The risk of heart infection higher after Covid when compared to incidence post-vaccination

Courtesy The American Heart Association

Study finds the risk of myocarditis was substantially higher in the four weeks after COVID-19 infection than after a first dose of a COVID-19 vaccine.

DALLAS -- In a detailed analysis of nearly 43 million people, the risk of myocarditis in unvaccinated individuals after COVID-19 infection was at least 11 times higher compared to people who developed myocarditis after receiving a COVID-19 vaccine or booster dose, according to new research published today in the American Heart Association’s flagship, peer-reviewed journal Circulation. This analysis included data from England’s National Immunization database for people ages 13 and older who received at least one dose of a COVID-19 vaccine between December 1, 2020 and December 15, 2021 in England.

Several previous studies and reports from public health agencies around the world including the U.S. Centers for Disease Control and Prevention have highlighted a possible connection and potentially increased risk of myocarditis after receiving an mRNA COVID-19 vaccine, generating considerable scientific, policy and public interest.

Typically thought to be trigged by a viral infection, myocarditis is the inflammation of the heart muscle, the myocardium. This condition is uncommon and may temporarily or permanently weaken the heart muscle and the heart’s electrical system, which keeps the heart beating normally. An episode of myocarditis may resolve on its own or with treatment, and may result in lasting damage to the heart. In the general population not during a global pandemic, it is estimated that approximately 10 to 20 people per 100,000 are diagnosed with myocarditis each year, according to the American Heart Association’s 2021 scientific statement on myocarditis.

“We found that across this large dataset, the entire COVID-19-vaccinated population of England during an important 12-month period of the pandemic when the COVID-19 vaccines first became available, the risk of myocarditis following COVID-19 vaccination was quite small compared to the risk of myocarditis after COVID-19 infection,” says first author of the study Martina Patone, Ph.D., a statistician at the Nuffield Department of Primary Health Care Sciences at the University of Oxford in Oxford, England. “This analysis provides important information that may help guide public health vaccine campaigns, particularly since COVID-19 vaccination has expanded in many parts of the world to include children as young as 6 months old.”

In this study, Patone and colleagues evaluated England’s National Immunization database of COVID-19 vaccinations for all people ages 13 or older who had received at least one dose of the ChAdOx1 (a two-dose adenovirus-vector COVID-19 vaccine developed by the University of Oxford and AstraZeneca, most similar to the one-dose Johnson & Johnson/Janssen COVID-19 vaccine available in the U.S.), the Pfizer-BioNTech or the Moderna COVID-19 vaccine (the same mRNA vaccines available in the U.S.) between December 1, 2020 and December 15, 2021. This dataset totaled nearly 43 million people, which included more than 21 million who had received a booster dose of any of the COVID-19 vaccines (meaning they had received a total of 3 doses of a COVID-19 vaccine). The database detailed the type of COVID-19 vaccines received, dates received and dose sequencing, along with individual demographic information including age and sex for each individual. Nearly 6 million people tested positive for COVID-19 infection either before or after COVID-19 vaccination during the study period.

England’s National Immunization database records were then cross-referenced and matched to the national offices with data on COVID-19 infection, hospital admission and death certificates for the same time period, December 1, 2020 through December 15, 2021. Individuals were classified based on age and sex to reveal which groups had the highest risk of myocarditis after a COVID-19 vaccine or after COVID-19 infection and hospitalization. The authors used the self-controlled case series (SCCS) method, which was developed to estimate the relative incidence of an acute event in a pre-defined post-vaccination risk period (1-28 days), compared to other times (pre-vaccination or long after vaccination). Being a within-person comparison, the analyses were controlled to adjust for any fixed characteristics, including sex, race or ethnicity, or chronic health conditions.

In the overall dataset of nearly 43 million people, the analyses found:

Fewer than 3,000 (n=2,861), or 0.007%, people were hospitalized or died with myocarditis during the one-year study period. 617 of these cases of myocarditis occurred during days 1-28 after receiving a COVID-19 vaccination, of which 514 were hospitalized.

People who were infected with COVID-19 before receiving any doses of the COVID-19 vaccines were 11 times more at risk for developing myocarditis during days 1-28 after a COVID-19 positive test.

The risk of COVID-19 infection-related myocarditis risk was cut in half among people infected after vaccination (received at least one dose of a COVID-19 vaccine).

The risk of myocarditis increased after a first dose of the ChAdOx1 COVID-19 vaccine (an adenovirus-vector vaccine most similar to the Johnson & Johnson/Janssen COVID-19 vaccine available in the U.S.) and after a first, second and booster dose of any of the mRNA COVID-19 vaccines. However, the risk of vaccine-associated myocarditis was lower compared to the risk of COVID-19 infection-associated myocarditis, except for after a second dose of the Moderna vaccine.

Myocarditis risk was found to be higher during days 1-28 after a second dose of the Moderna COVID-19 vaccine for people of all genders and ages, and the risk also persisted after a booster dose of the Moderna vaccine. However, people receiving a booster dose of Moderna were, on average, younger in comparison to those who received a booster dose of the ChAdOx1 or Pfizer-BioNTech vaccine, therefore, results may not be generalizable to all adults.

Risk of COVID-19 vaccine-associated myocarditis among women:

Of the nearly 21 million women, 7.2 million (34%) were younger than age 40, and a slightly increased risk of myocarditis was found among this younger age group after receiving a second dose of the Moderna COVID-19 vaccine: 7 estimated extra cases of myocarditis for every one million women vaccinated.

Among women older than age 40, a slight increased risk of myocarditis was associated with receiving a first or third dose of the Pfizer-BioNTech COVID-19 vaccine, respectively 3 and 2 estimated additional cases of myocarditis for every one million women vaccinated.

Risk of COVID-19 infection-associated myocarditis among women:

Among women younger than age 40, the risk of infection-associated myocarditis was higher compared to the risk of vaccine-associated myocarditis: 8 extra cases associated with having COVID-19 infection before vaccination.

Among women older than age 40, the risk of infection-associated myocarditis was higher compared to the risk of vaccine-associated myocarditis: 51 extra cases associated with having COVID-19 infection before vaccination.

Risk of COVID-19 vaccine-associated myocarditis among men:

Among the 18 million men in the dataset, all of whom received at least one COVID-19 vaccine, more than 6 million men (34%) were younger than age 40.

An increased risk of vaccine-associated myocarditis was found in men ages 40 and younger after a first dose of either of the mRNA COVID-19 vaccines (4 and 14 estimated extra cases for every one million men vaccinated with respectively Pfizer or Moderna vaccine), or a second dose of any of the three COVID-19 vaccines available in England during the study period: 14, 11 and 97 estimated additional cases of myocarditis for every one million men vaccinated, respectively for the ChAdOx1, the Pfizer-BioNTech or the Moderna vaccine.

The increased risk of developing myocarditis among males younger than age 40 was also higher after receiving two doses of the Moderna vaccine when compared to the risk of myocarditis after COVID-19 infection. The researchers noted, however, the average age of people who received the Moderna vaccine was 32 years, compared to the majority of those who received the other vaccines were older than age 40.

In men ages 40 and older, a slightly increased risk of myocarditis was found after a booster dose of either of the two mRNA vaccines (Pfizer-BioNTech or Moderna): 3 estimated extra cases of myocarditis for every one million men vaccinated with either mRNA vaccine.

Risk of COVID-19 infection-associated myocarditis among men:

Among men younger than age 40, the risk of infection-associated myocarditis was higher compared to the risk of vaccine-associated myocarditis: 16 extra cases associated with having infection before vaccination, with the only exception of a second dose of Moderna vaccine.

Among men older than age 40, the risk of infection-associated myocarditis was higher compared to the risk of vaccine-associated myocarditis: 85 extra cases associated with having infection before vaccination.

“It is important for the public to understand that myocarditis is rare, and the risk of developing myocarditis after a COVID-19 vaccine is also rare. This risk should be balanced against the benefits of the COVID-19 vaccines in preventing severe COVID-19 infection. It is also crucial to understand who is at a higher risk for myocarditis and which vaccine type is associated with increased myocarditis risk, ” said Professor Nicholas Mills, Ph.D., the Butler British Heart Foundation Chair of Cardiology at the University of Edinburgh and a co-author of the paper. “These findings are valuable to help inform recommendations on the type of COVID-19 vaccines available for younger people and may also help shape public health policy and strategy for COVID-19 vaccine boosters. The SARS-CoV-2 virus continues to shift, and more contagious variants arise; our hope is that this data may enable a more well-informed discussion on the risk of vaccine-associated myocarditis when considered in contrast to the net benefits of COVID-19 vaccination,” said another co-author Julia Hippisley-Cox, F.R.C.P., professor of clinical epidemiology and general practice at the University of Oxford.

