Category Archives: Covid-19

A substantial amount of study has been undertaken on vaccine hesitancy and the various elements influencing an individuals decision to accept or not accept a vaccine. SAGE developed three categories based on experience in various countries and comprehensive literature reviews to analyze these issues, referred to as the 3Cs model: complacency (not considering diseases as high-risk and vaccination as crucial), convenience (practical obstacles), and confidence (a lack of trust in vaccine safety and effectiveness) [2, 5]. This model was later revised in 2018, emphasizing the importance of more than just the concept of confidence, and emerged as the 5Cs model (Table1): confidence, complacency, constraints (modification of the term convenience to now include both structural and psychological barriers), calculation (individuals engagement in extensive information searching), and collective responsibility (communal orientation to protect others) [18, 19].

In 2016, Thomson et al. introduced a different taxonomy to explain vaccine uptake determining factors, known as the 5As. They identified five categories regarded as access (the ability of an individual to reach or be reached by vaccination), affordability (the capacity of an individual to afford vaccines either financially or non-financially), awareness (personal knowledge about the importance of vaccination as well as its objectives and risks), acceptance (the degree to accept or refuse vaccination), and activation (motivation/encouragement to receive vaccination) [20].

In the Indonesian context, there have been no studies specifically dedicated to assessing or exploring hesitancy regarding routine vaccination using the 5Cs approach. However, a recent study conducted by Sujarwoto et al. [21], which investigated COVID-19 vaccine hesitancy in a district in Indonesia, revealed that respondents held low levels of confidence and complacency beliefs about the vaccine. Furthermore, the study identified more general sources of mistrust within the community, particularly concerning health providers and vaccine developers. However, these factors may vary depending on individual, cultural, and societal contexts. By comprehending these elements, healthcare providers and public health officials can formulate precise strategies to tackle vaccine hesitancy and enhance vaccine acceptance and utilization, as presented in Table 1.

Misinformation and conspiracy theories are widely recognized as critical drivers of vaccine hesitancy. False information about the safety and efficacy of vaccines can spread quickly and easily through social media and other channels, which leading to fear and skepticism about vaccination [22, 23]. One prominent example of vaccine misinformation is the claim that the measles, mumps, and rubella (MMR) vaccine causes autism. As a result, some parents have refused to have their children vaccinated, which in the long term, could lead to outbreaks of measles in specific populations [24, 25].

During the COVID-19 pandemic in Indonesia, misinformation and hoaxes have contributed to vaccine hesitancy among parents and caregivers, especially concerning vaccines that require multiple injections as part of routine immunization [26, 27]. The proportion of children who received their primary measles and rubella immunizations experienced a decline from 95% in 2019 to 87% in 2021. Moreover, there has been a substantial increase in the percentage of children who were not administered the diphtheria, pertussis, and tetanus (DPT) immunizations, rising from 10% in 2019 to 26% in 2021 [27]. This situation poses a significant risk to children, as it increases their susceptibility to a range of preventable diseases.

Beside misinformation and conspiration theories, lack of trust in government and healthcare institutions could impact the vaccine hesitancy. For instance, the case of Tuskegee Syphilis Study, which was conducted by unethically on African American men, has resulted in Black communities [28] enduring mistrust of government and healthcare institutions. Similarly, in Indonesia, the lack of trust in the government has been triggered by various factors, including past conflicts in certain provinces [29] and the governments response to the COVID-19 situation [30]. This lack of trust is exacerbated by existing disparities in healthcare access and delivery, which could lead people to be hesitant about getting the vaccine due to concerns about unequal distribution and difficulty of access [31, 32].

Next, vaccine safety and adverse effects is commonly stimulating vaccine hesitancy [33]. People may be unwilling to get immunized out because they are worried about adverse reactions, especially if they have a history of allergies or prior medical disorders [19, 33]. In the past, there have been questions about the safety of the HPV vaccine due to claims made by certain people that it can result in chronic discomfort, seizures, and even death [34]. The vaccine is safe and effective, but scientific evidence has shown that these allegations are mainly baseless [34, 35].

Similarly, concerns about the safety of the COVID-19 vaccine have been expressed, particularly in light of its rapid development and emergency use authorization [36]. Clinical studies and real-world data have consistently shown that these vaccines are highly effective with minimal risk of severe side effects [37]. However, a national survey on COVID-19 vaccine acceptance conducted by the Ministry of Health of Indonesia, which included 112,888 participants, revealed some concerning results. It showed that 64.8% were willing to take the vaccine, 7.6% were unwilling to take it, and 26.6% were unsure about whether to get vaccinated. Furthermore, participants in the survey expressed various concerns about COVID-19 vaccines. Specifically, 30% were uncertain about the vaccines safety, 22% had reservations about its effectiveness, 12% expressed fears of potential side effects, 8% cited religious or belief-related reasons, and 15% cited other factors [38].

In the social context, previous studies showed that cultural and religious beliefs may also play a role in vaccine hesitancy [39]. Some individuals may be hesitant to get vaccinated due to religious or cultural beliefs that conflict with vaccination, such as the belief that illness is Gods punishment or that alternative remedies are more effective than modern medicine [40].

Concerns about the use of fetal cells in vaccine development and the belief that illnesses are divine punishment have contributed to vaccine reluctance in some Orthodox Jewish communities, for instance [41, 42]. Correspondingly, in Indonesia, a country where approximately 87% of the population is Muslim, concerns have arisen over the use of non-halal components obtained from pork in vaccine formulations. These concerns have the potential to increase vaccine hesitancy in the country [43].

In addition, vaccine hesitancy may be influenced by socioeconomic variables such as low income, educational attainment, and limited healthcare accessibility [44]. Individuals residing in financially disadvantaged conditions may encounter obstacles in accessing vaccinations, such as financial constraints or scheduling conflicts that prevent them from receiving the vaccine promptly, or they may opt not to receive it [44, 45]. Individuals with lower education levels may have a restricted understanding of vaccines and their advantages, rendering them more vulnerable to misinformation [46]. In addition, inadequate healthcare accessibility may impede individuals from obtaining vaccinations on time, while restricted access to precise health information may result in misconceptions or skepticism regarding vaccines [47].

Behavioural scientists have investigated how heuristics, including vaccination, might influence judgement and decision making. Heuristics, a mental shortcut that enables people to solve problems quickly and make intuitive decisions, can be helpful when initiated by the correct variables [48, 49]. However, the influence of wrong circumstances such as misinformation and disinformation, and anti-vaccine movement, can lead to systemic errors or cognitive biases. For example, omission bias occurs when people tend to view harms from the act commission (actions) as more excellent than harms from omission (inactions); confirmation bias refers to the finding that strong initial beliefs are resistant to change because they influence how subsequent information is interpreted; and the Dunning Krueger effect, in which people who lack expertise fail to accurately assess their knowledge in comparison to experts on the subject [49].

