Executive Summary
On January 30, 2020, the World Health Organization (WHO) declared the SARS-CoV-2 outbreak a Public Health Emergency of International Concern. By March 11, 2020, the number of cases had increased 13fold in two weeks, there were more than 118,000 cases in 114 countries, and 4,291 people had died, prompting WHO to characterize COVID -19 as a pandemic. Now, two years after that assessment, nearly a million deaths have been recorded in the U.S, we have seen multiple waves of major out- breaks and evolution of variants of the virus. This update focuses on what has happened between January and March of 2022. Highlights that are summarized in this update include:

Major milestones have been marked by the startling number of cases, hospitalizations, and deaths caused by COVID both in the U.S. and worldwide, omicron taking over with a vengeance, approval of second booster shots, new drugs authorizations and full approvals, changes in guidelines shifting masking decisions largely to individuals, ending of nation-wide contact tracing, availability of free at-home testing kits, and the end of federal funding for testing and treating of otherwise uninsured individuals.

Much remains unchanged, including hospital, dental practice, nursing home and teacher shortages and burnout; continuing vaccine hesitancy; inequities and disparities in disease rate and treatments; continuing erosion of trust; and dissemination of misinformation.

We’re becoming unhinged with desperate pleas to courts to get unproven treatments delivered to critically ill patients, Florida issuing guidelines arguing that healthy children aged 5-17 years may not benefit from vaccines despite a host of scientific evidence that proves otherwise, other court cases against best science, unruly public transportation passengers objecting to mandates, acts of violence against healthcare workers and scientists, and fraud tied to federal coronavirus aid programs.

Much as been learned (or confirmed), including growing numbers of studies that substantiate vaccine and booster efficacy; how long booster shore-up protection lasts, and that homologous and heterologous vaccine/booster combinations are essentially equivalent; that Omicron-specific studies may not bring many, if any advantage; the unvaccinated children recovering from COVID don’t have infection-related antibodies; that COVID infection can affect pregnancy outcomes, increase risk of new diabetes diagnosis, increase risk of depression and anxiety in severe cases, create brain fog that may overlap ‘chemo brain’ and/or Alzheimer’s, affect male sexual function, decrease lung capacity, and increase the risk of cardiovascular disease. In addition, a mini-epidemic of Long-COVID is evolving, effectiveness and limitations of treatments varies, and animal-human transmission has been documented.

Complicating barriers exist, including the potential of relief aid to hospitals likely to end soon, funding running out, controversy about whether second booster doses are need and/or appropriate, whether at-home COVID-tests are curbing COVID transmission, and confusing information.

What’s next, addresses how much of the public is ready to return to normal, what the pandemic’s next act might be, that care is shifting away from hospitals, why millions could lose Medicaid coverage, that wastewater monitoring could replace in-person testing, and when, if ever, the pandemic will be over – and what do we mean by ‘being over’?

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