient to end COVID-19 as a public health threat. Other recommendations with at least 99% agreement by the authors include communicating effectively with the public and engaging communities in managing the pandemic response. 

The paper emphasizes health and social policy recommendations that can be implemented in months, not years, to help bring this public health threat to an end, according to Quique Bassat, co-author of the study and ICREA professor at Barcelona Institute for Global Health. 

Airborne agreement 

The experts overwhelming agree that the SARS-CoV-2 virus is primarily transmitted through the air in a smoke-like manner—not through heavy respiratory droplets that quickly fall to the ground, or by touching surfaces—and should be addressed accordingly. 

“The airborne acknowledgement is very important,” said Jimenez, who is a leading expert in the airborne transmission of COVID-19. “Understanding and acknowledging how this virus primarily transmits between people is vital to its prevention. It is also critical for communicating accurate messages about how to stop contracting and transmitting this deadly and disabling disease.” 

Structural changes such as improving indoor ventilation and air filtration are even more critical now, he said, as those most at risk of severe disease can no longer rely on others to practice basic prevention measures, such as wearing masks or isolating when testing positive for COVID-19. 

96% of the authors agree or somewhat agree that wide use of high-filtration and well-fitting face masks (such as N95s, KN94s, KN95s and FFP3 respirators) are important to reduce transmission, especially in high-risk settings like hospitals, indoor bars and restaurants, gyms and any space with talkative or highly active unmasked groups of people. 

Jimenez notes that opening building and car windows, using portable air filters (such as HEPA filters or low-cost Corsi-Rosenthal boxes), and upgrading air filtration systems in a building’s HVAC system to MERV13 filters (which can capture very fine particles) all improve indoor ventilation and air filtration. 

Joshua Barocas

Joshua Barocas, associate professor of infectious disease and internal medicine at the University of Colorado Anschutz.

A compounded threat for public health and healthcare

The pandemic is still disproportionately impacting vulnerable populations, and without addressing the inequities involved, it will continue to be a public health threat around the world, said Joshua Barocas, co-author on the paper and associate professor of infectious disease and internal medicine at the University of Colorado Anschutz.

“This is perhaps the area by which every other public health response needs to be measured against. Are we just providing vaccinations? Or are we making sure that anyone who is eligible for a vaccination can get it?” said Barocas. 

Comprising two of the top 10 recommendations, the study states that “pandemic preparedness and response should address pre-existing social and health inequities,” and that low and middle-income countries need better access to technologies that allow them to develop and maintain their own affordable vaccines, tests and therapeutics. 

The authors note that the COVID-19 pandemic has also compounded other infectious disease outbreaks, like Ebola, Monkeypox, Polio and HIV, as well as other public health crises, such as antimicrobial resistance, drug overdoses, housing insecurity, gun violence, war and famine. It has also put unsustainable strain on health care systems globally, affecting access to and quality of care for both acute and chronic health conditions. 

“If we don’t address the systemic issues and collateral damage of COVID-19 as a public health threat, that puts us all at risk for worse health outcomes in general,” said Barocas.

COVID-19: Secure a COVID-19 Treatment Telehealth Appointment | Wisconsin Department of Health Services – Wisconsin Department of Health Services

Person having a video visit with a physicianIf you test positive for COVID-19, antiviral treatments are available to help prevent you from becoming seriously ill, hospitalized, or dying. You must be able to take this treatment within five days of your symptoms starting. Due to this short amount of time, the Wisconsin Department of Health Services (DHS) is offering telehealth services to quickly connect with a clinician who can determine if you are eligible for this treatment and prescribe it. It is essential that people who test positive for COVID-19 seek access to a prescribing clinician as soon as possible, even if symptoms are mild.

Life-saving COVID-19 antiviral treatments are free and available at over 600 pharmacies in the state. Insurance is not required. Treatment is not a substitute for vaccination, which can prevent serious illness, hospitalization, and death.

Telehealth is only for COVID-19 treatment, not for any other medical need or for medical emergencies. If you are experiencing a medical emergency, please dial 911.

  • A list of medications, supplements, or vitamins you are taking.
  • A copy of your lab results within the last three months if you have kidney disease.

Clinicians are available seven days a week from 8 a.m. to 8 p.m. CT.

