Three years after more than 3,600 health workers died of COVID-19, occupational safety experts warn that those on the front lines may once again be at risk if the Centers for Disease Control and Prevention takes its committee’s advice on infection control guidelines in health care settings, including hospitals, nursing homes, and jails. In early November, the committee released a controversial set of recommendations the CDC is considering, which would update those established some 16 years ago.

The pandemic illustrated how a rift between the CDC and workplace safety officials can have serious repercussions. Most recently, the giant hospital system Sutter Health in California appealed a citation from the state’s Division of Occupational Safety and Health, known as Cal/OSHA, by pointing to the CDC’s shifting advice on when and whether N95 masks were needed at the start of the pandemic. By contrast, Cal/OSHA requires employers in high-risk settings like hospitals to improve ventilation, use air filtration, and provide N95s to all staff exposed to diseases that are — or may be — airborne.

The agencies are once again at odds. The CDC’s advisory committee prescribes varying degrees of protection based on ill-defined categories, such as whether a virus or bacteria is considered common or how far it seems to travel in the air. As a result, occupational safety experts warn that choices on how to categorize COVID, influenza, and other airborne diseases — and the corresponding levels of protection — may once again be left to administrators at hospitals, nursing homes, and jails or prisons.

Eric Berg, deputy chief of health at Cal/OSHA, warned the CDC in November that, if it accepted its committee’s recommendations, the guidelines would “create confusion and result in workers being not adequately protected.”

Also called respirators, N95 masks filter out far more particles than looser-fitting surgical masks but cost roughly 10 times as much, and were in short supply in 2020. Black, Hispanic, and Asian health workers more often went without N95 masks than white staffers, which helped explain why members of racial and ethnic minorities tested positive for COVID nearly five times as often as the general population in the early months of the pandemic. (Hispanic people can be of any race or combination of races.)

Cal/OSHA issued dozens of citations to health care facilities that failed to provide N95 masks and take other measures to protect workers in 2020 and 2021. Many appealed, and some cases are ongoing. In October, the agency declined Sutter’s appeal against a $6,750 citation for not giving its medical assistants N95 masks in 2020 when they accompanied patients who appeared to have COVID through clinics. Sutter pointed to the CDC’s advice early in the pandemic, according to court testimony. It noted that the CDC called surgical masks an “acceptable alternative” in March 2020, “seemed to recommend droplet precautions rather than airborne precautions,” and suggested that individuals were unlikely to be infected if they were farther than 6 feet away from a person with COVID.

This is a loose interpretation of the CDC’s 2020 advice, which was partly made for reasons of practicality. Respirators were in short supply, for example, and physical distancing beyond 6 feet is complicated in places where people must congregate. Scientifically, there were clear indications that the coronavirus SARS-CoV-2 spread through the air, leading Cal/OSHA to enact its straightforward rules created after the 2009 swine flu pandemic. Workers need stiffer protection than the general population, said Jordan Barab, a former official at the federal Occupational Safety and Health Administration: “Health workers are exposed for eight, 10, 12 hours a day.”

The CDC’s advisory committee offers a weaker approach in certain cases, suggesting that health workers wear surgical masks for “common, often endemic respiratory pathogens” that “spread predominantly over short distances.” The draft guidance pays little attention to ventilation and air filtration, and advises N95 masks only for “new or emerging” diseases and those that spread “efficiently over long distances.” Viruses, bacteria, and other pathogens that spread through the air don’t neatly fit into such categories.

“Guidelines that are incomplete, weak, and without scientific basis will greatly undermine CDC’s credibility,” said a former OSHA director, David Michaels, in minutes from an October meeting where he and others urged CDC Director Mandy Cohen to reconsider advice from the committee before it issues final guidance next year.

Although occupational safety agencies — not the CDC — have the power to make rules, enforcement often occurs long after the damage is done, if ever. Cal/OSHA began to investigate Sutter only after a nurse at its main Oakland hospital died from COVID and health workers complained they weren’t allowed to wear N95 masks in hallways shared with COVID patients. And more than a dozen citations from Cal/OSHA against Kaiser Permanente, Sharp HealthCare, and other health systems lagged months and years behind health worker complaints and protests.

Outside California, OSHA faces higher enforcement obstacles. A dwindling budget left the agency with fewer workplace inspectors than it had in 45 years, at the peak of the pandemic. Plus, the Trump and Biden administrations stalled the agency’s ongoing efforts to pass regulations specific to airborne infections. As a result, the agency followed up on only about 1 in 5 COVID-related complaints that employees and labor representatives officially filed with the group from January 2020 to February 2022 — and just 4% of those made informally through media reports, phone calls, and emails. Many deaths among health care workers weren’t reported to the agency in the first place.

Michaels, who is now on the faculty at the George Washington University School of Public Health, said the CDC would further curtail OSHA’s authority to punish employers who expose staff members to airborne diseases, if its final guidelines follow the committee’s recommendations. Such advice would leave many hospitals, correctional facilities, and nursing homes as unprepared as they were before the pandemic, said Deborah Gold, a former deputy chief of health at Cal/OSHA. Strict standards prompt employers to stockpile N95 masks and improve air filtration and ventilation to avoid citations. But if the CDC’s guidance leaves room for interpretation, she said, they can justify cutting corners on costly preparation.

