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Michelina Moen lost her job and health insurance in April. Only weeks earlier she had begun to feel ill and not her usual energetic self — in what she describes as a textbook case of “really bad timing.”

The Orlando, Florida, resident sought treatment in May. After a series of tests, doctors told Moen she had a rare kidney condition that would require months of treatment.

“Losing the coverage ended up being worse than losing the job,” said Moen, 36, a dancer who had worked for both Walt Disney World and Universal Studios. “It was very stressful.”

Moen rushed to find replacement coverage. With help from a social service agency, she enrolled in a plan through healthcare.gov, the federal Affordable Care Act insurance marketplace. Because she and her husband, Brett, were not working — he had been laid off by Disney, too — they qualified for federal subsidies, so the coverage cost her just $35 a month. Most of her medical expenses, which involve traveling frequently to Jacksonville for specialty treatment, are covered.

Moen’s husband recently found a job, however, and the increase in the couple’s income likely means her subsidy will fall and she’ll have to pay more for health insurance. Moen said she’ll evaluate her options and may switch plans during this year’s ACA open enrollment period, which began Nov. 1 and ends Dec. 15 for coverage starting Jan. 1.

“A priority is to continue seeing my medical team in Jacksonville,” Moen said.

Moen is one of millions of Americans who have been dropped from their jobs and their employer-provided health insurance since March, when the coronavirus first ravaged the economy. Although no official tally exists, studies indicate that at least 10 million workers lost their insurance but that about two-thirds of them found alternative coverage — through a new job, Medicaid, a spouse’s or parent’s plan, or the ACA marketplaces.

That leaves at least 3 million people without coverage, the most added in a single year since accurate record-keeping began in 1968. And experts are worried that, as the virus continues to play havoc with the economy, new rounds of business closings and layoffs could add to that number.

Navigators Want More Resources

The unprecedented situation has health insurance counselors (called navigators), ACA marketplace staff members and insurers scrambling to assist a possible surge of people looking for health insurance during open enrollment.

For the 36 states that rely on the federal ACA enrollment platform — healthcare.gov — the Trump administration awarded grants totaling $10 million for marketing and outreach this year, the same level as in 2019. In 2016, the last year of the Obama administration, navigator grants totaled $63 million.

Many navigator organizations say they don’t have the resources from the federal government to do the job as they would like.

“I’m trying not to panic,” said Jodi Ray, executive director of Florida Covering Kids & Families. “We’ve seen substantially more people needing coverage and help in recent months compared to last year, and more are new to being uninsured.”

Ray said her team is booked with appointments well into November. But she bemoans the fact that she has a third of the counselors she had a few years ago — 50, compared with 150 — and only a tiny ad budget.

Like Ray, Jeremy Smith, program director at First Choice Services in Charleston, West Virginia, said his team is expecting “tens of thousands more people” needing help compared with last year — but no bigger budget to serve them. First Choice provides telephone-based enrollment assistance in West Virginia, New Hampshire, Iowa and Montana with a federal grant of $100,000 per state.

“We are talking to a lot more people who have had job-based coverage for years,” Smith said. “This is the first time they are having to find insurance elsewhere. They don’t know what to do or who to trust.”

In Wisconsin, the governor shifted $1 million into health insurance outreach, in part to make up for a lack of federal funds, said Allison Espeseth, managing director at Covering Wisconsin, the state’s navigator agency. She said the money will go to radio and TV spots, billboards, bus ads and small grants to community organizations.

“A lot of people who lost jobs and insurance didn’t know they could enroll before open enrollment, so we are hoping to see them now,” Espeseth said.

Toula Barber, 60, is happy to be among those who got clear and useful help. “I’m not that savvy with computers and figuring all this stuff out,” said Barber, who lives in Manchester, New Hampshire. After she lost her job as a waitress in August, Barber’s health insurance lapsed at the end of September. A First Choice Services navigator helped her find a plan with coverage that started Oct. 1. She pays $200 a month after subsidies.

Because that plan has a $6,000 deductible, however, Barber said she would look for something better during open enrollment, in consultation with the same navigator.

An analysis published last summer found evidence of a shortage of enrollment assistance. It also pointed out that people who turned to insurance brokers rather than independent navigators for help sometimes were presented with the option of plans (such as short-term policies or cancer-only policies) that don’t meet ACA standards.

“The bottom line was that nearly 5 million people who sought help during the last open enrollment could not find it,” said Karen Pollitz, a senior fellow at KFF and one of the authors of the study. “I’m concerned that people will face barriers to finding help this year, too.”

Some States Are Pushing Harder

In contrast to the states that use the federal website, healthcare.gov, many of the 15 states that run their own ACA marketplaces are committing more resources to outreach and marketing this year to meet the higher demand.

“We market aggressively,” said Peter Lee, executive director of Covered California, that state’s marketplace. “We want everyone who needs coverage to get it.” Of Covered California’s $440 million budget this year, Lee said $140 million will go for marketing and outreach. In addition, California is inserting information about the marketplace and subsidized coverage in all unemployment checks.

Just short of 300,000 Californians have enrolled since the pandemic began, and about half did so because they lost employment-based coverage, said Lee.

At the same time, however, about 1 in 4 Covered California enrollees dropped out this year, higher than the normal turnover as some newly qualified for Medicaid and an unknown number could no longer afford the premiums. Still, enrollment was at an all-time high of 1.5 million as of June.

In New York, state officials and private groups have been helping people enroll in Medicaid, marketplace plans or other state-supported programs.

“We’ve been super busy since April,” said Elizabeth Benjamin, vice president of health initiatives at the Community Service Society of New York, an independent advocacy group for low-income residents. “Our governor prioritized this, so it’s going well.”

