CMS announces that Medicare beneficiaries are now eligible for free Covid-19 tests at participating pharmacies, a study finds Covid-19 is associated with an increased risk of diabetes, and more in this week's roundup of Covid-19 news.

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• A second booster shot of the Pfizer-BioNTech vaccine provided additional, albeit short term, protection against infection and severe illness among older adults, according to a new study from Israel. For the study, researchers analyzed health records from the Israeli Ministry of Health on more than 1.2 million adults ages 60 and older who were eligible for a fourth Covid-19 dose between Jan. 10 and March 2, when the omicron variant was dominant. The rate of confirmed virus infections and cases of severe illness among those who had received four doses was then compared to those who had received just three. Overall, the researchers found that the rate of infections was twice as high in the three-dose group than the four-dose group after four weeks. In addition, the rates of severe disease were 3.5 times higher in the three-dose group than the four-dose group after four weeks, and increased to 4.3 times higher after six weeks. However, protection against infection seemed to be short-lived, waning after four weeks and largely disappearing after eight weeks. Protection against severe illness did not show a similar decline, but researchers said the follow-up period was too short to determine whether the protection would hold up long term. Some limitations of the study include its relatively short follow-up period and the fact that it did not report data on deaths. (Anthes, New York Times, 4/5)

• CMS on Monday announced that Medicare Part B beneficiaries are now eligible to receive up to eight free at-home Covid-19 tests per month. Previously, the Biden administration launched an initiative to provide free at-home tests to individuals with private insurance. In February, CMS announced it would also cover at-home tests for Medicare beneficiaries following pressure from lawmakers and advocates for older Americans. "For the first time in its history, Medicare is paying for an over-the-counter test," said Meena Seshamani, director of the Center for Medicare at CMS. "[T]his initiative will significantly increase testing access for Americans most vulnerable to COVID-19 and will provide valuable information for future payment policy supporting accessible, comprehensive, person-center health care." According to Modern Healthcare, Medicare beneficiaries will be able to access the free tests at participating pharmacies, including CVS, Costco Pharmacy, Walgreens, and more. (Sullivan, The Hill, 4/4; Goldman, Modern Healthcare, 4/4)

• Several health conditions significantly increase a person's risk of contracting a breakthrough Covid-19 infection, according to new research from Epic. For the study, researchers analyzed medical records from nearly 14 million U.S. patients between January 2021 and January 2022. Overall, the researchers found that pregnancy, followed by solid organ transplant, and immune system deficiencies were the health conditions that increased a person's risk the most. Specifically, pregnant individuals were 1.91 times more likely to get a breakthrough infection, those with solid organ transplants were 1.83 times more likely, and those with an immune system deficiency were 1.63 times more likely. Other comorbidities that increased the risk of a breakthrough infection, although to a lesser degree, included kidney disease, liver disease, and mental health issues. "These findings support the CDC's recommendation that patients with a high-risk comorbidity may need to use enhanced infection prevention beyond vaccination to minimize the risk of a COVID-19 breakthrough infection," the researchers wrote. In addition, public health leaders and pregnancy specialists noted that the findings suggest further research is needed to find out how to best protect pregnant individuals and their babies from Covid-19. "To me, the most important question the new study raises is, is there an increased rate of severe illness and death in pregnant patients after a certain period of time [following vaccination]," said Brenna Hughes, vice chair for obstetrics and quality in the department of obstetrics and gynecology at the Duke University School of Medicine. (Garfinkel, Axios, 3/31; Goldstein/Keating, Washington Post, 3/31; Vakil, The Hill, 4/1)

• Even mild cases of Covid-19 may lead to an increased risk of being diagnosed with diabetes within a year, according to a new study published in Lancet Diabetes & Endocrinology. For the study, researchers used data from the U.S. Department of Veterans Affairs to analyze 181,280 patients who had a positive Covid-19 test between March 1, 2020, and Sept. 30, 2021. These patients were compared with two separate control groups and were followed for a median of 352 days. Overall, the researchers found that people who recovered from Covid-19 were 40% more likely to be diagnosed with type 2 diabetes within 12 months than those who never had Covid-19. The risk of developing diabetes increased if a Covid-19 patient was hospitalized or needed ICU care. "What's surprising is that it is happening in people with no prior risk factors for diabetes" before they had Covid-19, said Ziyad Al-Aly, the lead author of the study. In total, the researchers estimate that 1% to 2% of people who have had Covid-19, or between 800,000 and 1.6 million people, will subsequently develop diabetes. According to Al-Aly, the study's findings show that health care providers need to pay more attention to the potential long-term effects of Covid-19. "We need to start treating COVID as a risk factor for diabetes," he said. (Diaz, NPR, 3/31; Jacobs, New York Times, 4/3)

• Covid-19 hospitalizations in the United States last week dropped to their lowest levels since 2020. According to Modern Healthcare, there were an average of 11,860 people hospitalized with Covid-19 last week, a steep decline from more than 145,000 hospitalized in mid-January. In addition, HHS data indicates that the number of Covid-19 patients in the ICU has also been declining, falling to fewer than 2,000 beds nationwide. "I can't hear that [data on Covid-19 hospitalizations] without shouting 'hallelujah' because the stress and strain of the last two years has been so enormous," said Nancy Foster, VP for quality and patient safety policy at the American Hospital Association. However, she noted that hospitals and their staff are likely to remain busy, largely due to staffing challenges or patients who had previously delayed care coming in. Separately, Jason Salemi, an epidemiologist from the University of South Florida, cautioned that the omicron subvariant BA.2, which is now the dominant coronavirus variant in the United States, may lead to another surge in cases and hospitalizations, much like it did in other countries, including Britain. "We're probably under-detecting true infections now more than at any other time during the pandemic," he said. (AP/Modern Healthcare, 4/3; McPhillips, CNN, 4/1)