Authors noted there are two unanswered questions that likely require further investigation. The first is about myocarditis risk among children ages 13-17 because there were too few cases of myocarditis to quantify the risk specific to this age group. Secondly, researchers were not able to directly compare the death rate after COVID-19 infection vs. death after COVID-19 vaccination since the database only included people who had received at least one COVID-19 vaccine. More expansive data and a different analysis are still needed to address these questions and numerous other COVID-19 topics.

The study has two notable limitations. The number of cases of myocarditis among individuals who received a booster dose of the ChAdOx1 or Moderna vaccines was too small to calculate the risk of myocarditis. Additionally, researchers cannot exclude the possibility of over- or under-estimated risk due to misclassification of any health information in the database, though the U.K.’s National Health Service is known to provide timely and accurate data.

AHA agrees with CDC guidelines, recommends Covid-19 booster

(Amreican Heart Association) -- As the Omicron variant spreads, COVID-19 vaccination is more important than ever. The American Heart Association continues to align with expert guidance from the U.S. Centers for Disease Control and Prevention (CDC) – the nation’s infectious disease experts - regarding COVID-19 vaccinations and booster shots.

Recently, the CDC extended recommendations for a booster dose of COVID-19 vaccines to all adults ages 18 and older, including the allowance to "mix & match" the types of COVID-19 vaccines for the booster dose. According to the CDC, the additional COVID-19 vaccine dose may be from any of the three COVID-19 vaccines authorized or approved in the U.S. – either the Pfizer-BioNTech, Moderna or Johnson & Johnson COVID-19 vaccines. The mix & match regimen is available only for booster doses of the COVID-19 vaccines, not for the primary vaccination series, which still requires the same, initial two doses of either the Pfizer-BioNTech or Moderna COVID-19 vaccine.

The CDC recommends a booster of either the Moderna or Pfizer-BioNTech COVID-19 vaccine (mRNA vaccines) for all adults at least 6 months after receiving two-doses of the same mRNA COVID-19 vaccine. Adults ages 18 and older who previously received one dose of the Johnson & Johnson COVID-19 vaccine (an adenovirus vector vaccine) are eligible for a booster dose two months after the initial dose. They may select a second dose of the Johnson & Johnson COVID-19 vaccine or a booster dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccines.

The American Heart Association/American Stroke Association, a global force for longer, healthier lives for all, affirms the CDC’s guidance on COVID-19 vaccines.

The Association remains concerned about the continuing gaps in COVID-19 vaccination among people from all eligible age groups in the U.S. including people from diverse racial and ethnic groups and among pregnant women, especially in light of the Omicron variant. Therefore, it continues to urge all adults and children ages 5 and older in the U.S. to receive all COVID-19 vaccines as soon as they are eligible, as recommended by the CDC and fully approved or authorized for emergency use by the FDA.

"With the Omicron variant spreading, we urge everyone 5 and older to get vaccinated against COVID-19 and get the booster when they are eligible. The booster shots are particularly important for adults ages 50 and older who have underlying medical conditions or any adult living in a long-term care facility," said American Heart Association volunteer President Donald M. Lloyd-Jones, M.D., Sc.M., FAHA, who is also the Eileen M. Foell Professor of Heart Research, professor of preventive medicine, medicine and pediatrics, and chair of the department of preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

"As cited by the CDC, recently published research indicates a COVID-19 vaccine booster dose provides increased protection against COVID-19 infection, severe complications and death. Breakthrough cases of COVID-19 infection after vaccination are possible, however, serious side effects and needing hospitalization among people who are vaccinated continue to be rare and mild. The benefits of the vaccine and boosters far outweigh the very limited risk."

The Association also supports the CDC’s ongoing safety recommendations: mask wearing for all people regardless of vaccination status when indoors, frequent handwashing and social distancing. Along with COVID-19 vaccination, these safety protocols are essential to minimizing the spread of the COVID-19 virus and reducing the risk of infection, hospitalization and death.

"As the COVID-19 pandemic impacts our families and communities for a second winter and holiday season, we encourage everyone to remain vigilant against the COVID-19 virus. The COVID-19 vaccines are paramount to saving lives, protecting our families and loved ones against COVID-19 infection, severe illness and death. We urge everyone to get vaccinated as soon as possible so that it is a winter filled with joyous memories," urged Lloyd-Jones.

Don't have health insurance for an updated COVID-19 vaccine? Here's how to get one free

BrandPoint - While COVID-19 activity is still below the levels seen last year at this time, COVID-19 hospitalizations are rising quickly. There is still time to get yourself and your loved ones vaccinated. Getting an updated COVID-19 vaccine is the best way to stay protected against serious illness from COVID-19. The Centers for Disease Control and Prevention (CDC) recommends that everyone 6 months and older stay up to date with COVID-19 vaccination. Vaccination also lowers your risk of getting long COVID - a wide range of health problems that can last weeks, months or even years after COVID-19 infection.

Most adults can get a free updated COVID-19 vaccine through their private health insurance, Medicare or Medicaid plans. However, some health insurance plans don't fully cover the cost of a COVID-19 vaccine, and an estimated 25-30 million people living in the U.S. don't have health insurance.

To address this concern, CDC's Bridge Access Program is offering adults who are uninsured or whose insurance doesn't fully cover COVID-19 vaccination a free, updated COVID-19 vaccine. This program will end by Dec. 31, 2024. To date, more than a million COVID-19 vaccine doses have been provided through the program.

Bridge Access Program

There is no enrollment process or application to qualify, and you don't need to provide identification or proof of insurance to get a vaccine through the Bridge Access Program. If you are 18 years or older and don't have health insurance, or your plan doesn't fully cover an updated COVID-19 vaccine, the Bridge Access Program can provide one for free at participating CVS, Walgreens and eTrueNorth-partnering pharmacies, local health centers and health providers.

How to find a vaccine through the Bridge Access Program

Follow these steps to find pharmacies and health care providers participating in the Bridge Access Program near you:

* Visit Vaccines.gov.

* Select "Find COVID-19 Vaccines."

* Enter your 5-digit ZIP code in the search bar and select which vaccine option(s) you're interested in finding.

* Select "Search for COVID-19 Vaccines."

* Select the option "Bridge Access Program Participant" to show participating providers and pharmacies.

When you find a convenient location, call ahead to confirm that they can provide you with a free updated COVID-19 vaccine through the Bridge Access Program. If you can't find a participating pharmacy or provider near you, check back later because new locations are still being added.

Why get vaccinated now?

Viruses constantly change through mutation and sometimes these mutations result in a new strain (or variant) of the virus. It's important to know that the updated COVID-19 vaccines offer protection against the variants spreading throughout our communities right now.

The cold winter months are a time when people spend more time in crowded indoor settings, where respiratory viruses, including COVID-19, may be more readily transmitted. Getting an updated COVID-19 vaccine will help protect you from serious illness.

Don't let cost stop you from getting an updated COVID-19 vaccine this year. Free COVID-19 vaccines are still available. If you are uninsured or your plan won't fully cover it, visit Vaccines.gov today to find a Bridge Access Program provider near you.

Updated COVID-19 vaccine approved by FDA coming soon

by Matt Sheehan
OSF Healthcare

Photo provided

Dr. Doug Kasper

PEORIA - The fall virus season is upon us, and the U.S. Food & Drug Administration just approved one of the newest tools to protect Americans from severe illness.

The updated COVID-19 vaccine is expected to be available at pharmacies around the country in the coming weeks.

The mRNA vaccine is not a booster, says Doug Kasper, MD, an infectious disease specialist with OSF HealthCare. He says it’s recommended for a much broader portion of the population.

"The vaccine is now recommended for everybody 6 months and older as a one-time, once-a-year vaccine," Dr. Kasper says. “The vaccine has been updated. For people who are at really high risk, those 65 and older or with respiratory conditions, they may get a second shot. This would be in a six-month interval in the springtime.”

Does the vaccine prevent me from getting COVID-19?

The quick answer? No, much like you find with the annual influenza vaccine.

"The vaccine seeks to protect severe outcomes associated with COVID-19. It doesn't protect you from getting COVID, it tries to decrease the severity of how sick you would get," Dr. Kasper says.

While there has been an uptick in COVID-19 cases recently, Dr. Kasper says there has not been an increase in COVID hospitalizations. He attributes this to robust natural immunity in the population and adding this COVID-19 vaccine is just another way to protect yourself from severe illness.

FDA’s “What to Know” sheet

The 2024-2025 formula has been updated to protect against the Omicron variant KP.2.

