Science
Here's why some high-risk patients aren't getting drugs to combat COVID
As the toll from the COVID-19 pandemic continued to mount, antiviral medications such as Paxlovid were hailed by health officials as an important way to reduce the risk of severe illness or death.
Yet the drugs have remained underused, studies have found. In Boston, a group of researchers wanted to know why — and what could be done about it.
Their new findings, published Thursday by the U.S. Centers for Disease Control and Prevention, suggest that some vulnerable patients were not offered the prescription medicines at all, and that doctors need more education to make sure the drugs get to patients who could benefit.
Researchers from the VA Boston Cooperative Studies Program delved into records from the Veterans Health Administration to look more closely at what happened to high-risk patients who never got Paxlovid, remdesivir or molnupiravir. They focused on 110 patients who received organ transplants or had other medical conditions such as chronic lymphocytic leukemia that were likely to leave them immunocompromised and thus at greater risk from COVID-19 despite being vaccinated.
Their analysis in the CDC’s Morbidity and Mortality Weekly Report found that 20% of those patients turned down the drugs when they were offered. But the remaining 80% of patients were never offered such treatment in the first place.
In some cases, medical providers decided not to give patients the COVID-19 drugs because they were worried about how they could interact with other medications patients were already taking, including cholesterol-lowering statins and a drug used to reduce the risk that a transplanted organ would be rejected. In other cases, doctors demurred because their patients had experienced COVID-19 symptoms for more than five days beforehand, beyond the recommended window for getting Paxlovid.
Despite public alarm about “Paxlovid rebound,” in which symptoms recur after treatment, none of the medical records noted it as a reason not to give the drug, the study found. But in almost half of the cases in which people weren’t offered the medication, no reason was given by medical providers other than patients having mild symptoms, the researchers found.
But people with mild symptoms early in their illness are “exactly the target group for getting the treatment,” said Dr. Paul Monach, who heads the rheumatology section at the Veterans Affairs Boston Healthcare System and was the study’s lead author.
The drugs are recommended for people with mild-to-moderate COVID-19 who are at high risk of severe illness due to their age or medical conditions — the same kind of patients that the Boston researchers were scrutinizing. The CDC urges doctors to treat high-risk patients within five days rather than waiting for their symptoms to worsen.
“Every case starts off mild,” and it’s unpredictable whether they will become more severe, said Dr. Davey Smith, an infectious disease specialist at UC San Diego who was not involved in the study. “It might not be until the fifth or sixth day that you get into trouble — and by that time it’s too late to take these medications.”
Smith said he was especially alarmed that people whose immune systems were weakened were not getting the antiviral drugs. “Those are the people who are still coming into our hospital. And those are the ones who are dying. … It breaks my heart every time I see them in the hospital and they just didn’t get the medication.”
It breaks my heart every time I see them in the hospital and they just didn’t get the medication.
— Dr. Davey Smith, infectious disease specialist at UC San Diego
The Boston researchers said their findings suggest that physicians need more education about when to consider using the drugs. Patients, in turn, could be encouraged to reach out to medical providers sooner after they start showing symptoms.
Monach added that some Veterans Health patients who weren’t offered the drugs had gone home before their coronavirus test results had been returned. Clinical staff such as nurses had phoned them to follow up, but did not appear to have mentioned the possibility of antiviral medication, based on the records reviewed by the researchers.
“That doesn’t mean that people weren’t doing their jobs,” Monach said, “but I don’t think those people had been informed, as part of their normal jobs, what the indication would be for giving Paxlovid.”
Concerns about Paxlovid and other COVID-19 medications not reaching patients who could benefit have persisted since soon after the drugs became available. Just months after Paxlovid received emergency use authorization from the Food and Drug Administration, a national survey from the COVID States Project found that among people infected with the coronavirus between May and early July of 2022, only 11% reported having taken antivirals. Among a higher-risk group of people — those over the age of 65 — the rate was 20%, “higher, but still low.”
Another study of patients in the Veterans Affairs health system found that as of early 2023, less than a quarter of outpatients who tested positive for coronavirus infections were receiving any kind of anti-COVID medication. And researchers have also found alarming gaps in who is getting Paxlovid, with Black and Latino patients obtaining such treatment at markedly lower rates than white and non-Latino ones, even among immunocompromised patients.
“I have been banging my head against the wall for my colleagues not using medications,” Smith said.
If physicians or patients are concerned about “rebound,” he said, “COVID has this waxing and waning of symptoms anyway,” whether you take medication or not. “And we know this medication, in higher-risk individuals, keeps people out of the hospital and from dying.”
