The White House on Tuesday said eligible Americans should get the updated COVID-19 boosters by Halloween to have maximum protection against the coronavirus by Thanksgiving and the holidays, as it warned of a “challenging” virus season ahead.
Dr. Ashish Jha, the White House COVID-19 coordinator, said the U.S. has the tools, both from vaccines and treatments, to largely eliminate serious illness and death from the virus, but stressed that’s only the case if people do their part.
“We are not helpless against these challenges,” he said. “What happens this winter is up to us.”
So far the Centers for Disease Control and Prevention says only about 11.5 million Americans have received the updated shots, which are meant to provide a boost of protection against both the original strain of COVID-19 and the BA.5 variant that is dominant around the world. Jha said studies suggest that if more Americans get the updated vaccines, “we could save hundreds of lives each day this winter.”
More than 330 people die on average each day of COVID-19, according to CDC data, with the U.S. death toll standing at over 1.05 million.
Jha acknowledged the slower pace of vaccinations, saying, “we expected September to be a month where it would just start picking up.” He added that the White House expects more Americans to get the updated boosters this month around the time when they get their annual flu shots. He also emphasized that they should look to get them soon to be protected when they gather with family and friends.
“I think people should get vaccinated before Halloween,” he said.
Jha criticized Congress, which has refused the White House’s $22 billion budget request for virus response, saying that has kept the U.S. from building a stockpile of tests to use in the event of a new winter surge.
“You can’t fight a deadly virus without resources,” he said, “and congressional inaction is really costly.”
Chinese cities were imposing fresh lockdowns and travel restrictions after the number of new daily COVID-19 cases tripled during a weeklong holiday, ahead of a major Communist Party meeting in Beijing next week.
The latest lockdown started Monday in Fenyang city in northern China’s Shanxi province after a preliminary positive case was found in citywide testing the previous day, state broadcaster CCTV reported.
In the nearby Inner Mongolia region, the capital Hohhot announced that outside vehicles and passengers would be prohibited from entering the city starting Tuesday. Hohhot has recorded more than 2,000 cases over about 12 days.
China is one of the few places in the world still resorting to harsh measures to keep the disease from spreading. The long-ruling Communist Party is particularly concerned as it tries to present a positive image of the nation in the run-up to a once-in-five-years party congress that starts Sunday.
Travel was down during an annual National Day holiday that began Oct. 1, as authorities discouraged people from leaving their cities and provinces. But the number of new daily cases has still grown to about 1,800 from 600 at start of the break.
Leaders don’t want a major outbreak to cast a pall over the congress, but their strict “zero-COVID” approach has taken an economic toll, particularly on small businesses and temporary workers. Many in China hope the pandemic policy will ease after the meeting.
Outbreaks have been reported across the country, with the largest in Inner Mongolia and the far-west Xinjiang region. Both have been recording several hundred new cases a day.
Both Shanghai, where residents endured prolonged lockdowns earlier this year, and the national capital Beijing have had a small but growing number of cases. Two Shanghai districts announced closures of cinemas and other entertainment venues last week.
Lining up for a free virus test several times a week has become the norm for many Chinese, with Beijing and other cities requiring a negative test result within 72 hours to enter parks, office buildings, shops and other public places.
Telemedicine exploded in popularity after COVID-19 hit, but limits are returning for care delivered across state lines.
That complicates follow-up treatments for some cancer patients. It also can affect other types of care, including mental health therapy and routine doctor check-ins.
Over the past year, nearly 40 states and Washington, D.C., have ended emergency declarations that made it easier for doctors to use video visits to see patients in another state, according to the Alliance for Connected Care, which advocates for telemedicine use.
Some, like Virginia, have created exceptions for people who have an existing relationship with a physician. A few, like Arizona and Florida, have made it easier for out-of-state doctors to practice telemedicine.
Doctors say the resulting patchwork of regulations creates confusion and has led some practices to shut down out-of-state telemedicine entirely. That leaves follow-up visits, consultations or other care only to patients who have the means to travel for in-person meetings.
Susie Rinehart is planning two upcoming trips to her cancer doctor in Boston. She needs regular scans and doctor visits to monitor a rare bone cancer that has spread from her skull to her spine.