Notwithstanding the unwillingness of specific individuals to receive vaccines, it is important to acknowledge the existence and impact of the anti-vaccine movement. They engage in campaigns against vaccines, frequently disseminating inaccurate information and instilling apprehension regarding their safety and efficacy [50]. The current campaign has the potential to generate vaccine hesitancy among individuals who had previously placed their trust in the healthcare system and vaccination initiatives. The outcome is an escalating count of individuals who hesitate or deliberately decline vaccination, resulting in decreased vaccination rates and heightened susceptibility to diseases that vaccines can prevent [50, 51]. Consequently, it is fundamental to acknowledge the apprehensions of individuals who are hesitant towards vaccines and furnish precise information to refute the misinformation propagated by the anti-vaccine movement.

Vaccine hesitancy has been found to be associated with a range of socio-economic and demographic variables. The prevalence of concerns regarding the safety and effectiveness of vaccines is observed to be higher in high-income countries (HICs), as opposed to low- and middle-income countries (LMICs), where factors such as cultural and religious convictions, unfavorable past encounters with foreign medical interventions and vaccination initiatives, and challenges within healthcare systems are more prevalent [52]. Common factors between the two categories encompass a lack of trust in medical institutions and governmental bodies, the spreading of conspiracy theories, and the dissemination of misinformation through social media [19, 52].

Parents who declined to vaccinate their children or held a pessimistic outlook towards vaccination were found to be more susceptible to demonstrating such apprehensions [53]. The primary rationale cited by parents in India, Nigeria, and Pakistan for abstaining from vaccinating their children was the perceived risk of adverse effects associated with immunization. The apprehension regarding severe adverse effects may stem from prior encounters with unfavorable incidents after immunization, which may be attributed to the vaccination process [54,55,56]. This, together with the belief that vaccines may cause harm, has led to the perception that vaccinations result in adverse reactions such as fever. Furthermore, a commonly reported conjecture was that the polio vaccine administration was linked to adult sterility, leading to a significant number of parents declining to immunize their children with the vaccine [56].

In the Indonesian context, vaccine hesitancy can be attributed to various factors, given the countrys middle-income status. The complexity of the issue presents a significant challenge [26]. Vaccine hesitancy in Indonesia is a multifaceted problem that requires tailored and collaborative efforts across various sectors. Despite the governments initiatives to improve vaccination rates, there remains a substantial gap in our understanding of the factors influencing vaccine acceptance and hesitancy [26, 57].

Furthermore, it is critical to highlight the significant disparities in vaccine coverage observed across Indonesias nationwide measles and rubella (MR) immunization program. Coverage rates vary widely among districts, ranging from as low as 2% to as high as 100%. Notably, more than one-third of districts report coverage rates below the established threshold of 70%. The link between the discontinuation of vaccination programs due to hesitancy and the subsequent decline in coverage rates is well-established [26].

Moreover, the hesitancy to receive the COVID-19 vaccine in Indonesia has been found to be highly correlated with various socio-demographic characteristics, including age, residential location, educational attainment, employment status, and family economic situation. Participants from Indonesia, Myanmar, Thailand, and Vietnam exhibited a higher degree of hesitancy towards receiving COVID-19 vaccines compared to their counterparts from the Philippines [58].

Additionally, concerns about vaccine safety have played a substantial role in shaping public discourse. Negative perceptions of vaccine safety, including anxieties about the rapid pace of vaccine development, have been identified as a primary driver of hesitancy. In low- and middle-income countries (LMICs) like Indonesia, where documented COVID-19 cases and fatalities have been relatively lower, individuals may perceive the disease as less severe, leading to reduced willingness to accept any potential risks associated with vaccination [59].

Finally, it is worth emphasizing that confidence in routine vaccinations has declined amid the ongoing COVID-19 pandemic. This trend has been observed in numerous countries, with some experiencing a significant decrease of up to 44 percentage points. The diminishing confidence level, coupled with the unique challenges faced by LMICs, has further exacerbated vaccine hesitancy in Indonesia [60].

In high-income countries, vaccine hesitancy could originate from complacency, as vaccine-preventable diseases have declined in these regions. In 2019, there were more than 1200 reported measles cases across 31 states in the United States [61]. This trend can be partially attributed to vaccine hesitancy [62]. Certain parents resisted vaccinating their children because of concerns regarding vaccines safety and probable negative consequences. Meanwhile, a few others declined vaccination due to their religious or philosophical convictions. The epidemic underscored the necessity for enhanced instruction and consciousness regarding the importance of immunizations, alongside endeavors to counteract the dissemination of false information concerning immunizations and enhance immunization availability. In Europe, there have been recent outbreaks of vaccine-preventable diseases such as measles and mumps [27, 63], which have been attributed to vaccine hesitancy. Vaccine hesitancy in certain nations is linked to a dearth of confidence in governmental and healthcare establishments, alongside a conviction that vaccines are superfluous owing to advancements in sanitation and hygiene. These outbreaks have led to demands for heightened vaccination rates and initiatives aimed at addressing vaccine hesitancy through public awareness drives and improved availability of vaccines.

Moreover, a contentious issue exists regarding the administration of the human papillomavirus (HPV) vaccine, which further exacerbates hesitancy [34]. Although the vaccine has demonstrated effectiveness in preventing cervical cancer and other diseases associated with HPV, some parents in developed countries are unwilling to immunize their children due to worries regarding the vaccines safety and potential negative consequences. The safety concerns surrounding the HPV vaccine were subject to investigation in Denmark [64]. The media initiated coverage of purported unfavorable occurrences concerning Danish females, encompassing a documentary that portrayed a cohort of girls exhibiting diverse incapacitating symptoms that were presumed to have been induced by HPV vaccination. The findings indicate a rapid decline in the utilization of HPV vaccination in the specified nation during the period spanning from 2009 to 2014 [64]. In certain instances, the reluctance has been intensified by inaccurate information propagated through social media and other communication platforms. As a result, the vaccination rates for HPV in certain high-income nations have persisted below the recommended levels set by public health authorities, leading to a continued susceptibility to HPV-associated illnesses among those who have not received the vaccine.

More:

Vaccine hesitancy and equity: lessons learned from the past and how they affect the COVID-19 countermeasure in ... - Globalization and Health

In the United States, nearly 1 in 4 female adolescents and young adults test positive for sexually transmitted infections (STIs) annually, a statistic made even more troubling by the fact that these young women often avoid health care due to cost, transportation, and confidentiality concerns. With more than 33% of adolescents reporting no primary care provider, this demographic often relies on emergency departments (EDs) and inpatient (IP) settings for their health care needs.

