Nonstop inflammation and immune problems top the list of potential causes of long COVID, but doctors say it's growing clear that more than one thing is to blame for the wide swath of often debilitating symptoms that could last months or even years. [Medscape]

"I think that it's a much more complex picture than just inflammation, or just autoimmunity, or just immune dysregulation. And it's probably a combination of all three causing a cascade of effects that then manifests itself as brain fog, or shortness of breath, or chronic fatigue," says Alexander Truong, MD, a pulmonologist and assistant professor at Emory University School of Medicine, who also runs a long COVID clinic.

Long COVID, post-COVID-19 condition, and post-acute sequelae of SARS-CoV-2 (PASC) are among the terms used by the National Institutes of Health to describe the long-term health issues faced by an estimated 10% to 30% of people infected with COVID-19. Symptoms — as many as 200 — can range from inconvenient to crippling, damage multiple organ systems, come and go, and relapse. Long COVID increases the risk of worsening existing health problems and triggering new ones, including cardiovascular disease and type 2 diabetes.

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Better nursing home protections are needed for future health emergencies, says a data brief from the US Department of Health and Human Services Office of Inspector General (OIG). [JAMA Network]

The new OIG report found that during the first year of the pandemic, bimonthly COVID-19 or likely COVID-19 diagnosis rates among Medicare beneficiaries peaked at 75% or higher at 1358 nursing homes nationwide. “For-profit nursing homes made up a disproportionate percentage of these homes,” the report’s authors wrote. The result was mortality close to 20%, or about double that in facilities with lower diagnosis rates.

The report recommends examining and revising as necessary nurse staffing requirements; improving how surveys identify infection control risks; and providing more oversight and technical assistance to homes found to be at high infection risk.

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A recent systematic review of studies found that people who have been vaccinated against COVID-19 and have had a previous SARS-CoV-2 infection, known as having hybrid immunity, have better protection against the Omicron variant than those with only a previous infection. [JAMA Network]

The effectiveness of hybrid immunity against hospital admission or severe disease was 97% at 12 months compared with 75% after infection alone. Effectiveness against reinfection was 42% for hybrid immunity and 25% for previous infection at 12 months.

The findings, published in The Lancet Infectious Diseases, suggest that people with hybrid immunity may not need COVID-19 vaccine booster doses as soon as people who are vaccinated but have never been infected, the authors noted. “Producing estimates of protection for vaccines targeting new variants will be crucial for COVID-19 vaccination policy and decision-making bodies,” the authors wrote.

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Artificial intelligence (AI) technologies to help authors improve the preparation and quality of their manuscripts and published articles are rapidly increasing in number and sophistication. These include tools to assist with writing, grammar, language, references, statistical analysis, and reporting standards. Editors and publishers also use AI-assisted tools for myriad purposes, including to screen submissions for problems (eg, plagiarism, image manipulation, ethical issues), triage submissions, validate references, edit, and code content for publication in different media and to facilitate postpublication search and discoverability.¹

In November 2022, OpenAI released a new open source, natural language processing tool called ChatGPT.^2,3 ChatGPT is an evolution of a chatbot that is designed to simulate human conversation in response to prompts or questions (GPT stands for “generative pretrained transformer”). The release has prompted immediate excitement about its many potential uses⁴ but also trepidation about potential misuse, such as concerns about using the language model to cheat on homework assignments, write student essays, and take examinations, including medical licensing examinations.⁵ In January 2023, Nature reported on 2 preprints and 2 articles published in the science and health fields that included ChatGPT as a bylined author.⁶

^{Full article here}

^{Download PDF here} 

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Evidence of the efficacy and safety of messenger RNA (mRNA) COVID-19 vaccines in children aged 5 to 11 years has been emerging. The collected data will inform clinicians, families, and policy makers. [JAMA Network] 

Download full paper here> 

Objective  To evaluate the efficacy and safety of mRNA COVID-19 vaccines in children aged 5 to 11 years in a systematic review and meta-analysis.

Data Sources  PubMed and Embase databases were searched on September 29, 2022, without language restrictions.

Study Selection  Randomized clinical trials and observational studies comparing vaccinated vs unvaccinated children aged 5 to 11 years and reporting efficacy or safety outcomes were included. Studies reporting safety outcomes in vaccinated children only (ie, no control group) were also included.