Rinehart doesn’t have a specialist near her home outside Denver who can treat her. These visits were done virtually during the pandemic.
She will travel without her husband to save money, but that presents another problem: If she gets bad news, she’ll handle it alone.
“It’s stressful enough to have a rare cancer, and this just adds to the stress,” the 51-year-old said.
Rinehart’s oncologist, Dr. Shannon MacDonald, said telemedicine regulation enforcement seems to be more aggressive now than it was before the pandemic, when video visits were still emerging.
“It just seems so dated,” said MacDonald, who recently co-wrote a piece about the issue in The New England Journal of Medicine.
To state medical boards, the patient’s location during a telemedicine visit is where the appointment takes place. One of MacDonald’s hospitals, Massachusetts General, requires doctors to be licensed in the patient’s state for virtual visits.
It also wants those visits restricted to New England and Florida, where many patients spend the winter, said Dr. Lee Schwamm, a vice president for the Mass General Brigham health system.
That doesn’t help doctors like MacDonald who see patients from around the country.
Cleveland Clinic also draws a lot of patients from out of state. Neurosurgeon Dr. Peter Rasmussen worries about how some will handle upcoming travel, especially because winter can bring icy weather.
A fall “literally could be life ending” for someone with a condition like Parkinson’s disease who has trouble walking, he said.
Psychiatrists have a different concern: Finding doctors for patients who move out of state. This is especially difficult for college students who temporarily leave home.
Most U.S. counties have no child and adolescent psychiatrists, noted Dr. Shabana Khan, chair of the American Psychiatric Association’s telepsychiatry committee.
“If we do try to transition patients, often there is no one there,” Khan said.
Helen Khuri’s mother found a specialist to help her when the 19-year-old’s post-traumatic stress disorder flared up last spring. But the Emory University student had to temporarily move from Atlanta to Boston for treatment, even though she never set foot inside the hospital offering it.
She rented an apartment with her father so she could be in the same state for telemedicine visits, a situation she deemed “ridiculous.”
“It didn’t necessarily make sense to … kind of uproot my life, just to receive this three-week treatment program,” Khuri said.
Even people seeing doctors close to home can be affected.
Dr. Ed Sepe’s Washington, D.C., pediatric practice has patients in Maryland who have started driving a few miles across the border into the city to connect by video. That saves them a 45-minute trip downtown for an in-person visit.
“It’s silly,” he said. “If you are under a doctor’s care, and you are in the U.S., it doesn’t make any sense to have geographic restrictions for telemedicine.”
Sepe noted that low-income families tend to be in jobs that don’t allow time off for in-person visits. Some also have a hard time getting transportation. Video visits were helping with these obstacles.
“It’s bigger than just telemedicine,” he said. “There’s a missed opportunity there to level the playing field.”
States can play an important role in telemedicine’s growth by guarding against fraud and protecting patient safety, according to Lisa Robin, an executive with the Federation of State Medical Boards.
But the federation also recommends that states loosen some telemedicine restrictions.
That includes permitting virtual follow-ups for someone who has traveled out of state to seek care or for people who temporarily move but want to stay with a doctor.
States could also form regional compacts with their neighbors to ease cross-border care, noted Dr. Ateev Mehrotra, a Harvard health policy professor who studies telemedicine.
“There’s so many ways that these issues can be addressed,” he said
In the meantime, patients who need care now are trying to figure out how to manage it.
Lucas Rounds isn’t sure how many visits he will make to see MacDonald in Boston to monitor his rare bone cancer. The 35-year-old Logan, Utah, resident already spent months away from home earlier this year, undergoing radiation and surgery.
Plus he has a wife and three young girls and expenses like a mortgage to consider.
Rounds says he has to think about taking care of his family “if the worst happens.”
“If I die from cancer, then all these expenses we’ve accrued … those are dollars that my family wouldn’t have,” he said.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
Older people with limited mobility and those with chronic health conditions requiring the use of electrically powered medical devices were especially vulnerable when Hurricane Ian slammed into Southwest Florida, and experts warn such risks to society’s oldest are growing as disasters increase with the impact of climate change.