One challenge Benjamin noted are the fears that a case currently before the Supreme Court might overturn the law. “Our clients keep asking whether the ACA will still be around next year,” she said. “We reassure them it will.”

Madeline McGrath, 27, sought insurance help from the service society in May after her coverage through the Peace Corps expired. The corps laid off all its overseas staff in March. Madeline was in Moldova. She returned home to Chazy, New York. She qualified for Medicaid, and just in the nick of time: A few weeks earlier, she had been diagnosed with Crohn’s disease, a chronic digestive disorder.

“I’ll stick with Medicaid since my co-payments are very low,” said McGrath, who is pursuing a graduate degree.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Nursing homes are still taking days to get back COVID-19 test results as many shun the Trump administration’s central strategy to limit the spread of the virus among old and sick Americans.

In late summer, federal officials began distributing to nursing homes millions of point-of-care antigen tests, which can be given on-site and report the presence or absence of the virus within minutes. By January, the Department of Health and Human Services is slated to send roughly 23 million rapid tests.

But as of Oct. 25, 38% of the nation’s roughly 15,000 nursing homes have yet to use a point-of-care test, a KHN analysis of nursing home records shows.

The numbers suggest a basic disagreement among the Trump administration, state health officials and nursing home administrators over the best way to test this population and how to strike the right balance between speed and accuracy. Many nursing homes still primarily send samples out to laboratories, using a type of test that’s considered more reliable but can take days to deliver results.

As a result, in 29% of the approximately 13,000 facilities that provided their testing speed to the government, results for residents took an average of three days or more, the analysis found. Just 17% of nursing homes reported their average turnaround time was less than a day, and the remainder tended to get results in one or two days. Wait times for test results of staff members were similar.

Those lags could have devastating consequences, because even one undetected infection can quietly but rapidly trigger a broad outbreak. It’s especially concerning as winter sets in and the pandemic notches daily records of infections.

In the meantime, the coronavirus continues its march through institutions. Nursing homes have reported more than 262,000 infections and 59,000 deaths since the government began collecting the information in May. Even without estimating how many residents died from COVID-19 before then, reported nursing home deaths amount to more than a quarter of all COVID-19 fatalities in the U.S. so far.

During the week ending Oct. 25, the most recent period for which data is available, a third of skilled nursing facilities reported a new suspected or confirmed coronavirus infection of a resident or staff member.

Many state public health authorities and nursing homes have ongoing reservations about the rapid tests. They are considered less accurate than the more expensive ones sent out to laboratories, which are known as polymerase chain reaction, or PCR, tests and identify the virus’s genetic material but often take days to complete. And their manufacturers say the rapid tests are designed for people with symptoms — not for screening a general population.

In early November, the Food and Drug Administration warned of false positive results — where someone is told incorrectly they are infected — associated with one type of rapid COVID test, and urged providers to follow Centers for Disease Control and Prevention recommendations for using them in nursing homes. False negatives are also a concern because people who don’t know they are infected can unwittingly spread the virus.

HHS bought millions of rapid tests to distribute to nursing homes as the federal government imposed new mandates for the facilities to test staffers at least once a month. Routine staff testing increases to as often as twice a week for homes in areas with the highest infection rates. The Centers for Medicare & Medicaid Services, which is part of HHS, does not recommend testing asymptomatic residents unless a new outbreak occurs or a resident routinely goes outside the facility.

Leaders in multiple states, including Nevada, Vermont and Illinois, have moved to ban antigen tests in nursing homes or limit their use.

“I thought the hard part was getting the testing to the different facilities,” said David Grabowski, a health care policy professor at Harvard Medical School. Instead, he said, “The major barriers to the use of rapid testing seem to be a lack of guidance on when and how to use the tests, coupled with concerns about their accuracy.”

Dr. Michael Wasserman, immediate past president of the California Association of Long Term Care Medicine, said the national effort has been chaotic and inadequate.

The federal government “just hands stuff off to nursing homes and then says, ‘Hey, it’s yours; go use it,’” he said. “And then when things fall apart, ‘We’re not to blame.’”

Nursing homes that don’t trust the rapid tests are having to shoulder the higher cost of lab tests. It costs Stuart Almer, president and CEO of Gurwin Jewish Nursing & Rehabilitation Center on New York’s Long Island, $125,000 a week to conduct lab tests on up to 1,500 residents and staff members.

“We embrace the testing,” Almer said. “But how are we supposed to continue operating and paying for this?”

Goodwin House in Virginia, which includes skilled nursing and assisted living facilities, had performed more than 9,500 tests for COVID-19 as of late October, said Joshua Bagley, an administrator. Only 100 of them were antigen tests. “The majority of our focus is still toward the PCR testing,” Bagley said.

The concerns of state health officials were perhaps most evident in Nevada, where in early October the state banned antigen testing in nursing homes. HHS said the order was illegal, and it was revoked within days.

“There is no such thing as a perfect test,” Adm. Brett Giroir, a senior HHS official who leads the Trump administration’s COVID testing efforts, said on a call with reporters Nov. 9. For example, Giroir said, a risk of PCR tests is that they could provide a positive diagnosis when a person is no longer “actually infectious.”

Although there have been widespread accuracy concerns over antigen tests, certain tests the administration is distributing nationwide have comparable accuracy to lab-based tests, he said.

Other state responses have not been as aggressive as Nevada’s but nonetheless demonstrated unease over how best to use the devices, if at all.

Vermont recommends the use of antigen tests after a known COVID exposure but says they should not be used to diagnose asymptomatic people.