STI test / jarun011 - stock.adobe.com

With the COVID-19 pandemic having decreased healthcare access in the United States, adolescents at risk for sexually transmitted diseases were further compromised. At the time, health experts warned of adverse outcomes on sexual and reproductive health (SRH) for adolescents.

Recently, a study published in Hospital Pediatrics compared changes in STI diagnoses during adolescent visits at childrens hospitals during the COVID-19 pandemic to diagnoses before the pandemic.1 Investigators conducted the retrospective cohort study using the Pediatric Health Information System database comparing adolescent (aged 11 to 18 years) hospital visits with an STI diagnosis by the International Classification of Diseases, 10th revision, during COVID-19 from 2020 to pre-COVID-19 (2017 through 2019).

A total of 2,747,135 adolescent visits from 44 hospitals in the United States were studied, of which 10,941 resulted in an STI diagnosis. The majority (54.5%) of the STI diagnoses were the primary diagnosis: an STI was the primary diagnosis for 36% of IP visits and 66% of ED visits. Where an STI was a secondary diagnosis, the most common primary diagnoses included urinary tract infections, sepsis, acute vaginitis, and unspecified abdominal pain.

READ MORE: COVID-19 Vaccination Effective at Preventing Long COVID in Children, Adolescents

During the summer of 2020, compared to the pre-COVID-19 period, there was an increase (30.4%) in median inpatient weekly visits overall with an STI diagnosis, as well as an increase in visits in fall 2020 (27.3%). Investigators also acknowledged that other recent studies have shown decreased STI testing and increased STI diagnoses in various clinical settings during COVID-19 periods of 2020.

Our findings may be partially driven by changes in health care utilization (eg, loss of primary care access and school-based sexual education) and increased reliance on nontraditional settings for SRH care, including hospital-based care, noted the authors.

Researchers concluded that as a result of this increase in adolescent inpatient visits with an STI diagnosis in 2020, further work is needed to improve STI care, particularly for this demographic. In the study, the authors noted, Given our findings and recent literature on SRH care of adolescents during COVID-19, efforts are needed to optimize SRH care and offset risk for increased STIsto prepare for future pandemics. To optimize STI testing and treatment, innovative efforts are needed, including virtual and in-person outreach, to increase adolescent access to SRH education and care. These efforts are instrumental to reduce the risk for STIs among adolescents cared for in the hospital with the potential to improve related health outcomesin future health care crises.

READ MORE: COVID-19 Resource Center

This article originally appeared in Contemporary OB/GYN.

Read the original here:

Increase in STIs Among Adolescents Witnessed During COVID-19 Pandemic - Drug Topics

by Timothy McQuiston, Vermont Business Magazine COVID-19 cases and hospitalizations remained relatively low last week after a long period of edging higher from last summer through early January. Cases and hospitalizations increased slightly for the week. However, fatalities have not seen a related spike nor decline. Deaths reported by the Vermont Department of Health continue to average about 6 a week, for a pandemic total now of 1,112 as of January 20, 2024 (the most recent data available). Total deaths in January are 23 so far and are nearing a monthly level not seen in a full year.

The VDH reported January 31, 2024, that COVID-19 hospitalizations were up 7 last week to a statewide total of 46. COVID-19 activity remains in the "Low" range, according to the VDH. Reported cases last week were 307, up 32 for the week.

Of the total deaths to date, 895 have been of Vermonters 70 or older. There have been 3 deaths of Vermonters under 30 since the beginning of the pandemic.

CDC states that already an estimated 97% of Americans have some level of immunity, from either vaccination or infection or both, which they said will help keep down new transmission and lessen serious outcomes.

New COVID-19 variant JN.1: Experts explain symptoms, how to spot and treat the new strain

(see data tables below)

Report Timeframe: January 21 to January 27, 2024

The hospitalizations dataset contains day-level data reported from all Vermont hospitals each Tuesday. Reported numbers are subject to correction.

The number of reportable COVID-19 cases is still available in this report, below. Laboratory-confirmed and diagnosed COVID-19 cases and COVID-19 outbreaks must still be reported to the Vermont Department of Health.

There were 4 outbreaks last week, 1 at schools, and 3 at long-term care facilities (LTC). There were 9 outbreaks the week before.

Vermont Department of Health recommendations: Preventing COVID-19 (healthvermont.gov)

Vermont has the second lowest fatality rate in the US (128.7 per 100K; Hawaii 102.5/100K). Mississippi (441.1/100K) and Oklahoma (438.7/100K) have the highest rates. The US average is 294.1/100K (CDC data).

There has been a total of 1,174,626 COVID-related deaths to date in the US (CDC) and 7,023,271 globally (WHO).

Following an analysis of COVID-19 data, the VDH reported in January 2023 a cumulative 86 additional COVID-associated deaths that occurred over the course of the pandemic but had not been previously reported. Most of those deaths occurred in 2022.

COVID-19 Update for the United States

Early Indicators

Test Positivity

% Test Positivity

6.3%

(January 21 to January 27, 2024)

Trend in % Test Positivity

-4.6% in most recent week

Emergency Department Visits

% Diagnosed as COVID-19

2.0%

(January 21 to January 27, 2024)

Trend in % Emergency Department Visits

-11% in most recent week

These early indicators represent a portion of national COVID-19 tests and emergency department visits. Wastewater information also provides early indicators of spread.

Severity Indicators

Hospitalizations

Hospital Admissions

22,636

(January 21 to January 27, 2024)

Trend in Hospital Admissions

-10.9% in most recent week

Deaths

% of All Deaths in U.S. Due to COVID-19

3.6%

(January 21 to January 27, 2024)

Trend in % COVID-19 Deaths

No change in most recent week

Total Hospitalizations

6,771,932

CDC | Test Positivity data through: January 27, 2024; Emergency Department Visit data through: January 27, 2024; Hospitalization data through: January 27, 2024; Death data through: January 27, 2024. Posted: February 2, 2024 12:00 PM ET

The Delta variant took off in August 2021, which resulted in the heaviest number of deaths before vaccines and their boosters helped alleviate serious COVID cases. Multiple Omicron variants are now circulating and appear more virulent than previous variants, but perhaps not more dangerous, according to the CDC.

AP April 5, 2023: WHO downgrades COVID pandemic, says it's no longer a global health emergency

Walk-in vaccination clinics run by the state closed on January 31, 2023. Learn more

Vermonters are reminded that all state COVID testing sites were closed as of June 25, 2022. PCR and take-home tests are available through doctors' offices, pharmacies and via mail from the federal government. The federal government officially ended its pandemic response as of May 11, 2023. See more information BELOW or here: https://www.healthvermont.gov/covid-19/testing.

