White House pushes COVID antiviral amid funding stalemate with Congress

Federal judge temporarily blocks Biden administration from ending Title 42

The best editorial of the weekend: A physician explains the “desperation” NC’s Medicaid expansion blockade has caused

North Carolina’s refusal to expand Medicaid is a cruel experiment that’s caused large numbers of premature and unnecessary deaths, write physician Steve Luking. Image: AdobeStock

If you haven’t already, be sure to catch the extraordinary essay that veteran Rockingham County physician Steve Luking penned for the Greensboro News & Record over the weekend. In “As lawmakers wait; people are dying,” Luking makes plain in straightforward human terms what statistics have shown repeatedly over the last decade as Republican legislators have refused to follow the lead of most other states by expanding Medicaid to cover uninsured lower income North Carolinians: the decision is quite literally killing people.

And, not surprisingly (at least to anyone with a heart and a brain) the pandemic has made things much worse — especially in rural areas like the ones he served for three decades. After describing how he and his brother/medical partner set up open-air tents in 2020 to deal with the influx of COVID-19 patients, Luking writes this:

If legislators had stood at my side as I cared for the uninsured sick, many who were essential workers, I think they would reconsider their votes against Medicaid expansion. More than one in eight essential workers are uninsured in our state. Expansion would have provided basic coverage for many of them.

For instance, a single mom with two children, Dianne (patients’ names have been changed to protect their privacy) worked in a local grocery store. She had lost her Medicaid coverage when she was hired. She did not qualify for insurance, and so she was stuck, essentially uninsurable.

I saw Dianne one day in my tent, early in the pandemic. She had a fever and a bad cough, and felt miserable and scared. Several co-workers had come down with COVID.

The swab was positive. She told me she couldn’t pay for it so I gave her a loaner oxygen monitor, and watched her leave to pick up her kids at school.

Very early in the pandemic, before we had office-based testing, I also saw a feverish, uninsured farmhand. He was wheezing and appeared potentially unstable. When I advised him to go to the ER, he shook his head no.

“No insurance, can’t afford it,” he said. He drove away, undiagnosed.

Another uninsured patient was an aide for an elderly client who was hospitalized with COVID-19. She, too, developed a fever and cough and rapid breathing, but refused to go to the ER because she already had a prior thousand-dollar bill.

What kind of society demands that essential workers keep working in a dangerous pandemic, while squarely rejecting their access to insurance?

Luking then goes on to take comfortable lawmakers, like Greensboro’s Rep. Jon Hardister, to task for their offensive statements about not expanding Medicaid to “able-bodied” people — a term that probably holds superficial appeal with right-wing focus groups, but makes no sense at all in the real world. Here’s Luking: Read more

Public transportation passengers should consider continuing to wear masks, a Duke expert says

Though a federal judge struck down mask mandates for public transportation this week, a Duke infectious disease specialist said Thursday that passengers should still consider wearing them.

For people who must take public transportation to work, “I think there are still plenty of compelling reasons why they should think carefully about masks,” said Dr. Cameron Wolfe, an associate professor at the Duke University School of Medicine.

Dr. Cameron Wolfe, Duke University

Dr. Cameron Wolfe, Duke University

The U.S. Justice Department is appealing the court decision.

Airline passengers have been the focus of this week’s reports on mask mandate developments.

Airline studies early in the pandemic found that cabin airflow reduces the risk of passengers becoming infected, Wolfe said, but studies also show that there’s still a risk if the person in the next seat is infected.

“You need to assume public transportation risk is non-zero,” he said Thursday in an online question-and-answer session with reporters.

A week’s worth of information on North Carolina COVID-19 cases the state released Wednesday shows new cases increased from 4,851 to 7,279. The totals are an undercount because the popularity of home tests means that many positive cases are not reported. The percentage of people going to hospital emergency rooms with COVID systems has remained steady at 2% for more than a month, according to DHHS.

The omicron subvariant BA.2 accounts for most cases identified by genetic sequencing in North Carolina over last month.

The virus that causes COVID-19 is becoming more contagious as it evolves, but is not causing more serious illness, the Duke experts said.

“As far as we can tell, the vaccines are still very effective against all of the variants,” said David Montefiori, a Duke professor who has studied the effectiveness of COVID-19 vaccines. “It’s important to get boosted for protection against the omicron variants.”

State health officials have estimated that more than 90% of North Carolinians have some immunity to COVID-19, either through vaccinations or previous infections.

High “population immunity” means high rates of COVD hospitalizations and death are unlikely, Montefiori said. It’s important to keep track of new variants, he said, but not obsess over all of them.

“We just have to get used to the fact that this virus is going to be with us for a long time and it’s going to continue to evolve,” he said.

More time is needed to understand how much of a problem waning immunity represents, Montefiori said. And a question remains whether a variant emerges against which the existing vaccines are ineffective.

“It will be more important that vaccines change to keep up with that new variant should a variant  emerge that does effectively escape our vaccines,” he said.

CDC concludes a mask mandate is still needed for travelers, clearing way for court battle