This treatment is not a substitute for vaccination, which can prevent serious illness, hospitalization, and death. Learn more about getting vaccinated.

Learn more about COVID-19 treatments on DHS’ treatments webpage.

Telehealth service is offered in collaboration with Color Health, Inc. If you need help, contact the Color Support Team at 844-352-6567 or email from 8 a.m. to 7 p.m. CT.

You can use telehealth if you:

  • Test positive for COVID-19 and have mild to moderate symptoms which started no more than five days ago.
  • Are currently in Wisconsin.
  • Are ages 18 and over.
  • Are at risk for developing severe COVID-19.

People who have had symptoms for more than five days, who may be pregnant, or who may not be at risk for severe illness based on age and medical history may not be eligible for antiviral treatment through this program.

If you are experiencing a medical emergency, please dial 911.

Risk factors for becoming severely ill with COVID-19 include:

  • Age 65+
  • Asthma
  • COPD
  • Cancer
  • Diabetes
  • Hypertension
  • Overweight
  • Chronic Kidney Disease
  • Chronic Liver Disease
  • Chronic Lung Disease
  • Dementia
  • Physical inactivity
  • Smoking
  • Disabilities
  • Heart disease
  • HIV
  • Weakened immune system
  • Mental health conditions
  • Pregnancy
  • Sickle Cell or Thalassemia
  • Solid organ or blood cell transplant
  • Stroke
  • Substance use disorders
  • Tuberculosis

For a full list of risk factors, see the Centers for Disease Control and Prevention (CDC) webpage.

  • A smartphone or computer that has video capacity, or a landline.
  • A list of all medications, vitamins, and supplements you are taking.
  • A copy of your lab results within the last three months if you have kidney disease.
  • Telehealth is a free service, neither you nor your insurance will be charged for the consultation.
  • The antiviral medications are also provided free of charge either at a pharmacy, or when overnight mailed to you.

Consultations for COVID-19 antiviral treatment are currently available in Amharic, Arabic, English, French, Haitian Creole, Hmong, Korean, Mandarin Chinese (simplified and traditional), Marshallese, Portuguese, Russian, Somali, Spanish, Tagalog, and Vietnamese.

  • You can find pharmacies that have supplies of the antiviral pills Paxlovid and/or Lagevrio by consulting our map. There are over 600 pharmacies in the state of Wisconsin that carry these medications.
  • You could also elect to receive the pills in the mail.
    • If you choose home delivery, prescriptions received before 4 p.m. CT Sunday through Monday will be sent via next-day air to street addresses.
      • FedEx doesn’t deliver overnight on Sunday, so shipping is not available on Saturday.
      • This service is unavailable for P.O. boxes.
    • If you are requesting a consultation on Saturday, you may want to consider pharmacy pickup instead.
    • You’ll be able to discuss pharmacy options with your clinician and may change your choice based on their guidance.

You will receive an email from our pharmacy partner WellDyne when your prescription ships. It will also include tracking information.

  • You do not need insurance.
  • No insurance information will be collected if you have health insurance.
  • There is an intake form that needs to be filled out to get started, that should take about five minutes.
  • Once your intake form is submitted, your telehealth call will start within five to 30 minutes.
  • The telehealth appointment is unlikely to last longer than 30 minutes. If you are connecting to the appointment via smartphone, be sure to have enough battery power to last through the call.
  • You do not need an app or special software.
  • If you have a smartphone or a computer with internet capabilities, you only need access to video. You can also access telehealth through a phone call from a landline.
  • For video consultations: A health care provider will wait up to 10 minutes for you to join the call. If you miss your appointment, please request another on by logging in to your account at Color Health.
  • For telephone consultations: If you don’t answer the first call, they’ll call you one more time after 10 minutes. If you miss both calls, please request another by logging in to your account at Color Health, or by phoning 833-273-6330.

You can email or call 844-352-6567. They are open from 8 a.m. until 7 p.m. CT seven days a week.

With Covid-19, there’s no such thing as a sure thing – POLITICO

ON THE REBOUND — CDC Director Rochelle Walensky has a rebound Covid-19 infection, the agency said in a statement Monday, a development that underscores — for the dwindling number of people paying attention — this is, once again, a Confusing Pandemic Moment.