Starting May 11, 2023, the CDC and Vermont Department of Health will no longer use the COVID-19 Community Level to measure COVID-19 activity in the U.S. and Vermont. Instead, Vermont's statewide COVID-19 level will be measured by the rate of COVID-19 in people being admitted to the hospital, per 100,000 residents.

Focusing on hospitalization data is a better estimate of how COVID-19 is impacting the community now that reported COVID-19 cases represent a smaller proportion of actual infections. This also allows us to compare Vermonts hospitalization levels with other parts of the country.

The Delta variant caused a surge in COVID-related fatalities last fall and into the winter.

The highest concentration of deaths was from September 2021 through February 2022. Overall, December 2020 and January 2022 were the worst months with 72 fatalities each.

The US confirmed its first case of COVID-19 on January 20, 2020.

Vermonters ages 6 months and older are eligible for COVID-19 vaccines. Getting vaccinated against COVID-19 is the safer way to build protection from serious illnesseven for those who have already had COVID-19. Learn more about COVID-19 vaccines (CDC)

COVID-19 vaccines are free and widely available. Anyone can get vaccinated in Vermont, including those who live in another state, are non-U.S. citizens, or who have no insurance. See Vermont's current vaccine rates

Know your rights when getting free vaccines.

You are considered up-to-date if you are over the age of 6 years old and have received a bivalent (updated) COVID-19 vaccine.Learn more about kid vaccines

If you are unable or choose not to get a recommended bivalent mRNA vaccine, you will be up to date if you received the Novavax COVID-19 vaccine doses approved for your age group.

Find more on recommended doses from CDC

COVID Vaccine Information for Health Care Professionals

More on COVID-19 Vaccines (CDC)

Recommended COVID Vaccine Doses (CDC)

Find a COVID-19 vaccine near you.

Image

Use Vaccines.gov to find a location near you, then call or visit the location's website to make an appointment.

Vaccines.gov

Everyone 6 months of age and older is eligible to get a COVID-19 vaccination.Most children are also now eligible for a bivalent dose that offers increased protection against the original strain and omicron variants.

See more on recommended vaccine doses by age group (CDC)

Resources for parents and caregivers

https://www.vermontfamilynetwork.org/ccfk/

Tips for Helping Kids Feel Ready for Any Vaccine (Vermont Family Network)

#factsheet

What Families with Children Should Know About COVID-19 Vaccines (translated)

https://www.youtube.com/watch?v=lWcqHOgQIVg&t=5s

Conversations About COVID-19 Vaccines for Children with Vermont Pediatricians (American Academy of Pediatrics)

If you cannot get vaccines through any of the options above, our local health offices

offer immunization clinics by appointment.

Need a ride? If you do not have transportation to get a free COVID-19 vaccine or booster, please contact your local public transportation provider or callVermont Public Transportation Association (VPTA)

at 833-387-7200.

English language learners, or immigrant or refugee community members, who would like to learn about more about vaccine clinics can contact theAssociation of Africans Living in Vermont

(AALV) at 802-985-3106.

If you lost your vaccine card or your information is wrong:

Recommendations for keeping your vaccination card and record up to date

Find more COVID-19 translations

COVID-19 resources for people who are deaf and hard of hearing

Report your COVID-19 test results

See the original post:

VDH: COVID deaths not seeing decline - Vermont Biz

A study today in the Annals of Internal Medicine shows that while telemedicine helped some groups seeking mental health care during the COVID-19 pandemic, Americans with serious mental health symptoms suffered from a decline in in-person outpatient mental health visits that has persisted.

Moreover, this lack of outpatient care for those with significant mental illness was seen mostly in patients with lower incomes and education levels.

In a related study, fewer Swedish teens sought care for mental health issues during COVID-19, but their mental health appeared to improve during the pandemic.

"Thanks to a rapid pivot to telemental health care, there was an overall increase during the pandemic of adults receiving outpatient mental health care in the United States," said Mark Olfson, MD, MPH, of Columbia University, first author of the Annals study, in a university press release.

"However, the percentage of adults with serious psychological distress who received outpatient mental health treatment significantly declined."

The study was based on trends seen in participants in the Medical Expenditure Panel Survey Household Component, given from 2018 to 2021 to 86,658 adults. Respondents were asked how frequently in the previous 30 days they had felt so sad that nothing could cheer them up, nervous, restless or fidgety, hopeless, that everything was an effort, or worthless (all, most, some, a little, or none of the time). Responses were scored from 0 to 4, with a score of 13 or higher defining serious psychological distress, the authors said.

During the study period, the rate of serious psychological distress among adults increased from 3.5% to 4.2%, the authors said, likely due to the pandemic and subsequent lockdowns, stress, job loss, and school disruptions.

The rate of outpatient mental health care increased from 11.2% to 12.4% overall from 2018 to 2021. But the rate decreased from 46.5% to 40.4% among adults with serious psychological distress.

Instead, people with higher education degrees, more moderate ranking of mental illness, and younger adults were more likely to use telemental care. Adults over the age of 45 did not see the same increase in telemental care, nor did those seeking care for bipolar disorder or schizophrenia.

By 2021, the authors wrote, approximately one third of adults who received outpatient mental healthcare had received one or more mental health video visits.

"Several groups also had difficulty accessing telemental health care including older individuals and those with lower incomes and less education," observed Olfson. "These patterns underscore critical challenges to extend the reach and access of telemental health services via easy-to-use and affordable service options."

In a new study from Sweden, researchers show that secondary school students who did distance learning in the pandemic were less likely to seek out mental health services than peers who stayed in person, but overall mental health appeared to improve in this age-group.

During the first months of the pandemic, from mid-March to mid-June 2020, Swedish upper secondary school students (ages 17 to 19) were taught remotely.

Care for psychiatric conditions, particularly depression and anxiety, decreased by 4.4% in this group compared to secondary school students aged 14 to 16 who continued to attend school, and the difference remained 21 months into the pandemic.

Contrary to other studies on school closures, the findings from Sweden suggest that distance learning benefited older teens.

"If young people were not accessing healthcare through normal channels, such as school health services, we should be seeing that they are more likely to seek emergency or unplanned care. Instead, we are seeing the opposite," said study author Helena Svaleryd, PhD, of Uppsala University, in a university press release.

The researchers suggest several possible explanations for this mental illness decrease, including reduced stress, more flexible schedules, reduced social pressure, and a reduction in the perceived demands of academic performance.

