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C.D.C. Advisers Endorse Pfizer Vaccine for Children Ages 12 to 15

The federal government on Wednesday took a final step toward making the Pfizer-BioNTech coronavirus vaccine available to adolescents in the United States, removing an obstacle to school reopenings and cheering millions of families weary of pandemic restrictions.

An advisory committee to the Centers for Disease Control and Prevention voted to recommend the vaccine for use in children ages 12 to 15. The C.D.C. director, Dr. Rochelle Walensky, is expected to review the recommendations and approve them later on Wednesday.

“Approving Covid-19 vaccines for children 12 to 15 years of age is an important step in removing barriers for vaccinating children of all ages,” said Dr. Yvonne Maldonado, who represents the American Academy of Pediatrics on the federal Advisory Committee on Immunization Practices.

Many parents are eagerly anticipating the availability of vaccines for children, at least in part to speed their return to schools. Roughly one-third of eighth graders, usually 13 or 14 years old, are still learning fully remotely.

at least as effective in 12- to 15-year-olds as it has been in older teenagers and adults. Apart from a slight increase in the frequency of fevers, the shots also seemed to have comparable, mostly negligible side effects.

The company plans to continue monitoring trial participants for two years after the second dose to assess the vaccine’s long-term safety and efficacy.

The Food and Drug Administration reviewed the clinical data and on Monday authorized the Pfizer vaccine for use in these children, capping weeks of anticipation from parents and children about a swifter return to normalcy.

“While it’s true that children are generally spared from severe disease, the fact that they’ve been unable to be vaccinated has caused major disruptions in their lives that have real developmental consequences,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “Vaccination of this age cohort will allow these children to more fully return to their normal lives.”

about 20,000 pharmacies nationwide are expected to offer the vaccine for free to these children.

survey by the Kaiser Family Foundation.

Some of those parents may change their minds, as other children safely receive vaccines and resume in-person schooling, or rejoin team sports like football and basketball that involve close contact, the researchers suggested.

Others may wait until they must comply with school requirements. Public schools in all 50 states require certain vaccines, but officials may not be able to enforce compliance until the Pfizer-BioNTech vaccine gains the F.D.A.’s full approval.

The vaccine has emergency authorization now. Pfizer has applied to the F.D.A. for full approval, but that process is expected to take several months. Even after approval, students may still opt out by citing medical reasons or religious beliefs.

State and local leaders will need to make particular efforts to reach children in low-income families or in communities of color. Black and Hispanic adults have among the lowest rates of vaccination: As of May 3, just 25 percent of Black people and 27 percent of Hispanic people had been inoculated, compared with 39 percent of white people.

Making the vaccine accessible to these communities will require easier transportation and storage of doses. The Pfizer-BioNTech vaccine can be stored for only five days in standard refrigerators. The companies are planning to ship smaller packs for use in doctors’ offices, and are developing a formulation that can be refrigerated for up to 10 weeks.

Pfizer and BioNTech plan in September to submit requests for authorization of the vaccine in children ages 2 to 11.

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Covid Pandemic Forces Families to Rethink Nursing Home Care

Even before the pandemic began 14 months ago, nursing homes had become the source for rampant, antibiotic-resistant infections. The facilities also faced systemic problems like high turnover among nursing home staff and the gaming of the federal government’s rating system, which made it hard for families to judge the quality of homes.

For years, federal health officials and some insurers have tried to encourage more stay-at-home care, and the pandemic has created a sense of urgency.

“It’s really changed the paradigm on how older adults want to live,” said Dr. Sarita Mohanty, the chief executive of the SCAN Foundation, a nonprofit group focused on issues facing older adults. The vast majority of those adults would prefer to stay at home as they age, she said.

“What’s happened is a welcome sort of market correction for nursing homes,” said Tony Chicotel, a staff attorney for California Advocates for Nursing Home Reform in San Francisco. Some families, he said, “ended up agreeing to a nursing home without giving it a lot of deliberation.” But after trying home care during the pandemic, many families found keeping an older relative at home was a viable alternative, he said.