One patient recently told him, “‘Well, the last time I got COVID, I didn’t take the medicine and I was fine,’” Smith said. The problem is “that’s true until it’s not. You can only dodge the bullet so many times,” and the risks grow for an individual as they age. “Every time that you get COVID, you are getting it at a time when you are older.”
Last month, the California Department of Public Health issued an advisory to physicians and other healthcare providers, lamenting the underuse of such medications despite an “ample supply.” It faulted unfamiliarity with new medications and misperceptions that the drugs were scarce.
“Once an individual is diagnosed with COVID-19, early treatment with antivirals is the only existing strategy to decrease the risk of serious illness and prevent hospitalization,” the state agency said. “The greatest benefit of antiviral treatment is seen in those at highest risk for severe disease. … Risks including Paxlovid rebound, are minimal, especially when weighed against benefits.”
Dr. Richard Dang, an assistant professor of clinical pharmacy at USC, said that “it’s always worth the conversation” about whether to take Paxlovid or another antiviral when someone tests positive.
The medicines are most effective for people at high risk, but that is a broader swath of the adult population than many people realize, including people who are overweight, have asthma or heart conditions, and even people from racial and ethnic groups that have had worse outcomes from COVID-19, Dang said. Since the risks increase with age, “if you’re above 50 years old, you should definitely consider Paxlovid,” he said.
“At the end of the day, having some potentially unpleasant side effects that some people report — maybe like stomach upset or metallic taste — is far better than going to the hospital because of COVID,” he said.
Science
Video: NASA Announces Artemis III Crew
new video loaded: NASA Announces Artemis III Crew
transcript
transcript
NASA Announces Artemis III Crew
NASA announced the crew of Artemis III mission, which will fly to low-Earth orbit to test rendezvous and docking maneuvers with one or two lunar landers.
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“I am excited to welcome you as the next crew in the Artemis journey to successfully return to the moon — this time to stay.” “I’m honored by the role that I’ve been given. I’m also very humbled by the task in front of us. But first and foremost, I’m grateful.” “So with that, the Artemis II crew, comrade, hands you the baton. You got the controls.” “As you know, we had a significant anomaly at our Launch Complex 36A on May 28. We’ve redoubled our efforts and are moving forward.”
By Alisa Shodiyev Kaff
June 9, 2026
Science
Santa Monica Mountains’ last steelhead trout survived the Palisades fire — and even had babies
Scientists feared the Santa Monica Mountains’ last remaining steelhead trout were dead, smothered by debris flows unleashed by the Palisades fire.
But the endangered fish surprised them: A team of biologists recently spotted 30 of the rare trout — and 21 babies — in Topanga Creek.
“There was a lot of happy dancing in the creek,” said Rosi Dagit, principal conservation biologist for the Resource Conservation District of the Santa Monica Mountains, which works with public and private landowners to conserve natural resources.
That’s because the steelhead here are endangered, at both the state and federal levels. Once, they swam in most streams of the Santa Monicas, but their numbers plummeted amid overfishing and coastal development. Increasingly frequent wildfire has further stressed their habitat. Topanga Creek, a biodiversity hot spot, is home to their last known population in the mountains that stretch from the Hollywood Hills to Point Mugu in Ventura County.
The trout that were spotted, including this one, are part of a distinct Southern California population that’s listed as endangered at the state and federal levels.
(RCDSMM Stream Team)
The California Department of Fish and Wildlife spearheaded a complex mission to rescue trout threatened by the Palisades fire that sparked in January 2025.
Time was of the essence. The fire hadn’t yet been fully contained. But rain was on the way, which would sweep massive amounts of sediment from the denuded hillsides into the water. Fish are often killed this way.
Crews stunned the fish with electricity, scooped them up in buckets, trucked them to a hatchery and ultimately moved them to Arroyo Hondo Creek in Santa Barbara County.
Within days, Topanga Creek was choked with mud. Some assumed the fish left behind were goners.
But in March, the conservation district’s team found four. The following month, when water conditions were clearer, they saw more.
“These fish continue to amaze me,” said Kyle Evans, environmental program manager for the state Department of Fish and Wildlife, who had seen the damage to the creek. “I had seen populations get wiped out in similar situations. So when I heard, I was thrilled.”
Evans surmises the fish that survived were in an area of the creek where less charred material and sediment were swept in.
“These fish likely hunkered down, were hiding under some rocks or places to try to get away from the main concentration of flow,” he said. “And luckily they weren’t buried.”
The ones that were spotted were fairly small, around 6 to 14 inches. Rainbow trout and steelhead trout are the same species, but with different lifestyles. If the fish remain in freshwater, they’ll be considered rainbows. However, they can migrate to the ocean and become steelhead, where they typically grow larger before returning to their natal waters to spawn.