More here:

US outpatient care for serious mental health issues declined during COVID-19 - University of Minnesota Twin Cities

Latin America and the Caribbean (LAC) was the region with the highest COVID-19-related death count worldwide (Msemburi et al. 2023), despite implementing stringent public health and social measures (PHSM). At the same time, these policies caused large short-term economic losses by reducing working hours in a sizable fraction of the labour force. In many cases, these short-term costs, mainly in terms of productivity losses and social isolation, were so high that policymakers and individuals were unable to sustain them. This, in turn, triggered a heated and broadly politicised lives vs livelihood debate (Rothwell and Makridis 2020, Levy Yeyati and Malamus 2020), with wildly dissimilar government responses across the region despite the recognition that most economic losses in output (Levy Yeyati and Filippini 2021b) and human capital (de La Maisonneuve et al. 2023) were persistent, affecting lives in the long run. Yet, the question remained unanswered: what would have been the economic impact of tighter/looser PHSM?

To address this question, we built an integrated epidemiological-economic (epi-econ) model to evaluate, in hindsight, the epidemiological, economic, and social trade-offs involved in the PHSM decision, and calibrated it to four LAC countries Argentina, Brazil, Mexico, and Jamaica in the year with the highest death toll in the region, 2021 (Rubenstein et al. 2023). Our model, available at https://iecs.shinyapps.io/covid-model-v2/, is recursive: the outcome from the epidemiological side block impacts the economic outcomes, and vice versa, by incorporating a novel component: lockdown fatigue (Levy Yeyati and Sartorio 2020), that is, the marginal compliance of the PHSM decreases with the stringency/length of the measures, and the drop of the death count (reflecting psychosocial and economic factors).

In line with the DAEDALUS model (Haw et al. 2022), if the policymaker has an economy-focused approach, PHSM will ease and the mortality rate will likely increase. On the other hand, if the priority is to curb the case curve (a safety-focused approach), the economy will have to endure a highly stringent and lengthy lockdown and a likely sizable decline in GDP. However, the lockdown fatigue limits the capacity of the policymaker to discourage mobility over time, constraining the effectiveness of prolonged PHSM policies.

On the epidemiological side, our model provides a framework in which population dynamics are described in mathematical terms, capturing the number of people in separate compartments and the relationships between those compartments. We use an SVEIR transmission model (Augustovski et al. 2023), augmented with a macroeconomic and social impact model of the PHSM, adjusted for the different vaccination strategies in each country.

Figure 1 The SVEIR transmission model

To improve the transmission dynamics, we incorporate specific age-strata mixing patterns matrices to represent the social interactions and effective contact rates at each of these four settings: home, school, work (including transportation), and community. Modified matrices are derived from a model representing the impact of PHSMs on each stratum (school closures, non-essential business and public transport restrictions, staying at home, shielding the elderly, mandatory masks, etc.)

On the economic side, the model quantifies the GDP loss associated with mobility restrictions, incorporating the interaction of the lockdown measures with the behaviour of the population (lockdown fatigue, estimated as the time-varying degree of compliance with mobility measures).

The main link between the PHSM and the economic impact works through the reduction in working hours. The stringency of the mobility restrictions precludes workers to get to the workplaces, effectively reducing the workings hours and producing an economic loss. We assumed that, prior to the PHSM, workers put an optimal amount of hours into work; with PHSM in place, a share of workers is unable to go to their workplaces, reducing economic output (although we account for the fact that some work can be done remotely) and workplace mobility (in turn, viral spread).

In order to quantify the GDP loss, we need a detailed structure of the economic activity of the country, as more labour-intensive economies will be more exposed to mobility restrictions, and more informality in labour intensive sectors will amplify the GDP loss and the need for fiscal support to attenuate the impact of PHSM on the GDP loss. To map the impact of reduced mobility on GDP, we use sectoral value added and labour shares. Moreover, we calibrated incorporated differences in transitioning into remote working across sectors of the economy and countries.

Lockdown fatigue reflects both the increasing psychosocial burden of isolation, including living conditions, and a growing income need, particular taxing for low-income households and informal workers, leading to a decreasing effectiveness of PHSM policies (Levy Yeyati et al. 2021). We estimate a relationship between mobility restrictions and working hours (compliance) that decreases with the cumulative effective length (length adjusted by intensity) of the PHSM, and increases with recent COVID-related deaths (the fear factor). The results in a non-linear relationship that captures the gap between de-jure and de-facto intensity of mobility restrictions (Figure 2).

Figure 2 Lockdown fatigue: Mobility restriction and de facto reduction

To calibrate the model, we map the sequence of PHSM measures actually implemented at the country level in 2021. This sequence yields both a path for cumulative deaths over the year, and an estimation of the GDP loss. In general, governments imposed stringent measures earlier in 2021 and were able to ease them as the vaccination rates accelerated. These results determine benchmark deaths and GDP losses that are later compared to alternative simulated scenarios.

Figure 3 summarises how the two sides of the model interact. For each decision period, the economic model takes the epidemiological output (number of deaths in the previous seven days) as an input, whereas the epidemiological model takes the economic output (working hours) as an input.

Figure 3 Epi-econ integration

Our primary counterfactual scenario is that governments implement less stringent PHSM measures leading to increased deaths but a more modest GDP loss. Based on these alternative outcomes, we quantify the lives-livelihood trade-off as a sacrifice ratio: changes in GDP losses and COVID-related deaths when PHSM become less stringent. Naturally, we are not interested in comparing GDP with deaths, but rather in illustrating the short-run trade-offs, its determinants (comparing slopes) and the policy choices in each case (Figure 4). In particular, the slopes highlight disparities among countries. A steeper slope indicates that reducing GDP loss by 1% would result in a more substantial increase in the daily deaths a difference that emanates from a complex interplay of economic structures, health systems, and previous COVID-19 waves. More generally, the steeper the slope of the trade-off lines, the more challenging the epidemiological-economic trade-offs.

Figure 4Lives versus livelihoods

The model also looks into the interaction of PHSM and social indicators. In particular, it illustrates the widening poverty gap as the stringency of PHSM policies soften in the counterfactual scenario, converging as restrictions eased toward the end of 2021 (Figure 5).

Figure 5 Poverty rates

While the difference in the impact between high and low-income workers is not significant (Figure 5), the results suggest a lower exposure among higher-income workers, typically in low contact-intensive occupations or with a greater ability to transition to remote working.

Figure 6 Income gap

Finally, regarding gender disparities, the results somewhat challenge conventional expectations. We find no statistically significant difference between the income loss for both men and women, particularly during the initial stricter PHSM periods although the simulations do not take into account the incidence of the increased burden of home work within the household.

Figure 7 Gender gap

In navigating the fraught complexities of pandemic response, policymakers face the daunting task of strategic decision-making (Ferranna et al. 2021), particularly in emerging economies where economic losses are expected to be more persistent. Our model, publicly available and customizable, is a powerful tool for policymakers to assess trade-offs in the context of their unique socio-economic landscapes. In particular, the presence of a steep short-term trade-off between health and economics losses emphasises the relevance of targeted pharmaceutical policies, notably increased vaccination coverage.