Unvaccinated individuals 6 months through 4 years of age are eligible to receive three doses of the updated, authorized Pfizer-BioNTech COVID-19 vaccine or two doses of the updated, authorized Moderna COVID-19 vaccine.
Individuals 6 months through 4 years of age who have previously been vaccinated against COVID-19 are eligible to receive one or two doses of the updated, authorized Moderna or Pfizer-BioNTech COVID-19 vaccines (timing and number of doses to administer depends on the previous COVID-19 vaccine received).
Individuals 5 years through 11 years of age regardless of previous vaccination are eligible to receive a single dose of the updated, authorized Moderna or Pfizer-BioNTech COVID-19 vaccines; if previously vaccinated, the dose is administered at least two months after the last dose of any COVID-19 vaccine.
Individuals 12 years of age and older are eligible to receive a single dose of the updated, approved Comirnaty (manufactured by Pfizer BioNTech) or the updated, approved Spikevax (manufactured by Moderna); if previously vaccinated, the dose is administered at least two months since the last dose of any COVID-19 vaccine.
Additional doses are authorized for certain immunocompromised individuals ages 6 months through 11 years of age as described in the Moderna COVID-19 vaccine and Pfizer-BioNTech COVID-19 vaccine fact sheets.

Commercial retailers are the way to go

As the vaccines from Pfizer and Moderna become available, the Centers for Disease Control & Prevention (CDC) will publish a pharmacy lookup website at https://www.vaccines.gov/en/vaccines.gov to help people find the nearest vaccine locations.

Dr. Kasper says the best bet at getting a vaccine appointment for COVID-19 or influenza, is through pharmacies at local commercial retailers like Target, Walgreens, CVS or Walmart.

Free COVID-19 home tests are coming back

“The U.S. government will make the at-home COVID testing available for free again this year. You can request up to four home tests that will be delivered to your address for free,” Dr. Kasper says. That gives people another option for testing if they think they're developing signs of COVID even after receiving a vaccine, which can be another way to avoid wait lines at urgent cares, ERs or primary care clinics, and to keep themselves isolated until symptoms have resolved.”

The U.S. Department of Health & Human Services reports that COVIDTests.gov will be the website to order from once the website is active.

Status of the Novavax vaccine

A third manufacturer, Novavax, makes a protein-based vaccine similar to influenza vaccines. While it hasn’t been approved by the FDA, Dr. Kasper suspects it will be soon.

"It likely will be approved, and Novavax has been a prior manufacturer of COVID-19 vaccines. That is a third option that will be coming that isn't mRNA based for people to consider if they had an adverse reaction with Pfizer or Moderna in the past,” Dr. Kasper says.

Can I get the COVID-19 and flu vaccine at the same time?

"There's no issue with timing on getting the COVID and influenza vaccines. The RSV vaccine is recommended to be given separate," Dr. Kasper says. “Most of that has to do with the fact they weren't studied together, there's not an adverse issue with it. For the population, COVID and influenza are recommended across almost all age groups. RSV is for our older population, so we recommend spacing that out by a week or two.”

For all vaccine questions, Dr. Kasper recommends speaking with your primary care team to review your options.

Two weeks of executive orders issued by Illinois Gov. J.B. Pritzker in response to the Coronavirus pandemic

By Joe Tabor, Illinois Policy

In the last two weeks, Gov. J.B. Pritzker has issued a series of executive orders in response to the spread of the COVID-19 virus in Illinois.

These executive orders have limited the size of public gatherings, suspended enforcement of certain laws and agency operations, and closed schools and nonessential businesses in an effort to slow the spread of the virus and prevent the state’s health care system from being inundated with severely ill patients. The governors of New York, California, and Ohio have issued similar executive orders.

But where do those executive powers come from? And what is or isn’t allowed?

While the federal government is a government of enumerated powers – it can only exercise the powers specifically granted to it by the U.S. Constitution – state governments retain what is known as “police powers” to protect the welfare, safety and health of their residents, in keeping with the 10th Amendment of the U.S. Constitution.

This system means that states have more flexibility to act without running up against constitutional barriers. It also means states, not the federal government, have the power to tighten or loosen the restrictions ordered by state governors.

The governor’s authority to issue the recent series of COVID-19 executive orders comes from Section 7 of the Illinois Emergency Management Agency Act. In the case of a disaster such as a viral epidemic, the governor can issue a proclamation declaring that disaster, allowing him to exercise the emergency powers authorized in the act for a period of up to 30 days. State and local police can work together to enforce orders given under these emergency powers.

Pritzker declared a statewide disaster on March 9, triggering his emergency powers. He began issuing a series of executive orders a few days later.

Pritzker’s emergency powers include but are not limited to the following, which have been cited in the governor’s orders thus far:

To suspend any provisions of regulatory statute that would prevent, hinder or delay necessary action by the state or state agencies.

To utilize all available resources of the state government reasonably necessary to cope with the disaster.

To redirect state departments or agencies toward disaster response purposes.

To control the movement of persons and occupancy of premises within the disaster area.

To provide temporary emergency housing.

To control, restrict, and regulate the use, sale, or distribution of food, feed, fuel, clothing and other commodities, materials, goods, or services.

Pritzker is not the first Illinois governor to invoke the Emergency Management Agency Act. For example, former Gov. George Ryan twice made use of the provisions of Section 9 that allowed him to transfer money to the Illinois Emergency Management Agency after a tornado hit Centralia, Illinois, in 2002.

Here is a timeline of Pritzker’s executive orders so far:

March 12:
COVID-19 Executive Order No. 1:

Extends the application deadlines for cannabis growers, infusers, and transporters to March 30, 2020

March 13:
COVID-19 Executive Order No. 2:

Cancels all public and private gatherings of 1,000 people or more

Closes the Thompson Center to the general public

Suspends the two-year continuous service requirement for state employees to receive advancement of sick leave

COVID-19 Executive Order No. 3:

Closes all public and private K-12 schools through March 30

Suspends definition of student “chronic absences” so that it will not include absences due to COVID-19 closures and absences

Suspends the requirement that school districts gain approval for the implementation of e-learning programs

March 15:
COVID-19 Executive Order No. 4:

Clarifies that the closure of schools does not close the buildings for food provision or noneducational purposes like polling places

March 16:
COVID-19 Executive Order No. 5:

All bars and restaurants must cease all on-premises consumption through March 30 (later extended)

Prohibits all public and private gatherings of 50 people or more

Suspends one-week waiting period for unemployment claims

Suspends Open Meetings Act requirement that members of a public body must be physically present. Encourages postponing official government business when possible, and when conducting government business can’t be postponed, making video and phone access available to the public

March 17:
COVID-19 Executive Order No. 6:

Suspends expiration of vehicle registration, driver’s licenses, parking decals, state ID cards and related proceedings

Suspends filing requirements for statements of economic interest by certain public officials and state employees under governmental ethics laws

March 19:
COVID-19 Executive Order No. 7:

Mandates health insurance issuers regulated by the Department of Insurance cover the costs of in-network telehealth services

March 20:
COVID-19 Executive Order No. 8:
Orders residents to stay at home, barring exceptions such as essential travel for essential work or supplies, exercise and recreation, through April 7.

Defines essential businesses, operations and government functions that are exempt from the order

Reduces allowable public and private gathering size to no more than 10 people

Orders all law enforcement officers to cease enforcing eviction orders for residential premises

March 23:
COVID-19 Executive Order No. 9:

Suspends requirement that Department of Corrections provide relevant state’s attorney’s office 14 days’ notice before an inmate receives an early release for good conduct and replaces with requirement that notice be provided as far in advance as possible or as quickly as possible

Makes several minor revisions, clarifications or additions to previous executive orders

March 24:
COVID-19 Executive Order No. 10:

Suspends prohibition on hiring nursing assistants who are inactive on the Healthcare Worker Registry if they meet certain criteria

Extends the conditional employment period for nurse assistants pending fingerprinting/criminal background check

Suspends provision requiring 30-day written notice from the Department of Juvenile Justice before a youth inmates target release date and replaces with requirement that the department notify the state’s attorney’s office of release dates with as much advance notice as possible or as quickly as possible

Suspends requirement that Miners’ Examining Board hold an exam once every month

March 26: COVID-19 Executive Order No. 11:

Suspends all admissions to the Illinois Department of Corrections from all Illinois county jails, with exceptions at the sole discretion of the Director of the Illinois Department of Corrections for limited essential transfers

COVID-19 Executive Order No. 12:

Allows two-way audio-video communication to satisfy the requirement that a person must “appear” before a Notary Public

Allows any act of witnessing required by Illinois law may be completed remotely by via two-way audio-video communication if the communication meets certain requirements

Allows all legal documents to be signed in counterparts by witnesses and signatory absent an express prohibition, and sets out specific procedures when the signing requires a Notary Public

March 27:
COVID-19 Executive Order No. 13:

Suspends requirements on the administration of assessments, school terms, and the calculation of daily pupil attendance

Allows ISBE to implement rules regarding remote learning

Permits the use of early childhood block grant funding to provide child care for children of employees performing essential work

Any bids received by a school district for construction purposes may be communicated and accepted electronically

March 28:
COVID-19 Executive Order No. 14:

Suspends provisions of the vehicle code regarding repossession of vehicles

Allows training for Private Detective, Private Alarm, Private Security, Fingerprinting Vendor, and Locksmith Acts to be completed through online instruction COVID-19 Executive Order No. 15:

Further Extends the deadlines for previously extended cannabis-related licenses to April 30

Directs Department of Agriculture to accept all craft grower, infuser, and transporter license applications post-marked on or before April 30, 2020 via certified US Mail

April 1:
COVID-19 Executive Order No. 16:

Extends previous executive orders to last until April 30

COVID-19 Executive Order No. 17:

Directs that elective surgeries be cancelled or postponed

Protects health care facilities, professionals, and volunteers from from civil liability for any injury or death alleged, unless caused by gross negligence or willful misconduct

April 6:
COVID-19 Executive Order No. 18:

Allows a verbal attestation documented by the State constitutes a valid signature for applications for public assistance, rather than requiring an audio recording

Allows unsigned applications for public assistance received by mail to be signed by a verbal attestation by telephone

COVID-19 Executive Order No. 19:

Suspends the 14-day limit for inmate furloughs

Allows furloughs for medical, psychiatric or psychological purposes

April 7:
COVID-19 Executive Order No. 20:

Suspends date requirements for township annual meetings

Suspends license renewal limits for funeral director and embalmer interns

Suspends supervision requirement for funeral director interns when transporting bodies to a cemetery, crematory, or final place of disposition

Permits persons in the care of the Illinois Department of Children and Family Services who are 18 or older to remain in their placement

Suspends the requirement for healthcare workers that designated students, applicants, and employees must have their fingerprints collected electronically and transmitted to the Illinois Department of State Police within 10 working days, provided that they are transmitted within 30 working days of enrollment in a CNA training program or the start of employment

Originally published by Illinois Policy on April 9, 2020. Published by permission.

Young people recover quickly from rare effect caused by COVID-19 vaccine

by American Heart Association

Most young people under the age of 21 who developed suspected COVID-19 vaccine-related heart muscle inflammation known as myocarditis had mild symptoms that improved quickly, according to new research published today in the American Heart Association’s flagship journal Circulation.

Myocarditis is a rare but serious condition that causes inflammation of the heart muscle. It can weaken the heart and affect the heart’s electrical system, which keeps the heart pumping regularly. It is most often the result of an infection and/or inflammation caused by a virus.

"In June of this year, the U.S. Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices reported a likely link between mRNA COVID-19 vaccination and myocarditis, particularly in people younger than 39. However, research continues to find COVID-19 vaccine-related cases of myocarditis uncommon and mostly mild," said Donald. M. Lloyd-Jones, M.D., Sc.M., FAHA, president of the American Heart Association, who was not involved in the study. "Overwhelmingly, data continue to indicate that the benefits of COVID-19 vaccination – 91% effective at preventing complications of severe COVID-19 infection including hospitalization and death – far exceed the very rare risks of adverse events, including myocarditis."

"The highest rates of myocarditis following COVID-19 vaccination have been reported among adolescent and young adult males. Past research shows this rare side effect to be associated with some other vaccines, most notably the smallpox vaccine," said the new study’s senior author Jane W. Newburger, M.D., M.P.H., FAHA, associate chair of Academic Affairs in the Department of Cardiology at Boston Children’s Hospital, the Commonwealth Professor of Pediatrics at Harvard Medical School and a member of the American Heart Association’s Council on Lifelong Congenital Heart Disease and Heart Health in the Young. "While current data on symptoms, case severity and short-term outcomes is limited, we set out to examine a large group of suspected cases of this heart condition as it relates to the COVID-19 vaccine in teens and adults younger than 21 in North America."

Using data from 26 pediatric medical centers across the United States and Canada, researchers reviewed the medical records of patients younger than 21 who showed symptoms, lab results or imaging findings indicating myocarditis within one month of receiving a COVID-19 vaccination, prior to July 4, 2021. Cases of suspected vaccine-associated myocarditis were categorized as "probable" or "confirmed" using CDC definitions.

Of the 139 teens and young adults, ranging from 12 to 20 years of age, researchers identified and evaluated:

Most patients were white (66.2%), nine out of 10 (90.6%) were male and median age was 15.8 years.

Nearly every case (97.8%) followed an mRNA vaccine, and 91.4% occurred after the second vaccine dose.

Onset of symptoms occurred at a median of 2 days following vaccine administration.

Chest pain was the most common symptom (99,3%); fever and shortness of breath each occurred in 30.9% and 27.3% of patients, respectively.

About one in five patients (18.7%) was admitted to intensive care, but there were no deaths. Most patients were hospitalized for two or three days.

More than three-fourths (77.3%) of patients who received a cardiac MRI showed evidence of inflammation of or injury to the heart muscle.

Nearly 18.7% had at least mildly decreased left ventricular function (squeeze of the heart) at presentation, but heart function had returned to normal in all who returned for follow-up.

"These data suggest that most cases of suspected COVID-19 vaccine-related myocarditis in people younger than 21 are mild and resolve quickly," said the study’s first author, Dongngan T. Truong, M.D., an associate professor of pediatrics in the division of cardiology at the University of Utah and a pediatric cardiologist at Intermountain Primary Children’s Hospital in Salt Lake City. "We were very happy to see that type of recovery. However, we are awaiting further studies to better understand the long-term outcomes of patients who have had COVID-19 vaccination-related myocarditis. We also need to study the risk factors and mechanisms for this rare complication."

Researchers say future studies should follow patients who have suffered vaccine-associated myocarditis over a longer term, since this study examined only the immediate course of patients and lacks follow-up data. Additionally, there are several important limitations to consider. The study design did not allow scientists to estimate the percentage of those who received the vaccine and who developed this rare complication, nor did it allow for a risk/benefit ratio examination. The patients included in this study were also evaluated at academic medical centers and may have been more seriously ill than other cases found in a community.

"It is important for health care professionals and the public to have information about early signs, symptoms and the time course of recovery of myocarditis, particularly as these vaccines become more widely available to children," Truong said. "Studies to determine long-term outcomes in those who have had myocarditis after COVID-19 vaccination are also planned."

Researchers recommend that health care professionals consider myocarditis in individuals presenting with chest pain after receiving a COVID-19 vaccine, especially in boys and young men in the first week after the second vaccination.

"This study supports what we have been seeing – people identified and treated early and appropriately for COVID-19 vaccine-related myocarditis typically experience mild cases and short recovery times," Lloyd-Jones said. "These findings also support the American Heart Association’s position that COVID-19 vaccines are safe, highly effective and fundamental to saving lives, protecting our families and communities against COVID-19, and ending the pandemic. Please get your child vaccinated as soon as possible."

Covid-19 declaration ends on May 11, testing and treatment coverage costs will be passed on to patients

Alexandra Koch/Pixabay

Before the PHE ends, people are encouraged to order free COVID-19 tests from the government and get up to date on vaccinations. COVID-19 healthcare costs, insurance coverage, and benefits set to change dramatically.

by Champaign-Urbana Public Health District

Champaign – On May 11, 2023, the COVID-19 public health emergency (PHE) will officially end, marking a significant milestone in the fight against the pandemic. The declaration of the PHE was initially made on January 31, 2020 to mobilize and coordinate a nationwide response to the COVID-19 outbreak. The state of Illinois followed on March 9, 2020. Since then, Illinois residents could collect additional SNAP benefits, more than 1.4 million children received pandemic EBT (nutrition) support, and Medicaid benefits expanded so residents could access telehealth and additional resources.

Before the PHE ends, people are encouraged to order free COVID-19 tests from the government (four tests per residential address) and get up to date on vaccinations. Individuals can check if they are up to date by visiting https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html and can find where to receive vaccines by visiting vaccines.gov for pharmacy locations or by visiting https://www.c-uphd.org/covid-vaccinations.html. Individuals with healthcare facilities should call their provider’s office for more information or to set up an appointment. Free at-home COVID tests can be ordered at https://special.usps.com/testkits or by calling 1-800-232-0233.

Beginning May 11, coverage for COVID-19 testing will change. The requirement for private insurance companies to cover COVID-19 tests without cost sharing, both over-the-counter (OTC) and laboratory tests, will end and individuals should reach out to their insurance provider for details. The Centers for Disease Control and Prevention (CDC) Increasing Community Access to Testing (ICATT) program will continue no-cost testing for uninsured persons, though there may be a reduction in testing locations after the PHE ends. Individuals can find a no-cost testing location by visiting https://testinglocator.cdc.gov/Search.

From OSF spokesperson Tim Ditman, "The end of the Public Health Emergency declaration means that most waivers enacted during the pandemic which allowed flexibilities in providing and billing for services also end. The main exception is telehealth services for Medicare enrollees. Those waivers have been extended until the end of calendar year 2024, so services and billing for telehealth services for Medicare enrollees will not change. We will be making necessary adjustments in other areas. Find more information at osfhealthcare.org."