Nursing homes rose from the almshouses in England and America that cared for the poor. In the United States, passage of the Social Security Act in 1935 provided money for states to care for the elderly. Thirty years later, the Medicaid program expanded funding, making long-term care homes central to elder care, said Terry Fulmer, the president of the John A. Hartford Foundation, an advocacy group for older adults. “If you pay the nursing homes, that’s where you go,” Dr. Fulmer said.

It wasn’t until the 1970s that some programs began to pay for home care, and the number of nursing home residents nationwide started to slowly decline, with occupancy levels in recent years flattened to about 80 percent, according to data from the Kaiser Family Foundation.

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Parents Are Reluctant to Get Their Children Vaccinated for Covid-19, Poll Shows

The American public’s willingness to get a Covid vaccine is reaching a saturation point, a new national poll suggests, one more indication that achieving widespread immunity in the United States is becoming increasingly challenging.

Only 9 percent of respondents said they hadn’t yet gotten the shot but intended to do so, according to the survey, published in the April edition of the Kaiser Family Foundation’s Vaccine Monitor. And with federal authorization of the Pfizer vaccine for adolescents ages 12 through 15 expected imminently, the eagerness of parents to let their children be vaccinated is also limited, the poll found.

Overall, slightly more than half of those surveyed said they had gotten at least one dose of the vaccine, a finding that matches data from the Centers for Disease Control and Prevention.

“We’re in a new stage of talking about vaccine demand,” said Mollyann Brodie, executive vice president of Kaiser’s Public Opinion and Survey Research Program. “There’s not going to be a single strategy to increase demand across everyone who is left. There will be have to be a lot of individually targeted efforts. The people still on the fence have logistical barriers, information needs, and lots don’t yet know they are eligible. Each strategy might move a small number of people to get vaccinated, but all together, that could matter a lot.”

With a growing number of scientists and public health experts concluding that it is unlikely that the country will reach the threshold of herd immunity, the Biden administration has stepped up efforts to reach those who are still hesitant. On Tuesday, the administration announced steps to encourage more pop-up and mobile vaccine clinics and to distribute shots to primary care doctors and pediatricians as well as local pharmacies.

The survey also showed that confidence in the Johnson & Johnson vaccine had suffered a significant blow after the 10-day pause in dispensing it while the authorities examined rare incidents of life-threatening blood clots in people who had taken it. While 69 percent of people said they had confidence in the safety of the vaccines made by Pfizer and Moderna, only 46 percent felt confident about the safety of the Johnson & Johnson vaccine. Among adults who have not been vaccinated, one in five said that the news about the Johnson & Johnson shot had prompted them to change their minds about getting a Covid-19 vaccine.

The survey did show that there had been some progress among Republicans, who have been among the firmest holdouts. Among that group, 55 percent said they had gotten a shot or intended to do so, up from 46 percent in March. The percentage who will “definitely not” get the vaccine is shrinking as well, down to 20 percent from 29 percent in March.

The results were based on telephone surveys of a nationally representative sample of 2,097 adults from April 15 through April 29.

A consortium of universities that includes Harvard, Northeastern and Rutgers has been conducting online polls during the pandemic and recently focused on parents. The group’s latest survey, conducted throughout April and reaching 21,733 adults across 50 states, found that the divide between mothers and fathers in views about the vaccine for children had widened.

Fathers are becoming more accepting, with their resistance falling to 11 percent from 14 percent since February. But over a quarter of mothers, researchers said, still say they are “extremely unlikely” to vaccinate their children. Both genders are more resistant to the vaccine for younger children than for teenagers. Other research shows that mothers tend to have more sway over the final decision than fathers.

The responses from parents may well change over time, experts say. Just as adults were far more reluctant last summer when the vaccine was still a concept, parents surveyed several weeks ago, when imminent authorization for children under 16 had not been widely discussed, might also have been reacting to a hypothetical situation rather than a reality.

But pediatricians and others who are seen as trusted sources of information are already aware that they have considerable work to do to instill vaccine confidence in this latest cohort.

