A new COVID gap

Today, many more New Yorkers are infected with COVID-19 than official figures report, and compounding the challenge is that far too many of these New Yorkers are unaware of the treatment that is now available to prevent theirs Infection becomes life-threatening according to the latest research.

As we enter the middle of the third year of this no-longer-novel coronavirus pandemic, our recovery efforts continue to follow the changing reality.

The latest variants of the virus are so widespread that researchers estimate 1.5 million New Yorkers were infected in the last week of April and the first week of May. The official COVID-19 case count for those two weeks was 49,253.

“The true magnitude of the BA.2/BA.2.12.1 surge in NYC has been grossly underestimated by routine SARS-CoV-2 surveillance,” wrote the researchers, from the School of Public Health at City University of New York an article distributed Friday on the preprint service Medrxiv.

“This gap between the official case numbers and the actual infection burden appears to be widening over time,” said the researchers, led by CUNY Professor Denis Nash. “The estimate of 1.5 million infections is about 31 times higher than the 49,253 cases in NYC’s official case count…our previous similar survey during NYC’s BA.1 surge estimated reported cases 3-4 times lower were than the true number of infections.”

In both cases, the researchers based their estimates on telephone and online surveys of about 1,000 New Yorkers who were asked various questions to determine if they had a recent history of confirmed or probable infection. The researchers recommended that public health officials conduct such surveys regularly to track the pandemic “at least until there is more certainty that the impact of future waves on public health outcomes (hospitalizations and deaths) will be significantly reduced.”

Unreported Test Results

The shortfall seems to have several reasons. Many people infected with COVID-19 never get tested or only test at home with self-administered kits, the results of which are not reported. However, the CUNY investigation also suggests that thousands of positive test results from clinics and pop-up testing sites are also going unreported.

Perhaps as worrying as the unrecorded magnitude of the pandemic was what researchers tracked about a delay in response.

“Our study suggests that awareness and uptake of nirmatrelvir/ritonavir (PaxlovidTM) was low in adults with SARS-CoV-2 infection,” they reported.

Paxlovid is the brand name of an antiviral treatment from Pfizer that has been shown in clinical trials to be highly effective in reducing the risk of serious illness or death from COVID-19. These studies were conducted in unvaccinated patients, but both city and federal governments recommend treatment for those who have been vaccinated, especially if they belong to vulnerable groups.

Long COVID research

Trials are ongoing to measure the effectiveness of Paxlovid in people who have been vaccinated before becoming infected. Another line of research is trying to determine if Paxlovid, as well as delayed vaccination, can help reduce the syndrome known as Long COVID, which appears to affect between 20% and 25% of all COVID patients, according to the latest research.

Meanwhile, the federal government says it has an unused inventory of one million of Paxlovid’s five-day courses.

Nash and his colleagues estimated that 29% of those infected with Covid in late April and early May met the general requirements to receive Paxlovid, were aged 65 or older, or had any of the numerous “comorbidities” that increase susceptibility to the virus.

Yet only about 15 percent said they had actually received the treatment, and more than half (55%) said they had never heard of it. Three percent said they tried to get it but couldn’t.

Nash and his colleagues expressed concern that the data “point to some important disparities in access to antivirals” that warrant more attention.

“These are potentially important findings that warrant further investigation and monitoring with programmatic course corrections as needed,” the researchers said. “Unequal uptake of antivirals among at-risk individuals with COVID-19 could further exacerbate inequalities in exposure to SARS-CoV-2, which has had a disproportionate impact on racial/ethnic minorities and other groups.”

For example, Paxlovid use was far higher among those with health insurance and those with higher incomes and higher education. Whites and Asians used the treatment more than Blacks and Hispanics.

“It is crucial to design and implement large-scale public health initiatives with equity in mind and to anticipate how they may create new inequalities or exacerbate existing inequalities,” the researchers urged.

Paxlovid distribution

Federal officials say that uptake of Paxlovid is actually higher here in the Northeast, so it would be logical to assume the CUNY results underestimate national shortfalls in Paxlovid uptake.

The White House announced on Thursday that it was taking steps to make Paxlovid easier to access. That effort includes establishing state-funded clinics, including in New York, that are authorized to perform COVID testing and immediately prescribe Paxlovid to those who test positive and meet the recommended requirements.

“Basically,” said Dr. Ashish K. Jha, the White House COVID-19 coordinator, told the New York Times, “We’re trying to get to the point where COVID deaths are largely preventable, and I think we’re pretty close. “

On average, seven New Yorkers die each day with COVID-19, well below the worst times in April 2020 (average 760 deaths per day with probable or confirmed COVID-19 infections) or January of this year (average 128 deaths per day).

“Deaths from this disease really should go down,” Jha said.

However, the researchers noted one factor that may complicate that hope.

“Although many individuals susceptible to a severe outcome were infected and were not using rapid antivirals,” they reported. “It appears that most had a high level of protection from a severe outcome through vaccination and booster shots in addition to a prior history of infection.”

They said this so-called hybrid protection from the mix of vaccination and prior infection “may partially explain why NYC has yet to see a large increase in hospitalizations during this current surge, even with BA.2.12.1 predominating.”

However, they noted that these protections are “temporary” and added: “Given the uncertainty of how the remainder of the surge will impact severe outcomes among those who remain vulnerable, the magnitude of the current surge calls for additional precautions to be taken Reduce the risk of spreading to the general population.”

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