Two Covid problems – The New York Times

The short-term and long-term shortcomings of the country’s current Covid-19 policies are quite different.

In the short term, the main problem is the lack of demand for Covid vaccines and treatments: not enough people are trying to get them. In the longer term – in the second half of this year – the bigger problem could be a lack of care, especially if cases pick up again.

I think that distinction has been lost in some parts of the public debate. Yesterday, President Biden called for additional Covid funding after Congress removed that money from its recent spending bill over a disagreement over how it should be paid.

“We need to secure additional supplies now,” Biden said in a short speech just before receiving his second booster shot on stage. “We can’t wait to act until we find ourselves in the middle of another wave. It will be too late.”

Biden is right that the lack of funding creates problems. To ensure adequate supplies of vaccines and treatments later this year, the government will likely need to take action soon. Democrats and Republicans debated a potential deal this week.

But the potential funding gap is far from the whole problem. A lack of money isn’t stopping many Americans from getting vaccinated or receiving valuable treatments now. Even if Congress passes more Covid funding, the country will still face a problem that is more about information and persuasion than dollars.

For months, the United States has been swamped with Covid shots, and many Americans would benefit from getting one. About a quarter of adults remain unvaccinated, while about another quarter are vaccinated but not boosted, according to the Kaiser Family Foundation. A booster shot greatly reduces the likelihood of contracting severe Covid disease, especially for vulnerable people such as the elderly and those who are immunocompromised.

I know that last point may sound counterintuitive. Elderly and immunocompromised people, even when boosted, face a higher Risk of serious illness than a healthy, younger person. But a booster shot still reduces the risk more for a vulnerable person than for an average person. It’s a general dynamic in medicine: treatments tend to be most valuable to those most vulnerable, even if they don’t eliminate risk.

Despite the tremendous value of additional vaccinations, many Americans simply don’t get them. The number of vaccinations administered per day, including starting doses and booster doses, has fallen to the lowest level since the mass vaccination campaign began in early 2021.

What could help?

Employer and client orders would likely get more people to take their first shots. Previous employer mandates have generally resulted in more people getting vaccinated and only a tiny proportion resigning or being made redundant. But mandates have gone out of fashion. Even some politically liberal places, like New York City and Washington, DC, have dropped theirs lately.

Seems like it should be more doable to fund more people as it affects people who have already had an injection. Still, boosters are lagging behind. Many Americans seem confused about the importance of a booster shot.

The scientific evidence suggests that everyone who is eligible should receive an initial booster shot. A second booster shot – which is now available for people over 50, among others – may also be useful, although the benefits appear smaller. And if you’re boosted and have already received Omicron, you probably don’t need another refresher just yet, notes Dr. Eric Topol of Scripps Research (as part of his helpful review of the evidence).

The story is similar for both Evusheld (a drug that appears to boost immunity in immunocompromised people) and post-infection treatments that reduce the risk of serious illness. They are widespread, but many people are unaware of them.

Many doctors also seem unsure of how and when to prescribe them. “Doctors are starting to use this,” a Biden administration official told me, “but it’s taking a while for things to pick up in medical practice.”

Biden yesterday announced a new federal website – Covid.gov – that will allow people to search for pharmacies near them that offer both Evusheld and the treatments. I found most parts of it easy to use. But I also thought Rob Relyea, a Microsoft engineer turned advocate for immunocompromised people, had a good critique on Twitter: The Evusheld information is too hard to find.

The bottom line is that Americans would benefit from hearing a clear set of repeated messages:

  • A booster shot can save your life.

  • Many immunocompromised people would probably benefit from Evusheld, and it is available.

  • People at risk – like the elderly – should speak to a doctor as soon as they test positive for Covid and seek treatments that may reduce severity, such as paxlovid or molnupiravir.

As Biden said yesterday, “America has the tools to protect people.”

However, as more people become aware of the treatments, some of them will likely run out later this year. And if the federal government waits until then to act, it could find that other countries have bought the available supply. “You can’t snap your fingers and buy that stuff,” the Biden administration official told me.

The government has already reduced shipments of one type of treatment – monoclonal antibodies – it sends to states. It has also said that it will reduce new orders from Evusheld in the coming days.

A Covid bill would likely cost $10 billion to $15 billion, or less than 0.25 percent of the annual federal budget. Republicans in Congress have said that instead of increasing the deficit, money should be diverted from another area. My colleague Sheryl Gay Stolberg, who is reporting on the pandemic from Washington, said Congress is likely to agree on a funding source soon, perhaps before lawmakers go into their April recess. But nobody knows for sure.

Related:

For decades, most LGBTQ romance novels were self-published or published by niche publishers. That has changed, writes Elizabeth Harris of the Times. Now queer romance novels come from the biggest publishers and are prominently displayed in stores.

Some of them are becoming bestsellers, like Casey McQuiston’s “Red, White & Royal Blue,” a 2019 love story about a British prince and the American president’s son. Experts see its success as a turning point for the genre. Publishers have long assumed that only LGBTQ readers are interested in queer romance novels. But readers regularly tell McQuiston, “Oh, my mom and her book club are reading this.”

The new novels also break with the long-standing trope of queer characters meeting tragic endings. An LGBTQ romance novel promises the opposite. “Customers come in and say, ‘I just want something that’s gay and happy,'” said Laynie Rose Rizer, a bookstore manager in Washington, DC. “And I’m like, ‘I have 10 different options for you.'”

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