After testing positive for Covid-19 last week, Walensky took the antiviral treatment Paxlovid, tested negative and then tested positive again after experiencing more mild symptoms. The director is fully boosted and has received the updated bivalent booster that targets the Omicron variants dominant in the U.S. right now.

As we know, rebounds after Paxlovid aren’t uncommon. Both President Joe Biden and First Lady Jill Biden have had rebound infections after taking the antiviral pill. A June CDC study found that rebound cases were unlikely to lead to hospitalization and generally milder than the first infections.

That’s blunted some people’s interest in the treatment, but a study published in JAMA Network Open last week suggests rebound infections aren’t limited to people treated with Paxlovid. Researchers from the University of California, San Diego, and Harvard found that nearly a third of the patients they studied experienced symptoms after being symptom-free for two days. In those cases, most symptoms were mild.

Adding to the uncertainty: Two separate studies from Harvard and Columbia found that the new bivalent boosters may not be any more effective than the first-generation shots. Peter Marks, the FDA’s director of the Center for Biologics Evaluation and Research, was quick to throw cold water on the studies, saying they were too small and limited to be conclusive. He said better data about the new boosters would be coming soon.

Will anyone be paying attention when it does? Only 22.8 million Americans — just 7.3 percent of the eligible population — have received a bivalent booster shot, despite the Biden administration’s ongoing push to encourage people to get it ahead of the winter.

Walensky’s breakthrough and rebound infections are unlikely to hurt that campaign or stop anyone from saying no to treatment if they get Covid-19. Millions have already tuned the CDC out. But for those who haven’t, her case is a potent reminder that after nearly three years of living with this virus, there’s still no such thing as a sure thing.

WELCOME TO TUESDAY PULSE — So it turns out there is a “planet killer” asteroid out there that’s been hiding behind the sun’s glare. It’s just really, really far away. I hope that’s all any of us ever need to know. Send your news and tips to [email protected] and [email protected].

TODAY ON OUR PULSE CHECK PODCAST, Lauren Gardner talks with Alice Miranda Ollstein about how the increase in RSV cases casts attention on a handful of drugmakers with vaccines in the pipeline. Plus, Alice’s dispatch from Michigan where Gov. Gretchen Whitmer is trying to make an economic case for abortion rights.

WAITING ON THE RSV VACCINE — The sudden surge in respiratory syncytial virus cases among children across the nation has put fresh attention on the handful of drugmakers with vaccines and therapies in development, POLITICO’s Lauren Gardner and Katherine Ellen Foley report.

But it’s doubtful that RSV vaccines for children will be available in the near term. The first ones likely to become available will be for the elderly and pregnant people. Pfizer has said it plans to file an application to the FDA in the fall, and GSK expects to file for approvals by the end of the year.

Backstory: Pandemic-associated lockdowns in 2020 disrupted the normal circulation of viruses in the population, and flu and RSV rates plummeted that winter. Since then, respiratory diseases have peaked at unusual times, with RSV cases rising in the spring and summer of 2021 and beginning to spike this year as early as August.

More than 6,000 cases of RSV were PCR- or antigen-confirmed across all age groups during the week of Oct. 22, according to the CDC, compared with fewer than 30 recorded RSV cases during the last week of October 2020.

The vaccine: National Institutes of Health researchers have worked on developing an RSV vaccine since the 1960s. One potential vaccine candidate worsened the disease in babies who were inoculated and later exposed to RSV. Roughly 80 percent of the children in the trial who contracted RSV later were hospitalized and two died.

After “decades of frustration,” NIH scientists made a breakthrough in 2013 that paved the way for two vaccine options closest to seeking regulatory approval. But they’re geared toward older individuals, not children.

“It probably will be the next great pediatric vaccine,” said Paul Offit, director of the Vaccine Education Center and a doctor at the Children’s Hospital of Philadelphia. But “it hasn’t been an easy vaccine to make.”

SCATHING FEEDBACK ON FDA’S TOBACCO PROGRAM — Legal, industry and public health experts told the outside panel reviewing the FDA’s tobacco regulatory decision-making that the agency’s process is so slow and opaque that it’s ineffective, POLITICO’s Katherine Ellen Foley reports.

As part of the process, anonymous FDA staffers have also said the Center for Tobacco Products’ regulation is driven by politics instead of the science behind the impact of new tobacco products on the agency’s mission to reduce any harm to adult consumers or youth.