Although the CDC committee and OSHA both claim to follow the science, researchers arrived at contradictory conclusions because the committee relied on explicitly flawed trials comparing health workers who wore surgical masks with those using N95s. Cal/OSHA based its standards on a variety of studies, including reviews of hospital infections and engineering research on how airborne particles spread.

In decades past, the CDC’s process for developing guidelines included labor representatives and experts focused on hazards at work. Barab was a health researcher at a trade union for public sector employees when he helped the CDC develop HIV-related recommendations in the 1980s.

“I remember asking about how to protect health care workers and correction officers who get urine or feces thrown at them,” Barab said. Infectious disease researchers on the CDC’s committee initially scoffed at the idea, he recalled, but still considered his input as someone who understood the conditions employees faced. “A lot of these folks hadn’t been on hospital floors in years, if not decades.”

The largest organization for nurses in the United States, National Nurses United, made the same observation. It’s now collecting signatures for an online petition urging the CDC to scrap the committee’s guidelines and develop new recommendations that include insights from health care workers, many of whom risked their lives in the pandemic.

Barab attributed the lack of labor representation in the CDC’s current process to the growing corporate influence of large health systems. Hospital administrators prefer not to be told what to do, particularly when it requires spending money, he said.

In an email, CDC communications officer Dave Daigle stressed that before the guidelines are finalized, the CDC will “review the makeup of the workgroups and solicit participation to ensure that the appropriate expertise is included.”

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.

©2023 KFF Health News. Distributed by Tribune Content Agency, LLC.

U.S. men dying nearly 6 years before women is now the largest life expectancy gap between sexes since 1996, according to new research led by Harvard T.H. Chan School of Public Health and UC San Francisco.

The life expectancy gender gap of 5.8 years in 2021 was a jump from 4.8 years in 2010, when the gap was at its smallest in recent history.

The pandemic, which took a disproportionate toll on men, was the biggest contributor to the widening gap from 2019 to 2021 — followed by unintentional injuries and poisonings (mostly drug overdoses), accidents, and suicide.

“There’s been a lot of research into the decline in life expectancy in recent years, but no one has systematically analyzed why the gap between men and women has been widening since 2010,” said first author Brandon Yan, a UCSF internal medicine resident physician and research collaborator at Harvard Chan School.

Life expectancy in the U.S. dropped in 2021 to 76.1 years — falling from 78.8 years in 2019, and 77 years in 2020.

The shortening lifespan of Americans has been attributed in part to so-called “deaths of despair.” The term refers to the increase in deaths from such causes as suicide, drug use disorders, and alcoholic liver disease, which are often connected with economic hardship, depression, and stress.

“While rates of death from drug overdose and homicide have climbed for both men and women, it is clear that men constitute an increasingly disproportionate share of these deaths,” Yan said.

Using data from the National Center for Health Statistics, Yan and fellow researchers from around the country identified the causes of death that were lowering life expectancy the most. Then, they estimated the effects on men and women to see how much different causes were contributing to the gap.

Before the COVID pandemic, the largest contributors were unintentional injuries, diabetes, suicide, homicide, and heart disease.

But during the pandemic, men were more likely to die of the virus. That was likely due to a number of reasons — including differences in health behaviors, as well as social factors, such as the risk of exposure at work, reluctance to seek medical care, incarceration, and housing instability.

“We have brought insights to a worrisome trend,” Yan said. “Future research ought to help focus public health interventions towards helping reverse this decline in life expectancy.”

A pre-pandemic common cold coronavirus infection may help set the stage for long COVID, according to Boston researchers who have been looking to explain why some patients end up facing the long-lasting, debilitating symptoms.

The researchers from Brigham and Women’s Hospital and Massachusetts General Hospital teamed up with experts in immunology and virology to look for clues about long COVID in blood samples from patients with autoimmune rheumatic diseases.

The team found that among these patients, those who developed long COVID were more likely to have expanded, pro-inflammatory antibodies specific to a coronavirus that causes the common cold.

A person’s viral history, especially prior infection and expansion of antibodies against a pre-pandemic coronavirus, could prime the immune system for developing long COVID, according to the researchers.

“Our study offers evidence and explanation for why some of our patients may be experiencing the persistent and wide-ranging symptoms of long COVID,” said co-corresponding author Zachary Wallace, of the Division of Rheumatology, Immunology and Allergy at Massachusetts General Hospital.

“Identifying a biomarker that helps us better understand current and previous infections could shed light on an inappropriate immune response that leads to some cases of long COVID,” Wallace added.

Up to 45% of individuals with rheumatic diseases — which include rheumatoid arthritis and other chronic autoimmune disorders that cause inflammation — experienced persistent symptoms associated with long COVID 28 days after acute infection with SARS-CoV-2.

Patients with rheumatic diseases are also at risk for more severe disease and complications from acute infection.

The researchers compared immunological changes in patients with rheumatic diseases who recovered from COVID. Specifically, they looked for differences in the immunological fingerprints left behind by previous infections.

The team found an unexpected signal tied to OC43, a coronavirus that causes common cold symptoms. Individuals with long COVID were more likely to have antibody responses specific to this form of coronavirus.

