Science

A new coronavirus variant may be behind California's COVID rise

Published

2 years ago

January 2, 2024

A new coronavirus variant may be behind California's COVID rise

Coronavirus transmission is once again spiking in California entering the winter holiday season — and a new subvariant may be partly to blame, officials say.

This latest subvariant, JN.1, is now estimated to account for roughly 44% of COVID-19 cases nationally, according to the latest data from the U.S. Centers for Disease Control and Prevention.

That share is twice as high as any other identified subvariant, and a startling rise from the prior estimate of 21% for the two-week period that ended Dec. 9.

“We’re also seeing an increasing share of infections caused by JN.1 in travelers, wastewater and most regions around the globe,” the CDC said in a statement. “JN.1’s continued growth suggests that the variant is either more transmissible or better at evading our immune systems than other circulating variants.”

The World Health Organization this week classified JN.1 as a “variant of interest,” meaning it has potentially concerning characteristics — such as an ability to more easily infect individuals or avoid the protection afforded by vaccines and therapeutics.

Current vaccines, anti-COVID drugs and tests continue to work well against JN.1, the CDC said.

JN.1 is an offshoot of another Omicron subvariant, BA.2.86, which was unofficially nicknamed Pirola.

Pirola was already deemed worrisome because of its unusually high number of mutations, which might empower it to more easily infect those who haven’t received a recent COVID-19 vaccination. JN.1 has an additional mutation.

Experts say all those mutations mean it’s likely that people who have been relying on older vaccinations received more than a year ago, or a previous infection earlier this year, may not be protected enough to avoid a new run-in with the coronavirus this winter.

“It is possible that at least part of the local increase in transmission is driven by new COVID-19 strains gaining dominance in Los Angeles County, including JN.1,” the county Department of Public Health said in a statement.

Doctors say the rise of JN.1 is another reason why people — especially those who are older — should get the latest COVID-19 vaccination that became available in September.

Coronavirus transmission and COVID-19 hospitalizations, though undoubtedly on the rise, aren’t at the levels seen at this same time last year.

But the increase has been sharp. For the week ending Dec. 16, there were 2,924 new coronavirus-positive hospital admissions in California, up nearly 50% from a month earlier.

And it’s not just COVID-19. Clinics in Southern California report being busy with other viral illnesses, too — namely flu and respiratory syncytial virus, or RSV.

“Definitely, we’re seeing more people that are coming through the door, especially the younger and the older,” said Dr. Daisy Dodd, an infectious disease specialist with Kaiser Permanente Orange County. People with underlying medical issues, such as diabetes and asthma, she added, are “much more symptomatic.”

In L.A. County, about 18% of specimens tested at sentinel labs are coming back positive for flu, as are 12% of specimens tested for RSV and 11% tested for the coronavirus. The test positive rates of flu and the coronavirus are continuing to grow, while the rate for RSV has plateaued at a high level.

Coronavirus levels recorded in L.A. County’s wastewater have doubled over the last month. For the week ending Dec. 9, the most recent data available, viral levels in sewage were at 39% of the peak seen last winter, the most recent major spike for the region.

But the increase in infections, to this point, has not translated into a surge of people needing intensive care, Dodd said.

At UC San Francisco, there are now 27 coronavirus-positive patients who are currently hospitalized, up from around 20 a few weeks ago. Earlier in November, that census was in the 10s, said Dr. Peter Chin-Hong, an infectious disease specialist there.

“That is probably fueled by this new variant, JN.1,” Chin-Hong said. “It’s not that the variant causes people to be sicker. It’s just that if a lot of people are infected, a proportion of them will go to the hospital. And the more people that get infected, that number is higher.”

Notably, COVID-19, flu and RSV seem to be all “colliding this year,” Chin-Hong said. “Last year, RSV would have gone down by now.”

Other factors in the spread of COVID-19, which have been seen consistently this time of year since the pandemic began, are holiday travel and gatherings indoors. And in the first holiday season since the end of COVID’s emergency phase, people are perhaps not being as cautious as they once were in terms of testing or staying at home if they are sick.

Dr. Rafael Montalvo — chair of the urgent care department for the Facey Medical Group, which oversees clinics in Burbank, Mission Hills and Valencia — said some patients who are sick have been fairly nonchalant about their illness and are eager to work or remain out and about. Healthcare workers, he said, take care to try to convince patients to stay home when they’re ill.

