Tens of thousands of Americans are hospitalized with COVID-19 every week. Thousands die from it every month. And yet, an antiviral treatment proven to lessen the chances of severe outcomes is going underused. The drug, Paxlovid, is lauded by experts as a powerful tool that can prevent hospitalization and death from COVID-19. But the high price and doctors’ hesitation to prescribe the pills mean the five-day treatment isn’t getting to everyone who would benefit from it. “When you read in your local newspaper that in this hospital, they’ve got this many COVID patients, most of those are preventable hospitalizations,” said Dr. Amesh Adalja, a senior scholar at Johns Hopkins University who sees Paxlovid as a useful tool to treat COVID-19. One Centers for Disease Control and Prevention study found that Paxlovid can decrease hospitalization risks among adults by 51%. The drug is recommended for older people and other adults with certain underlying conditions. When Paxlovid was first authorized for emergency use in the U.S. in December 2021, it was free for anyone who needed it. Once the government stopped funding the treatment, Pfizer set a list price of $1,390. The drug remains free for people on federal insurance programs like Medicaid and Medicare through the end of this year, and uninsured people also can get it for free. But many of those people must go through a patient assistance program run by Pfizer to get the discounts. People on commercial insurance with high out-of-pocket costs can also get financial help through a separate co-pay assistance program. Independent pharmacy owners find Paxlovid is expensive to carry because of reimbursement rates from commercial insurers, said Kurt Proctor, a senior vice president at the National Community Pharmacists Association. “If you’re losing 5% on a $10 prescription, it’s very different than losing 5% on a $1,400 prescription product,” he said. The high list price also is turning off some patients. When Celise Ballow, of Junction, Utah, got COVID-19 recently, she never got the medication. Ballow said her doctor declined to write her a prescription after telling her it wouldn’t be covered by her insurance. Now she wonders if she could have avoided some of the infection’s worst effects if she had been able to get the medication. “I’m going on a month and a half and I’m still having nebulizer treatments. … I’m still exhausted,” Ballow said. Another factor hurting uptake appears to be the long list of medications that shouldn’t be taken with Paxlovid. Many doctors may simply decide the risk of drug interactions isn’t worth it. “If people are on four or five different medications, it does tend to be a pain to double check ‘is there an interaction here?’” said Dr. Sarah George, an infectious diseases professor at St. Louis University. Seeing a possible significant drug interaction “tends to put a physician off from prescribing a drug, even if there is a workaround,” she said. The people most likely to benefit from Paxlovid were the least likely to get it in 2022, according to a recent study. The study by Harvard researchers found that Paxlovid was disproportionately given to Medicare patients with lower risk of severe infection. If it had been properly utilized, the authors concluded, more than 16,000 COVID-19 deaths could have been prevented. Dr. Michael Barnett, a Harvard health

A rare drone attack jolted Moscow early Tuesday, causing only light damage but forcing evacuations as residential buildings were struck in the Russian capital for the first time in the war against Ukraine. The Kremlin, meanwhile, pursued its relentless bombardment of Kyiv with a third assault on the city in 24 hours. The Russian Defense Ministry said five drones were shot down in Moscow and the systems of three others were jammed, causing them to veer off course. President Vladimir Putin called it a “terrorist” act by Kyiv. The attack, while causing only what Moscow Mayor Sergei Sobyanin said was “insignificant damage” to several buildings, brought the war home to civilians in Russia’s capital. Two people received treatment for unspecified injuries but did not need hospitalization, Sobyanin said, adding that residents of two high-rise buildings damaged in the attack were evacuated. Andrei Vorobyov, governor of the wider Moscow region, said some of the drones were “shot down on the approach to Moscow.” Ukraine made no direct comment on the attack, which would be one of its deepest and most daring strikes into Russia since the Kremlin launched its full-scale invasion of Ukraine more than 15 months ago. Putin said Moscow’s air defense “worked in a satisfactory way,” but added it was “clear what we need to do to plug the gaps” in the system. “The Kyiv regime … attempts to intimidate Russia, Russian citizens and strikes at civilian buildings,” he said at a public event, responding to a question from the head of a Kremlin-allied think tank. “It is, of course, a clear indication of terrorist activity.” Putin charged that Ukraine launched Tuesday’s attack in response to Russia striking Ukraine’s military intelligence headquarters in Kyiv over the weekend. But Andrii Cherniak, a Ukrainian intelligence representative, said the Kremlin’s forces failed to hit the building because its missiles were shot down. Asked by The Associated Press whether there was