SHIELD Illinois testing at the University of Illinois’ Campus Recreation Center East (CRCE) will close on May 26, with the option to relocate to another location until June 30. Additional information will be provided if announced.

Additionally, the CDC has stated there will be reduced reporting of negative laboratory tests for SARS-CoV-2. The change will impact the percent positivity metric used for transmission level reporting. Transmission levels have been used in healthcare settings to determine prevention measures and mitigation strategies. Champaign-Urbana Public Health will continue to report transmission levels for as long as the data is available. The CDC is currently determining how to address healthcare guidance without the use of transmission levels.

The Champaign-Urbana Public Health District would like to remind residents of steps they can take after the PHE ends to protect themselves and the community:

Stay up to date with COVID-19 vaccines and boosters. The FDA has recently authorized the bivalent booster for all doses starting at six months of age, as well as a second bivalent booster for individuals aged 65 and older who have had their primary vaccination series and are at least four months out from a previous bivalent booster shot.

Immunocompromised individuals may receive a single additional dose of a bivalent COVID-19 vaccine at least two months following a dose of a bivalent vaccine. Additional doses may be administered at the discretion of, and at intervals determined by, their healthcare provider. Those who might qualify should reach out to their medical provider for further discussion.

The monovalent Moderna and Pfizer-BioNTech COVID-19 vaccines are no longer authorized for use in the United States.

Alternatives to mRNA vaccines (Novavax or Johnson & Johnson’s Janssen) remain available for individuals who cannot or will not receive an mRNA vaccine.

If a person tests positive for COVID-19 after May 11, they should not delay treatment. Staying home when sick, frequent hand washing, mask-wearing, and social distancing are still the most effective ways to keep COVID-19 transmission low.

Administrator Julie Pryde says, "The public health emergency declaration is ending, but COVID is still out there making people sick and taking lives. Please stay current on vaccinations. If you develop symptoms of COVID, local healthcare providers can test for COVID, influenza, and RSV at the same visit. Determining which virus you have can help get treatment early when it is most effective."

5 steps for COVID-19 long-haulers during their recovery

Photo: Edward Jenner/Pexels

StatePoint Media

More than a year into the COVID-19 pandemic, it’s becoming clear that some patients who were infected with the virus may have a longer path to recovery than others to feel like themselves again.

As of today, there have been 1,582 confirmed cases of the Coronavirus in the six villages covered by The Sentinel. Of the 19,023 cases diagnosed in Champaign County, 18,531 are considered "Recovered". However, many of those who survived the initial onslaught to their immune system still suffer from lingering effects of the infection.

A new analysis of Cigna claims data estimates that about seven to 10 percent of its commercial customers diagnosed with COVID-19 could be considered "long-haulers", or patients experiencing symptoms for longer than 12 weeks after initially getting sick. That claim falls in line with a study that states that about 10 percent of people who’ve had COVID-19 will experience prolonged symptoms one, two or even three months after they were infected.

While a wide range of symptoms have been observed, the most common include a persistent cough, breathlessness, muscle and body aches, and chest heaviness or pressure. Also sometimes present are skin rashes, palpitations, fever, headache, diarrhea, and pins and needles - an uncomfortable tingling or prickling, usually felt in the arms, legs, hands or feet.

"Much remains to be learned about the potential long-lasting effects of COVID-19, but the good news is that the health care community is working to support people in their recovery long after they leave the hospital," says Dr. Steve Miller, executive vice president and chief clinical officer, Cigna.

Dealing with Long COVID is a struggle for many

Dr. Miller, a nationally-recognized advocate for greater access, affordability and excellence in health care, is offering the following tips for those grappling with "Long COVID".

1. Take care of your mental health: It’s no secret that we’re facing a mental health crisis in America that will remain long after COVID-19 restrictions are eased. Last year alone, Cigna’s pharmacy benefit manager saw a nearly 8 percent increase in people using antidepressants.

Recovery from COVID-19 can be physically and mentally draining, especially for people whose symptoms persist for many weeks or months.

Cigna research shows at least 5 percent of its patients who recovered from COVID-19 developed a mental health disorder in the following months. The good news is that the pandemic has rapidly accelerated the availability and adoption of a range of behavioral health options, making it easier to find a mental health counselor who can help. In fact, 60 percent of Cigna behavioral health customers are now using virtual services – 97 percent of which had previously never had a virtual visit before the pandemic.

2. Take advantage of care managers: Many health plans have expanded access to virtual and telehealth services that can help you avoid additional trips to the clinic or emergency room.

Equally important, some health plans offer individualized support in your recovery from a "care manager". Think of them as a personal health advocate. They will check in to see how you’re feeling, help connect you with needed specialists and follow-up treatments, and will even check in on your family.

Patients who had a post-discharge visit with a provider, either in-person or virtually, and engaged with a Cigna care manager, saw savings of almost $2,000 in 60-day post-COVID costs. Care managers also helped people recover and return to work a full week sooner than average.

3. Get vaccinated when you can. Some preliminary reports show that getting the COVID-19 vaccine has helped improve symptoms for long-haulers.

4. Find a "long-hauler" clinic. Researchers are still learning about COVID-19’s long-term impacts, and there are a number of clinics opening across the country focused solely on treating COVID long-haulers. The National Institutes of Health has also dedicated $1.1 billion to the study of "Long COVID", and Cigna is coordinating closely with them and these clinics to support its customers. Connection is crucial, so also consider seeking out an online long-hauler support network like Survivor Corps.

5. Keep practicing COVID-19 precautions. Everyone is ready to get back to doing the things they love, but none of us are safe until all of us are safe. America is in a race to reach herd immunity before more contagious variants gain momentum. Continue wearing masks, washing your hands and practicing social distancing and encourage family and friends to do the same.

CDC relaxes COVID isolation protocols

Earlier today, the Centers for Disease Control and Prevention announced a recommendation that individuals who exhibit no symptoms after testing positive for Covid-19 need only to isolate for five days instead of the previously recommended 10 days.

The CDC justified the new guidance in a press release. "Both updates come as the Omicron variant continues to spread throughout the U.S. and reflects the current science on when and for how long a person is maximally infectious."

The change comes on the heals of a plea from the airline and healthcare industries who are experiencing labor shortages due to employees having to observe isolation guidelines.

Press release from the CDC:

Given what we currently know about COVID-19 and the Omicron variant, CDC is shortening the recommended time for isolation from 10 days for people with COVID-19 to 5 days, if asymptomatic, followed by 5 days of wearing a mask when around others. The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after. Therefore, people who test positive should isolate for 5 days and, if asymptomatic at that time, they may leave isolation if they can continue to mask for 5 days to minimize the risk of infecting others.

Additionally, CDC is updating the recommended quarantine period for those exposed to COVID-19. For people who are unvaccinated or are more than six months out from their second mRNA dose (or more than 2 months after the J&J vaccine) and not yet boosted, CDC now recommends quarantine for 5 days followed by strict mask use for an additional 5 days. Alternatively, if a 5-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure. Individuals who have received their booster shot do not need to quarantine following an exposure, but should wear a mask for 10 days after the exposure. For all those exposed, best practice would also include a test for SARS-CoV-2 at day 5 after exposure. If symptoms occur, individuals should immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19.

Isolation relates to behavior after a confirmed infection. Isolation for 5 days followed by wearing a well-fitting mask will minimize the risk of spreading the virus to others. Quarantine refers to the time following exposure to the virus or close contact with someone known to have COVID-19. Both updates come as the Omicron variant continues to spread throughout the U.S. and reflects the current science on when and for how long a person is maximally infectious.

Data from South Africa and the United Kingdom demonstrate that vaccine effectiveness against infection for two doses of an mRNA vaccine is approximately 35%. A COVID-19 vaccine booster dose restores vaccine effectiveness against infection to 75%. COVID-19 vaccination decreases the risk of severe disease, hospitalization, and death from COVID-19. CDC strongly encourages COVID-19 vaccination for everyone 5 and older and boosters for everyone 16 and older. Vaccination is the best way to protect yourself and reduce the impact of COVID-19 on our communities.

Illinois steps up amid federal vaccine guidance uncertainty

The Illinois Department of Public Health recommends COVID-19 shots for all adults this fall. The standing order ensures access through local pharmacies and health care providers.

by Ben Szalinski
Capitol News Illinois

SPRINGFIELD - The Illinois Department of Public Health has recommended all adults get a COVID-19 shot this fall despite federal guidelines that narrowed the group of people recommended for the shot.

IDPH released a standing order on Tuesdays that recommends the COVID-19 vaccine for all children between six and 23 months; children ages 2 through 17 that have an underlying risk or live in a home with another person who is at high risk for severe complications from COVID-19; any child whose parents want them to get a vaccine; people who are pregnant, planning to be pregnant or postpartum; and all adults.