Last week, the five-person panel, organized by the Reagan-Udall Foundation and led by former FDA chief of staff Lauren Silvis, heard comments from the public and some FDA staffers in addition to the experts on how the agency’s Center for Tobacco Products could more effectively execute its mission. An online comment portal is open through Nov. 7.

WHY ISN’T WEED ON THE AGENDA? More than two-thirds of American voters say they support marijuana legalization, but fewer than 1 in 5 congressional candidates in the 2022 primaries staked out clear positions on cannabis policy, POLITICO’s Natalie Fertig and Holly Otterbein report.

One month before Election Day, Biden — who has been notoriously wary of legalizationannounced a series of executive actions aimed at federal drug reform: He pardoned more than 6,500 people with federal convictions for marijuana possession and began a review process that could federally decriminalize weed.

But few candidates in next week’s midterms are following his lead. In 2020, criminal justice reform was a major issue for voters in the wake of the murder of George Floyd, and cannabis policy received a boost in attention because of that. But in 2022, the focus has primarily been on democracy, crime, abortion and the economy. That, some strategists say, has kept candidates from discussing cannabis.

Without clear evidence that cannabis support moves the needle positively in their races, candidates are wary of deviating from the status quo, experts say.

OBAMACARE CALL CENTER WORKERS TO STRIKE — Hundreds of call center workers at the nation’s largest federal call-center contractor plan to strike today, the first day of Affordable Care Act open enrollment.

The workers at Maximus, the contractor in Tysons Corner, Virginia, staff call centers that handle Medicare and ACA Federally Facilitated Marketplace calls. During open enrollment, call volume dramatically increases and workers are pushed to their limits and expected to answer back-to-back calls about complex issues, workers say.

The workers want a minimum wage of $25 an hour, at least 30 minutes per shift of non-call time and policies protecting them from abusive calls, which worsened during the pandemic, including the ability to hang up or escalate calls.

Maximus said in a comment to POLITICO that only 1 percent of its 11,000 call center workers were involved in the strike today.

The company also disputed the workers’ characterization of its break policy and policies protecting them from abusive calls, saying it provides “reasonable and flexible break policies” and that “employees can request bathroom breaks at any time and employees who work 8 hours can take two 15-minute rest breaks in addition to their half hour lunch break.”

“Maximus respects the dignity and well-being of our employees,” Eileen Cassidy Rivera, vice president of public relations and communications said in a comment. “While we haven’t seen evidence of a growing trend in abusive or obscene calls, we have a very clear Standard Operating Procedure to protect our employees when we occasionally receive such calls. If a caller is persistently inappropriate or obscene, or uses derogatory or disrespectful language, our employees are empowered to immediately end the call. They are not required to warn the abusive caller that the call is being terminated and are not required to ask their supervisor for permission to disconnect a call.”

GROUPS CALL ON CONGRESS TO ACT ON HOME INFUSION — Patient groups, providers and pharmacists are calling on lawmakers to pass new legislation that seeks to make it easier for patients on Medicare to get infusion therapy at home.

In a letter sent Monday to Congressional leadership, the 30 signatory organizations say the way that the Centers for Medicare and Medicaid Services is implementing a dedicated Medicare home-infusion therapy benefit is so restrictive that it’s standing in the way of patient access.

They say the Preserving Patient Access to Home Infusion Act (S. 2652 (117)) would ensure Medicare beneficiaries’ access to home care as their counterparts with private insurance do. The letter follows a similar effort from dozens of health systems and hospitals that have already called on Congress to advance the bill in August.

“With every commercial health plan in the country providing robust coverage for home infusion therapy, it’s confounding that Medicare hasn’t been able to get this benefit right,” said Shea McCarthy, director of legislative affairs at the National Home Infusion Association.

AND A NEW LAWMAKER SCORECARD — Patients Rising Now, the advocacy group for patients with chronic illness, releases its scorecard today of lawmakers based on their votes, co-sponsorship and other actions that support the chronic disease community.

Takeaway: The report’s authors say it shows that while healthcare issues are largely bipartisan, the trend in Congress of sweeping legislative packages is preventing specific, targeted bills from making it to the floor for a vote.