Ohio was initially reluctant to deploy them after Republican Gov. Mike DeWine’s false positive result from an antigen device, although the tests have since been adopted, said Peter Van Runkle, executive director of the Ohio Health Care Association, which represents some  skilled nursing facilities in the state.

Some nursing homes say relying on antigen tests has made a monumental difference. In Hutchinson, Kansas, Wesley Towers Retirement Community has used both types of tests, but it was Abbott’s BinaxNOW antigen test that detected its first two asymptomatic people with COVID-19, said Gretchen Sapp, Wesley Towers’ vice president of health services.

“We have more confidence that our staff are indeed COVID free or that they are out and not exposing residents. And that is incredibly helpful,” Sapp said. “The biggest challenge is I need more tests.”

A total of 1,150 homes told the federal government they did not have enough supplies for point-of-care tests for all workers, the KHN analysis found. Nursing homes can go through millions of tests quickly when testing monthly or more often, depending on the level of COVID-19 in the area.

White House spokesperson Michael Bars said the administration is working “hand-in-hand with our state and local partners” and “doing more than ever to protect the health and safety of high-risk age groups most susceptible to the virus.”

Janet Snipes, executive director of Holly Heights Care Center in Denver, said antigen tests have been useful to screen staff members despite a few false-positive results. One test was used on a clergy member a resident had summoned.

“We wouldn’t have been able to allow him in, but we were able to do the antigen testing,” she said. “With the vulnerable residents we serve, we’re hoping for more antigen testing, more testing period, more testing of any type.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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For decades, people struggling with illnesses of all kinds have sought help in online support groups. This year, such groups have been in high demand for COVID-19 patients, who often must recover in isolation.

But the fear and uncertainty regarding the coronavirus have made online groups targets for the spread of false information. And to help fellow patients, some of these groups are making it a mission to stamp out misinformation.

Shortly after Matthew Long-Middleton got sick on March 12, he joined a COVID-19 support group run by an organization called Body Politic on the messaging platform Slack.

“I had no idea where this road leads, and so I was looking for support and other theories and some places where people were going through a similar thing, including the uncertainty,” said Long-Middleton, 36, an avid cyclist who lives in Kansas City, Missouri. His illness started with chest discomfort, then muscle weakness, high fever, loss of appetite and digestive problems. In addition to all the physical symptoms, the mystery weighed on him, making him feel like he and other patients “have to figure this out for ourselves.”

But with the support came misinformation. Group members reported taking massive amounts of vitamins — including vitamin D, which can be harmful in excess — or trying other home remedies not backed by science.

Experts warned that such false or unverified information spread on online support groups can not only mislead patients, but also potentially undermine trust in science and medicine in general.

“Even if we’re not actively seeking information, we encounter these kinds of messages on social media, and because of this repeated exposure, there’s more likelihood that it’s going to seep into our thinking and perhaps even change the way that we view certain issues, even if there’s no real merit or credibility,” said Elizabeth Glowacki, a health communication researcher at Northeastern University.

In an effort to help fellow COVID-19 sufferers, some patients, like Vanessa Cruz, spend most of their days fact-checking their online support groups.

“It’s really become like a second family to me, and being able to help everybody is a positive thing that comes out of all this negativity we’re experiencing right now,” Cruz said.

Cruz, a 43-year-old mother of two, moderates the Facebook COVID-19 support group called “have it/had it” from her home in the Chicago suburbs. She’s also a “long-hauler” who has been dealing with COVID-19 symptoms, including fatigue, fever and confusion, since March.

The worldwide group has more than 30,000 members and has recently been buzzing with reports from India about treating COVID-19 with a common tapeworm medication (it’s not FDA-approved and there’s little evidence it works) — as well as speculation about President Donald Trump’s recent diagnosis.

Other troubling posts include people pushing hydroxychloroquine, which has not been proved effective in treating COVID-19, and sharing the viral video “America’s Frontline Doctors,” which promotes other unproven treatments and spreads conspiracy theories.

Cruz said supporting fellow patients can be a tricky balance of getting the facts right but also giving people who are scared the chance to be heard.

“It’s like you really don’t know what to question, what to ask for, how to reach for help,” Cruz said. “Instead of doing that, they just write up their story, basically, and they share it with everybody.”

To keep the group evidence-based, it has built up a 17-person fact-checking team, which includes two nurses and a biologist. Someone on the team reviews every post that goes up.

However, many online COVID-19 groups don’t have the resources or strategy to address misinformation.

Mel Montano, a 32-year-old writing instructor who lives in New York and has also felt sick since March, said she left a large Facebook support group because she was frustrated by the conspiracy theories that filled its posts.

“All of these conflicting theories completely took away from the focal point of it,” Montano said. “It was a mess.”

Montano is now a moderator of the Body Politic group on Slack.

Facebook and Twitter have made changes in their approaches toward COVID-19 misinformation, including additional fact-checking, removing posts that contain falsehoods and removing users or groups that spread them.

However, critics say more changes are needed.

Fadi Quran, director of campaigns for Avaaz, a human rights group that focuses on disinformation campaigns, said Facebook needs to revise the way it prioritizes content.

“Facebook’s algorithm prefers misinformation, prefers the sensational stuff that’s going to get clicks and likes and make people angry,” Quran said. “And so the misinformation actors, because of Facebook, will always have the upper hand.”

A study by Avaaz showed that misinformation and disinformation had been viewed on Facebook four times as often as information from official health groups, like the World Health Organization.

Facebook did not respond to inquiries for this story.

COVID-19 patient Long-Middleton thinks the problem goes deeper than getting the data right. He said a lot of bad information is spread because patients so badly want to find ways to feel better.