high-level concern that the invasion of Ukraine was endangering Russian civilians, Putin’s spokesman Dmitry Peskov said only that attacks on Russia reinforced the need to prosecute what the Kremlin calls the “special military operation.” A senior Russian lawmaker, Andrei Kartapolov, said the apparent purpose of the attacks was to unnerve the Russian people. “It’s an intimidation act aimed at the civilian population,” he was quoted by Russian news site RBC as saying. “It’s designed to create a wave of panic.” Russian political analyst Tatiana Stanovaya, a senior fellow at the Carnegie Russia Eurasia Center, said the Kremlin’s policy is to play down the attacks. “You ask, why is Putin behaving like this, does he really not understand and fear the consequences?” she wrote in a Telegram post. “Apparently he isn’t afraid, and everything is built on the idea that has been voiced more than once about a patient people who will understand everything and endure everything.” Moscow residents reported hearing explosions before dawn. Police were seen working at one site of a crashed drone in southwest Moscow. An area near a residential building was fenced off, and police put the drone debris in a cardboard box before carrying it away. At another site, apartment windows were shattered and there were scorch marks on the building’s front. It was the second reported strike on Moscow since May 3, when Russian authorities said two

New Jersey’s gambling revenue matched its all-time high of $5.2 billion in 2022, but only half that amount was won by casinos from in-person gamblers. Figures released Tuesday by the New Jersey Division of Gaming Enforcement show the casinos, the horse tracks that take sports bets, and online partners of both types of gambling won $5.21 billion last year, up 10% from a year earlier and matching a level last seen in 2006. That was just before the advent of https://in.1xbet.com/bingo casino gambling in neighboring Pennsylvania sent New Jersey’s gambling industry into a downward spiral that eventually led to the closures of five of the 12 casinos that were operating at the time. But the 2022 number was reached with a hefty assist from internet gambling and sports betting — revenue streams that help contribute to the bottom line but are also heavily shared with third parties such as sports books and tech platforms. Sarah Grady, assistant director of the Lloyd Levenson Institute at Stockton University, which studies the Atlantic City gambling industry, said it took an enormous amount of work by the casinos and state government to replicate the levels of 2006, when gambling revenue consisted solely of what was won from in-person gamblers. “To compare these returns, it is important to consider how much the market has changed in the past 16 years,” she said. “To achieve the returns we have today took a substantial expansion and diversification of the New Jersey gaming product to compete with increased competition from neighboring states.” That included the legalization of internet gambling in 2013, and the introduction of sports betting in 2018 following a U.S. Supreme Court ruling in a case brought by New Jersey that cleared the way for any state to offer legal sports betting; about two-thirds of the states now do. “In 2022, the Atlantic City casino industry continued to face challenges, including the lingering effects from the pandemic, a difficult economy and high inflation,” said Mark Giannantonio, president of the Casino Association of New Jersey. “As we move into a new year, Atlantic City casinos are committed to providing the best possible experience for our customers, which includes making significant investments that will continue to solidify Atlantic City’s position as a world-class resort destination with top-notch dining, shopping and entertainment offerings.” In-person winnings from gamblers finally surpassed pre-pandemic levels of 2019 — a long-sought goal of the Atlantic City casino industry. The casinos won $2.78 billion from in-person gamblers in 2022, compared with $2.68 billion in 2019. Six casinos had more total gambling revenue in 2022 than they did the year before. The market-leading Borgata won $1.3 billion in overall gambling revenue, up 18.2%. The Golden Nugget won $581 million, up 10.2%; Hard Rock won $576 million, up 12.7%; Ocean won $389 million, up 13.6%; Tropicana won $365 million, up 2.9%, and Bally’s won $198 million, up 37.3%. Harrah’s won $258 million, down 3.4%; Caesars won $239 million, down 1%, and Resorts won $168 million, down 0.3%. Resorts Digital, the casino’s online arm, won $546 million, up 21.3%. Caesars Interactive NJ won $113 million, up 1%. In terms of in-person gambling revenue, the Borgata won $724 million, up 19.5%. Hard Rock won $492 million, up 14.2%; Ocean won $356 million, up 16.3%; Harrah’s won $257 million, down