Almost all of the dozens of people killed by Ian in hardest hit Lee County were 50 or older, with many in their 70s, 80s and even 90s. That’s highlighted the rising dangers for those least likely to be able to flee such disasters and those most likely to be impacted by the aftermath.
Climate change makes hurricanes wetter and more powerful, but it also increases the frequency of heat waves like ones that scorched the Pacific Northwest the last two summers, killing scores of mostly aged people. It’s also intensified drought fueled wildfires like the inferno that incinerated the California town of Paradise in 2018, killing 85 people, again mostly older.
“It’s not terribly surprising that physically frail, socially isolated people are the most likely to die in these events. But it is politically significant,” said New York University sociology professor Eric Klinenberg. “If we know people are at risk, why aren’t we doing more to help them?”
Klinenberg, who wrote the book “Heat Wave: A Social Autopsy of Disaster in Chicago” about extreme heat that killed more than 700 mostly older and Black people in July 1991, called Ian a mere preview.
“We saw this happen in Chicago, in (Hurricane) Katrina, in (Superstorm) Sandy, and we are going to see more and more as the globe becomes increasingly hotter,” he said.
Florida in particular will feel the increased impact of climate-fueled disasters, sitting in the path of many Atlantic storms and with a large share of retirees drawn by warm weather, a vast coastline and relatively cheap housing. About 29% of Lee County’s population is 65 and older.
One of the more dramatic stories of Ian demonstrates the risks. Johnny Lauder’s 86-year-old mother Karen Lauder, who uses a wheelchair, initially refused to evacuate. But as the water inside her home began to rise nearly above her head, she was unable to flee and her son had to come rescue her in an ordeal he documented.
The extreme dangers some face when they lose power was especially clear in Lee County, where an 89-year-old man died after the electricity he needed for his oxygen went out and then his backup generator failed.
Florida has attempted to address some of these issues by setting up shelters where people with health conditions that require electricity for oxygen, dialysis and devices like ventilators can preregister to stay.
AARP Florida Director Jeff Johnson praised the special shelters, saying the state’s county emergency management agencies had modernized and improved evacuation operations the past two decades.
“There is room for improvement, but it would be wrong to say they aren’t doing anything,” he said.
Home-based networks that deliver care and services to older people, as well as neighborhood associations and faith communities can also help by checking on socially isolated older people, Johnson said.
Several hurricane survivors sat in wheelchairs Thursday outside one special shelter set up at an elementary school in Fort Myers.
Merrill Bauchert, 60, was staying there because Ian destroyed his home and he needs electricity for the CPAP machine he uses for severe sleep apnea.
Bauchert said dozens of residents from a senior living facility were staying there, many of them with mobility problems or dependent on electrical medical devices to stay alive.
Large oxygen tanks were used at first for people with breathing problems, he said, but those were later replaced with mechanical oxygen generators for individual use. Conditions have improved with restored water service, but the early days were tough, Bauchert said.
With many people too frail to go outside and no sewer service inside, using the restroom involved putting a plastic bag in a toilet and sitting down, sometimes with help.
“You were actually doing your business in a trash bag. Take the trash bag, tie it in a knot, throw it in the trash can and put another bag in for the next person,” he said.
Gov. Ron DeSantis has recognized the disproportionate effect Ian had on the state’s older residents, and the need for local groups to help their recovery.
“It hit in areas that have a lot of elderly residents, and I’ve met a lot of the folks,” DeSantis said at a news conference Thursday. “So you’re somebody who’s maybe 85 years old. You may not be able to do the same home repair that you used to be able to do when you were younger.”
While the death toll of over 100 and property damage from Ian was catastrophic, Hurricane Katrina caused far more deaths and destruction in August 2005.
Researchers have concluded that nearly half of those killed by Katrina in Louisiana were 75 or older. A 2006 Senate Committee report noted a failure by all levels of government to effectively evacuate thousands of older, sick and disabled people from New Orleans as neighbors with cars fled the city.
Older people are also at risk from heat in the days and weeks after major storms.
After Hurricane Ida slammed Louisiana in 2021, of nine New Orleans residents killed by heat and 10 for whom heat was a contributing cause of death, only four — two in each group — were under the age of 60, according to information provided by the Orleans Parish Coroner’s Office.