“They’re actually pretty surprised when they [found out they’ve] come down with COVID,” Montalvo said. Unlike before, when people might have known where they picked up the coronavirus, “now, they’re not aware of any direct exposures.”

For the week ending Dec. 16, there were an average of 601 coronavirus-positive people in L.A. County’s hospitals, up about 66% from the prior month.

The burden COVID is posing on L.A. County’s health system is still relatively low, however. For the week that ended Dec. 9, L.A. County was reporting 6.5 new coronavirus-positive hospital admissions for every 100,000 residents, which is considered a low level as defined by the CDC.

Still, there may be some warning signs. There were 24 new COVID outbreaks in skilled nursing facilities for the week that ended Tuesday, which represents a medium level of concern in the county’s established rubric. And for the week that ended Sunday, 5% of emergency department encounters in L.A. County were classified as related to the coronavirus, also enough to warrant a medium level of concern.

In Santa Clara County, Northern California’s most populous, coronavirus levels in the San Jose area’s sewage are at 62% of last winter’s peak.

Hospital conditions are worse elsewhere. Fresno County, which like the wider Central Valley has been particularly hard hit throughout the pandemic, said its hospitals are reporting “severely impacted conditions … due to a historic number of admitted patients and people accessing the emergency department with non-urgent medical problems.”

Fresno County’s hospitals are operating at least 20% to 40% over capacity, and “are holding admitted patients in their emergency department for up to four days and are using conference rooms and non-patient areas to hold patients,” the local Department of Public Health said in a statement. Emergency room waiting times are now routinely exceeding 10 hours for some patients.

“We need everyone’s help to slow down the number of people using the emergency room for non-emergency medical issues,” Dan Lynch, the county’s emergency medical services director, said in a statement.

The CDC recommends that virtually everyone age 6 months and older get a fresh COVID-19 and flu vaccination this winter. RSV vaccinations are also available for babies, those age 60 and older, and those who are pregnant.

Uptake of the most recent COVID-19 vaccination has been lackluster, however. Across California as of Nov. 30, 27% of seniors age 65 and up have received the latest shot. That rate is 21% in L.A. County, 25% in Orange County, and 27% in San Diego and Ventura counties; but less than 20% in the Inland Empire.

In the San Francisco Bay Area’s most populous counties, around 40% of seniors have received the latest COVID-19 vaccination.

As of Dec. 9, just 42% of adults nationwide had received a flu shot, 18% had received an updated COVID-19 vaccine, and 17% of those age 60 and up had received an RSV vaccine, according to reports published this week by the CDC. Notably, just one in three nursing home residents were up to date with their COVID-19 vaccinations.

“Many adults who had not received the vaccines reported being open to vaccination,” one of the reports said.

The public health risk posed by JN.1 is similar to other subvariants in the sprawling Omicron family, the first version of which emerged a little more than two years ago. While these variants don’t pose the same threat as years prior, given a degree of immunity from past infections and immunizations, people who haven’t received a recent COVID-19 vaccination — particularly the new formula — are at greater risk.

“JN.1 [and other coronavirus variants] continue to cause disease and too many are falling ill, requiring hospitalizations or advanced clinical care, are dying, and developing long COVID,” Maria Van Kerkhove, WHO’s technical lead on COVID-19, wrote in a social media post. Nationally, about 1,000 coronavirus-infected people a week are dying.

Health officials have also urged people and healthcare providers to utilize anti-COVID drugs like Paxlovid when possible.

Some have been reluctant to take or prescribe the drug after reading last year of a purported “post-Paxlovid rebound,” in which COVID-19 symptoms reappear after having seemingly resolved. However, doctors have also long noted that COVID rebound can happen without taking Paxlovid. And a new study published this week by the CDC reaffirmed that COVID rebound can happen regardless of whether one takes anti-COVID drugs like Paxlovid or molnupiravir.

“Rebound should not deter providers from prescribing lifesaving antiviral treatments when indicated to prevent morbidity and mortality from COVID-19,” the report said.

CDC Director Dr. Mandy Cohen and others have urged people to take non-pharmaceutical precautions, such as wearing a mask in public settings, moving gatherings outdoors and improving ventilation, staying home when sick and avoiding people who are ill.