The study is restricted to individuals with rheumatic diseases, and further research is needed to determine if their findings will apply more widely to patients without a pre-existing autoimmune disorder.

“By starting with patients with rheumatic diseases, we may be able to develop biomarkers that help us understand who is at high risk for developing long COVID and strategically enroll individuals into clinical trials to either prevent long COVID or develop therapies to treat it,” said Wallace. “This study represents an important step in that direction.”

The risk of new disease, disability and death remains elevated in some patients as long as two years after catching COVID-19, according to a large study showing the infection’s prolonged heath impact.

People who were never sick enough to be hospitalized for acute COVID still had a higher risk than uninfected people of developing long COVID-related disorders such as dangerous blood clots, diabetes and lung, gastrointestinal and musculoskeletal disease two years later, according to the study published Monday in the journal Nature Medicine.

Some 65 million people globally are estimated to be living with so-called post-COVID-19 condition — a number reported to be steadily increasing in the absence of approved treatments and continuing viral spread. The research from the Clinical Epidemiology Center of the Veterans Affairs St. Louis Health Care System in Missouri shows how longterm ailments that afflict COVID survivors add to the disease burden of the pandemic.

“While many people’s long COVID symptoms improve slowly over time, this can take years, and some symptoms persist even beyond that point,” said Michael Peluso, an assistant professor of medicine at the University of California, San Francisco. “The disability attributed to these post-COVID conditions is sobering.”

Long COVID has been linked to more than 200 symptoms affecting every organ system. Epidemiologist Ziyad Al-Aly and colleagues used the VA’s national databases to compare the incidence of 80 post-acute health problems among 138,818 veterans who survived the first month of a COVID infection during the first year of the pandemic with almost 6 million who weren’t infected during the same period.

Those who weren’t hospitalized for COVID had an increased risk of developing 31% of the 80 ailments after two years of follow up, compared with non-infected controls, while hospitalized COVID patients had a higher chance of developing 65% of them.

“It’s very clear that people hospitalized during the acute phase of a SARS-CoV-2 infection have a really long and arduous road to recovery,” Al-Aly said in an interview. “They have a significantly higher risk of death, even at two years.”

The increase in mortality risk from COVID-19 wasn’t significant beyond six months for non-hospitalized patients, but remained significantly elevated through the two years for those who had been hospitalized, the study found. Most users of the VA health system are older males, which might limit how applicable the study’s findings are to other groups, the authors said.

Lasting Damage

A severe case of COVID may cause long-lasting alterations to the innate immune system, the body’s first line of defense against pathogens, researchers said Friday in a separate study that points to why the disease can cause persistent inflammation and widespread organ damage. Yet another study published Monday found COVID may trigger new-onset hypertension, especially among hospitalized patients.

The VA study measured the burden of disease from long COVID in disability-adjusted life years, or years lost due to disability.

Cumulatively at two years, long COVID contributed a burden of 80.4 disability-adjusted life years for every 1,000 people who caught COVID but weren’t sick enough to be hospitalized, and 642.8 disability-adjusted life years for every 1,000 patients who were hospitalized for acute illness.

The disability burden “is extremely high, even in the non-hospitalized group, and shows the severity of the impact long COVID is having and will continue to have on society,” said Hannah Davis, who co-founded the Patient-Led Research Collaborative, which studies long COVID, after she developed the condition herself in early 2020.

The “timely and very important analysis” from the VA researchers confirms what doctors have heard from patients in the clinic and in smaller studies, UCSF’s Peluso, who’s also studying COVID’s effects, said in an email. More research is needed on the long-term risks associated with COVID, Peluso said.

“It also reinforces the urgency of figuring out exactly what beyond the initial infection causes these post-acute symptoms and sequelae so that we can identify treatments to return people to their regular health sooner and minimize ongoing disability,” he said.

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©2023 Bloomberg News. Visit at bloomberg.com. Distributed by Tribune Content Agency, LLC.

ST. LOUIS (AP) — Firefighter and paramedic Mike Camilleri once had no trouble hauling heavy gear up ladders. Now battling long COVID, he gingerly steps onto a treadmill to learn how his heart handles a simple walk.

“This is, like, not a tough-guy test so don’t fake it,” warned Beth Hughes, a physical therapist at Washington University in St. Louis.

Somehow, a mild case of COVID-19 set off a chain reaction that eventually left Camilleri with dangerous blood pressure spikes, a heartbeat that raced with slight exertion, and episodes of intense chest pain.

He’s far from alone. How profound a toll COVID-19 has taken on the nation’s heart health is only starting to emerge, years into the pandemic.

“We are seeing effects on the heart and the vascular system that really outnumber, unfortunately, effects on other organ systems,” said Dr. Susan Cheng, a cardiologist at Cedars-Sinai Medical Center in Los Angeles.

It’s not only an issue for long COVID patients like Camilleri. For up to a year after a case of COVID-19, people may be at increased risk of developing a new heart-related problem, anything from blood clots and irregular heartbeats to a heart attack –- even if they initially seem to recover just fine.

Among the unknowns: Who’s most likely to experience these aftereffects? Are they reversible — or a warning sign of more heart disease later in life?