Lauren Lyles-Stolz has joined the National Association of Chain Drug Stores as senior director of reimbursement, innovation and advocacy. Most recently, she served as health legislative assistant for Rep. Brad Schneider (D-Ill.).

The Washington Post reports on the deadly mechanics of crowd events like the tragedy in Seoul.

In South Sudan, which has one of the world’s worst maternal mortality rates, a U.N.-supported maternal clinic is about to close due to lack of funding, The Associated Press reports.

Fentanyl is now behind 1 in 5 youth deaths in California, the San Jose Mercury News reports.

CLARIFICATION: Pulse has been updated to include comments from Maximus.

Governor Hochul Updates New Yorkers on State’s Progress Combating COVID-19 –

Governor Kathy Hochul today updated New Yorkers on the state’s progress combating COVID-19.     

“As New Yorkers celebrate Halloween today with friends, family and neighbors, I urge everyone to remain vigilant and to use all available tools to keep themselves, their loved ones and their communities safe and healthy,” Governor Hochul said. “Be sure to stay up to date on vaccine doses, and test before gatherings or travel. If you test positive, talk to your doctor about potential treatment options.”

Governor Hochul also announced earlier this month that children ages 5 and older may now receive the bivalent booster shots that are recommended to increase protection against COVID-19. The State Department of Health updated its guidance after the U.S. Food and Drug Administration amended its emergency use authorization and the Centers for Disease Control and Prevention updated its clinical guidance, which collectively will allow more children to safely boost their immunity against COVID-19.

The Governor continues to urge New Yorkers to get their bivalent COVID-19 vaccine boosters. To schedule an appointment for a booster, New Yorkers should contact their local pharmacy, county health department, or healthcare provider; visit; text their ZIP code to 438829, or call 1-800-232-0233 to find nearby locations.

In addition, Governor Hochul is encouraging New Yorkers to get their annual flu vaccine as flu season is already widespread across New York State. The flu virus and the virus that causes COVID-19 are both currently circulating, so getting vaccinated against both is the best way to stay healthy and to avoid added stress to the health care system.

The State Department of Health is continuing its annual public education campaign, reminding adults and parents to get both flu and COVID-19 shots for themselves and children 6 months and older. Advertisements in both English and Spanish language began running earlier this month. 

Last week, Governor Hochul and the state Department of Health warned New Yorkers that COVID-19, seasonal flu, and RSV cases are all rising and encouraged New Yorkers to get flu and COVID-19 vaccinations and boosters, and take important prevention steps including distancing, masking and hygiene during the cold weather months. 

For information about flu vaccine clinics, contact the local health department or visit

Today’s data is summarized briefly below:    

1.    Cases Per 100k – 13.59
2.    7-Day Average Cases Per 100k – 20.20
3.    Test Results Reported – 36,849
4.    Total Positive – 2,656
5.    Percent Positive – 6.59%**     
6.    7-Day Average Percent Positive – 5.98%**      
7.    Patient Hospitalization – 2,801 (-53)*
8.    Patients Newly Admitted – 425*
9.    Patients in ICU – 269 (-8)*
10. Patients in ICU with Intubation – 110 (-9)*
11. Total Discharges – 356,237 (+442)*
12. New deaths reported by healthcare facilities through HERDS – 29*  
13. Total deaths reported by healthcare facilities through HERDS – 58,751*  

** Due to the test reporting policy change by the federal Department of Health and Human Services (HHS) and several other factors, the most reliable metric to measure virus impact on a community is the case per 100,000 data — not percent positivity.       

The Health Electronic Response Data System is a NYS DOH data source that collects confirmed daily death data as reported by hospitals, nursing homes and adult care facilities only.      

Important Note: Effective Monday, April 4, the federal Department of Health and Human Services (HHS) is no longer requiring testing facilities that use COVID-19 rapid antigen tests to report negative results. As a result, New York State’s percent positive metric will be computed using only lab-reported PCR results. Positive antigen tests will still be reported to New York State and reporting of new daily cases and cases per 100k will continue to include both PCR and antigen tests. Due to this change and other factors, including changes in testing practices, the most reliable metric to measure virus impact on a community is the case per 100,000 data — not percent positivity.   

  • Total deaths reported to and compiled by the CDC – 74,996

This daily COVID-19 provisional death certificate data reported by NYS DOH and NYC to the CDC includes those who died in any location, including hospitals, nursing homes, adult care facilities, at home, in hospice and other settings.  