After nearly six months of symptoms, Long-Middleton said he’s returned to better health in the past month, though he continues to check in on fellow support group members who are still struggling.

He never tried risky treatments discussed in the group himself, but he understands why someone might.

“You want to find hope, but you don’t want the hope to lead you down a path that hurts you,” he said.

This story is part of a partnership that includes KCUR, NPR and Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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When KHN Editor-in-Chief Elisabeth Rosenthal heard a sample of the voices that correspondent Sarah Jane Tribble brought back from her reporting trip to rural Kansas, Rosenthal said she knew the story needed to be told through audio.

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That’s the genesis for “No Mercy,” season one of the podcast “Where It Hurts.” The series documents the fallout after Mery Hospital closed in Fort Scott, Kansas.

Rosenthal and Tribble were featured on the latest episode of Crooked Media’s “America Dissected: Coronavirus.”

“When a rural hospital shuts down, it’s much more than health care that’s lost. It was really pulling the fabric of this town apart economically and socially,” Rosenthal said.

Fort Scott is a town of about 8,000, and more than 200 people — from janitorial staff to physicians — lost their jobs when the hospital closed.

“The trickle-down effect of a major anchor institution in a rural community closing is not just from the hospital jobs but from all the jobs supporting the hospital,” said Tribble, who grew up in southeastern Kansas and is the host of “No Mercy.”

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The coronavirus pandemic is an added stress for rural hospitals, she said.

“COVID, despite what Donald Trump has said, is not a good moneymaker. It is a money loser for hospitals,” Rosenthal said. “If you’re teetering on the edge, as these hospitals were, a massive pandemic that requires a lot of high-intensity care, that will not get reimbursed that well, is going to push you over the edge.”

Pfizer’s announcement on Monday that its COVID-19 shot appears to keep nine in 10 people from getting the disease sent its stock price rocketing. Many news reports described the vaccine as if it were our deliverance from the pandemic, even though few details were released.

There was certainly something to crow about: Pfizer’s vaccine consists of genetic material called mRNA encased in tiny particles that shuttle it into our cells. From there, it stimulates the immune system to make antibodies that protect against the virus. A similar strategy is employed in other leading COVID-19 vaccine candidates. If mRNA vaccines can protect against COVID-19 and, presumably, other infectious diseases, it will be a momentous piece of news.

“This is a truly historic first,” said Dr. Michael Watson, the former president of Valera, a subsidiary of Moderna, which is currently running advanced trials of its own mRNA vaccine against COVID-19. “We now have a whole new class of vaccines in our hands.”

But historically, important scientific announcements about vaccines are made through peer-reviewed medical research papers that have undergone extensive scrutiny about study design, results and assumptions, not through company press releases.

So did Pfizer’s stock deserve its double-digit percentage bump? The answers to the following five questions will help us know.

1. How long will the vaccine protect patients?

Pfizer says that, as of last week, 94 people out of about 40,000 in the trial had gotten ill with COVID-19. While it didn’t say exactly how many of the sick had been vaccinated, the 90% efficacy figure suggests it was a very small number. The Pfizer announcement covers people who got two shots between July and October. But it doesn’t indicate how long protection will last or how often people might need boosters.

“It’s a reasonable bet, but still a gamble that protection for two or three months is similar to six months or a year,” said Dr. Paul Offit, a member of the Food and Drug Administration panel that is likely to review the vaccine for approval in December. Normally, vaccines aren’t licensed until they show they can protect for a year or two.

The company did not release any safety information. To date, no serious side effects have been revealed, and most tend to occur within six weeks of vaccination. But scientists will have to keep an eye out for rare effects such as immune enhancement, a severe illness brought on by a virus’s interaction with immune particles in some vaccinated persons, said Dr. Walt Orenstein, a professor of medicine at Emory University and former director of the immunization program at the Centers for Disease Control and Prevention.

2. Will it protect the most vulnerable?

Pfizer did not disclose what percentage of its trial volunteers are in the groups most likely to be hospitalized or to die of COVID-19 — including people 65 and older and those with diabetes or obesity. This is a key point because many vaccines, particularly for influenza, may fail to protect the elderly though they protect younger people. “How representative are those 94 people of the overall population, especially those most at risk?” asked Orenstein.

Both the National Academy of Medicine and the CDC have urged that older people be among the first groups to receive vaccines. It’s possible that vaccines under development by Novavax and Sanofi, which are likely to begin late-phase clinical trials later this year, may be better for the elderly, Offit noted. Those vaccines contain immune-stimulating particles like the ones contained in the Shingrix vaccine, which is highly effective in protecting older people against shingles disease.

3. Can it be rolled out effectively?

The Pfizer vaccine, unlike others in late-stage testing, must be kept supercooled, on dry ice around 100 degrees below zero, from the time it is produced until a few days before it is injected. The mRNA quickly self-destructs at higher temperatures. Pfizer has devised an elaborate system to transport the vaccine by truck and specially designed cases to vaccination sites. Public health workers are being trained to handle the vaccine as we speak, but we don’t know for sure how well it will do if containers are left out in the Arizona sun too long. Mishandling the vaccine along the way from factory to patient would render it ineffective, so people who received it could think they were protected when they were not, Offit said.

4. Could a premature announcement hurt future vaccines?

There’s presently no way to know whether the Pfizer vaccine will be the best overall or for specific age groups. But if the FDA approves it quickly, that could make it harder for manufacturers of other vaccines to carry out their studies. If people are aware that an effective vaccine exists, they may decline to enter clinical trials, partly out of concern they could get a placebo and remain unprotected. Indeed, it may be unethical to use a placebo in such trials. Many vaccines will be needed in order to meet global demand for protection against COVID-19, so it’s crucial to continue additional studies.