Topanga Creek hasn’t fully recovered from the damage it sustained, but scientists say it’s looking better. Surveys last year were “so depressing,” Dagit said, with very few animals, and stretches that were essentially transformed into flat roads from all the sediment buildup. Some of the riparian canopy burned right down to the creek.
Then came 32 inches of rain over the last nine months, scouring out and moving sediment, creating deeper pools. Dagit said they recently found newt egg masses for the first time in years, as well as a few adult newts and many frogs. Plants that provide cover are starting to recover.
She provided photos comparing certain pools last year and this year, some dramatically transformed. In September 2025, the Shrine Pool could have been an overgrown hiking trail. This April, it was filled with shallow water.
The Shrine Pool in September 2025, left, and the same location in April 2026, right, with RCDSMM’s Isaac Yelchin donning a wetsuit.
(RCDSMM Stream Team)
Topanga Creek is home to another endangered fish, the small but hardy northern tidewater goby, often described as cute. Not long before the trout operation, Dagit led a rescue of hundreds of these fish too. Many were repatriated to the lagoon at the mouth of the creek in a moving ceremony last June.
There’s still the matter of what to do with the trout that were moved to Santa Barbara County last year. Evans would like to bring them home to the Santa Monicas at some point, but isn’t sure if it will happen. On one hand, they could bolster the small, genetically isolated surviving population. On the other, they might inadvertently bring in a disease or bacteria. There is some time to decide. Evans estimates the creek still needs to recover for two to three more years.
For now, the fish are functioning fine in their adopted creek. Experts worried the trauma wrought by the move would disrupt their spawning process, but they had babies that spring. This year, they spawned again.
Science
Pacifica pier cracks, another coastal casualty as seas continue to rise
The Pacifica Municipal Pier was shut down and taped off Thursday after city workers noticed cracks running through the landmark structure and concrete chunks falling into the ocean.
It’s just one of many coastal California structures that have recently crumbled under pressure from a rising and relentless ocean.
Officials from the small, beach city south of San Francisco said the pier was closed due to “cracking, separation, and displacement of the concrete walkway and structural elements.”
It will stay closed while structural engineers asses its safety.
Photos taken by city employees show a wide crack that runs from top to bottom and across the structure as well. Other photos show a large horizontal crack under the foundation of a small restaurant on the pier, the Chit Chat Cafe.
The cafe was also shut down.
This is not the first time the 53-year-old pier has shown signs of stress. In 2021, part of it was shut down after handrails along the edge collapsed. And in 2023, after a series of storms pummeled the Central California coast, damaging parts of the pier, the structure was partially closed for more than year.
Those same storms caused extensive damage in Aptos and Capitola, 70 miles south, where piers and waterfront infrastructure were swept away or damaged.
In 2024, a 150- to 180- foot section of the Santa Cruz wharf was ripped off by powerful waves.
At least 10 of the state’s dozens of coastal public piers were closed for part or all of 2024 due to structural damage sustained in winter storms since 2022. At least five others have longer-term upgrades planned to address structural issues.
“These things are costly to maintain,” said Zach Plopper, senior environmental director at Surfrider. “They are a part of our California coastal culture in many ways, but we’re going to need to reckon with, one, the state that they’re in, and two, the continuous and worsening threats they’re going to experience,”
He said most of the piers were constructed in the early 1900s, and they weren’t built to withstand decades of rough seas, storms and rising sea level.
“With this incoming El Niño, which is forecasted to be significant, and this marine heat wave we’re in the midst of, we’re kind of in uncharted waters as far as what this winter could bring in terms of storms and swells to the California coast, and we’re likely going to see a lot more damage,” he said. “Not just piers, but roads and other coastal infrastructure up and down the state.”
There was no storm in Pacifica earlier this week, so no single event could be blamed for the destruction.
However, a 2025 report from an outside engineering firm, GHD, found that several sections of the pier were in “poor” or “serious” condition, and they recommended closure before anticipated storms or events that could “subject the piles to high winds, swells and large waves.”
The firm found several areas of the pier where concrete was missing and rebar was exposed and corroding.
“The pier has continued to experience high winds and large waves in a harsh marine environment,” the engineers wrote in the report, noting that continuous exposure to seawater or marine spray was “detrimental” to the structure.
A 2023 city report estimated it would cost $19 million to repair.
That same year, a state law was enacted to require local governments along the California coast to plan for sea level rise in the coming decades.
Sea level has risen some 8 inches, on average, along the coast in the past 150 years, Plopper said, and researchers anticipate another foot in the next 25 years.
“We’re going to see profound shifts on our coastline, none that we have ever experienced before, and building static structures on the coast just doesn’t work all that well,” he said. “We’re going to have to make some really hard decisions.”
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