The model is not intended to pin down an optimal PHSM schedule, a balancing act (Baldwin 2020) that ultimately depends on policy weights that are bound to differ even between policy makers in the same country. Rather, it offers a first insight on the dynamic relationship between PHSM, public behaviour and outcomes in a policy tool that simulates the costs of alternative PHSM programmes and updates them as data becomes available, a first step for better preparedness in the future.

Augustovski F, A Bardach, A Santoro, F Rodriguez-Cairoli, A Lpez-Osornio, F Argento, M Havela, A Blumenfeld, J Ballivian, G Solioz and A Capula (2023), Cost-effectiveness of COVID-19 vaccination in Latin America and the Caribbean: an analysis in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru, Cost Effective Resource Allocation 21(1): 21.

Baldwin, R (2020), COVID, remobilisation and the stringency possibility corridor: Creating wealth while protecting health, VoxEU.org, April 10.

de la Maisonneuve, C, B gert and D Turner (2023), Quantifying the macroeconomic impact of COVID-19-related school closures on human capital, VoxEU.org, January 24.

Ferrana, M, J P Sevilla and D Bloom (2021), Alternative value frameworks for assessing Covid-19 pandemic policies, VoxEU.org, 2 August.

Haw D, P Christen, G Forchini, S Bajaj and K Hauck (2020), DAEDALUS: An Economic-Epidemiological Model to Optimize Economic Activity While Containing the SARS-CoV-2 Pandemic, Imperial College London.

Levy Yeyati, E and F Filippini (2021a), Pandemic divergence: The social and economic costs of Covid-19, VoxEU.org, May 12.

Levy Yeyati, E and F Filippini (2021b), Social and Economic Impact of COVID-19, The Independent Panel for Pandemic Preparedness and Response, Background paper 13.

Levy Yeyati, E and A Malamud (2020). How to Think About the Lockdown Decision in Latin America, Americas Quarterly,2 April.

Levy Yeyati, E and L Sartorio (2020). Take me out: De facto limits on strict lockdowns in developing countries, Covid Economics 39(2).

Levy Yeyati, E, L Sartorio and P Goldstein (2021), Lockdown fatigue: The declining effectiveness of lockdowns, VoxEU.org, 30 March.

Msemburi W, A Karlinsky, V Knutson, S Aleshin-Guendel, S Chatterji and J Wakefield (2023), The WHO estimates of excess mortality associated with the COVID-19 pandemic, Nature 613(7942): 130-137.

Rothwell, J and C Makridis (2020), The real cost of political polarisation: Evidence from the COVID-19 pandemic, VoxEU.org, 10 July.

Rubinstein, A, F Filippini, A Santoro, E Levy Yeyati, A L Lpez Osornio, A L Bardach, C Cejas, S Bauhoff, F Augustovski, A L PichonRiviere (2023), Lives Versus Livelihoods: The Epidemiological, Social, And Economic Impact Of COVID-19 In Latin America and The Caribbean, Health Affairs 42(12).

Santoro A, A L Osornio, I Williams, M Wachs, C Cejas, M Havela, A Bardach, A Lpez, F Augustovski, A Pichn Riviere and A Rubinstein (2022), Development and application of a dynamic transmission model of health systems preparedness and response to COVID-19 in twenty-six Latin American and Caribbean countries, PLOS Global Public Health 2(3).

Go here to read the rest:

Lives versus livelihoods: The COVID-19 trade-off from an epidemiological-economic perspective - CEPR

1. In this randomized controlled trial, patients experiencing symptomatic coronavirus disease 2019 (COVID-19) saw significant improvement in symptom resolution times compared to the placebo group.

2. Further investigation is needed to specifically delineate the impact of simnotrelvir on older COVID-19 patients.

Evidence Rating Level: 1 (Excellent)

Study Rundown: COVID-19 has been a major public health concern since the initial pandemic occurrence in 2020. Though vaccinations are beneficial, they have not been completely effective at preventing the more recent strains of COVID-19. The new variants have strong immune evasion, thus warranting the search for a new drug affecting these variants. Simnotrelvir (SIM0417), an oral small-molecule antiviral agent targeting the SARS-CoV-2 3CLpro, has been proposed as a treatment. When used against the omicron variant of SARS-CoV-2 in vitro, simnotrelvir showed antiviral activity with acceptable side effects. In this double-blind randomized control trial, patients with mild-to-moderate COVID-19 had shorter-lasting symptoms after receiving simnotrelvir plus ritonavir. In the study, those experiencing respiratory symptoms showed more benefits from Simnotrelvir when compared to the placebo. Those in the treatment group had a decrease in their viral load until day nine when compared to those in the placebo group. The placebo group could have experienced unblinding due to the unique taste of the placebo drug, as it only contained excipients. This study only included younger individuals, so the safety and efficacy of this drug on the elderly remains unclear. Overall, early intervention with simnotrelvir plus ritonavir safely showed reduced length of symptoms in patients with COVID-19.

Click here to read the study in NEJM

In-Depth [randomized controlled trial]: A randomized controlled trial in China examined the effects of simnotrelvir on COVID-19 patients. The eligibility criteria included being 18 or older, having signs or symptoms of COVID-19 within three days before the first dose, having at least one symptom before the first dose, and having a mild or moderate severity of the illness. To determine the severity levels, the Food and Drug Administration provided definitions to help classify the participants in the study. The study provided exclusion criteria, including serious kidney, liver, or heart disease, along with the use or expected use of medications that interfere with cytochrome P-450 3A4. The symptoms of COVID-19 most commonly found in participants were dry throat (76.2%), cough (73.4%), and stuffy or runny nose (55.9%). The simnotrelvir group had a significantly shorter time for symptom resolution (180.1 hours; 95% Confidence Interval [CI], 162.1 to 201.6) than the placebo group did (216.0 hours; 95% CI, 203.4 to 228.1). The fever and systemic symptoms resolution times were similar in both groups. However, the simnotrelvir group experienced significantly faster resolution of respiratory symptoms (-41.4 hours; 95% CI, -70.7 to -13.3). From the time of receiving the first dose until day 29, there was a lower incidence of adverse events in the placebo group than in the simnotrelvir group (21.6% vs. 29.0%). The placebo group experienced two serious adverse events, whereas the simnotrelvir group did not experience any. In summary, this studys results suggest that simnotrelvir plus ritonavir is an effective and safe treatment for COVID-19, resulting in earlier respiratory symptom resolution.