Other now-familiar measures include using hand sanitizer or regularly washing your hands, especially before eating, after sneezing or coughing, or while in public, the L.A. County Department of Public Health said.

“Consider talking with friends and family so they know to be cautious about gathering if they show signs of infection,” such as having a sore throat or a fever, the agency said. “Event hosts may want to consider asking their guests to test for COVID-19 before celebrations, especially if older or immunocompromised people will be present.”

California continues to require most insurers to reimburse covered people for the costs of up to eight at-home COVID tests per month, although people may need to obtain the tests through an “in-network” provider for the tests to remain free.

People who test positive for the coronavirus should isolate for at least five days following onset of symptoms or their first positive test result, whichever came first. The day a person starts having symptoms or had their first positive test is considered Day Zero, and the earliest a patient can exit isolation is by the end of Day 5.

According to the L.A. County Department of Public Health, infected people can end isolation after Day 5 if they have been fever free for 24 hours without using fever-reducing medications, and don’t have any other symptoms, or their symptoms are mild and improving.

The agency strongly recommends people get a negative rapid test result before ending isolation between Days 6 and 10. Isolation can generally end after Day 10 without needing a negative test result, unless you still have a fever.

Infected people are encouraged to wear a mask around others for a full 10 day-period following onset of symptoms or their first positive test. But the agency says that people who meet the criteria to end isolation after Day 5 can stop wearing a mask, too, if they have two consecutive negative coronavirus test results taken at least one day apart.

Science

Trump administration declares ‘war on sugar’ in overhaul of food guidelines

Published

1 day ago

January 7, 2026

Press Room

Trump administration declares ‘war on sugar’ in overhaul of food guidelines

The Trump administration announced a major overhaul of American nutrition guidelines Wednesday, replacing the old, carbohydrate-heavy food pyramid with one that prioritizes protein, healthy fats and whole grains.

“Our government declares war on added sugar,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a White House press conference announcing the changes. “We are ending the war on saturated fats.”

“If a foreign adversary sought to destroy the health of our children, to cripple our economy, to weaken our national security, there would be no better strategy than to addict us to ultra-processed foods,” Kennedy said.

Improving U.S. eating habits and the availability of nutritious foods is an issue with broad bipartisan support, and has been a long-standing goal of Kennedy’s Make America Healthy Again movement.

During the press conference, he acknowledged both the American Medical Association and the American Assn. of Pediatrics for partnering on the new guidelines — two organizations that earlier this week condemned the administration’s decision to slash the number of diseases that U.S. children are vaccinated against.

“The American Medical Association applauds the administration’s new Dietary Guidelines for spotlighting the highly processed foods, sugar-sweetened beverages, and excess sodium that fuel heart disease, diabetes, obesity, and other chronic illnesses,” AMA president Bobby Mukkamala said in a statement.

Science

Contributor: With high deductibles, even the insured are functionally uninsured

Published

2 days ago

January 6, 2026

Press Room

Contributor: With high deductibles, even the insured are functionally uninsured

I recently saw a patient complaining of shortness of breath and a persistent cough. Worried he was developing pneumonia, I ordered a chest X-ray — a standard diagnostic tool. He refused. He hadn’t met his $3,000 deductible yet, and so his insurance would have required him to pay much or all of the cost for that scan. He assured me he would call if he got worse.

For him, the X-ray wasn’t a medical necessity, but it would have been a financial shock he couldn’t absorb. He chose to gamble on a cough, and five days later, he lost — ending up in the ICU with bilateral pneumonia. He survived, but the cost of his “savings” was a nearly fatal hospital stay and a bill that will quite likely bankrupt him. He is lucky he won’t be one of the 55,000 Americans to die from pneumonia each year.

As a physician associate in primary care, I serve as a frontline witness to this failure of the American approach to insurance. Medical professionals are taught that the barrier to health is biology: bacteria, viruses, genetics. But increasingly, the barrier is a policy framework that pressures insured Americans to gamble with their lives. High-deductible health plans seem affordable because their monthly premiums are lower than other plans’, but they create perverse incentives by discouraging patients from seeking and accepting diagnostics and treatments — sometimes turning minor, treatable issues into expensive, life-threatening emergencies. My patient’s gamble with his lungs is a microcosm of the much larger gamble we are taking with the American public.

