The latest COVID-19 developments

In May of 2023, the COVID-19 public health emergency officially expired in the U.S. and the World Health Organization declared the end of the COVID-19 global health emergency.^1,2 Although SARS-CoV-2 continues to spread and pose health risks, particularly to at-risk groups, significant progress has been made to decrease its disease burden. In the U.S., COVID-19 hospitalizations are at the lowest level since they started to be reported in August of 2020 and COVID-19 dropped from the third leading cause of death in 2020-2021 to the seventh leading cause in 2023 at this time.³

At Private Health Management, our team of PhD-led research experts continuously monitor the latest news, research, and developments for new insights on COVID-19 to improve the health and safety of our clients. Here’s the latest FAQ:

What does the end of the COVID-19 Public Health Emergency mean?
The end of the public health emergency in the U.S. represents a key shift for COVID-19 from the acute emergency phase to the long-term state of ongoing management with less involvement and funding from the federal government. In addition, the ability to monitor risk levels in the community continues to decline, as gaps in COVID-19 surveillance grow. For example, the CDC has stopped tracking cases, and data quality and frequency of reporting has decreased. However, key metrics will continue to be monitored by the CDC, including hospitalizations and wastewater levels. In general, COVID-19 surveillance will be monitored more similarly to other respiratory illnesses, like influenza.

Will vaccines and treatments continue to be available for free?
The federal stockpile of vaccines and treatments remains free to all while supplies last. Once the stockpile is gone, COVID-19 vaccines will continue to be free for most people with health insurance, if they receive the vaccine in-network, but will likely face cost sharing for treatments such as Paxlovid. Additionally, COVID-19 testing has become more expensive for many insured people, with fewer options for free tests and more expected cost sharing.

What is the latest information on booster shots?
The FDA has authorized a second bivalent COVID-19 booster shot for people aged 65 and older (who have received their first bivalent shot at least 4 months earlier) and people who are immunocompromised (and who have received their first bivalent shot at least 2 months prior). Currently, the FDA does not recommend an additional bivalent booster for patients who are not in these groups.

What is the latest on Long COVID?
Many people in the U.S. are currently experiencing symptoms of Long COVID, most commonly fatigue, “brain fog” (difficulty thinking and concentrating), and cough. As of March 2023, it is estimated that around 16 million (6%) adults in the U.S. currently have Long COVID and about 1 in 10 patients who become infected with SARS-CoV-2 will develop Long COVID symptoms.^4,5 Research suggests there are several ways to reduce your risk of getting Long COVID, including COVID-19 vaccination and treatment with Paxlovid soon after developing symptoms of infection.^6–8

Are there effective treatments for Long COVID?
Currently, there are no medications specifically approved for treating Long COVID, but many clinical trials are under way. Post-COVID care centers around the U.S. work with patients to manage their specific symptoms using a variety of strategies including:

• Relaxation techniques to help with fatigue and sleep problems
• Medications to relieve common symptoms such as cough, pain, or headache
• Counseling for emotional and mental health problems, such as depression or anxiety
• Treatment for diabetes, heart disease, or other serious conditions that can be affected by Long COVID
• Taste and smell training to help regain COVID-related loss of these senses

Did you know that using a Training N’ Treatment protocol may help to regain COVID-related losses in taste and smell? Read PHM’s clinical research study led by Dr. Robert Simon, PHM’s Chief Medical Officer.

Are there any new COVID-19 variants to be aware of?
The CDC continues to monitor for new variants, as it is still possible that variants that evade the current vaccines and treatments could evolve. The latest variant of interest in the U.S. is called XBB.1.16 (also referred to as “Arcturus”). This variant is an Omicron strain, related to the current dominant strain XBB.1.5, but can spread faster. It accounted for 14% of cases as of the week of May 13, 2023.3 XBB.1.16 does not appear to cause more severe infections, and existing treatments and vaccines are expected to work well against this strain. There have been some reports that conjunctivitis (pink eye) may be more common with XBB.1.16 than with other COVID-19 strains.⁹

What are the current treatment recommendations for COVID-19?
For many patients, particularly those who have been vaccinated or had prior infection with SARS-CoV-2, COVID-19 symptoms are mild and can be managed at home without prescription medication, but for patients who are at higher risk or have severe symptoms, there are several FDA-authorized treatments available. The U.S. National Institutes of Health currently recommends the following treatments for adult patients¹⁰:

Treatments for adult COVID-19 patients who are not hospitalized¹⁰

PATIENT GROUP	Treatment Recommendations
All Patients	+ Symptom management + Dexamethasone and other corticosteroids should NOT be administered in non-hospitalized patients
Patients at high risk for hospitalization or sever disease	Administration of an antiviral medication (in order of preference): + Paxlovid (oral) within 5 days of symptom onset, or + Remdesivir (intravenous) within 7 days of symptom onset (if Paxlovid cannot be taken), or + Molnupiravir (oral) as soon as possible after symptom onset (if Paxlovid or remdesivir are not appropriate for the patient)

Treatments for adult patients who are hospitalized due to COVID-19¹⁰

PATIENT GROUP	Treatment Recommendations
Patients who do not need oxygen supplementation	+ Remdesivir (antiviral) if patient is at high risk of progressing to severe COVID-19 + Dexamethasone and other corticosteroids should NOT be administered
Patients who need oxygen supplementation	+ Remdesivir (antiviral) treatment + Dexamethasone (anti-inflammatory) treatment + Baricitinib or tocilizumab (immunomodulator) treatment

*Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

References

1. Affairs (ASPA), A. S. for P. Fact Sheet: End of the COVID-19 Public Health Emergency. HHS.gov https://www.hhs.gov/about/news/2023/05/09/fact-sheet-end-of-the-covid-19-public-health-emergency.html (2023).
2. Statement on the fifteenth meeting of the IHR (2005) Emergency Committee on the COVID-19 pandemic. https://www.who.int/news/item/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic.
3. COVID Data Tracker Weekly Review. Centers for Disease Control and Prevention https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html (2023).
4. Long COVID: What Do the Latest Data Show? KFF https://www.kff.org/policy-watch/long-covid-what-do-latest-data-show/ (2023).
5. Davis, H. E., McCorkell, L., Vogel, J. M. & Topol, E. J. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol 21, 133–146 (2023).
6. Tsampasian, V. et al. Risk Factors Associated With Post−COVID-19 Condition: A Systematic Review and Meta-analysis. JAMA Internal Medicine (2023) doi:10.1001/jamainternmed.2023.0750.
7. Taylor, L. Covid-19: Vaccination reduces severity and duration of long covid, study finds. BMJ 380, p491 (2023).
8. Nirmatrelvir and the Risk of Post-Acute Sequelae of COVID-19 | medRxiv. https://www.medrxiv.org/content/10.1101/2022.11.03.22281783v1.
9. Pink Eye May Be a Symptom of COVID-19 in Children. American Academy of Ophthalmology https://www.aao.org/eye-health/news/pink-eye-symptom-covid19-coronavirus-children (2023).
10. Clinical Management of Adults Summary. COVID-19 Treatment Guidelines https://www.covid19treatmentguidelines.nih.gov/tables/management-of-nonhospitalized-adults-summary/.