By Margaret Salinas, PhD, MS, APRN, FNP-C
Three years after the initial spread of COVID-19, the virus has claimed the lives of more than 1.1 million people in the United States alone. Even so, the days of panic and head-to-toe plastic suits are—thankfully— a thing of the past.
Recommended for nurses: COVID-19 CE Courses
COVID fatigue and statistics
Despite our collective fatigue of the virus, thousands of Americans are hospitalized each week due to COVID-19, and more are seen in outpatient settings.
Data show that both new COVID cases and long-COVID diagnoses are declining in the U.S. since the last major surge in January 2022, although the cases are likely underreported due to the common use of home tests. Amid declining cases, the US government announced in January 2023 that national and public health emergency declarations will come to an end on May 11, 2023.
With this change in mind, individuals using private insurance or Medicare will no longer receive coverage for home tests, although some states may still provide tests to residents. Vaccine coverage is expected to continue. Patients using Medicaid can anticipate COVID coverage to endure until 2024, due to provisions under the American Rescue Plan and Inflation Reduction Act. However, some people may lose Medicaid coverage, as rules preventing states from removing people from Medicaid are slated to end.
COVID FAQs
The use of home tests, people with repeated infections, the ever-changing variants, and long-COVID symptoms complicate the presentation of a patient with upper or lower respiratory infection symptoms.
Here are some questions you many encounter.
Q: I tested negative at home. Now what?
A: First, a quick reminder about the types of tests. Nucleic acid amplification tests (NAATs), including PCR, LAMP, CRISPR, are commonly used in healthcare settings and detect genetic material. Therefore, they are highly sensitive. Highly sensitive tests are unlikely to return false negative results. However, people may continue to test positive for 1-2 months after the acute infection.
The rapid antigen tests (RATs) supplied as home tests detect viral protein. These tests are less sensitive and have a delayed positivity because the virus needs to replicate enough times to be detectable. For this reason, someone with symptoms of COVID should receive 2-3 negative RATs before being considered truly negative.
Q: I was exposed to COVID. Now what?
A: If you are asymptomatic and have not recently had COVID, you should test at least 5 days after exposure with either an NAAT or three RATs separated by 48 hours. Researchers believe the incubation period for COVID-19 to be 3-5 days; therefore, testing before 5 days may return a false negative result.
Q: I recently had COVID and returned to my provider with symptoms or exposure. Now what?
A: Anyone who had COVID within the past 31-90 days who returns with symptoms should be tested with RATs instead of NAATs to test to avoid a false positive from the previous infection.
A symptomatic person should test at least twice 48 hours apart before they can consider themselves truly negative. Anyone with COVID less than 31 days ago who returns with symptoms may test positive from the earlier infection on both types of tests, making a true diagnosis very difficult.
The latest on COVID vaccines
Vaccination rates in the US are highest among the 65+ age group, with 94% having completed the primary series. However, only 39.6% of this group have received the bivalent booster. Bivalent booster vaccines are now available for all ages and have demonstrated increased antibody response in high-risk individuals compared to monovalent vaccines.
Despite the distribution of more than 12.7 billion COVID vaccines worldwide, vaccine hesitancy persists. While recent research demonstrates that an individual’s vaccine hesitancy may vary over even short periods of time, factors such as racial or gender discrimination, vaccine safety concerns, and lack of trust in healthcare providers remain prevalent.
Trusted healthcare providers are critical. Research demonstrates that the odds of vaccine hesitancy were lower among patients with an established primary care provider.
Recommended for nurses: COVID Vaccine Facts vs. Fiction
Addressing vaccine hesitancy
For those working with clients or patients experiencing vaccine hesitancy, here are a few tips to consider:
- Ask open-ended questions
- Provide accurate information about the side effects
- Be clear about benefits of vaccination
- Share personal stories as appropriate to help them understand vaccines
- Have answers to commonly asked questions or conspiracy theories
- Remind patients and clients that being fully vaccinated before contracting COVID-19 decreases the chances of reporting long COVID
Who is still at risk?