The Centers for Disease Control and Prevention on Thursday endorsed updated COIVD-19 boosters, opening the way for a fall vaccination campaign that could blunt a winter surge if enough Americans roll up their sleeves. The new boosters targeting today’s most common omicron strains should begin arriving in pharmacies and clinics within days. The decision by CDC Director Rochelle Walensky came shortly after the agency’s advisers voted in favor of the recommendation. The shots “can help restore protection that has waned since previous vaccination and were designed to provide broader protection,” she said in a statement. The tweaked shots made by Pfizer and rival Moderna offer Americans a chance to get the most up-to-date protection at yet another critical period in the pandemic. They’re combination or “bivalent” shots — half the original vaccine and half protection against the BA.4 and BA.5 omicron versions now causing nearly all COVID-19 infections. The CDC’s advisers struggled with who should get the new boosters and when because only a similarly tweaked vaccine, not the exact recipe, has been studied in people so far. But ultimately the panel deemed the updated injections the best option considering the U.S. still is experiencing tens of thousands of COVID-19 cases and about 500 deaths every day — even before an expected new winter wave. “I think they’re going to be an effective tool for disease prevention this fall and into the winter,” said CDC adviser Dr. Matthew Daley of Kaiser Permanente Colorado. Comparing the tweak that has been studied in people and the one the U.S. actually will use, “it is the same scaffolding, part of the same roof, we’re just putting in some dormers and windows,” said Dr. Sarah Long of Drexel University. The CDC recommendation was the last step before shots can begin. Pfizer said it expected to deliver 3 million doses to vaccination sites around the country by Tuesday. The original COVID-19 vaccines still offer strong protection against severe illness and death, especially among younger and healthier people who’ve gotten at least one booster. But those vaccines were designed to target the virus strain that circulated in early 2020. Effectiveness drops as new mutants emerge and more time passes since someone’s last shot. Since April, hospitalization rates in people over age 65 have jumped, the CDC said. The updated shots are only for use as a booster, not for someone’s first-ever vaccinations. The Food and Drug Administration cleared Pfizer’s bivalent option for people 12 and older while Moderna’s is for adults only. A big unknown: exactly how much benefit people will get from one of those extra shots. The CDC said more than 1,400 people have been included in several studies of a prior tweak to the vaccine recipe targeting an earlier omicron strain named BA.1. That omicron-targeting combo shot proved safe and able to rev up virus-fighting antibodies, and European regulators on Thursday recommended using that type of booster. In the U.S., the FDA wanted fall boosters to target the currently circulating omicron strains. Rather than waiting until possibly November for more human studies to be finished, the agency accepted mouse testing that showed the newer tweak sparked a similarly good immune response. That’s how flu vaccines are updated every year, the CDC noted. Dr. Pablo Sanchez of the Ohio State University was the only

The omicron wave that assaulted the United States this winter also bolstered its defenses, leaving enough protection against the coronavirus that future spikes will likely require much less — if any — dramatic disruption to society. Millions of individual Americans’ immune systems now recognize the virus and are primed to fight it off if they encounter omicron, or even another variant. About half of eligible Americans have received booster shots, there have been nearly 80 million confirmed infections overall and many more infections have never been reported. One influential model uses those factors and others to estimate that 73% of Americans are, for now, immune to omicron, the dominant variant, and that could rise to 80% by mid-March. This will prevent or shorten new illnesses in protected people and reduce the amount of virus circulating overall, likely tamping down new waves. Hospitals will get a break from overwhelmed ICUs, experts agree. “We have changed,” said Ali Mokdad, a professor of health metrics sciences at the University of Washington in Seattle. “We have been exposed to this virus and we know how to deal with it.” The coronavirus — the current variant or future ones that are sure to pop up — remains a dangerous germ. It is still infecting more than 130,000 Americans and killing more than 2,000 every day. Tens of millions of people remain vulnerable. And there will be future outbreaks. The notion of a “herd immunity” that could stop the virus has slipped away under the harsh reality of new variants, waning immunity, and the rejection of vaccines by some Americans. But the coronavirus is no longer new. Two years ago it arrived in a nation where nobody’s immune system had seen it before. The entire population — 330 million people — were immunologically naive, that is, susceptible to infection. “I am optimistic even if we have a surge in summer, cases will go up, but hospitalizations and deaths will not,” said Mokdad, who works on the Institute for Health Metrics and Evaluation model, which calculated the 73% figure for The Associated Press. With varying degrees of relief and caution, many Americans are starting to return to their pre-pandemic lifestyles. Sarah Rixen, 41, of Bismarck, North Dakota, started singing again with a civic chorus after taking a year off. Now, with omicron winding down, she said she feels more confident than at any time since the crisis began. “But I am still a