5. Could the Pfizer study expedite future vaccines?

Scientists are vitally interested in whether the small number who received the real vaccine but still got sick produced lower levels of antibodies than the vaccinated individuals who remained well. Blood studies of those people would help scientists learn whether there is a “correlate of protection” for COVID-19 — a level of antibodies that can predict whether someone is protected from the disease. If they had that knowledge, public health officials could determine whether other vaccines under production were effective without necessarily having to test them on tens of thousands of people.

But it’s difficult to build such road maps. Scientists have never established correlates of immunity for pertussis, for example, although vaccines have been used against those bacteria for nearly a century.

Still, this is good news, said Dr. Joshua Sharfstein, a vice dean at the Johns Hopkins Bloomberg School of Public Health and a former FDA deputy commissioner. He said: “I hope this makes people realize that we’re not stuck in this situation forever. There’s hope coming, whether it’s this vaccine or another.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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El anuncio de Pfizer de que su vacuna contra COVID-19 prevendría que nueve de cada 10 personas contraigan la enfermedad hizo que el precio de sus acciones se disparara. Muchos titulares describieron a la vacuna como si fuera la liberación de la pandemia, aunque se dieron pocos detalles.

Ciertamente hay para presumir: la vacuna de Pfizer consiste en material genético llamado ARNm encerrado en partículas diminutas que lo transportan a las células. Desde allí, estimula al sistema inmune para que produzca anticuerpos que protejan contra el virus.

Se emplea una estrategia similar en otras potenciales vacunas contra COVID-19 que lideran esta carrera. Si las vacunas de ARNm pueden proteger contra el virus y, presumiblemente, otras enfermedades infecciosas, será una noticia trascendental.

“Esta es una novedad verdaderamente histórica”, dijo el doctor Michael Watson, ex presidente de Valera, una subsidiaria de Moderna que actualmente está realizando ensayos avanzados de su propia vacuna de ARNm contra COVID-19. “Tenemos una nueva clase de vacunas en nuestras manos”.

Pero históricamente, los anuncios científicos importantes sobre vacunas se realizan a través de artículos de investigación médica revisados ​​por colegas, que han sido objeto de un escrutinio exhaustivo desde el diseño del estudio hasta sus resultados, no a través de comunicados de prensa de la farmacéutica.

Entonces, ¿merecían las acciones de Pfizer su aumento porcentual de dos dígitos? Las respuestas a las siguientes cinco preguntas nos ayudarán a saberlo.

1. ¿Cuánto tiempo protegerá la vacuna a los pacientes?

Pfizer dice que, hasta la semana del 2 de noviembre, 94 personas de las aproximadamente 40,000 en el ensayo habían desarrollado COVID-19. Si bien no dijeron exactamente cuántos de los enfermos se habían vacunado, la cifra de eficacia del 90% sugiere que fue un número muy pequeño.

El anuncio de Pfizer cubre a las personas que recibieron dos vacunas entre julio y octubre. Pero no indica cuánto tiempo durará la protección o con qué frecuencia se pueden necesitar refuerzos.

“Es una apuesta razonable, pero sigue siendo una apuesta decir que la protección durante dos o tres meses es similar a seis meses o un año”, dijo el doctor Paul Offit, miembro del panel de la Administración de Alimentos y Medicamentos (FDA) que probablemente revisará la vacuna para su aprobación en diciembre.

Normalmente, las vacunas no reciben una licencia hasta que demuestran que pueden proteger por uno o dos años.

La empresa no dio a conocer ninguna información de seguridad. Hasta la fecha, no se han revelado efectos secundarios graves, y la mayoría tiende a ocurrir dentro de las seis semanas posteriores a la vacunación.

Pero los científicos deberán estar atentos a efectos raros como una reacción adversa del sistema inmune o alguna enfermedad grave en personas vacunadas, dijo el doctor Walt Orenstein, profesor de medicina en la Universidad Emory y ex director del programa de inmunización de los Centros para el Control y Prevención de Enfermedades (CDC).

1. ¿Protegerá a los más vulnerables?

Pfizer no reveló qué porcentaje de los voluntarios del ensayo representan a los grupos con más probabilidades de ser hospitalizados o de morir por COVID-19, incluidas las personas de 65 años o más y las que padecen diabetes u obesidad.

Este es un punto clave porque muchas vacunas, particularmente las de la influenza, pueden no proteger a los adultos mayores, pero sí a los más jóvenes. “¿Cuán representativas son esas 94 personas de la población general, especialmente las que están en mayor riesgo?”, se preguntó Orenstein.

Tanto la Academia Nacional de Medicina como los CDC han instado a que las personas mayores estén entre los primeros grupos en recibir la vacuna. Es probable que las que están desarrollando Novavax y Sanofi, que probablemente comiencen los ensayos clínicos de fase 3 a finales de este año, sean mejores para los mayores, apuntó Offit. Esas vacunas contienen partículas inmunoestimulantes como las que tiene la vacuna Shingrix, que es muy eficaz para proteger a las personas mayores contra el herpes zóster o culebrilla.

1. ¿Se puede implementar con eficacia?

La vacuna de Pfizer, a diferencia de otras que están en la última fase de pruebas, debe mantenerse muy bien enfriada, en hielo seco a unos 100 grados bajo cero, desde el momento en que se produce hasta unos días antes de que se inyecte. El ARNm se autodestruye rápidamente a temperaturas más altas.

