1. Todd, Betsy MPH, RN

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COVID-19, three years in. By late 2022, the United States had recorded nearly 97 million cases of COVID-19 (likely an undercount, as home and medical office test results are rarely reported) and more than 1 million deaths. As of November 17, about 29,000 new U.S. cases were still being reported daily. The Omicron variant and its subvariant BA.2 dominated in 2022 and caused the largest surge in cases since the beginning of the pandemic. In a new study of long COVID, researchers analyzed pooled data from more than 1 million COVID-infected people in 22 countries and found that 6.2% still had respiratory problems, fatigue, mood disorders, or cognitive problems three months after infection. Women and people hospitalized for COVID-19 (especially if in need of critical care) had a higher risk of developing long COVID. People who received the initial two-dose series of COVID-19 vaccine had a decreased risk of developing long COVID. Vaccine uptake in the United States remains suboptimal. By September, 68% of the population had received the initial two-dose vaccine, but only 33% had received any boosters. And 58% of children ages six months to 17 years have not received an initial vaccine dose.

Figure. Image courte... - Click to enlarge in new windowFigure. Image courtesy of the Centers for Disease Control and Prevention.

Mental health issues on the rise. In an October 2022 survey by the Centers for Disease Control and Prevention (CDC), 36% of respondents ages 18 years and older said they have experienced recent symptoms of anxiety or depression, up from 10.8% in the CDC's 2019 survey. For young adults 18 to 29 years of age, the figure was 51.7%. Concerns about burnout from stresses of the pandemic appear to be ongoing, not only in the workplace, but among parents working from home. An Ohio State University study noted that 66% of working parents report burnout, and that this sometimes leads to punitive parenting behaviors. A new recommendation from the U.S. Preventive Services Task Force calls for annual screening for anxiety in children and adolescents ages eight to 18. And in July, the United States transitioned the 10-digit Suicide Prevention Lifeline to a new, three-digit Suicide and Crisis Lifeline that can be reached by dialing 988.


Monkeypox spreads globally. Early in the year, an epidemic of monkeypox quickly spread around the globe. Most infections occurred in men who have sex with men. By late November, there had been 29,000 cases and 12 deaths in the United States, and over 80,000 cases worldwide. Such an explosion of cases had not been seen previously, and many of the affected countries had previously experienced only singular infections. These observations led to new disease insights. Unlike in previous monkeypox outbreaks, prodromal symptoms and fever were often absent, shorter incubation periods were common, and, in many cases, only a few lesions were present. In August, the Food and Drug Administration issued an emergency use authorization for intradermal administration of the Jynneos monkeypox and smallpox vaccine, allowing for a dose one-fifth of the usual subcutaneous dose and extending vaccine supplies.


Disparities in vaccine availability were evident in many cities, recalling the inequitable distribution of AIDS treatment early in that epidemic.


Polio resurgence. In July, an unvaccinated 20-year-old New York man was diagnosed with paralytic polio. Poliovirus found in wastewater samples from two New York counties was genetically linked to the patient's virus, reflecting ongoing community transmission, and New York declared a state of emergency. Most cases of polio are asymptomatic but continue the chain of transmission and therefore pose a risk to unvaccinated people. Pockets of very low vaccination rates still exist in some parts of the United States, exacerbated by the pause in vaccination in some states during the COVID-19 pandemic. The World Health Organization has added the United States to its list of polio outbreak countries.


Inflation Reduction Act passes. The Inflation Reduction Act, signed into law by President Joe Biden on August 16, will decrease health care costs for some consumers over the next several years. The new law extends premium subsidies in the Affordable Care Act insurance marketplaces for three more years. Beginning in 2023, insulin copays for Medicare recipients will be limited to $35 per month, and tax penalties will be levied on drug companies who raise year-over-year prices on any drug by amounts that exceed the rate of inflation. In 2025, a $2,000 cap on out-of-pocket drug expenses for Medicare Part D users goes into effect. In 2026, Medicare will be able to negotiate drug prices on 10 of the highest-cost prescription drugs.-Betsy Todd, MPH, RN