Each region’s 7-day average of cases per 100K population is as follows:       


Friday, October 28, 2022

Saturday, October 29, 2022

Sunday, October 30, 2022

Capital Region 




Central New York 




Finger Lakes 




Long Island 








Mohawk Valley 




New York City 




North Country 




Southern Tier 




Western New York 








Each region’s 7-day average percentage of positive test results reported over the last three days is as follows**:              


Friday, October 28, 2022

Saturday, October 29, 2022

Sunday, October 30, 2022

Capital Region




Central New York




Finger Lakes




Long Island








Mohawk Valley




New York City




North Country




Southern Tier




Western New York








** Due to the test reporting policy change by the federal Department of Health and Human Services (HHS) and several other factors, the most reliable metric to measure virus impact on a community is the case per 100,000 data — not percent positivity.          

Each New York City borough’s 7-day average percentage of positive test results reported over the last three days is as follows **:              

Borough in NYC 

Friday, October 28, 2022

Saturday, October 29, 2022

Sunday, October 30, 2022









New York












** Due to the test reporting policy change by the federal Department of Health and Human Services (HHS) and several other factors, the most reliable metric to measure virus impact on a community is the case per 100,000 data — not percent positivity.       

Yesterday, 2,656 New Yorkers tested positive for COVID-19 in New York State, bringing the total to 6,164,090. A geographic breakdown is as follows:       


Total Positive

New Positive









































































































































St. Lawrence







































Below is data that shows how many hospitalized individuals who have tested positive for COVID-19 were admitted for COVID-19/COVID-19 complications and how many were admitted for non-COVID-19 conditions:


COVID-19 Patients currently hospitalized

Admitted due to COVID or complications of COVID

% Admitted due to COVID or complications of COVID

Admitted where COVID was not included as one of the reasons for admission

% Admitted where COVID was not included as one of the reasons for admission

Capital Region






Central New York






Finger Lakes






Long Island












Mohawk Valley






New York City






North Country






Southern Tier






Western New York












The Omicron variant now represents more than 95% of the viruses in circulation. For more information on variant tracking, please visit here: COVID-19 Variant Data | Department of Health (      

On Friday, October 28, there were 29 total new deaths were reported due to COVID-19, bringing the total to 58,751. A geographic breakdown is as follows, by county of residence:     


New Deaths                                   









New York


















Grand Total


Important Note: HERDS data collection from health care facilities is not currently required on weekends or holidays. The survey will resume today and the facility/death data will be displayed in tomorrow’s report. The numbers with an asterisk were reported on Friday, October 28.

New Yorkers looking to schedule vaccine appointments for 5-11-year-old children are encouraged to contact their child’s pediatrician, family physician, county health departments, Federally Qualified Health Centers (FQHCs), rural health centers, or pharmacies that may be administering the vaccine for this age group. Parents and guardians can visit, text their ZIP code to 438829, or call 1-800-232-0233 to find nearby locations. Make sure that the provider offers the Pfizer-BioNTechCOVID-19 vaccine, as the other COVID-19 vaccines are not yet authorized for this age group.       

Visit our website for parents and guardians for new information, frequently asked questions and answers, and resources specifically designed for parents and guardians of this age group.       

NYC health commissioner tests positive for COVID-19 – Gothamist

New York City Health Commissioner Ashwin Vasan said he has tested positive for Covid-19 and is isolating at home.

“A positive COVID test is always a sobering experience, however, I am grateful that my symptoms are quite mild, which I credit to my recent booster dose,” Dr. Vasan said in a statement issued Sunday morning. “I continue to encourage all New Yorkers to get their boosters as soon as possible so that they can enjoy the holiday season with the peace of mind that vaccination offers. While vaccination isn’t an absolute failsafe, it does power up our bodies to reduce COVID’s potentially devastating impact. “

Vasan said he will continue to work while isolating at home for a five-day period, as recommended by the federal Centers for Disease Control and Prevention.

“I am grateful for the ability to isolate at home, and have child-care and family support, which I know is not the case for all New Yorkers,” he said.