Dr. Sean O’Leary, a pediatrician in Denver who is vice chairman of the committee on infectious diseases for the American Academy of Pediatrics, predicted that just as adults had swarmed Covid vaccine providers during the initial weeks of distribution, parents and pent-up young teenagers would rush for it at the start, too.

But Dr. O’Leary, who often gives talks to pediatricians about how to motivate patients to accept vaccinations, worries that a slowdown will inevitably follow. To persuade hesitant parents, he said, “we have to make the vaccine available in as many places as possible.”

He added, “If parents and patients are in the pediatrician’s office and the doctor can say, ‘Hey, I’ve got it,’ that may be enough of a nudge for them to say, ‘Let’s go ahead and do this.’”

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Antibody rates among Black and Hispanic New Yorkers are double those of others, new estimates show.

New York City health officials estimate that nearly a quarter of adult New Yorkers were infected with the coronavirus during the catastrophic wave of last spring, and that the toll was even higher among Black and Hispanic residents.

The estimates, based on antibody test results for more than 45,000 city residents last year, suggest that Black and Hispanic New Yorkers were twice as likely as white New Yorkers to have had antibodies to the coronavirus — evidence of prior infection.

Hispanic New Yorkers had the highest rate, with about 35 percent testing positive for antibodies, according to the study, whose authors include officials and researchers at the city Health Department and the National Institute for Occupational Safety and Health. Among Black New Yorkers, 33.5 percent had antibodies. Among Asian New Yorkers, the rate was about 20 percent. For white New Yorkers, the rate was 16 percent.

Antibody surveys of segments of the population have become a useful way to gauge what percentage of people were infected and what groups were most at risk, especially since there was limited testing for the virus during the first wave.

The new paper, which has been accepted by the Journal of Infectious Diseases, has substantial limitations: Of the 45,000 New Yorkers in the study, fewer than 3,500 were Black, a major underrepresentation. And the participants were recruited partly through advertisements online, which the study’s authors acknowledge may have attracted people who believed they had been exposed to Covid-19.

But the study adds to experts’ understanding of the disproportionate toll that the pandemic has taken on Black and Latino people.

Its findings also come amid a push to vaccinate more people in the United States. A recent survey conducted by the Kaiser Family Foundation found that the number of Americans, particularly Black adults, who want to get vaccinated has continued to increase. According to an analysis last month by The New York Times, Black people were still being inoculated at half the rate of white people. The disparities are especially alarming as Black and Latino people and Native Americans have been dying at twice the rate of white people.

In New York City, about 44 percent of white adults have received at least one dose of a Covid-19 vaccine, while 26 percent of Black adults and 31 percent of Latino adults have, according to city data.

Experts and community leaders across the country say that over all, the lower vaccination rates are linked to technological and linguistic barriers and disparities in access to vaccination sites. Other factors include social media misinformation and a hesitancy to be vaccinated. Hesitancy among African-Americans, experts say, can be tied to a longstanding mistrust of medical institutions that have long mistreated Black people.

have comparatively fewer white workers.

“These were the people who did not have the luxury of being able to work virtually,” she said.

Dr. Kitaw Demissie, who is dean of the School of Public Health at SUNY Downstate Medical Center in Brooklyn and was not involved in the study, noted that household crowding may have also contributed to differing infection rates. Some predominately Latino neighborhoods which were particularly hard hit in the first wave had high rates of household crowding.

More than 32,000 people in New York City have died from Covid-19 in total, according to a New York Times database.

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Biden Takes On Sagging Safety Net With Plan to Fix Long-Term Care

President Biden’s $400 billion proposal to improve long-term care for older adults and those with disabilities was received as either a long overdue expansion of the social safety net or an example of misguided government overreach.

Republicans ridiculed including elder care in a program dedicated to infrastructure. Others derided it as a gift to the Service Employees International Union, which wants to organize care workers. It was also faulted for omitting child care.

For Ai-jen Poo, co-director of Caring Across Generations, a coalition of advocacy groups working to strengthen the long-term care system, it was an answer to years of hard work.