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U.S. Senator Tammy Duckworth (D-IL) and U.S. Senate Majority Whip Dick Durbin (D-IL) joined U.S. Senator Bob Casey (D-PA) and U.S. Representative Debbie Dingell (D-MI-6) in introducing legislation to expand access to home and community-based services for older adults, people with disabilities and injured workers, while increasing pay and improving benefits for the caregivers who provide this life-sustaining care. The Better Care Better Jobs Act would enhance Medicaid funding for home care, helping many of the over 650,000 people on waiting lists nationally finally receive care in the setting of their choice, allowing them to stay active in their communities and live independently. This legislation would also strengthen the caregiving workforce, improve quality of life for families and boost the economy by creating good-paying jobs to make it possible for families and workers alike to thrive economically. [RiverBend.com] 

Full article here>

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Previously vaccinated adults in the U.S. who have not received the bivalent COVID-19 booster vaccine were often unaware they were eligible, didn't know it was available, or thought they already had immunity, according to survey data from the CDC. [MedPage Today]

Of more than 1,100 respondents who had received at least two prior doses and responded to an initial survey in early November 2022, 62.1% had not received the bivalent booster. When asked why they did not get it, 23.2% said they were unaware they were eligible, 19.3% said they didn't know where or that it was available, and 18.9% said they thought they already had immunity against infection, reported Alyssa H. Sinclair, MA, of Duke University in Durham, North Carolina, and colleagues.

Survey shows lack of awareness on eligibility, availability, and some just think they are immune

After being provided with eligibility and availability information, 67.8% of respondents who had not received the bivalent booster said they would, Sinclair and team noted in the Morbidity and Mortality Weekly Reportopens in a new tab or window.

"To help increase bivalent booster coverage, healthcare professionals and public health practitioners should use evidence-based strategies to convey information about booster vaccination recommendations and waning immunity, in addition to increasing convenient access to vaccination," they wrote.

When the researchers followed up with these individuals 1 month later, 28.6% reported that they had received the booster. Of the remaining individuals who had not yet gotten it but had said they would, 82.6% still intended to do so. Those who had not received the booster most commonly reported being too busy, forgetting, or worrying about side effects.

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Gov. Pritzker signed off Tuesday on a supplement to the current fiscal year budget that allocates millions of dollars to healthcare providers and agency leaders.

The plan increases the annual salary of state agency leaders, including those at the Department of Healthcare and Family Services and the Department of Public Health. [Health News Illinois] 

Other allocations include nearly $43.5 million to 15 specific hospitals. The supplement will provide $16.5 million from the state’s coronavirus emergency fund for HFS to safety-net hospitals and $30 million in Medicaid funding to community mental health providers, including those providing crisis care.

An amendment to the spending plan will provide $12.5 million in new supplemental funding to address workforce shortages for community-based providers serving children and adults with intellectual and developmental disabilities and serious mental illnesses.

Advocates like the Illinois Association of Rehabilitation Facilities had sought $56 million. 

The proposal also includes $20 million for the city of Chicago to support asylum seekers, intended to address “basic health and first aid” and address social determinants of health like housing, transportation and food.

And it allocates millions from the state’s COVID-19 remediation emergency fund to various organizations, including those promoting and advertising Illinois tourism.

 Wednesday’s signing comes after Pritzker approved a budget implementation plan earlier this month that includes $460 million in “hospital pandemic recovery stabilization payments.” Funds will be allocated to hospitals based on their class and what they received last year, with added considerations for safety-net hospitals.

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Several leaders of the Illinois agencies that oversee healthcare services will remain in place, Gov. JB Pritzker announced Monday.

That includes Dr. Sameer Vohra, who will continue to serve as director of the Department of Public Health. He has overseen the agency since last year, taking over for Dr. Ngozi Ezike, who initially led the agency under Pritzker’s administration. [Health News Illinois]

Other officials who are staying include Grace Hou, who will continue to serve as secretary of the Department of Human Services, a role she has held since 2019.

Paula Basta, who has led the Department of Aging as its director since 2019, will continue in that role. ​​Terry Prince will continue to serve as director of the Illinois Department of Veterans’ Affairs, a position he has held since 2021.

Several state agencies were not included in Pritzker’s announcement, including the Department of Healthcare and Family Services and the Department of Insurance.

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Five Illinois groups are set to receive just over $5.7 million from the U.S. Department of Education to support wrap-around services in academics, mental health programming and nutrition for students. [Health News Illinois] 

Frida Kahlo Community Organization will receive nearly $2.8 million, while Cook County School District 104 will receive $1.4 million. Three other groups will receive $500,00 each.

Illinois’ two senators praised the funding.

 “When we work to ensure kids in school have access to nutritious food, mental health resources and academic support, we are helping set them up for success,” said Sen. Tammy Duckworth, D-Ill.

See list of recipients here> 

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