The absolute risk of hospitalization and death remains low. However, those at high risk should consider treatment with nirmatrelvir/ritonavir (Paxlovid), which remains approved for emergency use. Research has shown that Paxlovid decreases hospitalization and death for adults over 50 years when initiated as soon as possible after symptom onset.
New research shows that people who are unhoused are almost two times more likely to die of COVID. While COVID fatigue grows, immunocompromised individuals may also suffer from loneliness as the world goes back to normal without them.
Encouraging the most vulnerable populations to get vaccinated and providing options for seeking care without additional risk of exposure is critical for supporting our most vulnerable populations.
References
- Balaji JN, Prakash S, Joshi A, Surapaneni KM. A Scoping Review on COVID-19 Vaccine Hesitancy among the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA+) Community and Factors Fostering Its Refusal. Healthcare. 2023; 11(2):245. https://doi.org/10.3390/healthcare11020245
- Chang, A. H., Kwon, J. J., Shover, C. L., Greenwell, L., Gomih, A., Blake, J., Del Rosario, A., Jones, P. S., Fisher, R., Balter, S., & Brosnan, H. K. (2022). COVID-19 Mortality Rates in Los Angeles County Among People Experiencing Homelessness, March 2020-February 2021. Public health reports (Washington, D.C. : 1974), 137(6), 1170–1177. https://doi.org/10.1177/00333549221115658
- Clifton, K., Gao, F., Jabbari, J., Van Aman, M., Dulle, P., Hanson, J., & Wildes, T. M. (2022). Loneliness, social isolation, and social support in older adults with active cancer during the COVID-19 pandemic. Journal of Geriatric Oncology, 13(8), 1122–1131. https://doi.org/10.1016/j.jgo.2022.08.003
- Dryden-Peterson, S., Kim, A., Kim, A. Y., Caniglia, E. C., Lennes, I. T., Patel, R., Gainer, L., Dutton, L., Donahue, E., Gandhi, R. T., Baden, L. R., & Woolley, A. E. (2023). Nirmatrelvir plus ritonavir for early covid-19 in a large U.S. health system : A population-based cohort study. Annals of Internal Medicine, 176(1), 77–84. https://doi.org/10.7326/M22-2141
- Link-Gelles, R., Ciesla, A.A., Fleming-Dutra, K.E. et al. (2022). Effectiveness of bivalent mRNA vaccines in preventing symptomatic SARS-CoV-2 infection—Increasing community access to testing program. Morbidity and Mortality Weekly Report. 7, 1526-1530. Doi: http://dx.doi.org/10/15585/mmwr.mm7148e1.
- National Center for Health Statistics. (2023 January 26). Post-COVID Conditions. https://data.cdc.gove/d/gsea-w83j
- Patel, P. Thornburg, N., & Gandhi, R.T. (2023 January 24). Updates to COVID-19 Testing and Treatment for the Current SARS-CoV-2 Variants [webinar]. Centers for Disease Control and Prevention. https://emergency.cdc.gov/coca/calls/2023/callinfo_012423.asp
- Perlis, R. H., Santillana, M., Ognyanova, K. et al. (2022). Prevalence and correlates of long COVID symptoms among US Adults. Journal of the American Medical Association Network Open, 5(10):e2238804. doi:10.1001/jamanetworkopen.2022.38804
- Pullen R. L., Jr (2022). Managing patients who are immunocompromised during the COVID-19 pandemic. Nursing, 52(12), 27–32. https://doi.org/10.1097/01.NURSE.0000892648.90577.03
- Shook, N.J., Oosterhoff, B., & Sevi, Baris. (2023). A longitudinal assessment of variability in COVID-19 vaccine hesitancy and psychosocial correlates in a national United States sample. Vaccine, 41(7), 1390–1397. https://doi.org/10.1016/j.vaccine.2022.12.065