“Even though I have been fighting for this for years,” she said, “if you would have told me 10 years ago that the president of the United States would make a speech committing $400 billion to increase access to these services and strengthen this work force, I wouldn’t have believed it would happen.”

knocking millions of women out of the labor force — or deplete their resources until they qualify for Medicaid.

Whatever the limits of the Biden proposal, advocates for its main constituencies — those needing care, and those providing it — are solidly behind it. This would be, after all, the biggest expansion of long-term care support since the 1960s.

“The two big issues, waiting lists and work force, are interrelated,” said Nicole Jorwic, senior director of public policy at the Arc, which promotes the interests of people with disabilities. “We are confident we can turn this in a way that we get over the conflicts that have stopped progress in past.”

And yet the tussle over resources could reopen past conflicts. For instance, when President Barack Obama proposed extending the Fair Labor Standards Act of 1938 to home care workers, which would cover them with minimum-wage and overtime rules, advocates for beneficiaries and their families objected because they feared that states with budget pressures would cut off services at 40 hours a week.

“We have a long road ahead of passing this into law and to implementation,” Haeyoung Yoon, senior policy director of the National Domestic Workers Alliance, said of the Biden proposal. Along the way, she said, supporters must stick together.

half of adults would need “a high level of personal assistance” at some point, typically for two years, at an average cost of $140,000. Today, some six million people need these sorts of services, a number the group expects to swell to 16 million in less than 50 years.

In 2019, the National Academy of Social Insurance published a report suggesting statewide insurance programs, paid for by a dedicated tax, to cover a bundle of services, from early child care to family leave and long-term care and support for older adults and the disabled.

This could be structured in a variety of ways. One option for seniors, a catastrophic insurance plan that would cover expenses up to $110 a day (in 2014 dollars) after a waiting period determined by the beneficiary’s income, could be funded by raising the Medicare tax one percentage point.

Mr. Biden’s plan doesn’t include much detail. Mr. Gleckman of the Urban Institute notes that it has grown vaguer since Mr. Biden proposed it on the campaign trail — perhaps because he realized the tensions it would raise. In any event, a deeper overhaul of the system may eventually be needed.

“This is a significant, historic investment,” Mr. Espinoza said. “But when you take into account the magnitude of the crisis in front of us, it’s clear that this is only a first step.”

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New Hampshire and Oklahoma Move to Open Covid Vaccines to Nonresidents

New Hampshire and Oklahoma announced plans this week to open up vaccine eligibility to outside residents as supply starts to grow and more states expand eligibility.

Gov. Chris Sununu, Republican of New Hampshire, said officials were confident that there would be enough shots to vaccinate outside residents by April 19, the same day that President Biden has called for every state to make all adults eligible for a shot. Mr. Sununu said New Hampshire was “well ahead” of that deadline after making all adults ages 16 or older in the state eligible for a vaccine on April 2.

“We’re going to have a lot of vaccine here,” he said at a news briefing on Thursday, “so we want to get it out to anyone who might actually be here in the state.”

The change came after Mr. Sununu faced criticism from students and Democratic lawmakers for not allowing out-of-state college students to get vaccinated in New Hampshire. He said last week that residents had to “come first” and that college students were at lower risk compared with other age groups.

New York Times vaccine tracker. New Hampshire is behind some other states, though, in fully vaccinating residents, with about 22 percent completely inoculated.

Oklahoma began allowing outside residents to get vaccinated in the state on Thursday, nearly two weeks after the state made all adults ages 16 or older eligible.

“We have always known there would be a point at which supply and increasing capacity would allow us to welcome residents from neighboring states into Oklahoma to get vaccinated,” Keith Reed, a deputy commissioner at the Oklahoma State Department of Health, said in a statement. “We are now reaching that point.”

About 35 percent of Oklahoma’s population has received at least one shot, and 22 percent are fully vaccinated.