“We’re about to exit this pandemic as even a sicker nation” because of virus-related heart trouble, said Washington University’s Dr. Ziyad Al-Aly, who helped sound the alarm about lingering health problems. The consequences, he added, “will likely reverberate for generations.”

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Heart disease has long been the top killer in the nation and the world. But in the U.S., heart-related death rates had fallen to record lows in 2019, just before the pandemic struck.

COVID-19 erased a decade of that progress, Cheng said.

Heart attack-caused deaths rose during every virus surge. Worse, young people aren’t supposed to have heart attacks but Cheng’s research documented a nearly 30% increase in heart attack deaths among 25- to 44-year-olds in the pandemic’s first two years.

An ominous sign the trouble may continue: High blood pressure is one of the biggest risks for heart disease and “people’s blood pressure has actually measurably gone up over the course of the pandemic,” she said.

Cardiovascular symptoms are part of what’s known as long COVID, the catchall term for dozens of health issues including fatigue and brain fog. The National Institutes of Health is beginning small studies of a few possible treatments for certain long COVID symptoms, including a heartbeat problem.

But Cheng said patients and doctors alike need to know that sometimes, cardiovascular trouble is the first or main symptom of damage the coronavirus left behind.

“These are individuals who wouldn’t necessarily come to their doctor and say, ‘I have long COVID,’” she said.

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In St. Louis, Camilleri first developed shortness of breath and later a string of heart-related and other symptoms after a late 2020 bout of COVID-19. He tried different treatments from multiple doctors to no avail, until winding up at Washington University’s long COVID clinic.

“Finally a turn in the right direction,” said the 43-year-old Camilleri.

There, he saw Dr. Amanda Verma for worsening trouble with his blood pressure and heart rate. Verma is part of a cardiology team that studied a small group of patients with perplexing heart symptoms like Camilleri’s, and found abnormalities in blood flow may be part of the problem.

How? Blood flow jumps when people move around and subsides during rest. But some long COVID patients don’t get enough of a drop during rest because the fight-or-flight system that controls stress reactions stays activated, Verma said.

Some also have trouble with the lining of their small blood vessels not dilating and constricting properly to move blood through, she added.

Hoping that helped explain some of Camilleri’s symptoms, Verma prescribed some heart medicines that dilate blood vessels and others to dampen that fight-or-flight response.

Back in the gym, Hughes, a physical therapist who works with long COVID patients, came up with a careful rehab plan after the treadmill test exposed erratic jumps in Camilleri’s heart rate.

“We’d see it worse if you were not on Dr. Verma’s meds,” Hughes said, showing Camilleri exercises to do while lying down and monitoring his heart rate. “We need to rewire your system” to normalize that fight-or-flight response.

Camilleri said he noticed some improvement as Verma mixed and matched prescriptions based on his reactions. But then a second bout with COVID-19 in the spring caused even more health problems, a disability that forced him to retire.

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How big is the post-COVID heart risk? To find out, Al-Aly analyzed medical records from a massive Veterans Administration database. People who’d survived COVID-19 early in the pandemic were more likely to experience abnormal heartbeats, blood clots, chest pain and palpitations, even heart attacks and strokes up to a year later compared to the uninfected. That includes even middle-aged people without prior signs of heart disease

Based on those findings, Al-Aly estimated 4 of every 100 people need care for some kind of heart-related symptom in the year after recovering from COVID-19.

Per person, that’s a small risk. But he said the pandemic’s sheer enormity means it added up to millions left with at least some cardiovascular symptom. While a reinfection might still cause trouble, Al-Aly’s now studying whether that overall risk dropped thanks to vaccination and milder coronavirus strains.

More recent research confirms the need to better understand and address these cardiac aftershocks. An analysis this spring of a large U.S. insurance database found long COVID patients were about twice as likely to seek care for cardiovascular problems including blood clots, abnormal heartbeats or stroke in the year after infection, compared to similar patients who’d avoided COVID-19.

A post-infection link to heart damage isn’t that surprising, Verma noted. She pointed to rheumatic fever, an inflammatory reaction to untreated strep throat –- especially before antibiotics were common — that scars the heart’s valves.

“Is this going to become the next rheumatic heart disease? We don’t know,” she said.

But Al-Aly says there’s a simple take-home message: You can’t change your history of COVID-19 infections but if you’ve ignored other heart risks –- like high cholesterol or blood pressure, poorly controlled diabetes or smoking -– now’s the time to change that.

“These are the ones we can do something about. And I think they’re more important now than they were in 2019,” he said.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

A new coronavirus subvariant, nicknamed Eris, has rapidly risen to prominence nationwide and is now thought to account for more U.S. cases than any of its counterparts at a time when transmission has been creeping upward.

It’s possible the subvariant, formally known as EG.5, may have even further immune-escape advantage than some earlier members of the sprawling Omicron family — a viral dynasty that has dominated the globe since December 2021.

But officials emphasize that doesn’t necessarily mean Eris will cause a big wave.

“There are a couple of mutations on this particular variant that may have more immune evasion again. But it is very similar, and still a subset variant of Omicron,” California state epidemiologist Dr. Erica Pan said in a briefing with health professionals Tuesday.