little leery that there could be another variant around the corner,” said Rixen, noting that her family and most of her relatives are fully vaccinated. “I am still going to wear a mask.” As mask mandates ease, workers return to offices and flights fill up, experts are trying to understand whether this return to normal can last, or if another setback is looming. To address that, researchers are trying to answer questions about the virus, the vaccine, and how our bodies respond: How fast is booster protection waning against omicron? How long does protection from infection last? How many mild infections were never reported? How many people got infected but had no symptoms? To find clues, they use health data from other countries such as Britain, Denmark, South Africa and Qatar to project what could be in store. Scientists at Johns Hopkins Bloomberg School

The U.S. on Friday opened COVID-19 booster shots to all adults and took the extra step of urging people 50 and older to seek one, aiming to ward off a winter surge as coronavirus cases rise even before millions of Americans travel for the holidays. Until now, Americans faced a confusing list of who was eligible for a booster that varied by age, their health and which kind of vaccine they got first. The Food and Drug Administration authorized changes to Pfizer and Moderna boosters to make it easier. Under the new rules, anyone 18 or older can choose either a Pfizer or Moderna booster six months after their last dose. For anyone who got the single-dose Johnson & Johnson vaccine, the wait already was just two months. And people can mix-and-match boosters from any company. “We heard loud and clear that people needed something simpler — and this, I think, is simple,” FDA vaccine chief Dr. Peter Marks told The Associated Press. The Centers for Disease Control and Prevention had to agree before the new policy became official late Friday. CDC Director Dr. Rochelle Walensky endorsed a recommendation from her agency’s scientific advisers that — in addition to offering all adults a booster — had stressed that people 50 and older should be urged to get one. “It’s a stronger recommendation,” said CDC adviser Dr. Matthew Daley of Kaiser Permanente Colorado. “I want to make sure we provide as much protection as we can.” The CDC also put out a plea for those who had previously qualified but hadn’t yet signed up for a booster to quit putting it off — saying older Americans and people with risks such as obesity, diabetes or other health problems should try to get one before the holidays. The expansion makes tens of millions more Americans eligible for an extra dose of protection. The No. 1 priority for the U.S., and the world, still is to get more unvaccinated people their first doses. All three COVID-19 vaccines used in the U.S. continue to offer strong protection against severe illness, including hospitalization and death, without a booster. But protection against infection can wane with time, and the U.S. and many countries in Europe also are grappling with how widely to recommend boosters as they fight a winter wave of new cases. In the U.S., COVID-19 diagnoses have climbed steadily over the last three weeks, especially in states where colder weather already has driven people indoors. And about a dozen states didn’t wait for federal officials to act before opening boosters to all adults. “The direction is not a good one. People are going inside more and, ‘oops,’ next week happens to be the largest travel week of the year, so it probably makes sense to do whatever we can here to try to turn the tide,” Marks told the AP. Vaccinations began in the U.S. last December, about a year after the coronavirus first emerged. More than 195 million Americans are now fully vaccinated, defined as having received two doses of the Pfizer or Moderna vaccines or the single-dose J&J. More than 32 million already have received a booster, a large proportion — 17 million — people 65 or older. Experts say that’s reassuring as seniors are at particularly high risk from COVID-19 and

Trisha Preston was transporting a patient in a mental health crisis in the back of her ambulance when suddenly the woman undid her seatbelt, jumped off the gurney and began attacking the veteran paramedic, punching her and pulling her hair. By the time Preston’s partner wrestled the woman to the floor, Preston had a concussion and bite marks on her arms. “It took me a good couple of months to get it out of my head. I was constantly thinking about it,” Preston said. “We’re all on high alert these days.” Her experience is part of a rash of attacks in recent months on paramedics in this Pacific Northwest city as they respond to a growing number of 911 calls for patients in mental health or drug-related crises. The uptick in violence is so severe that the private ambulance company that holds Portland’s 911 contract is training more than 500 of its employees in defensive tactics. The company is trying to better understand what’s happening in the field. “The frequency appears to be increasing. The severity appears to be increasing,” said Robert McDonald, an operations manager with American Medical Response. “This has gone unreported in so many ways that it’s difficult for us to get our arms around.” The increase in assaults dovetails with a new policy for the transport of