Pfizer pondrá en marcha un elaborado sistema para transportar la vacuna a los sitios de vacunación en camiones y cajas especialmente diseñadas. Ya se está capacitando a trabajadores de salud para manejar la vacuna, pero no se sabe con certeza qué tan bien funcionará si los frascos con las dosis se dejan bajo el sol de Arizona por mucho tiempo.

Un mal manejo de la vacuna en el camino de la fábrica al paciente la volvería ineficaz, por lo que las personas que la reciban podrían pensar que están protegidas cuando no lo están, explicó Offit.

1. ¿Un anuncio prematuro podría dañar las futuras vacunas?

Actualmente no hay forma de saber si la vacuna de Pfizer será la mejor en general, o para grupos de edad específicos. Pero si la FDA la aprueba rápidamente, eso podría dificultar que los fabricantes de otras vacunas realicen sus estudios. Si las personas saben que existe una vacuna eficaz, es posible que no quieran participar en ensayos clínicos, en parte debido a la preocupación de que puedan recibir un placebo y no estar protegidas. De hecho, puede ser poco ético usar un placebo en tales ensayos.

Pero se necesitarán muchas vacunas para satisfacer la demanda mundial de protección contra COVID-19, por lo que es crucial continuar con estudios adicionales.

1. ¿Podría el estudio de Pfizer acelerar futuras vacunas?

Los científicos están sumamente interesados ​​en saber si el pequeño número que recibió la vacuna real pero que se enfermó produjo niveles más bajos de anticuerpos que los individuos vacunados que se mantuvieron sanos. Los estudios de sangre de esas personas ayudarían a los científicos a saber si existe un “correlato de protección” para COVID-19, un nivel de anticuerpos que puede predecir si alguien está protegido contra la enfermedad.

Si tuvieran ese conocimiento, los funcionarios de salud pública podrían determinar si otras vacunas en producción serían efectivas sin tener que probarlas necesariamente en decenas de miles de personas.

Pero es algo difícil de hacer. Los científicos nunca han establecido correlaciones de inmunidad para la tos ferina, por ejemplo, aunque se han usado vacunas contra esas bacterias durante casi un siglo.

Aún así, ésta es una buena noticia, dijo el doctor Joshua Sharfstein, vicedecano de la Escuela de Salud Pública Bloomber de Johns Hopkins y ex comisionado adjunto de la FDA. “Espero que esto haga que la gente se dé cuenta de que no estamos atrapados en esta situación para siempre. Hay esperanza, ya sea con esta vacuna o con otra”, dijo.

Esta historia fue producida por Kaiser Health News, un programa editorial independiente de la Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Of his many plans to expand insurance coverage, President-elect Joe Biden’s simplest strategy is lowering the eligibility age for Medicare from 65 to 60.

But the plan is sure to face long odds, even if the Democrats can snag control of the Senate in January by winning two runoff elections in Georgia.

Republicans, who fought the creation of Medicare in the 1960s and typically oppose expanding government entitlement programs, are not the biggest obstacle. Instead, the nation’s hospitals, a powerful political force, are poised to derail any effort. Hospitals fear adding millions of people to Medicare will cost them billions of dollars in revenue.

“Hospitals certainly are not going to be happy with it,” said Jonathan Oberlander, professor of health policy and management at the University of North Carolina-Chapel Hill.

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Medicare reimbursement rates for patients admitted to hospitals average half what commercial or employer-sponsored insurance plans pay.

“It will be a huge lift [in Congress] as the realities of lower Medicare reimbursement rates will activate some powerful interests against this,” said Josh Archambault, a senior fellow with the conservative Foundation for Government Accountability.

Biden, who turns 78 this month, said his plan will help Americans who retire early and those who are unemployed or can’t find jobs with health benefits.

“It reflects the reality that, even after the current crisis ends, older Americans are likely to find it difficult to secure jobs,” Biden wrote in April.

Lowering the Medicare eligibility age is popular. About 85% of Democrats and 69% of Republicans favor allowing those as young as 50 to buy into Medicare, according to a KFF tracking poll from January 2019. (KHN is an editorially independent program of KFF.)

Although opposition from the hospital industry is expected to be fierce, that is not the only obstacle to Biden’s plan.

Critics, especially Republicans on Capitol Hill, will point to the nation’s $3 trillion budget deficit as well as the dim outlook for the Medicare Hospital Insurance Trust Fund. That fund is on track to reach insolvency in 2024. That means there won’t be enough money to fully pay hospitals and nursing homes for inpatient care for Medicare beneficiaries.

Moreover, it’s unclear whether expanding Medicare will fit on the Democrats’ crowded health agenda, which also includes dealing with the COVID-19 pandemic, possibly rescuing the Affordable Care Act if the Supreme Court strikes down part or all of the law in a current case, expanding Obamacare subsidies and lowering drug costs.

Biden’s proposal is a nod to the liberal wing of the Democratic Party, which has advocated for Sen. Bernie Sanders’ (I-Vt.) government-run “Medicare for All” health system that would provide universal coverage. Biden opposed that effort, saying the nation could not afford it. He wanted to retain the private health insurance system, which covers 180 million people.

To expand coverage, Biden has proposed two major initiatives. In addition to the Medicare eligibility change, he wants Congress to approve a government-run health plan that people could buy into instead of purchasing coverage from insurance companies on their own or through the Obamacare marketplaces. Insurers helped beat back this “public option” initiative in 2009 during the congressional debate over the ACA.

The appeal of lowering Medicare eligibility to help those without insurance lies with leveraging a popular government program that has low administrative costs.

“It is hard to find a reform idea that is more popular than opening up Medicare” to people as young as 60, Oberlander said. He said early retirees would like the concept, as would employers, who could save on their health costs as workers gravitate to Medicare.