The economic theory underpinning these high deductibles is known as “skin in the game.” The idea is that if patients are responsible for the first few thousand dollars of their care, they will become savvy consumers, shopping around for the best value and driving down healthcare costs.

But this logic collapses in the exam room. Healthcare is not a consumer good like a television or a used car. My patient was not in a position to “shop around” for a cheaper X-ray, nor was he qualified to determine if his cough was benign or deadly. The “skin in the game” theory assumes a level of medical literacy and market transparency that simply doesn’t exist in a moment of crisis. You can compare the specs of two SUVs; you cannot “shop around” for a life-saving diagnostic while gasping for air.

A 2025 poll from the Kaiser Family Foundation points to this reality, finding that up to 38% of insured American adults say they skipped or postponed necessary healthcare or medications in the past 12 months because of cost. In the same poll, 42% of those who skipped care admitted their health problem worsened as a result.

This self-inflicted public health crisis is set to deteriorate further. The Congressional Budget Office estimates roughly 15 million people will lose health coverage and become uninsured by 2034 because of Medicaid and Affordable Care Act marketplace cuts. That is without mentioning the millions more who will see their monthly premiums more than double if premium tax credits are allowed to expire. If that happens, not only will millions become uninsured but also millions more will downgrade to “bronze” plans with huge deductibles just to keep their premiums affordable. We are about to flood the system with “insured but functionally uninsured” patients.

I see the human cost of this “functional uninsurance” every week. These are patients who technically have coverage but are terrified to use it because their deductibles are so large they may exceed the individuals’ available cash or credit — or even their net worth. This creates a dangerous paradox: Americans are paying hundreds of dollars a month for a card in their wallet they cannot afford to use. They skip the annual physical, ignore the suspicious mole and ration their insulin — all while technically insured. By the time they arrive at my clinic, their disease has often progressed to a catastrophic event, from what could have been a cheap fix.

Federal spending on healthcare should not be considered charity; it is an investment in our collective future. We cannot expect our children to reach their full potential or our workforce to remain productive if basic healthcare needs are treated as a luxury. Inaction by Congress and the current administration to solve this crisis is legislative malpractice.

In medicine, we are trained to treat the underlying disease, not just the symptoms. The skipped visits and ignored prescriptions are merely symptoms; the disease is a policy framework that views healthcare as a commodity rather than a fundamental necessity. If we allow these cuts to proceed, we are ensuring that the American workforce becomes sicker, our hospitals more overwhelmed and our economy less resilient. We are walking willingly into a public health crisis that is entirely preventable.

Joseph Pollino is a primary care physician associate in Nevada.

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Ideas expressed in the piece

High-deductible health plans create a barrier to necessary medical care, with patients avoiding diagnostics and treatments due to out-of-pocket cost concerns^[1]. Research shows that 38% of insured American adults skipped or postponed necessary healthcare or medications in the past 12 months because of cost, with 42% reporting their health worsened as a result^[1].
The economic theory of “skin in the game”—which assumes patients will shop around for better healthcare values if they have financial responsibility—fails in medical practice because patients lack the medical literacy to make informed decisions in moments of crisis and cannot realistically compare pricing for emergency or diagnostic services^[1].
Rising deductibles are pushing enrollees toward bronze plans with deductibles averaging $7,476 in 2026, up from the average silver plan deductible of $5,304^[1]^[4]. In California’s Covered California program, bronze plan enrollment has surged to more than one-third of new enrollees in 2026, compared to typically one in five^[1].
Expiring federal premium tax credits will more than double out-of-pocket premiums for ACA marketplace enrollees in 2026, creating an expected 75% increase in average out-of-pocket premium payments^[5]. This will force millions to either drop coverage or downgrade to bronze plans with massive deductibles, creating a population of “insured but functionally uninsured” people^[1].
High-deductible plans pose particular dangers for patients with chronic conditions, with studies showing adults with diabetes involuntarily switched to high-deductible plans face 11% higher risk of hospitalization for heart attacks, 15% higher risk for strokes, and more than double the likelihood of blindness or end-stage kidney disease^[4].