Indiana also ended its residency requirement late last month. Dr. Kristina Box, the state health commissioner, said officials made the change to comply with Federal Emergency Management Agency vaccination site rules. The state also wanted to accommodate college students and residents who live with multiple people but may not have proof of residency. More than half of the states and the District of Columbia have residency requirements for vaccination, although most allow exceptions for out-of-state workers, according to a vaccine tracker from the Kaiser Family Foundation, a nonprofit organization focused on national health issues.

about three million shots a day, an increase from roughly two million in early March. Although millions of Americans are getting vaccinated, the country is reporting a sharp rise in new cases, with an average of 67,923 new reported cases a day over the past week, according to a New York Times database.

Jennifer Kates, a senior vice president of the Kaiser Family Foundation, said more states are likely to follow New Hampshire and Oklahoma’s path as vaccine production ramps up.

“If a state does feel more secure in its supply and is not feeling a crunch,” Dr. Kates said, “then the ability to help the national effort to vaccinate more people and remove barriers becomes important.”

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More Eager for Covid Vaccine but Skeptics Remain, U.S. Poll Says

As eligibility for Covid-19 vaccination rapidly expands to all adults in many states over the next month, a new poll shows a continuing increase in the number of Americans, particularly Black adults, who want to get vaccinated. But it also found that vaccine skepticism remains stubbornly persistent, particularly among Republicans and white evangelical Christians, an issue that the Biden administration has flagged as an impediment to achieving herd immunity and a return to normal life.

By now, roughly 61 percent of adults have either received their first dose or are eager for one, up from 47 percent in January, according to the latest monthly survey by the Kaiser Family Foundation.

The shift was most striking among Black Americans, some of whom have previously expressed hesitancy but who have also had access issues. Since just February, 14 percent more Black adults said they wanted or had already gotten the vaccine. Over all, Black adults, who have also been on the receiving end of vigorous promotional campaigns by celebrities, local Black physicians, clergy members and public health officials, now want the vaccine in numbers almost comparable to other leading demographic groups: 55 percent, compared with 61 percent for Latinos and 64 percent for white people.

The Biden administration has made equity a focus of its pandemic response and has added mass vaccination sites in several underserved communities. In early March, a New York Times analysis of state-reported race and ethnicity information showed that the vaccination rate for Black people in the United States was half that of white people, and the gap for Hispanic people was even larger.

administered hit 2.77 million on Tuesday, an increase over the pace the previous week, according to data reported by the Centers for Disease Control and Prevention.

The survey was taken between March 15 through March 22, among a random sample of 1862 adults.

Despite the progress, one in five adults (20 percent) say they would either definitely refuse the shot or only be vaccinated if required by their job or school. A number of employers and institutions are considering imposing such a requirement. Last week, Rutgers University became the first large academic institution to require students this fall to get the vaccine (with exemptions for some medical or religious reasons).

The people most likely to firmly oppose being vaccinated identify as Republicans (29 percent) or as white evangelical Christians (28 percent). In contrast, only 10 percent of Black adults said they would definitely not get it.

Awash in online misinformation, many cling to a fast-spreading myth — that tracker microchips are embedded in the shots.

For rural residents, access to the vaccine is so problematic that they see the logistics and travel time involved as simply not worth it.

With so many reasons cited to avoid the vaccine, crafting messages to coax vaccine confidence can be difficult. But the latest Kaiser report identified some approaches that seem to be successful in moving people to consider the shots.

At least two-thirds of the so-called wait and see group said they would be persuaded by the message that the vaccines are “nearly 100 percent effective at preventing hospitalization and death from Covid-19.” Other strong messages included information that the new vaccines are based on 20-year-old technology, that the vaccine trials included a broad diversity of candidates, and that the vaccines are free.

The survey also noted that many people who are hesitant would be amenable to certain incentives. As the country begins to open up and on-site work returns, the role of the employer in vaccination is becoming increasingly pertinent. A quarter of those who are hesitant and have a job said that they would get the shot if their employer arranged for workplace vaccination. Nearly as many would agree if their employers gave them financial incentives ranging from $50 to $200.

But over all, the strong growth in adults who have either gotten one dose of the vaccine or are inclined to get it is most likely because of their increasing familiarity with the notion. Surveys show that as they begin to know more friends and relatives who have gotten the shot, they can more readily imagine getting it themselves.

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