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Health leaders prepare for possible summer surge of cases fueled by virus variants

Diana Merchant self-tests for COVID-19 at a No Cost COVID-19 Drive-Through testing provided the GUARDaHEART Foundation at the Guirado Park in Whittier, Calif., Tuesday, Jan. 25, 2022. (AP Photo/Damian Dovarganes)
Diana Merchant self-tests for COVID-19 at a No Cost COVID-19 Drive-Through testing provided the GUARDaHEART Foundation at the Guirado Park in Whittier, Calif., Tuesday, Jan. 25, 2022. (AP Photo/Damian Dovarganes)
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WASHINGTON (TND) — Former White House Coronavirus Task Force coordinator Dr. Deborah Birx warned the U.S. should prepare for a surge of cases.

Speaking on CBS’ “Face the Nation,” Birx said the South will see increased caseloads in the summer and northern states will have surges in the winter.

"This is what we have to be prepared for in this country. We should be preparing right now for a potential surge in the summer across the Southern United States because we saw it in 2020 and we saw it in 2021,” Birx said on “Face the Nation.”

The U.S. is already dealing with an uptick in cases due to the omicron subvariant, BA.2. According to Centers for Disease Control and Prevention data, the U.S. has a seven-day average of about 56,000 new cases. Hospitalizations are also slightly increasing as case counts grow but are far from pandemic highs due to widely available vaccines and antiviral treatments.

Health experts say fluctuating case counts can be expected every year since it will be impossible to completely eradicate the virus. The virus is constantly mutating to avoid existing immunity from prior infections and vaccinations also ensure positive cases will continue.

“I think we attribute it to the doggone virus; we knew from the beginning that this was going to be a formidable challenge biologically. It's really just the biology of the virus, the fact that coronaviruses select for mutations (and) resistant strains very easily, very readily,” Dr. Mark Schleiss, an infectious disease physician and professor at the University of Minnesota.

The most recent subvariants of COVID-19 have been less likely to cause severe illness leading to hospitalizations. However, Schleiss encouraged people to keep their guard up and continue mitigation measures like wearing a mask in public settings.

“The good news is that we know that these mitigation measures masking and vaccination are helpful,” he said. “I think we need to continue to guard against infection and I think we need to be very careful not to sort of (responding) with nihilism and say, ‘I'm bound to get it.’”

Unlike in the early days of the pandemic, policymakers are less likely to be as concerned with raw case counts and are more focused on making decisions based on severe illness and death.

“Cases are going to occur and they're going to be largely because they're occurring in a population that has a lot of immunity that has tools like Paxlovid and tools like monoclonal antibodies, they're going to be increasingly de-linked from hospitals being overwhelmed,” said infectious disease physician and senior scholar at Johns Hopkins Center for Health Security Dr. Amesh Adalja.

Health officials at various levels of government have switched to a test-and-treat approach instead of lockdown measures to mitigate as many cases as possible.

The White House has invested billions in testing capacity and antiviral treatments to help people receive results quickly and get medication to avoid severe illness. It is also pushing for more medical professionals to prescribe Paxlovid, a Pfizer-created antiviral pill that reduces severe illness and death.

If administered within five days of experiencing symptoms, Paxlovid has been proven to reduce hospitalizations and deaths by 90% in patients most likely to have severe illness.

The current supply is expected to last at least several more months but the way to get a prescription may make it more difficult than necessary for many Americans. It requires seeking treatment within five days of experiencing symptoms and testing positive, along with a prescription.

The Biden administration has taken steps for drugstores and pharmacies to serve as one-stop-shops for testing and antiviral treatments. However, only doctors, physician assistants and nurse practitioners can prescribe the drug and those people are not available in every drugstore.

Adalja said leaving pharmacists out of the pool of medical professionals able to prescribe the drug severely hampers the test-and-treat approach.

“We have to think about expanding scope of practice for pharmacists — especially during public health emergencies — but also generally because we've seen scope of practice increase for physician assistants, nurse practitioners, psychologists, nurse anesthetists, nurse midwives,” he said. “I think this is all based on data and showing that they can perform activities safely that it doesn't necessarily require someone to be a medical doctor to be able to do a lot of this stuff.”

Getting access to the drug can be especially challenging in rural communities where the pharmacy doesn’t have the medical professionals necessary.

We need to make it more seamless and more user-friendly to get it out there, particularly into rural communities,” said Schleiss.

Rural communities are less likely to have high levels of vaccination but have been more likely to seek antiviral treatments or monoclonal antibodies.

“The reasons for that are complex but I'm optimistic that even the reluctance to vaccinate may be mitigated by an acceptance of an antiviral treatment,” Schleiss said.

To expand who can prescribe Paxlovid, federal health officials would need to reauthorize the drug under an emergency-use authorization to include more health professionals.

While the federal government has already purchased months' worth of antivirals and testing, the White House is still pleading with Congress to pass additional funding to keep the virus at bay. Lawmakers had come to a bipartisan agreement on a $10 billion package to fund the federal response into the future but it was derailed over arguments about the Biden administration's decision to rescind a Trump-era immigration policy allowing asylum-seekers to be turned away without hearing their claims due to public health concerns.

Without that funding, the government would be unable to provide free testing, treatments and vaccines as it has throughout the pandemic. It would also create new hurdles for people trying to receive treatment, as a vast majority of tools available to health professionals are approved under emergency use authorization, which means the government is the sole supplier of drugs like Paxlovid.

The lack of funding could lead to scarce supplies of vital treatments that are currently readily available for doctors.

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