The aftereffects of Hurricane Irma in 2017 took an especially large toll. The direct impacts of the storm killed more than 90 people in the U.S., but researchers at the University of South Florida and Brown University found 433 additional residents at Florida nursing homes died within 90 days of the storm, compared to the same period in 2015, when there were no hurricanes.
The study was prompted by the heat-related deaths of 12 residents at a Broward County nursing home that occurred when the storm knocked out air conditioning and staff didn’t move them to another facility. An administrator and three nurses were later charged.
Klinenberg, the sociologist who wrote about the Chicago heat deaths, said the fault lies in in how society cares for its elders not only during disasters, but daily.
“We live in an aging society and in a way we are victims of our own success,” he said. “Europe has the same problem. Also Japan and Korea. People are living decades longer because of medical science, but we don’t know how to care for them.”
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Snow reported from Phoenix. Janet McConnaughey in New Orleans contributed reporting.
Total Doses Distributed = 863,234,395. Total Doses Administered = 624,198,981. Number of People Receiving 1 or More Doses = 264,562,221. Number of People Fully Vaccinated = 225,870,613.
In California’s capital, massive tent encampments have risen along the American River and highway overpasses have become havens for homeless people, whose numbers have jumped a staggering nearly 70% over two years.
Among the 9,300 without a home is Eric Santos, who lost his job at a brewery and was evicted from his apartment in July. Now he carries a list of places where free meals are available and a bucket to mix soap and water to wash his hands, and to sit on.
“The bucket is part of my life now,” the 42-year-old said, calling it his version of Wilson, the volleyball that becomes Tom Hanks’ companion in the film “Castaway.”
Cities big and small around the country are facing a similar experience to Sacramento.
Fueled by a long-running housing shortage, rising rent prices and the economic hangover from the pandemic, the overall number of homeless in a federal government report to be released in coming months is expected to be higher than the 580,000 unhoused before the coronavirus outbreak, the National Alliance to End Homelessness said.
The Associated Press tallied results from city-by-city surveys conducted earlier this year and found the number of people without homes is up overall compared with 2020 in areas reporting results so far.
Some of the biggest increases are in West Coast cities such as Sacramento and Portland, Oregon, where growing homelessness has become a humanitarian crisis and political football over the past decade. Numbers are also up about 30% in South Dakota and Prince George’s County, Maryland, and 15% in Asheville, North Carolina.
The data comes from the Point in Time counts the federal government requires communities to conduct to reflect how many people are without homes on a given winter night. The counts usually rely on volunteer census-takers and are always imprecise. This year’s tallies were conducted amid the pandemic and advocates caution changed counting methods could have thrown off results.
Research has shown places seeing spikes in homelessness often lack affordable housing. Making matters worse, pandemic government relief programs — including anti-eviction measures, emergency rental assistance and a child tax credit that kept people housed who may have been on the streets otherwise — are ending.
Donald Whitehead Jr., executive director of the National Coalition for the Homeless, said the counts are generally rising more where housing costs are jumping the fastest — but the government’s response makes a difference, too.
Some communities where numbers are down, he said, “are really looking at housing people versus criminalizing people and putting them in encampments.”
In Sacramento, where rents are soaring and officials disagree on how best to deal with the problem, homelessness has jumped 68% from 2020 to 2022 — the most among larger cities reporting results so far.
The surge has been driven in part by the city’s legacy of being more affordable than other California cities, which has attracted new residents, overwhelming the housing market. People moving out of the San Francisco Bay Area, 90 miles (145 kilometers) to the southwest, have flooded Sacramento with more potential homeowners and renters, driving up prices.
A Zillow analysis found the average rent in July was $2,300 — a 28% increase since July 2019, before the pandemic began. Sacramento County’s median income was about $70,000 in 2020, according to the U.S. Census Bureau.
The crisis has deepened even as things have improved in other California cities that have contended for years with homelessness. Sacramento’s efforts to address the problem have been marred by years of squabbles between the city and county governments.
Sacramento Mayor Darrell Steinberg has made reducing homelessness a priority since taking office in 2017. The city now has more than 900 beds in shelters and motels, compared to about 100 five years ago and has moved to ban single-family zoning, a move that could make it easier to build more housing.