CVS Covid Vaccination — Signs advertise autumn vaccinations at a pharmacy in Chicago.

The recommendation bucks new and murky guidelines from the Centers for Disease Control and Prevention that recommend vaccines only for people ages 65 and older. A recent CDC advisory panel vote allowed people younger than 65 to receive the vaccine after being informed of the risks and benefits of the shot, backing away from requiring people to get a prescription in order to receive the vaccine.

Illinois’ latest recommendations follow the state’s Immunization Advisory Committee Monday vote on the issue.

“IDPH’s recommendations, made in consultation with our Immunization Advisory Committee, will ensure that residents can protect themselves and their family members this upcoming respiratory season,” IDPH Director Dr. Sameer Vohra said in a statement. “In addition, the accompanying standing order will allow residents access to COVID-19 vaccine in local pharmacies and other health care settings.”

Gov. JB Pritzker also issued an executive order earlier this month requiring IDPH to issue its own guidelines for vaccines this fall amid uncertainty over what the federal government would recommend.

“At a time when the federal government is abdicating its responsibility to provide clear, science-informed guidance, Illinois is stepping up,” Pritzker said in a statement. “Illinois will continue to empower providers and families across our state with the information and access they need to guard against illness and disease.”

JB Pritzker gets Covid vaccination — Gov. JB Pritzker receives his COVID-19 vaccine in 2022 at the Illinois State Fairgrounds.

IDPH’s standing order allows health care providers and pharmacies in Illinois to give COVID-19 shots within the department’s guidelines. It also requires federal insurance plans, insurance plans under the Affordable Care Act and state-regulated insurance plans to cover the vaccines.

Insurance companies that are members of America’s Health Insurance Plans, which are most major insurance companies, plan to continue covering the shots, according to the Associated Press.

Other vaccines

The Trump administration has also been unclear about how it will approach future recommendations on other vaccines. A CDC advisory panel last week recommended against administering the combination of measles, mumps, rubella and chickenpox vaccines, MMRV, to children under 4 years old.

IDPH is recommending children and adults follow the CDC’s prior guidelines that recommend the MMRV.

IDPH is also recommending everyone receive flu shots this fall.

RSV vaccines are also recommended for adults aged 74 years old and older, adults at high risk for severe illness who are over 50, people who are between 32 and 36 weeks of pregnancy and children between eight and 19 months who are at a high risk of severe illness.

Capitol News Illinois is a nonprofit, nonpartisan news service that distributes state government coverage to hundreds of news outlets statewide. It is funded primarily by the Illinois Press Foundation and the Robert R. McCormick Foundation.

TAGGED: Illinois COVID-19 vaccine recommendations, IDPH fall vaccine guidelines, COVID-19 vaccine for all adults, JB Pritzker executive order, RSV and flu vaccine guidance

She had a change of heart on the Covid vaccine

(NAPSI) — Stephanie Bramlett of Winder, Georgia, is one of many in the Southeast region who has experienced the effects of COVID-19 firsthand. Earlier this year, when the entrepreneur and mother of three was told she could get vaccinated, she was hesitant. She eats well, exercises regularly and never gets sick with the flu, so she assumed she’d be fine even if she was exposed to the virus. "I didn’t want to be first," Bramlett said. "It felt too new."

Then her son attended church camp, and, unknowingly, brought the virus home. Bramlett woke up one morning with a throbbing headache, 103-degree fever and fatigue. She also discovered she had lost her sense of smell and taste, telltale symptoms of the coronavirus. Eleven days later, she couldn’t get out of bed. Her head was hurting so badly that her husband took her to the hospital where they checked her for a brain bleed.

"I was terrified because I had never had head pain like this before," said Bramlett. She was diagnosed with inflammation of her brain vessels and myocarditis, a heart condition that made her heart feel like she was constantly running on a treadmill. Her body swelled as her kidney functions failed. Her recovery ultimately took 72 days.

"It was really, really scary and I don’t wish that on anybody," Bramlett says of the experience.

While Bramlett was ill, she asked her doctor if she could get vaccinated, but her medical team advised that she had to wait until she was feeling better. The moment she was cleared, Bramlett went right to the drug store for her vaccine.

"The hardest part was that people were dying all around me the entire time I was sick—healthy people, young people," Bramlett reflects. “I just felt so stupid. Here’s this vaccine available and I just assumed that it wouldn’t happen to me."

In fact, COVID-19 remains a serious threat across the U.S. as we head into the pandemic’s second winter. The Delta variant, which now makes up virtually all cases in the country, spreads more easily than the common cold and has led to a dramatic increase in hospitalizations nationwide. This rise in serious cases and deaths was most pronounced in the Southern U.S., where vaccination rates are lower.

What The CDC Says

According to the Centers For Disease Control and Prevention, people who have not yet been vaccinated are 29 times more likely to be hospitalized and 11 times more likely to die from COVID-19 complications, compared to those who have already received their vaccine.

Other CDC data reveals people ages 18 to 49 are the largest demographic hospitalized for COVID-19 as of September 25. Studies also show that even for individuals who have a mild case of COVID-19 and avoid hospitalization, they remain at risk of post-COVID symptoms, often called long COVID, that may last for weeks, months or longer. Symptoms of long COVID appear to affect as many as one in three people infected with the virus.

Bramlett now shares her experience with her friends and family to encourage them to consider being vaccinated. She urges everyone to talk to their doctor and learn about how they can keep themselves healthy and safe, so they can be present for their own children and families. To those still hesitant, Stephanie Bramlett says: "I understand. I understand that people are scared. I respect whatever decision you make or how you feel about the COVID-19 vaccine, but I would encourage people to do what they have to do to find the truth and do what you need to do to keep yourself healthy and safe."

Learn More

COVID-19 vaccines are safe, effective, widely available and free to everyone in the U.S. age twelve and older. Additionally, the FDA has formally approved Pfizer’s COVID-19 vaccine in the U.S. for those sixteen and older.

If you have questions about the COVID-19 vaccines, talk to a doctor or pharmacist, and visit www.GetVaccineAnswers.org for the latest information.

Children with COVID-19-related MIS-C condition usually recover in months

This study details the cardiovascular complications or damage found during a three-month follow-up period to assess the short-term impact of MIS-C.

by American Heart Association

DALLAS -- Heart function recovery returned within three months in children who developed COVID-19-related multisystem inflammatory syndrome (MIS-C), according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

MIS-C is a new illness identified during the COVID-19 pandemic that affects children about four to six weeks after exposure to COVID-19. The new condition has some overlapping symptoms with Kawasaki disease, however, MIS-C is associated with more profound inflammation. MIS-C can cause inflammation in different parts of the body, including the heart, lungs, kidneys and gastrointestinal organs. About 80%-85% of MIS-C cases across the U.S. and Europe have involved the heart’s left ventricle.

Photo: American Heart Assoc.

This study details the cardiovascular complications or damage found during a three-month follow-up period to assess the short-term impact of MIS-C. It also employs newer cardiac measurements, known as "strains," to assess heart function related to MIS-C. Strain testing is a more sensitive tool that can detect whether an area of the heart is deformed or if there are any subtle changes in heart function during cardiac contraction and relaxation.

"There is limited data at this time about how frequently and how long we should monitor heart function during the recovery state of MIS-C after the child leaves the hospital," said the study’s senior author Anirban Banerjee, M.D., a professor of clinical pediatrics at the University of Pennsylvania Perelman School of Medicine and an attending cardiologist with the Cardiac Center at the Children’s Hospital of Philadelphia, both in Philadelphia.

"Given that MIS-C was identified as a result of the COVID-19 pandemic, treatment protocols have not yet been standardized and follow-up care varies greatly, which may lead to confusion and anxiety among families of patients and their care team. Our research team hoped to provide some guidance and reduce the ambiguity on optimal care approaches, especially as it relates to sports participation," Banerjee added.

Researchers retroactively reviewed data on 60 children hospitalized with MIS-C due to COVID-19 exposure who were treated at two Philadelphia hospitals between April 2020 and January 2021. None of the children were initially diagnosed with COVID-19 before the onset of MIS-C symptoms. This group of children were 60% male, with an average age of 10 years. About 48% were Black children, 27% were white children, 15% were Hispanic children, 4% were Asian children and the race/ethnicity of 23% of the children was unknown. The participants were treated with intravenous immunoglobulin and/or systemic steroids. Researchers reviewed echocardiographic and clinical data from medical records, including demographic factors, testing, treatment and hospital outcomes.

Data on another 60 children who had structurally normal hearts and did not have MIS-C or COVID-19 exposure served as control subjects. Their average age was 11.5 years, and 55% were male; 62% white children, 27% Black children, 7% Hispanic children, 3% Asian and 8% unknown. The control participants were divided into two groups: 60% had echocardiograms on file that were done prior to the COVID-19 pandemic, and 40% had echocardiograms under rigid COVID-19 protocols after October 2020.