Image: PD

2024 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Read more here:

Simnotrelvir to reduces the symptoms of mild to moderate COVID-19 - 2 Minute Medicine

A team of University of Michigan researchers analyzed over 80 studies to assess the effectiveness of COVID-19 vaccine doses beyond the primary series. Their findings, based on 150 million patient observations, support the efficacy of both monovalent and bivalent boosters in preventing severe outcomes and underline the importance of annual vaccine updates.

New research highlighted the significant benefits of monovalent and bivalent COVID-19 boosters in preventing hospitalization and death, advocating for the periodic update of vaccines to match circulating virus variants.

First boosters, second boosters, monovalent, bivalent. Just like the SARS-CoV-2 virus strain, the vaccines to combat the virus are always changingand perhaps confusing.

With the goal of better understanding the variety of vaccines, their effectiveness and taking a look at the methods used globally to study vaccines effectiveness, a group of University of Michigan researchers, led by Sabir Meah and Bhramar Mukherjee, evaluated some 80 studies and 150 million observations from patient datasets across the world to understand the various designs and methods that were used to study effectiveness of COVID-19 vaccine doses following the primary series vaccination.

They then applied all the methods used in those studies to patient data from Michigan Medicine.

Meah is a School of Public Health alumnus with a masters degree in Biostatistics and currently a biostatistician in Urology at Michigan Medicine. Mukherjee is the John D. Kalbfleish Distinguished University Professor of Biostatistics, the Sioban Harlow Collegiate Professor of Public Health, and assistant vice president for research in the Office of the Vice President for Research.

What we have been able to create is a repository of methods that can be applied for future annual vaccines, Mukherjee said. It is important to have robust and reproducible results and reliable estimates of vaccine effectiveness to solidify public trust and fight misinformation.

Their full study is available in Science Advances. Meah explains more.

From the patient data you reviewed, could you explain your findings around bivalent and monovalent boosters?

In our study, we evaluated three different vaccination regimens: 1) the monovalent booster targeting the original strain, 2) the second monovalent booster also with the original formulation, and 3) the new bivalent vaccine updated in fall 2022 to target newer Omicron variants. We saw that all sequential doses provided a substantial benefit in terms of preventing hospitalization and death, and the estimates from the fall 2022 Omicron-specific vaccine dose were stronger from worldwide studies we looked at.

These findings support the practice of periodically updating the COVID-19 vaccines for currently circulating variants. Fortunately, it appears that in the U.S. and many other countries, such as those in the European Union, we will be getting updated COVID-19 vaccines on an annual frequency. The fall 2022 vaccine has already been succeeded by a new updated vaccine in fall 2023, which you can still get now in early 2024, if you havent already, targeting the even newer XBB1.5 Omicron variant.

We expect that our conclusions on the utility of updating vaccines should generalize to any updated COVID-19 vaccine, not just the fall 2022 bivalent vaccine, but additional monitoring and study of the real-world effectiveness of an annual vaccine is still necessary, and we hope that the findings of our research can aid these studies. What we have been able to do is to establish an analytic pipeline where researchers can study the vaccine effectiveness of future annual vaccine formulations.

Could you describe what biostatistics brings to the table on this topic?

Biostatistics and epidemiology provide a toolbox for the complex process of evaluating vaccine effectiveness in scientific observational studies. However, there are quite a number of different approachesboth in study design and methods that researchers have employed in vaccine effectiveness studies conducted all over the world, which is what motivated us to conduct our review of their methodology and results and subsequent case study of these methods using Michigan Medicine data.

Quite fortunately, a key finding of our study was that vaccine effectiveness estimates remain relatively stable and do not depend heavily on choice of methods for the outcomes of hospitalization and mortality. We did not observe this advantageous property for infection outcomes, but hospitalization and death are arguably much more important points of study as we advance further into the endemic stage of the pandemic.

Given what your research says about the power of COVID-19 boosters to prevent severe illness and hospitalization, what would you like this study to convey to the public?

COVID-19 vaccines examined in our study, including the fall 2022 bivalent vaccine, provided strong protection against hospitalization and death. We expect this pattern to continue with additional annual vaccines approved by the FDA, but continued study of future vaccines is warranted, and our findings provide some important points of consideration for these future studies.

Reference: Design and analysis heterogeneity in observational studies of COVID-19 booster effectiveness: A review and case study by Sabir Meah, Xu Shi, Lars G. Fritsche, Maxwell Salvatore, Abram Wagner, Emily T. Martin and Bhramar Mukherjee, 20 December 2023, Science Advances. DOI: 10.1126/sciadv.adj3747

Co-authors: Xu Shi, Lars Fritsche, Maxwell Salvatore, Abram Wagner, Emily Martin, all of U-M. Their cross-discipline collaboration is part of the School of Public Healths IDEAS, Interdisciplinary Discovery, Engagement + Actions for Society initiative.

Read the original post:

Vaccine Effectiveness: Which COVID-19 Shots Offer the Most Protection? - SciTechDaily

Babies whose mothers receive a COVID-19 vaccine during pregnancy are at no greater risk of adverse events and may be at lower risk of severe complications during birth, new data suggests.

The study the largest to assess the impact of COVID-19 vaccination in pregnancy to date provides reassurance that maternal vaccination is safe for developing infants.

COVID-19 vaccination is strongly recommended during pregnancy because it reduces the risk of infection for mother and baby. Even so, concerns about potential adverse events have resulted in fewer pregnant women taking up the offer of vaccination compared to other individuals of the same age.

To investigate the impact of COVID-19 vaccination in pregnancy on developing infants, Mikael Norman, aprofessor of paediatrics and neonatology the Karolinska Institute in Stockholm, Sweden, and colleagues turned to national registers in Norway and Sweden containing data from 98% of newborns conceived after COVID-19 vaccines became available.

Of the 196,470 infants included in the study, 52% of their mothers were not vaccinated against COVID-19, while the remaining 48% had received one or more doses of an mRNA-based COVID-19 vaccine either the Pfizer/BioNtech or Moderna vaccine. The babies' health was followed for at least four weeks after they were born.

The study, published inJAMA, found that COVID-19 vaccination in pregnancy was not associated with any increased risks in newborn infants. On the contrary,babies born to vaccinated individuals had half the risk of death of those whose mothers had not been vaccinated(0.9 vs. 1.8 deaths per 1,000 births). They were also at significantly lower risk of brain bleeds (1.7 vs. 3.2 per 1,000 births) and a type of brain damage caused by reduced oxygen supply to the brain before or shortly after birth (1.8 vs. 2.7 per 1,000 births). The incidence of other types of bleeding, blood clots or inflammation in various organ systems did not differ between the groups.

The researchers are unsure why babies born to mothers who received a COVID-19 vaccine were at lower risk of these complications, but they believe a direct vaccine effect is unlikely. "Previous studies have shown that the vaccine does not cross the placenta and that it cannot be found in umbilical cord blood," Norman said.