According to estimates from the U.S. Centers for Disease Control and Prevention, Eris comprised 17.3% of coronavirus specimens nationwide for the week ending Saturday, up from 11.9% a week earlier.

Eris is now estimated to be the most common distinctly identified subvariant nationwide. XBB.1.16, nicknamed Arcturus, has fallen to second place, and is estimated to comprise 15.6% of specimens. The third- and fourth-most common subvariants, respectively, are XBB.2.3, which some have nicknamed Acrux; and XBB.1.5, also known as Kraken.

In the Southwestern U.S. — California, Arizona, Nevada, Hawaii and the Pacific territories — the CDC estimates Arcturus is still the dominant subvariant, estimated to comprise 18.6% of viral specimens, with Eris second at 16.2%.

Unlike the pandemic’s earlier days, which were marked by distinctly different strains of the coronavirus struggling for dominance, more recent notable versions are all descendants of the Omicron variant. As a result, the World Health Organization hasn’t granted them official names beyond their alphanumeric identifiers — leading to an unofficial system, circulating on social media, using celestial or mythical monikers.

Eris shares its name with one of the largest known dwarf planets in our solar system. Formerly known as Xena, it’s about the same size as Pluto, NASA says, and three times farther away from the sun. Eris is also the name of the Greek goddess of discord and strife.

Eris “is essentially a sub-, sub-variant of XBB,” according to Pan. In her briefing, Pan said California is still largely seeing the Kraken subvariant, but that Eris is on the upswing, and now estimated to be about 12% “of what we’re seeing here in California.”

It’s clear that coronavirus transmission has started to tick up nationwide and in California. Coronavirus levels in wastewater in most parts of the state are now at a “medium” level. A week earlier, they were mostly at a “low” level, Pan said.

California’s test positivity rates also have gone up in the last two to three weeks, as have anecdotal reports indicating that COVID seems to be spreading more widely, Pan said.

“A lot of this may be from summer travel,” she said. “Thankfully, our hospitalizations are looking very reassuring so far.”

Deaths have also been stable and relatively low, Pan said. And because the differences between the latest subvariant are relatively minor, the autumn version of the COVID-19 vaccine that will be unveiled soon is still expected to do well against circulating variants later this year.

“The new vaccine … should still have good cross-coverage, because it’s still based on that XBB base,” Pan said.

COVID-19 hospitalizations nationwide fell to a record low for the pandemic in June, but have ticked up since.

Nationwide, there were 9,056 new COVID-19 hospitalizations for the week that ended July 29, up 12.5% from the prior week. The record low in terms of hospitalizations, 6,306, was set for the week that ended June 24.

In California, there were 1,416 new COVID-19 hospitalizations for the week that ended July 29, up 4% from the prior week. That’s more modest than the previous week-over-week increase, which was 12%.

All regions of the nation, as defined by federal officials, have seen an increase in COVID-19 hospitalizations in recent weeks. But they also all remain at near-record lows.

Some areas are seeing the pace of growth accelerate, however. New England saw a 26% increase in new COVID-19 hospitalizations for the week that ended July 29. The prior week-over-week change was 19%, and, before that, 5%.

The Mid-Atlantic region — Pennsylvania, Virginia, Maryland, West Virginia, Delaware, and the District of Columbia — saw a 19% increase in new weekly COVID-19 hospitalizations, up from a 4% jump the prior week.

In the Southeast region of Florida, Georgia, North Carolina, Tennessee, South Carolina, Alabama, Kentucky and Mississippi, new weekly COVID-19 hospitalizations rose by 23%, up from the prior week-over-week increase of 10%.

The region comprised of Texas, Louisiana, Oklahoma, Arkansas and New Mexico saw COVID-19 hospitalizations rise 9% for the most recent week, more gradual than the 18% prior week-over-week increase.

New York and New Jersey saw COVID-19 hospitalizations rise by 9%, a gentler increase from the prior week-over-week jump of 27%.

The region that comprises Missouri, Iowa, Kansas and Nebraska saw a 20% jump following a previous week-over-week decrease of 9%.

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©2023 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.

But in her new book Endemic: A Post-Pandemic Playbook, she is combining decades of experience in infectious diseases and HIV particularly, with her unique position on the sharp edge of pandemic policies to present a 10-point plan to prepare for future pandemics.

She discussed the book and her thoughts on what went right or wrong during COVID-19. Her answers have been edited for brevity and clarity:

Q: What does the title of your book, Endemic, mean, and why did you want to write this book now?

A: In the concept of infectious disease epidemiology, there are pathogens that we hope to get rid of in the world, and there are pathogens that we’re never going to get rid of. A pathogen that we’re never going to get rid of, unfortunately, is called endemic, meaning it gets to a stage where we live with it.

It starts out in a pandemic form, causing a lot of severe disease and mortality, and then it settles.

At the beginning of COVID I felt like there was a surprising lack of understanding infectious disease epidemiology, in how public health was responding to it.

It just seemed like there was this idea that we by human behavior can rid a region of a virus. But, I was just surprised because it just didn’t make sense that we could eliminate or eradicate it. It just didn’t make sense in terms of the biology of the virus.

Q: What about the COVID pandemic has been similar to previous pandemics and what’s been different this time around?