The eligibility age has been set at 65 since Medicare was created in 1965 as part of President Lyndon Johnson’s Great Society reform package. It was designed to coincide with the age when people at that time qualified for Social Security. Today, people generally qualify for early, reduced Social Security benefits at age 62, though they have to wait until age 66 for full benefits.

While people can qualify on the basis of other criteria, such as having a disability or end-stage renal disease, 85% of the 57 million Medicare enrollees are in the program simply because they’re old enough.

Lowering the age to 60 could add as many as 23 million people to Medicare, according to an analysis by the consulting firm Avalere Health. It’s unclear, however, if everyone who would be eligible would sign up or if Biden would limit the expansion to the 1.7 million people in that age range who are uninsured and the 3.2 million who buy coverage on their own.

Avalere says 3.2 million people in that age group buy coverage on the individual market.

While the 60-to-65 group has the lowest uninsured rate (8%) among adults, it has the highest health costs and pays the highest rates for individual coverage, said Cristina Boccuti, director of health policy at West Health, a nonpartisan research group.

About 13 million of those between 60 and 65 have coverage through their employer, according to Avalere. While they would not have to drop coverage to join Medicare, they could possibly opt to also pay to join the federal program and use it as a wraparound for their existing coverage. Medicare might then pick up costs for some services that the consumers would have to shoulder out-of-pocket.

Some 4 million people between 60 and 65 are enrolled in Medicaid, the state-federal health insurance program for low-income people. Shifting them to Medicare would make that their primary health insurer, a move that would save states money since they split Medicaid costs with the federal government.

Chris Pope, a senior fellow with the conservative Manhattan Institute, said getting health industry support, particularly from hospitals, will be vital for any health coverage expansion. “Hospitals are very aware about generous commercial rates being replaced by lower Medicare rates,” he said.

“Members of Congress, a lot of them are close to their hospitals and do not want to see them with a revenue hole,” he said.

President Barack Obama made a deal with the industry on the way to passing the ACA. In exchange for gaining millions of paying customers and lowering their uncompensated care by billions of dollars, the hospital industry agreed to give up future Medicare funds designed to help them cope with the uninsured. Showing the industry’s prowess on Capitol Hill, Congress has delayed those funding cuts for more than six years.

Jacob Hacker, a Yale University political scientist, noted that expanding Medicare would reduce the number of Americans who rely on employer-sponsored coverage. The pitfalls of the employer system were highlighted in 2020 as millions lost their jobs and workplace health coverage.

Even if they can win the two Georgia seats and take control of the Senate with the vice president breaking any ties, Democrats would be unlikely to pass major legislation without GOP support — unless they are willing to jettison the long-standing filibuster rule so they can pass most legislation with a simple 51-vote majority instead of 60 votes.

Hacker said that slim margin would make it difficult for Democrats to deal with many health issues all at once.

“Congress is not good at parallel processing,” Hacker said, referring to handling multiple priorities at the same time. “And the window is relatively short.”

Julie Rovner, chief Washington correspondent for KHN, participated in a discussion on KQED’s “Forum” about the arguments before the Supreme Court on Tuesday in a case that is challenging whether the Affordable Care Act is constitutional. You can hear the conversation and listeners’ questions here.

Can’t see the audio player? Click here to listen.

Family physician Maxwell Self is doing his same old job for a new employer. For two decades he was a doctor with Mercy Hospital. But when Mercy packed up and left, a federally qualified health center moved to town — into the hospital building itself — and hired Dr. Self.

The Community Health Center of Southeast Kansas does things differently.

“What CHC says really has teeth and they’re solid,” Self said. “There’s real follow-through. And I have a lot more, I feel like, freedom to take care of people the way I want to and to get them what they need.”

With nutrition counseling and mental health and addiction services, and even things like arranging rides for patients, the center offers people what they need to be healthy, clinic executives said — not only health care for when they’re sick.

In the final chapter of the podcast, we also meet Sherise Beckham, 31, who lost work as a dietitian at Mercy when the hospital closed — just as she was expecting her second child.

“Initially, I cried a lot because I would be losing my job as well as losing a place to have my baby,” Beckham said.

Beckham helps explain how much more difficult it can be to have a baby when a town loses full-service maternity care. Then, later when she gets a job at — where else? — the new CHC clinic, Beckham gives us a front-row seat to the new vision for health care in Fort Scott.

“Where It Hurts” is a podcast collaboration between KHN and St. Louis Public Radio. Season One extends the storytelling from Sarah Jane Tribble’s award-winning series, “No Mercy.”

Subscribe to Where It Hurts on iTunes, Stitcher, Google, Spotify or Pocket Casts.

And to hear all KHN podcasts, click here.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

SACRAMENTO — Of any state, California has the most to lose if the U.S. Supreme Court overturns the Affordable Care Act.

Health care coverage for millions of people is at stake, as are billions in federal dollars. Yet Democratic California leaders don’t have a plan to preserve the broad range of health care programs the state has adopted since it aggressively implemented Obamacare — including initiatives that go far beyond the federal health care law.

“We have made great strides and we don’t want to go back,” said Katie Heidorn, executive director of the nonprofit Insure the Uninsured Project. “This is real and we have to get our ducks in a row.”

The Supreme Court hears arguments Tuesday in the case, now known as California v. Texas. Texas and 18 Republican attorneys general, with backing from President Donald Trump and his administration, argue that Obamacare is unconstitutional because the law cannot stand without the tax penalty that accompanies the individual mandate, which is the requirement to have health coverage. The Republican-controlled Congress zeroed out the mandate’s tax penalty as part of the 2017 tax bill, which the Republican attorneys general say rendered both the mandate and the rest of the law unconstitutional.