But so far, it hasn’t been enough.
“People are becoming homeless much faster than we are getting them off the street,” Steinberg told the AP.
Santos is among them. He’s been able to sign up for food assistance but is still on a waiting list to access other benefits, he said. Each night he hunts for a park bench that feels safe to sleep on. When he lost a suitcase to broken wheels, he got rid of some of his warmer clothing, a decision he regrets as the fall evenings get colder.
“Luckily I’ve been able to keep afloat with what I have,” he said.
Steinberg has advocated for adopting a legal right to shelter and a legal obligation for people to accept it when offered. The approach has drawn some criticism from advocates who say it’s just a means of taking the problem out of the public eye without providing meaningful help for those who need it.
County officials voted in August to ban camping along Sacramento’s American River Parkway, with a misdemeanor charge for people who don’t comply. City voters will decide in November on a ballot measure requiring the city to open hundreds more shelter beds. But it would only take effect if the county agrees to pony up money for mental health and substance abuse treatment.
Still, the rise in homelessness is not uniform across the country.
In Boston, the number of people sleeping on the streets and in shelters has dropped 25% over two years as advocates focused on finding permanent housing for those on the streets the longest.
In some cities, “housing first” policies intended to move the homeless into permanent homes have paid off. And while the pandemic brought economic chaos, an eviction moratorium, boosted unemployment payments and family tax credits prevented some people from becoming homeless at all.
Along with Boston, numbers have fallen by about 20% or more in Houston, Philadelphia and Washington, D.C. Even in California, homeless counts are down in San Francisco, and growth has slowed significantly in Los Angeles.
The numbers have also dropped in California’s Orange County, where there have been extensive efforts to remove encampments — though some advocates there question the accuracy of the count.
In Boston, Steven Hamilton moved into a new apartment in September after decades staying on a friend or relative’s couch or in a homeless shelter.
With the help of a program run by the Boston Medical Center, he was able to get a subsidized apartment in a public housing development. His portion of monthly rent is $281 — or about 30% of his Social Security payments.
“I’m grateful,” he said. “I am not looking to move nowhere else. I am going to stay here until eternity. I lost a lot of stuff. I’m not going through that again.”
After what he called a “horrible nightmare” in a shelter with residents injecting drugs in the bathroom, the studio apartment has changed his outlook. He’s planning to get furniture, save money for a car and hopes to invite his family for Thanksgiving.
“I have a place I can call my own,” he said.
Hamilton’s studio apartment is the result of a Boston strategy whereby the city and area nonprofits use extensive outreach to get people who’ve been on the streets for over a year into apartments and then provide services such as drug treatment and life-skills training like budgeting with the help of case managers.
Since 2019, annual funding in Boston for homeless programs has jumped from $31 million to over $51 million.
Those efforts were bolstered last year by a city program that pulled together a list of homeless individuals to target for housing and other services. The city also moved to shut down one of its biggest homeless encampments, going tent-to-tent to assess the needs of those living there and referring more than 150 to shelters and other housing.
The efforts have not been seamless. There have been reports of a cleared-out tent city re-emerging. And family homelessness numbers, though down from 2020, have ticked up in the past year.
Still, the city has been able to reduce the numbers of homeless people to about 6,000, down 25% since 2020.
Boston’s shelters have become less crowded even as Zillow found the city’s average rent rose to $2,800 this summer — up 13% from three years earlier.
Housing advocates say prioritizing chronically homeless people ensures funds have the greatest impact, since the long-term homeless spend so much time in shelters. It also costs less to provide permanent housing than temporary shelter.
Lewis Lopez is among the success stories.
After cycling in and out of Boston shelters for several years, Lopez finally secured keys to his own apartment. No longer fearing his possessions would be stolen or he would get into fights over food, the 61-year-old felt he had finally gotten his life back.
“I felt so free, like a ton of bricks were lifted off my shoulders,” Lopez said of the studio apartment he has lived in for five years, paid for partly with federal funds.
“I felt like part of society again,” he said.
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Casey reported from Boston. Mulvihill reported from Cherry Hill, New Jersey. Kavish Harjai in Los Angeles contributed.
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Harjai is a corps members for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.