Although COVID-19 is no longer categorised as aPublic Health Emergency of International Concern, it remains a global health threat."COVID-19 is still present in society and is probably something we will have to deal with for a long time," said Norman. "It is therefore very important for the 100,000 women who become pregnant every year in Sweden, and the 130 million in the world, to know that vaccination with mRNA-vaccines against COVID-19 is safe for their babies.We found no increased risks, if anything, infants to vaccinated women had lower risks for some severe outcomes."

See the rest here:

New evidence confirms COVID-19 vaccination in pregnancy is safe for babies - Gavi, the Vaccine Alliance

The co-chairs of the Joint Audit Committee and the Evers administration are at odds over whether interest from federal COVID-19 funds should be deposited in the general fund.

The state collected more than $97 million in interest off the $3 billion in funds it received.

The Evers administration contends federal rules bar the interest earnings from going to the general fund because the state would no longer be able to meet tracking requirements for the money, and the Department of Administration is awaiting further guidance from the feds.

Meanwhile, Sen. Eric Wimberger, R-Green Bay, and Rep. Robert Wittke, R-Racine, cited a Legislative Audit Bureau report from December in arguing the money should be in the general fund.

The Joint Audit Committee that the two GOP lawmakers co-chair has a hearing today on the December audit in which they may discuss correspondence from DOA Secretary Kathy Blumenfeld on the topic, according to the hearing notice. If the interest is deposited in the general fund, it would give lawmakers a say in how it is spent. Dem Gov. Tony Evers has had sole authority to disburse federal COVID-19 dollars.

The December LAB report raised questions about the interest, which totaled $97.2 million through Nov. 30. The state was fronted $3 billion in Coronavirus State and Local Fiscal Recovery Funds through the American Rescue Plan Act President Joe Biden signed in early 2021, and that money was invested in a short term pool for excess cash until it was needed for expenditures, according to LAB.

The agency contends the interest on the COVID-19 funds wasnt received from the federal government, and thus there are no restrictions on its use. Because of that, LAB argues the money should be deposited into the general fund.

Blumenfeld sent Wimberger and Wittke two letters last month after they asked for an explanation on why the administration hadnt deposited the interest into the general fund. She wrote in one that DOAs reading of state and federal law contradicts the LFB conclusion. Thus, the agency believes the interest qualifies as money received from the feds because the earnings were originally the property of the federal government and could only be used by the state after receiving permission from the federal government.

Blumenfeld added the administration is awaiting more guidance from the U.S. Treasury.

A DOA spokesperson told WisPolitics the administration hasnt spent the interest as it awaits additional guidance.

Read Blumenfelds letter.

See the LAB report, which discusses the interest on pages 13-14.

Read the co-chairs letter.

Here is the original post:

Audit Committee co-chairs, Evers at odds over interest from COVID-19 funds - WisPolitics.com

DES MOINES More than $11 billion in federal funding was sent to Iowa via multiple aid packages designed to help Americans and local governments weather the effects of the COVID-19 pandemic.

More than $2.4 billion remains unspent by Iowa, according to a recent state report. But how was the rest of it spent? And whats planned for the remaining funds? Those questions were recently posed to The Gazette by a curious Iowan.

Curious Iowa is a series from The Gazette that seeks to answer Iowans questions about the state, its culture and the people who live here. To answer that question, we took a look at a recent report from the nonpartisan Iowa Legislative Services Agency. It analyzed how much the state received in federal financial assistance during the pandemic, where the state has allocated funds, and how much it still has to spend.

LSA issued the report in early August, and the financial analysis within the report is accurate as of July 28. That means the figures in the report are likely slightly different as of mid-October. The report tracks funding from 87 different federal programs.

State agencies in Iowa have reported receiving federal assistance totaling $11.047 billion, according to the LSA report.

That federal assistance came from six pieces of federal funding legislation passed in 2020 and 2021, including the CARES Act and Paycheck Protection Program passed in 2020 under former President Donald Trump, and the American Rescue Plan Act passed in 2021 under President Joe Biden.

Broadly speaking, $7.9 billion was allocated directly to state agencies, nearly $3 billion was allocated to the states Coronavirus Fiscal Recovery Fund, and $152 million was dedicated to a capital fund for broadband internet expansion.

Broken down by program, Iowas unemployment insurance program received the largest chunk of federal financial assistance: nearly $3 billion, according to the LSA report.

During the peak of the pandemic, unemployment claims spiked in Iowa and across the country as businesses were forced to close either by public health mandate or because of a lack of business. A large portion of the federal financial assistance was designed to help employers and workers survive that disruption.

More than $1.1 billion went to Iowas Medical Assistance Program, which supports the states Medicaid program.

Roughly $650 million in federal assistance designed to help state and local governments was sent to Iowa.

And a trio of education programs each received roughly $400 million in federal funds.

Given those programs received the most pandemic assistance funding, it comes as no surprise that the three state agencies that received the most funding were Workforce Development with $3 billion, Health and Human Services with $1.6 billion, and Education with $1.1 billion.

Of that $2.4 billion that the state has not yet allocated, the biggest chunks are in the state public health department and the Iowa Finance Authority, which operates housing assistance programs for homeowners and renters and has spent less than a third of its allotted federal funding.

Most of the funds have deadlines by which the money must be spent, and those deadlines are staggered over the coming years, depending on the funding source. In some cases, the state has until 2027 to spend pandemic relief funds.

There is nearly $1.1 billion remaining in the Iowa Coronavirus Fiscal Recovery Fund, according to the LSA report. Those funds carry broad spending authority: they can be used to address emergency and economic effects of the pandemic, replenish lost government revenues, or invest in water, sewer and broadband infrastructure.

Funds from the fiscal recovery fund must be spent by the end of 2026, or they will revert back to the federal government.

The public health department, which is now under the Health and Human Services department with the recent reorganization of state government, is yet to spend more than $337 million, according to the LSA report. Thats 60 percent of the federal funds awarded to the department.

The majority of the public health departments unspent funds are for the Epidemiology and Laboratory Capacity for Infectious Diseases Program, according to the LSA report. Expenses for that program are ongoing and funding will remain available in future years, the report says.

The Iowa Finance Authority is yet to spend $208 million; thats 68 percent of its allotted financial assistance. The bulk of those unspent funds are for the Emergency Rental Assistance program, and those funds also will remain available in future years, according to the LSA report.

The workforce development agency had $415.5 million still unspent, but that is just 12 percent of the funding it received.

Tell us what youd like us to investigate next.

Comments: (515) 355-1300, erin.murphy@thegazette.com

Go here to see the original:

Curious Iowa: Has the state spent all of its COVID-19 relief funding? - The Gazette