For the children with MIS-C, researchers analyzed images of the heart taken at the initial hospitalization (acute phase) and examined additional imaging for a portion of the children who also had scans up to three additional times – one week after the first scan (subacute phase); at the one-month follow-up; and at a three or four-month follow-up. The children were screened using conventional echocardiography, speckle tracking echocardiography – an imaging technique that analyzes the motion of the heart tissue - and cardiac magnetic resonance imaging (MRI) for images of the heart.

The study found:

Based on echocardiogram imaging, systolic and diastolic function in the left ventricle and systolic function in the right ventricle improved quickly within the first week, followed by continued improvement and complete normalization by three months.

81% of patients lost some contractile function in the left ventricle during the acute phase of illness, yet, by months three and four, contraction function had returned to normal.

MIS-C did not cause lasting coronary artery abnormalities. During the initial hospitalization, 70% of patients had evidence of some heart malfunction, however, all scans were normal by the three-month follow-up.

Using strain parameters to measure cardiac function, the results suggest that there is no subclinical cardiac dysfunction after three months.

"Recovery among these children was excellent," Banerjee said. "These results have important implications for our health care teams managing care for children with MIS-C. Our findings may also provide guidance for a gradual return to playing sports after cardiac clearance three to four months later. Tests needed for clearance include electrocardiogram and echocardiogram. We also recommend cardiac MRI for children who have highly abnormal baseline cardiac MRI during the acute stage or show evidence of continued severe left ventricle dysfunction."

The study researchers note there are still important gaps in existing knowledge about MIS-C, since COVID-19 and MIS-C are both new illnesses. The most important question yet to answer is how these children are faring one to two years after their initial hospitalization.

There are important limitations to note: the study was retrospective for clinical purposes and was not standardized for research. In addition, follow-up data was missing for some patients who dropped out of the study during follow-up stages. Banerjee explained that because both COVID-19 and MIS-C were newly discovered diseases, the timing of follow-up echocardiograms was somewhat arbitrary and driven by preference of different clinicians, rather than standard research protocol.

"The strength of the study is that researchers performed a detailed, serial assessment of cardiac function over the initial three to four months of illness," according to AHA volunteer expert Kevin G. Friedman, M.D., a member of the American Heart Association’s Young Hearts Council and the AHA’s Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, an attending physician in pediatric cardiology at Boston Children’s Hospital and associate professor of pediatrics at Harvard Medical School, both in Boston.

"This study provides additional evidence that myocardial involvement is transient and may not lead to long-term abnormalities in left ventricular diastolic or systolic function," Friedman said. "Although cardiac involvement in the acute stage of illness is common, it is reassuring that all patients recovered normal cardiac function within about one week. This data tells us that, fortunately, lasting heart injury is very uncommon in MIS-C. Even in those patients with significant cardiac abnormalities in the acute phase of illness, these changes resolved by 3-4 months."

Co-authors of the study are Daisuke Matsubara, M.D., Ph.D.; Joyce Chang, M.D., M.S.C.E.; Hunter L. Kauffman, B.S.; Yan Wang, R.D.C.S.; Sumekala Nadaraj, M.D.; Chandni Patel, M.D.; Stephen M. Paridon, M.D.; Mark A. Fogel, M.D.; and Michael D. Quartermain, M.D..

** Editor's note: This story was updated on Jan. 20 due to new information from the American Heart Association. The story initally said "During the initial hospitalization, 7% of patients had evidence of some heart malfunction". That number was suppose to be "70%".

Health experts say it is okay to get your flu and COVID shots at the same time

Lee Batsakis
OSF Healthcare

EVERGREEN PARK -- It happens every year: flu season, which typically peaks between December and February. This year will mark the third flu season with another virus also circulating: COVID-19. With an updated safe and effective COVID-19 booster shot now available, health experts are urging people to get both the flu and COVID vaccines in order to protect themselves this fall and winter.

Doctors recommend patients get both their flu and Covid booster by the end of this month for maximum protection against the two viruses.

Photo: CDC/Upslash

Since 2010, the Centers for Disease Control and Prevention (CDC) has recommended annual flu vaccines for everyone six months and older, with few exceptions. New this year is an added recommendation for a higher dose for those 65 and older. The CDC has also recommended the use of updated COVID-19 boosters from Pfizer-BioNTech for people ages 12 years and older and from Moderna for people ages 18 years and older.

If you have not yet received your COVID-19 booster shot, or if you still have yet to receive an initial dose, it’s not too late.

"I urge everybody who is eligible to get a COVID booster to do so, and the reasons why are multifactorial. Number one is because your immunity wanes and you need to protect yourself. Number two is that the virus has changed slightly and the newest booster is most effective at protecting against those changes, " says Dr. Bill Walsh, an OSF HealthCare chief medical officer.

Dr. Walsh adds that it is important to get the seasonal flu shot as well as a COVID shot because they protect against different viruses.

"Please understand that the recommendation is for both the flu shot and the COVID shot. There is no cross reactivity even though the symptoms might be similar between COVID-19 and influenza. The influenza shot will not help against COVID, and the COVID vaccination will not protect you against influenza, " Dr. Walsh explains.

The timing of when to get your flu shot and COVID booster can be confusing. The CDC says if you haven’t yet gotten your initial recommended dose of the COVID-19 vaccine, to get one as soon as you can. Health experts typically recommend getting your seasonal flu vaccine by the end of October for best protection during the peak of flu season, and say it is safe to get both vaccines during the same visit.

"There are many times when you get more than one vaccine. Most of the time when you get a tetanus shot, it also includes pertussis. Many of the vaccinations pediatricians give to children have more than one vaccine in each shot. So, it is standard and normal for more than one vaccine to occur at a time, " Dr. Walsh says.

Dr. Walsh adds getting both shots done at once alleviates having to make multiple trips to your doctor’s office or local pharmacy. But this route may not be for everyone.

As with all vaccinations, there are mild side effects that both vaccines can cause, such as joint or muscle pain, fatigue, and chills. If you have experienced side effects from vaccines in the past and it took a couple days for them to subside, you may opt to get the vaccines at separate times.

"You know yourself best. If you are certain that you will get them both despite not getting them at one appointment, then that is completely fine, too. You may want to space them out because sometimes you have side effects. There have been a lot of questions about whether to get them both in one arm or in different arms so you have different injection sites. That really boils down to personal preference, " advises Dr. Walsh.

The important thing is making sure you do get both of these vaccinations to protect both yourself and your loved ones. Because the holiday season is approaching, you may have holiday gatherings on your calendar over the next few months. If you get your flu shot in October but choose to wait to get your COVID-19 booster at a later date, Dr. Walsh recommends getting it at least two weeks before any large gatherings in order to ensure the best protection against the virus.

To schedule your seasonal flu vaccine and COVID-19 booster, make an appointment with your primary care provider or local pharmacy. Talk to your primary care provider if you have any questions about either vaccine.

As Covid cases surge across the country, CDC only tracks a fraction of breakthrough cases

Jenny Deam and Jodi S. Cohen, ProPublica

Meggan Ingram was fully vaccinated when she tested positive for COVID-19 early this month. The 37-year-old’s fever had spiked to 103 and her breath was coming in ragged bursts when an ambulance rushed her to an emergency room in Pasco, Washington, on Aug. 10. For three hours she was given oxygen and intravenous steroids, but she was ultimately sent home without being admitted.

Seven people in her house have now tested positive. Five were fully vaccinated and two of the children are too young to get a vaccine.

As the pandemic enters a critical new phase, public health authorities continue to lack data on crucial questions, just as they did when COVID-19 first tore through the United States in the spring of 2020. Today there remains no full understanding on how the aggressively contagious delta variant spreads among the nearly 200 million partially or fully vaccinated Americans like Ingram, or on how many are getting sick.

The nation is flying blind yet again, critics say, because on May 1 of this year — as the new variant found a foothold in the U.S. — the Centers for Disease Control and Prevention mostly stopped tracking COVID-19 in vaccinated people, also known as breakthrough cases, unless the illness was severe enough to cause hospitalization or death.

Individual states now set their own criteria for collecting data on breakthrough cases, resulting in a muddled grasp of COVID-19’s impact, leaving experts in the dark as to the true number of infections among the vaccinated, whether or not vaccinated people can develop long-haul illness, and the risks to unvaccinated children as they return to school.

If you’re limiting yourself to a small subpopulation with only hospitalizations and deaths, you risk a biased viewpoint.

"It’s like saying we don’t count,” said Ingram after learning of the CDC’s policy change. COVID-19 roared through her household, yet it is unlikely any of those cases will show up in federal data because no one died or was admitted to a hospital.

The CDC told ProPublica in an email that it continues to study breakthrough cases, just in a different way. "This shift will help maximize the quality of the data collected on cases of greatest clinical and public health importance,” the email said.