A: It was actually most similar, in a way, to the influenza pandemic of 1918, and actually not very similar to its counterparts SARS and MERS. Those two human coronaviruses in this century were really limited in terms of their impact. They had a very high fatality rate, but they didn’t spread very quickly, and we could shut them down quick.

This coronavirus acted much more like influenza, which has a very high mutation rate.

During the influenza pandemic absolutely there were lockdowns, but they were very short. What they were trying to do during that lockdown was get the hospitals ready, figure everything out, figure out how it spread, and tell the population to do other things like wear masks and stay away from each other and stay outside.

It was the most progressive cities that kept the schools open in 1918, and that was really different than this pandemic where the blue state closed their schools for longer than the red states.

Q: In the book you say “public health is a service industry, not a police force.” Can you explain what you mean?

A: Since I am in the field of HIV, I manage a lot of addiction, and I manage a lot of STDs, and in those fields the idea of harm reduction is that people have human needs and society has needs, and you don’t make it just about the pathogen. You deal with the holistic needs of the individual in society, and you incorporate pathogen control into societal and individual needs.

In addiction, if you tell someone to just stop, they’re going to secretly go and use and maybe use with needles that are shared. But if you acknowledge that there’s a true addiction, and addiction is a physiologic state, then if you give them clean needles you can minimize the harm. It’s essentially just acknowledging that addiction is real, acknowledging, for example, that sexual needs are real. Don’t tell people to just stay away from each other.

So what would be acknowledging that with COVID? That school for kids is really needed, or that people get lonely and socially isolated when you’re telling them that they have to stay away from other people. And that can cause other effects, like mental health effects. It’s just kind of putting the problem into the context of other needs.

Using the police and using coercion, I don’t think it is a good way to do public health. Instead, just tell people how to stay safe.

Q: One of your principles for how to deal with future pandemics is “resources before restrictions,” why is that important?

A: The idea is that instead of restricting the entire population, like with mask mandates, capacity limits, closing down businesses, you give resources to those who need it the most. It’s providing resources to do the things that make sense.

If you have COVID, you need to stay home and isolate, so give people a resource or a way to stay home.

We don’t have a universal health care system, so when they shut down the city people were losing their insurance left and right. All these people who had HIV were trying to come to our clinic because they just suddenly lost all their insurance.

You had to provide resources to people when you shut down businesses. Instead you could provide resources for people to test and to stay home when they’re positive, and then eventually get vaccinated, which in my mind is the key to unlock a pandemic.

Q: You identify as “left of left” and you argue for universal health care in the U.S., but a lot of people associate your views on mask mandates and school closings more with conservatives. Can you explain how that happened?

A: I still have a Bernie Sanders sticker on my car from 2016, but I’m even ‘lefter’ than that, and what I mean by that is I’m actually really interested in global poverty. That’s what’s driven me into infectious disease.

What ended up happening with COVID is something got topsy turvy, it got associated with the left to be restrictive, and to close schools. Yet, that response favors the rich. So the public schools in San Francisco are closed for a very long time, but the private schools open more quickly. My children got to go to school but (my patients) didn’t get their kids to be in school, and I felt really guilty.

I felt really bad that I was part of the elite the public health response favored. I used to think about the left as favoring the working class, but the left did not favor the working class in terms of the COVID response.

It just completely confused me. My positions were more consistent with red state governors, and that led to a lot of unease. I felt really uncomfortable in my own skin. I looked towards all my patients, and they’re so lonely. they’re so miserable. They are working and their  8-year-old is at home alone online. Do they see what we we are doing to the poor?

Monica Gandhi, MD

Age: 54

Title: professor of medicine and associate division chief of the Division of HIV, Infectious Diseases, and Global Medicine at UCSF/ San Francisco General Hospital.

Residence: San Francisco

Education: University of Utah, Harvard Medical School

Family: two sons, 13 and 15 years old

Five things about Monica Gandhi

• Really likes Russian novels, reading Dostoyevsky’s “Devils” right now.
• Enjoys dark movies, like Danish films called “Celebration,” except it’s definitely not one.
• Connected to Indian Hinduism, after grieving processes for husband involved a lot of spirituality.
• Got two bonded cats during the pandemic, but one ran away so she got new buddy for her lonely cat, and then the second cat came back, so now she has three cats.
• Just loves being an HIV doctor.

If 2022 was the year of free COVID-19 test kits, 2023 is shaping up to be the year of fraudulent COVID-19 test kits.

Consider what happened to Judy, an 85-year-old Medicare recipient in Southern California (we’re withholding her last name because she’s concerned about being victimized further). One day this year, five COVID-19 test kits showed up at her home without her ever requesting them.

“I didn’t pay any attention to the unsolicited COVID tests, so I threw them out,” Judy said. “It wasn’t until some months later that I received my Medicare summary bill and I saw charges for over-the-counter COVID tests I didn’t order.”

Each kit cost $120 to $150 — and she was responsible for a portion of the bill.

Judy is just one of hundreds of people who have fallen victim to a new scam involving COVID-19 test kits, part of the rising trend of fraudulent activity since the start of the pandemic.

Here’s how it works: Scammers buy stolen Medicare numbers online or extract them directly from Medicare patients. They use these ID numbers to bill Medicare for over-the-counter test kits, collecting a tidy profit on each one and causing enrollees to receive kits they did not order.