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California Attorney General Xavier Becerra is leading the defense and says the law can stand without the mandate.

Legal experts predict the court is unlikely to rule until spring 2021, at the earliest. It could strike down the law entirely or keep parts of it, such as the ability for states to expand Medicaid to more adults, which has brought health insurance to roughly 12 million Americans. Or, the justices could preserve the law as is.

Even as legal experts say the addition of three Trump-nominated justices to the Supreme Court since the last time it weighed in on the law amounts to a legal wild card, Becerra is optimistic.

“We feel pretty confident that, as in the past, when the justices look to the fundamentals of the Affordable Care Act, they’re going to find that it is constitutional,” Becerra told California Healthline. “It would be near impossible right now to keep a state’s head above water without the Affordable Care Act.”

Democratic Gov. Gavin Newsom’s administration agreed the situation would be “catastrophic” for California if the law, or core parts of it, are overturned.

The state enthusiastically embraced Obamacare, and it gets more money than any other state under the law. It expanded its Medicaid program, called Medi-Cal, adding nearly 4 million enrollees as of June. It was the first to create a health insurance exchange, Covered California, which offers tax credits to help qualified Californians pay for coverage. Currently, about 1.5 million people are enrolled.

Since 2014, when the major provisions of the law took effect, California has cut its uninsured rate to historic lows — down to about 7% from 17% — and health insurance premiums for those buying coverage on the individual market are rising slower than before. The statewide average premiums for Covered California plans in 2020 and 2021 have increased less than 1%.

But if the court finds the law unconstitutional, about 5 million residents could lose health coverage, and the state stands to lose an estimated $27 billion in federal funds annually.

Of that, Medi-Cal would lose $20 billion and Covered California would lose nearly $7 billion, according to the state Department of Finance. Public health agencies, which also receive federal Obamacare funding, would also take a nearly $50 million hit.

California also offers much more than Obamacare provides, such as state subsidies to help low-income and middle-class families pay for their Covered California plans. It also covers full Medicaid benefits for unauthorized immigrants up to age 26. And as the Trump administration cut funding for outreach and enrollment, Covered California has continued to plow more money — $157 million this year — into such efforts.

Should Obamacare be struck down during a deepening financial and public health crisis, Newsom administration officials and lawmakers say California could not afford to continue its Medicaid expansion on its own. Millions of other low-income residents on Medi-Cal could face cuts to their benefits and insurance markets could be destabilized, sending insurance premiums soaring, state lawmakers warn.

And Covered California would be in peril, said Covered California Executive Director Peter Lee.

Lee told lawmakers in October that coming up with a replacement strategy would be a waste of time because the state couldn’t make up for such a monumental loss in funding.

“Talking about contingency plans is like talking about adding a few lifeboats to the Titanic,” he said. “We are not spending time on contingency plans, I’ll be really frank about that.”

Instead, Democratic lawmakers say they’d be forced to make painful health care cuts because, unlike the federal government, states can’t operate with budget deficits. And legislative leaders say they wouldn’t be able to finance the far more ambitious health care agenda they are eyeing under a Joe Biden-Kamala Harris administration.

“Peter Lee is right. I don’t know how we’d pivot and replace resources that should be coming to us from the federal government, because we’re in a budget crisis brought on by the pandemic,” Senate President Pro Tem Toni Atkins told California Healthline.

“We’ve gone from a $26 billion budget reserve and surplus in March to a $54 billion deficit, so this would put us in an impossible situation to continue to move forward creating more access from a health care perspective,” Atkins said.

Powerful lawmakers who lead the health committees in the state Senate and Assembly said they fear California would have to rescind programs approved just last year, including the state subsidies for low- and middle-income Californians.

To date, roughly 40,000 low- and middle-income people have benefited from those subsidies, expected to cost $240 million this year, according to Covered California.

Most likely, lawmakers said, the state would no longer be able to afford its 2019 expansion of Medi-Cal to unauthorized immigrants between ages 19 and 25, which is expected to cost roughly $100 million per year. About 75,000 unauthorized immigrants in that age group signed up for the program this year, according to the Department of Health Care Services.

California has codified other parts of Obamacare into state law that don’t require major state spending. These laws would preserve protections for some Californians should the federal law be invalidated.

For instance, state-regulated plans must cover dependents up to age 26, and this year Newsom approved laws prohibiting them from imposing annual or lifetime coverage limits. Also, state-regulated insurers are required to cover preventive care such as mammograms and vaccines.

But millions of Californians in plans regulated by the federal government would lose those protections.

“We’ve passed some bills that do a little patchwork, but it’s a fraction of what’s needed,” said state Sen. Richard Pan (D-Sacramento), who chairs the Senate Health Committee. “People with preexisting conditions are going to be in big trouble.”

Because the Supreme Court likely won’t issue its ruling for months, Newsom administration officials and lawmakers said they have time to come up with a plan should Obamacare be deemed unconstitutional. If necessary, they could call a special legislative session and Democratic lawmakers, with a supermajority in the legislature, could enact emergency legislation.

Dr. Robert Ross is a member of the Healthy California for All Commission, which is studying the feasibility of enacting a state-based single-payer system. He said the commission, with deep health policy expertise, also could be well poised to respond.

“All the lofty aspirations to do something that transformative turn to dust if the Affordable Care Act is blown up,” said Ross, president of the California Endowment, a foundation that focuses on expanding health care access among Californians. “We’d be having an entirely different, sobering conversation, and I’d hope our commission could put ideas in front of the governor for consideration.”

Samantha Young of California Healthline contributed to this report.