In addition to the hospitalization and death information, the CDC is working with Emerging Infections Program sites in 10 states to study breakthrough cases, including some mild and asymptomatic ones, the agency’s email said.

Under pressure from some health experts, the CDC announced Wednesday that it will create a new outbreak analysis and forecast center, tapping experts in the private sector and public health to guide it to better predict how diseases spread and to act quickly during an outbreak.

Tracking only some data and not releasing it sooner or more fully, critics say, leaves a gaping hole in the nation’s understanding of the disease at a time when it most needs information.

"They are missing a large portion of the infected," said Dr. Randall Olsen, medical director of molecular diagnostics at Houston Methodist Hospital in Texas. "If you’re limiting yourself to a small subpopulation with only hospitalizations and deaths, you risk a biased viewpoint."

On Wednesday, the CDC released a trio of reports that found that while the vaccine remained effective at keeping vaccinated people out of the hospital, the overall protection appears to be waning over time, especially against the delta variant.

Among nursing home residents, one of the studies showed vaccine effectiveness dropped from 74.7% in the spring to just 53.1% by midsummer. Similarly, another report found that the overall effectiveness among vaccinated New York adults dropped from 91.7% to just under 80% between May and July.

The new findings prompted the Biden administration to announce on Wednesday that people who got a Moderna or Pfizer vaccine will be offered a booster shot eight months after their second dose. The program is scheduled to begin the week of Sept. 20 but needs approval from the Food and Drug Administration and a CDC advisory committee.

No vaccine is 100% percent effective against transmission, health officials warned.

This latest development is seen by some as another example of shifting public health messaging and backpedaling that has accompanied every phase of the pandemic for 19 months through two administrations. A little more than a month ago, the CDC and the FDA released a joint statement saying that those who have been fully vaccinated "do not need a booster shot at this time.”

The vaccine rollout late last year came with cautious optimism. No vaccine is 100% percent effective against transmission, health officials warned, but the three authorized vaccines proved exceedingly effective against the original COVID-19 strain. The CDC reported a breakthrough infection rate of 0.01% for the months between January and the end of April, although it acknowledged it could be an undercount.

As summer neared, the White House signaled it was time for the vaccinated to celebrate and resume their pre-pandemic lives.

Trouble, though, was looming. Outbreaks of a new, highly contagious variant swept India in the spring and soon began to appear in other nations. It was only a matter of time before it struck here, too.

"The world changed," said Dr. Eric Topol, director of the Scripps Research Translational Institute, "when delta invaded."

The current crush of U.S. cases — well over 100,000 per day — has hit the unvaccinated by far the hardest, leaving them at greater risk of serious illness or death. The delta variant is considered at least two or three times more infectious than the original strain of the coronavirus. For months much of the focus by health officials and the White House has been on convincing the resistant to get vaccinated, an effort that has so far produced mixed results.

Yet as spring turned to summer, scattered reports surfaced of clusters of vaccinated people testing positive for the coronavirus. In May, eight vaccinated members of the New York Yankees tested positive. In June, 11 employees of a Las Vegas hospital became infected, eight of whom were fully vaccinated. And then 469 people who visited the Provincetown, Massachusetts, area between July 3 and July 17 became infected even though 74% of them were fully vaccinated, according to the CDC’s Morbidity and Mortality Weekly Report.

While the vast majority of those cases were relatively mild, the Massachusetts outbreak contributed to the CDC reversing itself on July 27 and recommending that even vaccinated people wear masks indoors — 11 weeks after it had told them they could jettison the protection.

And as the new CDC data showed, vaccines continue to effectively shield vaccinated people against the worst outcomes. But those who get the virus are, in fact, often miserably sick and may chafe at the notion that their cases are not being fully counted.

"The vaccinated are not as protected as they think," said Topol, "They are still in jeopardy."

The CDC tracked all breakthrough cases until the end of April, then abruptly stopped without making a formal announcement. A reference to the policy switch appeared on the agency’s website in May about halfway down the homepage.

"I was shocked," said Dr. Leana Wen, a physician and visiting professor of health policy and management at George Washington University. "I have yet to hear a coherent explanation of why they stopped tracking this information.”

The CDC said in an emailed statement to ProPublica that it decided to focus on the most serious cases because officials believed more targeted data collection would better inform "response research, decisions, and policy."

Sen. Edward M Markey, D-Mass., became alarmed after the Provincetown outbreak and wrote to CDC director Dr. Rochelle Walensky on July 22, questioning the decision to limit investigation of breakthrough cases. He asked what type of data was being compiled and how it would be shared publicly.

It is unclear how often breakthroughs occur or how widely cases are spreading among the vaccinated.

"The American public must be informed of the continued risk posed by COVID-19 and variants, and public health and medical officials, as well as health care providers, must have robust data and information to guide their decisions on public health measures," the letter said.

Markey asked the agency to respond by Aug. 12. So far the senator has received no reply, and the CDC did not answer ProPublica’s question about it.

When the CDC halted its tracking of all but the most severe cases, local and state health departments were left to make up their own rules.

There is now little consistency from state to state or even county to county on what information is gathered about breakthrough cases, how often it is publicly shared, or if it is shared at all.

"We’ve had a patchwork of information between states since the beginning of the pandemic,” said Jen Kates, senior vice president and director of global health and HIV policy at Kaiser Family Foundation.

She is co-author of a July 30 study that found breakthrough cases across the U.S. remained rare, especially those leading to hospitalization or death. However, the study acknowledged that information was limited because state reporting was spotty. Only half the states provide some data on COVID-19 illnesses in vaccinated people.

"There is no single, public repository for data by state or data on breakthrough infections, since the CDC stopped monitoring them,” the report said.

In Texas, where COVID-19 cases are skyrocketing, a state Health and Human Services Commission spokesperson told ProPublica in an email the state agency was "collecting COVID-19 vaccine breakthrough cases of heightened public health interest that result in hospitalization or fatality only."

Other breakthrough case information is not tracked by the state, so it is unclear how often breakthroughs occur or how widely cases are spreading among the vaccinated. And while Texas reports breakthrough deaths and hospitalizations to the CDC, the information is not included on the state’s public dashboard.

"We will be making some additions to what we are posting, and these data could be included in the future," the spokesperson said.

I thought, ‘COVID is over and I’m going to Disney World,’

South Carolina, on the other hand, makes public its breakthrough numbers on hospitalizations and deaths. Milder breakthrough cases may be included in the state’s overall COVID-19 numbers but they are not labeled as such, said Jane Kelly, an epidemiologist at the South Carolina Department of Health and Environmental Control.

"We agree with the CDC,” she said, "there’s no need to spend public health resources investigating every asymptomatic or mild infection.”

In Utah, state health officials take a different view. "From the beginning of the pandemic we have been committed to being transparent with our data reporting and … the decision to include breakthrough case data on our website is consistent with that approach," said Tom Hudachko, director of communications for the Utah Department of Health.

Some county-level officials said they track as many breakthrough cases as possible even if their state and the CDC does not.

For instance, in Clark County, Nevada, home of Las Vegas, the public health website reported that as of last week there were 225 hospitalized breakthrough cases but 4,377 vaccinated people overall who have tested positive for the coronavirus.

That means that less than 5% of reported breakthrough cases resulted in hospitalization. "The Southern Nevada Health District tracks the total number of fully vaccinated individuals who test positive for COVID-19 and it is a method to provide a fuller picture of what is occurring in our community,” said Stephanie Bethel, a spokesperson for the health district in an email.

Sara Schmidt, a 44-year-old elementary school teacher in Alton, Illinois, is another person who has likely fallen through the data hole.

"I thought, ‘COVID is over and I’m going to Disney World,’" she said. She planned a five-day trip for the end of July with her parents. Not only had she been fully vaccinated, receiving her second shot in March, she is also sure she had COVID-19 in the summer of 2020. Back then she had all the symptoms but had a hard time getting tested. When she finally did, the result came back negative, but her doctor told her to assume it was inaccurate.

"My guard was down," she said. She was less vigilant about wearing a mask in the Florida summer heat, assuming she was protected by the vaccination and her presumed earlier infection.

On the July 29 plane trip home, she felt mildly sick. Within days she was "absolutely miserable." Her coughing continued to worsen, and each time she coughed her head pounded. On Aug. 1 she tested positive. Her parents were negative.

Now, three weeks later, she is far from fully recovered and classes are about to begin at her school. There’s a school mask mandate, but her students are too young to be vaccinated. "I’m worried I will give it to them, or I will get it for a third time," she said.

But it is doubtful her case will be tracked because she was never hospitalized. That infuriates her, she said, because it downplays what is happening.

"Everyone has a right to know how many breakthrough cases there are," she said, "I was under the impression that if I did get a breakthrough case, it would just be sniffles. They make it sound like everything is under control and it’s not."

This story was originally published by ProPublica on August 20, 2021. ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

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