Different views on the topic

Expanding access to health savings accounts paired with bronze and catastrophic plans offers tax advantages that allow higher-income individuals to set aside tax-deductible contributions for qualified medical expenses, potentially offsetting higher out-of-pocket costs through strategic planning^[3].
Employers and insurers emphasize that offering multiple plan options with varying deductibles and premiums enables employees to select plans matching their individual needs and healthcare usage patterns, allowing those who rarely use healthcare to save money through lower premiums^[2]. Large employers increasingly offer three or more medical plan choices, with the expectation that employees choosing the right plan can unlock savings^[2].
The expansion of catastrophic plans with streamlined enrollment processes and automatic display on HealthCare.gov is intended to make affordable coverage more accessible for certain income groups, particularly those above 400% of federal poverty level who lose subsidies^[3].
Rising healthcare costs, including specialty drugs and new high-cost cell and gene therapies, are significant drivers requiring premium increases regardless of plan design^[5]. Some insurers are managing affordability by discontinuing costly coverage—such as GLP-1 weight-loss medications—to reduce premium rate increases for broader plan members^[5].

Science

Trump administration slashes number of diseases U.S. children will be regularly vaccinated against

Published

3 days ago

January 6, 2026

Press Room

Trump administration slashes number of diseases U.S. children will be regularly vaccinated against

The U.S. Department of Health and Human Services announced sweeping changes to the pediatric vaccine schedule on Monday, sharply cutting the number of diseases U.S. children will be regularly immunized against.

Under the new guidelines, the U.S. still recommends that all children be vaccinated against measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Haemophilus influenzae type B (Hib), pneumococcal disease, human papillomavirus (HPV) and varicella, better known as chickenpox.

Vaccines for all other diseases will now fall into one of two categories: recommended only for specific high-risk groups, or available through “shared clinical decision-making” — the administration’s preferred term for “optional.”

These include immunizations for hepatitis A and B, rotavirus, respiratory syncytial virus (RSV), bacterial meningitis, influenza and COVID-19. All these shots were previously recommended for all children.

Insurance companies will still be required to fully cover all childhood vaccines on the CDC schedule, including those now designated as optional, according to the Department of Health and Human Services.

Health Secretary Robert F. Kennedy Jr., a longtime vaccine critic, said in a statement that the new schedule “protects children, respects families, and rebuilds trust in public health.”

But pediatricians and public health officials widely condemned the shift, saying that it would lead to more uncertainty for patients and a resurgence of diseases that had been under control.

“The decision to weaken the childhood immunization schedule is misguided and dangerous,” said Dr. René Bravo, a pediatrician and president of the California Medical Assn. “Today’s decision undermines decades of evidence-based public health policy and sends a deeply confusing message to families at a time when vaccine confidence is already under strain.”

The American Academy of Pediatrics condemned the changes as “dangerous and unnecessary,” and said that it will continue to publish its own schedule of recommended immunizations. In September, California, Oregon, Washington and Hawaii announced that those four states would follow an independent immunization schedule based on recommendations from the AAP and other medical groups.

The federal changes have been anticipated since December, when President Trump signed a presidential memorandum directing the health department to update the pediatric vaccine schedule “to align with such scientific evidence and best practices from peer, developed countries.”

The new U.S. vaccination guidelines are much closer to those of Denmark, which routinely vaccinates its children against only 10 diseases.

As doctors and public health experts have pointed out, Denmark also has a robust system of government-funded universal healthcare, a smaller and more homogenous population, and a different disease burden.

“The vaccines that are recommended in any particular country reflect the diseases that are prevalent in that country,” said Dr. Kelly Gebo, dean of the Milken Institute School of Public Health at George Washington University. “Just because one country has a vaccine schedule that is perfectly reasonable for that country, it may not be at all reasonable” elsewhere.

Almost every pregnant woman in Denmark is screened for hepatitis B, for example. In the U.S., less than 85% of pregnant women are screened for the disease.

Instead, the U.S. has relied on universal vaccination to protect children whose mothers don’t receive adequate care during pregnancy. Hepatitis B has been nearly eliminated in the U.S. since the vaccine was introduced in 1991. Last month, a panel of Kennedy appointees voted to drop the CDC’s decades-old recommendation that all newborns be vaccinated against the disease at birth.

“Viruses and bacteria that were under control are being set free on our most vulnerable,” said Dr. James Alwine, a virologist and member of the nonprofit advocacy group Defend Public Health. “It may take one or two years for the tragic consequences to become clear, but this is like asking farmers in North Dakota to grow pineapples. It won’t work and can’t end well.”