#COVIDIsAirborne #BringBackMasks Trend, Questioning CDC Director’s Tweet on Covid-19 Precautions – Forbes

They say hindsight is 2020. But what’s been happening with the U.S. Covid-19 response in 2022 seems to be showing a lack of foresight. Wasn’t it 2020 when scientific studies showed that the Covid-19 coronavirus can spread beyond six feet via small respiratory droplets and that wearing face masks in turn may decrease transmission of the virus? So why then has #COVIDIsAirborne again been trending on Twitter over the past week? That’s because folks on Twitter have been wondering why face mask use and air purification have been noticeably absent from the Biden Administration’s messaging about Covid-19 precautions recently.

For example, back in mid-September, U.S. President Joe Biden had claimed that “the pandemic is over,” adding “If you notice no one is wearing masks.” As I covered back then for Forbes, that claim completely flew in the face of science because no real scientific organization had declared the pandemic over. Then there was the October 21 tweet from the Centers for Disease Control and Prevention (CDC) Director Rochelle Walensky, MD , MPH, about precautions against respiratory viruses such as the flu virus, respiratory syncytial virus (RSV), and the Covid-19 coronavirus that didn’t seem “air” apparent enough to a number of folks on Twitter:

As you can see, Lucky Tran, PhD, an organizer for the March for Science and a science communicator at Columbia University, pointed out that Walensky’s tweet didn’t even mention two key precautions against airborne viruses: face mask use and air ventilation/filtration. While getting an updated Covid-19 vaccine will help decrease your risk of more severe Covid-19 outcomes, it’s not going to prevent the virus from entering your nose or mouth. The only way the Covid-19 vaccine could possibly block the virus from entering your nose is if you were to shove multiple vaccine syringes up your nostrils, which you shouldn’t do for both safety and aesthetic reasons.

Similarly, practicing good hand hygiene is important as all three viruses can be transmitted via contaminated hands. But clean hands is not going to help prevent an airborne virus from entering your nose or mouth either. That’s unless you are constantly completely covering your nose and mouth with your hands at all times, which you also shouldn’t do because your hands are not permeable and being able to breathe is kind of important. Plus, you can’t doomscroll social media or take selfies if you are constantly using your hands to cover your nose and mouth.


So what about using your hands to wave away the virus? Well, on Twitter, @tmcdonnell4 asked “how many hours should I wash my hands to remove respiratory viruses from the air”:

The answer is no amount of hours will help you if your goal is to scoop the viruses out of the air with your hands. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not like a giant cat hair floating in the air. No amount of hand scooping or fanning or jazz hands is going to be enough to wave the virus completely away from you.

So has the SARS-CoV-2 somehow lost its ability to go airborne? Did it drink the opposite of Red Bull? No. It doesn’t seem that way. It would be very, very, very unusual for a virus to lose such an ability. On October 26, Ashish K. Jha, MD, MPH, the Biden Administration’s White House COVID-19 Response Coordinator, did say, “Covid, which is purely airborne,” during a White House press conference, as Jose-Luis Jimenez, PhD, a Distinguished Professor of Chemistry at the University of Colorado tweeted:

Now, calling the Covid-19 coronavirus “purely airborne” is not really correct either. Studies have shown that the virus can persist on different surfaces for a while as well, as I have covered for Forbes. And you probably wouldn’t ask someone with Covid-19, “hey do you have a trumpet or Hannibal Lechter facemask that you just used that I could lick?” Calling the SARS-CoV-2 purely airborne would be like calling a star basketball player purely a dribbler.

Regardless, Jha did seem to acknowledge the airborne nature of the SARS-CoV-2, which brings us back to original question: why hasn’t the Biden Administration been pushing face mask use and air filtration/purification more? Back on October 22, Eric Feigl-Ding, PhD, an epidemiologist and Chief of the COVID Risk Task Force at the New England Complex Systems Institute, tweeted out “I think we need to get #BringBackMasks and #COVIDIsAirborne trending again. Because #CovidIsNotOver,” as you can see here:

Both hashtags have indeed trended over the past week. Author Dana Parish added #COVIDIsAirborne to her story about her trip with her dog to the vet, assuming that the emoji that she used is of a dog and not a human with exceptionally long ears:

Joy Henningsen, MD, a Clinical Assistant Professor of Radiology at the University of Alabama-Birmingham, used #COVIDIsAirborne to point out that others in the U.S. beyond the Biden Administration seem to avoiding the “mask” word when it would seem to be appropriate to use:

And @DrFiliatrault employed the hashtag to pass along a video from RIKEN in Japan that visualized how the SARS-CoV-2 can go “airborne free” without masks:

Meanwhile, family doctor Nili Kaplan-Myrth, MD, PhD, tweeted with #BringBackMasks to urge political leaders to push for face mask wearing to do something to mitigate yet another Covid-19 surge in the coming months:

And Mandate Masks NY , an advocacy effort to “mandate masks in public places and schools when needed and provide free masks,” threw in the hashtag while tweet forwarding a photo of a sign that reminded people that having gotten vaccinated against Covid-19 alone won’t offer you the same type of protection that wearing a face mask will:

Remember that each Covid-19 precaution is like a slice of Swiss Cheese. Each has its own holes. It’s generally a good idea to cover your holes by layering on different Covid-19 precautions as you might layer on Swiss Cheese.

Therefore, it is quite puzzling why the Biden Administration hasn’t been mentioning face mask wearing and air filtration/purification more, especially since these would help against Covid-19, RSV, and influenza. Rick Bright, PhD, the former Deputy Assistant Secretary for Preparedness and Response and Director of the Biomedical Advanced Research and Development Authority (BARDA), tweeted out “Doesn’t it sound like wearing masks, improving ventilation and air filtration would help to address this #CovidIsAirborne virus and be more effective than hand washing,” while using the #CovidIsAirborne hashtag as well:

A response to Bright’s tweet above included a video from 2020 of Walensky saying that transmission of the SARS-CoV-2 consists of “a lot of aerosol.” That video came after the Trump Administration had spent the earlier half of 2020 not fully realizing or acknowledging how much of an aerosol component Covid-19 coronavirus transmission has. That resulted in delays in putting face mask wearing and air filtration/purification in place that year. Will not fully acknowledging this airborne component once again in 2022 be a 2020 too situation all over again?

‘Scrabble variants’ now cause the majority of new Covid-19 infections in the US – CNN

CNN  — 

The Omicron BA.5 subvariant is no longer the dominant cause of Covid-19 infections in the United States, according to estimates released Friday by the US Centers for Disease Control and Prevention.

Instead, a host of new sublineages – offshoots of BA.2, BA.4 and BA.5 – are now responsible for the majority of new infections in this country. Dr. Peter Hotez, director of the Center for Vaccine Development at Texas Children’s Hospital, calls these many new lineages “Scrabble variants” because they contain letters like X and Q that get high scores in the game.

The new variants descend from slightly different branches of the Omicron family tree, but they have evolved to share some of the same changes in their genomes that help them slip past our immunity against the virus.

The gaggle of new variants have been gaining ground against BA.5, which has dominated Covid-19 infections in the United States since July. BA.5 now accounts for 49.6% of new infections in this country.

Two variants, BQ.1 and BQ.1.1, have been growing especially fast. At the beginning of October, each one accounted for about 1% of new infections in the United States, but they have been roughly doubling in prevalence each week. Together, they now account for more than 1 in 4 new Covid-19 infections nationwide, according to CDC data.

BQ.1 is causing about 14% of new infections; BQ.1.1. is causing 13% of new infections. BA.4.6 is causing another 10%. BF.7 accounts for 7.5% of newly diagnosed Covid-19. A slew of other new variants accounts for smaller pieces of the Covid-19 pie.

These variants are not evenly distributed across the US. BQ.1.1 is now causing about 1 in 5 new Covid-19 infections in the Northeast, where cases and hospitalizations are rising. But that strain is causing just 3% of new Covid-19 infections in the Pacific Northwest.

These variants are slightly different from each other, but they all carry some of the same key mutations that help them skirt immunity from vaccines and past infections. This makes them more likely to lead to breakthrough infections and reinfections.

In a statement released Friday, the World Health Organization’s Technical Advisory Group on SARS-CoV-2 Virus Evolution said the most mutated families of the rising subvariants – XBB and BQ.1 – aren’t different enough from Omicron to be considered separate variants of concern.

XBB was detected in the United States in September, but it is not causing a significant number of cases in this country. It is particularly widespread in Singapore, where it is now the dominant circulating strain.

“The two sublineages remain part of Omicron, which continues to be a variant of concern,” the group said in a statement.