patients in a mental health crisis that grew out of a 2012 federal investigation that found police used excessive force against those with mental illness. Now, paramedics — not law enforcement — routinely take patients on mental health holds to the hospital, most often to a new psychiatric emergency room created specifically to stabilize those in the throes of a psychiatric crisis. In the past, police transported these patients in the backs of patrol cars, in handcuffs, to traditional emergency rooms less equipped to help them. The policy puts the city at the forefront of a growing national movement to decriminalize mental health by treating a psychiatric crisis as a medical emergency similar to a heart attack — not as a crime. Portland drew key parts of its new approach from Alameda County, California, where paramedic transports and a psychiatric emergency room model have reduced hospitalization rates for mental health emergencies by 85%, said Scott Zeller, vice president for acute psychiatry for Vituity, a multistate medical consultancy group. Cities from Billings, Montana, to San Bernardino, California, are also re-examining how they treat people in a psychiatric emergency. “If an ambulance comes to your house and takes you somewhere versus if the police come and take you away, that’s a whole different thing,” Zeller said. “These are medical issues … and when you have an exacerbation, you need the same type of emergency help that you would get if you fell down the stairs.” For paramedics, however, the shift that began in 2016 has meant a significant change in their daily work. For the past three years, the ambulance company has seen 911 calls for behavioral health increase 3% to 5% each year, while overall call volume has also increased. Behavioral health calls come with specific challenges, “where we may have a patient who is compliant, calm, easy to work with, and for whatever reason, they turn,” McDonald said. The policy on ambulance transportation is also paired with a new

The Kremlin said Wednesday it still expects a meeting between President Vladimir Putin and President Donald Trump to go ahead as planned despite a suggestion from Trump that it could be canceled. Trump, in an interview with The Washington Post on Tuesday, said he may cancel the sit-down with Putin in Argentina following Russia’s seizure of three Ukrainian naval ships last weekend. Kremlin spokesman Dmitry Peskov told reporters on Wednesday that the meeting is on and that Russia has not received “any other information from our U.S. counterparts.” Putin’s foreign affairs adviser, Yuri Ushakov, noted that the meeting, which is set for Saturday, has been prepared through official channels and Moscow expects Washington to notify it of any changes in the same way. “This meeting is necessary for both sides,” Ushakov said. “It’s important in view of the developing situation in the world.” The long-simmering conflict between Russia and Ukraine burst into the open on Sunday, when Russian border guards fired on three Ukrainian vessels and seized the ships and the crew. Trump said he would be receiving a “full report” from his national security team on Russia’s recent actions in eastern Ukraine and the Black Sea. He said he would decide on a course afterward. “Maybe I won’t have the meeting,” he said. “Maybe I won’t even have the meeting.” Trump added: “I don’t like that aggression. I don’t want that aggression at all.” The comments were Trump’s strongest to date in condemnation of Russia’s recent actions in Ukraine, where tensions are flaring. But White House aides were still planning for the Putin meeting after Trump’s comments. Ushakov, Putin’s aide, said that the naval encounter between Russia and Ukraine likely will be on the agenda of the planned meeting, which will start with the two presidents meeting privately before being joined by senior officials. He said that the Kremlin expects that the talks will touch on nuclear arms control, noting that it’s particularly important to discuss them in view of the U.S. intention to withdraw from the Intermediate-Range Nuclear Forces Treaty. “It’s extremely important to prevent an uncontrollable and senseless arms race,” he said. Ushakov said that the two presidents also are to discuss regional crises, including the situation in Syria, the Iranian nuclear deal and North Korea. The meeting between Trump and Putin is set to be just one of several high-profile foreign-policy engagements for the U.S. leader on the whirlwind two-day visit to Argentina. Trump also is set to meet with Chinese President Xi Jinping over dinner this weekend, in what may be a pivotal session to determining if and how the ongoing trade dispute between their countries could be resolved. The White House on Tuesday warned Xi against trying to wait out Trump in the ongoing talks, suggesting the Chinese economy was not as resilient to a trade war as would be the U.S. economy. The warning from Larry Kudlow, director of the National Economic Council, came ahead of the two leaders’ high-stakes sit-down on Saturday evening. Over the last year, the two countries have levied a series of tariffs on hundreds of billions of dollars of imports from one another, with the latest round of U.S. duties set to go into force in the new year. Xi said on Wednesday the international community needs to