The U.S. Department of Health and Human Services’ Office of Inspector General has received numerous complaints from around the country about this scam, said Scott Lampert, assistant inspector general for investigations at the Department of Human Services.

“We’re doing what we can to investigate them thoroughly and hold the criminals that are pursuing these schemes accountable,” Lampert said.

Lampert declined to reveal how many complaints the Office of Inspector General has received, the details of the investigations and how the office is holding criminals accountable. According to a news release updated in June, fraudulently ordered COVID-19 testing kits have cost Medicare more than $203 million.

The Justice Department in April accused a Florida physician and a marketer of illegally buying Medicare ID numbers and sending tests to seniors who did not request them. The scheme led to $8.4 million in fraudulent Medicare claims, the Justice Department said.

Some seniors were sent unsolicited tests only once, but others have been receiving them on a monthly basis, said Amy Nofziger, director of victim support for AARP’s Fraud Watch Network. Nofziger pointed out that certain states with higher populations of older adults, such as Florida, Arizona and New York, have become targets for criminals to exploit.

What happened to free COVID-19 home tests?

In January 2022, the Biden administration offered all households a limited number of rapid COVID tests for free, increasing access to testing as part of its effort to combat COVID-19. A few months later, in April 2022, the Centers for Medicare & Medicaid Services decided to pay for eight tests per month for those with Medicare Part B coverage.

Both offers ended on May 11, 2023, but Medicare still covers the cost of coronavirus lab tests ordered by a healthcare provider.

What tips should be kept in mind to help prevent fraud?

• Be cautious about unsolicited requests for your personal, medical and financial information. Medicare will not call enrollees to offer products, services or benefit reviews in exchange for your Medicare number.
• Be skeptical about any COVID-19 testing site or testing-related solicitation that demands your financial or medical information in order to receive a free test.
• Regularly check your quarterly Medicare Summary Notices, which list what Medicare is being billed for, to ensure that you recognize all of the charges to your account.
• Beware of anyone offering to sell you at-home COVID-19 test kits in exchange for your personal or medical information. Ensure your safety by purchasing FDA-approved COVID-19 test kits only from legitimate providers.

What do I do if an unsolicited test kit is sent to my home?

• Dispose of test kits to avoid any potential risks, but make sure to jot down any information on the package, such as the lot number, sender address and expiration date.
• Contact either Medicare at (800) 633-4227 or your Medicare provider to request a new Medicare beneficiary card with a new member number. The card will be mailed within two weeks. If possible, don’t use your old member number until you receive the new card.
• Submit a complaint about the fraud to the Office of Inspector General hotline or by calling (800) HHS-TIPS ([800] 447-8477).
• File a report with the Federal Trade Commission. This helps authorities investigate and prevent further fraudulent actions.
• If you have concerns about COVID-19 testing or your health, consult with healthcare professionals, such as your primary care physician or local health department, who can provide accurate information and guidance.

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©2023 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.

He also was ordered to pay $866,000 in restitution.

As the pandemic reached Connecticut in late 2020, DiMassa was empowered by West Haven’s mayor to approve spending for prevention measures and other unexpected costs and had signature authority over the money.

He admitted conspiring with his wife and two others — including John Trasacco, a convicted felon who introduced him to a gambling ring — to embezzle the federal grant money by creating dummy invoices and directing payments to sham companies.

In a short statement before U.S. District Judge Omar Williams imposed an admittedly “lenient” sentence, DiMassa acknowledged that his crimes have contributed to the erosion of faith in politics and government.

“I gave them another reason not to trust the government — another corrupt politician,” he said. “It’s hard to find words to express how I feel — embarrassed, ashamed, mortified.”

West Haven Mayor Nancy Rossi, who put DiMassa in charge of doling out the city’s share of federal pandemic relief money, told Williams before sentence was imposed that DiMassa deserved the maximum under the law — which would have been decades in prison. As part of his community service to be fulfilled after release, Rossi said the city would consider using him to “clean toilets and pick up trash.”

“Our trust was misplaced,” Rossi said. “He’s a liar, a con artist and a degenerate gambler.”

Rossi said efforts to restore faith in West Haven, which has been fiscally challenged for years and under the supervision of state budge officials for decades, were set back “for a generation” by the “cascade of negative media” that followed DiMassa’s arrest.

DiMassa’s lawyer, John Gulash, argued to Williams that the embezzlements were largely attributable to his client’s out-of-control gambling addiction.

“Mr. DiMassa suffered from a debilitating gambling addiction at the time of the offense,” Gulash, wrote in a long sentencing memorandum, “and his essentially unfettered access to a deep pool of federal funds and total lack of impulse control facilitated his precipitous downward spiral. The amount of money a gambler can waste is only limitedby the amount of money that he has or has access to.”

Williams said the length of time DiMassa will serve in prison is shorter than it might otherwise have been because of the amount of restitution he was ordered to make and his cooperation with FBI agents.

He pleaded guilty to three counts of conspiracy to commit fraud and agreed to testify against Trasacco, the only one of the four who claimed he was innocent and who was convicted after a trial. Trasacco, sentenced to eight years in prison in April, got about $430,000 of the stolen money.

DiiMassa testified that he met Trasacco through another of the conspirators, John Bernardo, at the cigar bar Mickey Blakes. Before long, DiMassa was betting at what federal prosecutors alleged in a court filing was an “illegal gambling operation” at a restaurant in Branford, where he also was handing Trasacco city checks for pandemic-related services that the city never received.

Of their first meeting, DiMassa testified, “We talked. We got to know each other. We smoked. I believe we had a beer … He told me that he had been in prison in the past.”

DiMassa was permitted to testify that Trasacco acknowledged having been in prison, but prosecutors were forbidden by court order from asking him about “organized crime” or Trasacco’s criminal history, which includes a half dozen prior convictions for crimes that include robbery and assault. When prosecutors suggested DiMassa may have conspired with Trasacco out of fear, U.S. District Judge Omar Williams closed the courtroom and ejected the public from what he said would be “a matter that is under seal.”

DiMassa admitted arranging three, separate conspiracies to steal COVID relief money – one each with Trasacco, Bernardo and his wife, Lauren Knox DiMassa. DiMassa kept all the money he stole with his wife, most of the money he stole with Bernardo and hardly any he stole with Trasacco.

Bernardo was sentenced prerviously to 13 months in prison. DiMassa’s wife was sentenced to six months.

All those convicted are ordered to make restitution for the stolen money.

DiMassa was allowed to accompany his pregnant wife to Texas, where she turned herself in to begin serving her sentence on May 23. He will remain free on bond unit ordered to report to prison himself at a date to be determined.

Before he was arrested and forced out of the state legislature, DiMassa held a variety of positions in West Haven’s government. He was arrested in October 2021. The others were charged later.

The embezzlement came to the attention of federal law enforcement officials through Democratic infighting for control of West Haven’s government. It resulted in greater state review of city spending by West Haven, a city that has flirted with insolvency and been subject to state oversight for decades.

DiMassa and Bernardo were accused of creating a phony partnership, Compass Investment Group, and using it as a vehicle to steal about $637,000.

Federal prosecutors said the two billed the city for a long list of services that included “as COVID-19 Legal + Lobbying + Site work for COVID-19 Clinic, Consulting Service-Legislative Review Executive Orders — COVID-19, Consulting Service-Suppo1i Staff Services, Monitors/Security Site (April 2021-May 2021), and Consulting Service Lobbying Service — COVID-19 Federal.” In reality, the indictment charges, the two did nothing for the city.

Bernardo is accused of getting about $50,000. When he pleaded guilty to a fraud charge earlier this year, Bernardo blamed DiMassa and complained he didn’t realize the extent of the theft until reading about it in the newspaper after his arrest.

“I had no idea what Mr. DiMassa was doing, how he was getting the money,” Bernardo said when he pleaded guilty. “When I heard it was between $500,000 and $800,000, I said, ‘What is going on here? Where is the money?’ “

DiMassa lost much of the money he stole with Bernardo at the Mohegan Sun Casino, where his purchases of tens of thousands of dollars in gambling chips correspond with illegal diversions from the COVID grants.

DiMassa’s wife — they were married days before his arrest — handed almost all the money she is accused of collecting, $147,776.10, to her husband, according to her lawyer.

Federal prosecutors said the checks issued to Lauren DiMassa under the heading “Youth Violence COVID-19 Associated Expenses,” included charges for “in-home counseling, cleaning supplies, special needs hourly service, WIFI assistance for low/moderate income families, counseling services, license fees, a fall youth clinic, meals, support group supplies, equipment rental, and youth clinic support group.”

Lauren DiMassa is accused of cashing 16 checks, keeping a portion of the funds and depositing the rest in an account she controlled. During the period in which the fraud occurred, July 2020 to October 2021, prosecutors said she did nothing in return for the money.

Trasacco, is accused of creating two dummy corporations, L&H company and JIL Sanitation Services, that he and DiMassa allegedly used to bill West Haven for fictitious COVID-related supplies and services. Among other things, federal prosecutors said the two billed the city for cleaning a school building that the indictment said “had been vacant and abandoned for years.”

Yet, as the interactive map below shows, many metro areas in the U.S. are experiencing flight from densely packed urban neighborhoods. Thousands of households abandoned neighborhoods in New York, Chicago and Boston. Many flocked to nearby suburbs, or relocated to the South and Sun Belt. But even in some of the hottest urban markets, downtown neighborhoods from Miami to Las Vegas have experienced a net drain in migration since the pandemic began while surrounding suburbs surged.

Our map, compiled from U.S. Postal Service change-of-address data, shows how American migration trends have shifted since the start of the pandemic. Zoom out to view the whole country and you’ll see the blue swaths concentrated in the south that represent a net positive migration flow.

Zoom in on your home ZIP code — or your Aunt Millie’s in Mills County, Texas, and your former neighbors’ in Nashville — to see how the population from household migration has changed. We’ve got nearly all 30,000 ZIP codes across the country covered — even in Hawaii and Alaska.

To search for your neighborhood, enter the ZIP code in the search box, then press enter to zoom to any location within the U.S. Or scroll around and see how things shake out nationally.

SEARCH YOUR ZIP: HOW HAS THE EXODUS IMPACTED YOU?