The United States has wasted more than 82 million Covid-19 vaccine doses, over 40% of U.S. counties are "Paxlovid deserts," and more in this week's roundup of Covid-19 news.

How to improve access to Covid-19 treatments

• The White House on Thursday outlined its strategy for vaccinating children under 5 against Covid-19, making 10 million doses available to states and health care providers for preorder ahead of FDA's potential authorization. According to Axios, FDA could authorize pediatric doses of the Covid-19 vaccines as soon as next week after its outside advisory committee reviews the vaccines on June 14 and 15. Currently, Moderna is seeking authorization for a two-dose vaccine for children under six, while Pfizer-BioNTech is seeking authorization for a three-dose vaccine for children under five. According to federal officials, if the shots are authorized, vaccines will likely to be available to young children starting June 21. However, it is not clear how many parents will choose to vaccinate their young children once the vaccines become available. According to an April survey from the Kaiser Family Foundation, only 18% of parents with children under five said they would get them vaccinated right away. An additional 38% of parents said they wanted to wait and see before vaccinating their young children, while 27% said they would definitely not vaccinate their children. (Weiland, New York Times, 6/9; Saric, Axios, 6/9; Weixel, The Hill, 6/9)

• The American Academy of Physical Medicine & Rehabilitation (AAPM&R) on Tuesday released a new consensus statement emphasizing the need for greater awareness of cardiovascular complication in patients with long Covid. According to the PASC Collaborative, cardiovascular issues may occur weeks to months after a patient's initial Covid-19 infection, and symptoms can range from "mild to incapacitating." In addition, the group noted that 5% to 29% of Covid-19 patients report cardiovascular symptoms, including chest pain, dyspnea, or palpitations, months after their initial recovery. In its guidance, AAPM&R encouraged physicians to be more vigilant about the potential of cardiovascular disease caused by long Covid, particularly for patients who previously had no history of such symptoms. To help physicians diagnose and treat long Covid patients with cardiovascular symptoms, the guidance recommends several best practices, including taking a full patient history, noting any common or worsening cardiac issues, and focusing on modification strategies for risk factors (hypertension, diabetes, obesity, etc.) that could affect Covid-19 morbidity and mortality. (DePeau-Wilson, MedPage Today, 6/7)

• The United States has wasted more than 82 million Covid-19 vaccine doses since the beginning of the pandemic, according to CDC data—a significant increase from a previous estimate of roughly 65 million wasted doses in February. CVS and Walmart accounted for more than 25% of vaccine doses that were thrown out, in part because of the sheer volume of vaccines they have administered. Among the U.S. states, Oklahoma and Alaska discarded the greatest proportion of vaccines doses they received at 28% and 27%, respectively. Part of this waste is due to the fact that Covid-19 vaccines come in multidose vials, all of which must be used within hours of opening. "The demand has plateaued or is coming down, and that leads to open-vial wastage—especially with multidose vials," said Ravi Anupindi, a professor of operations research and management at the University of Michigan. "It's a demand problem." According to the World Health Organization, this amount of waste is expected for large vaccination campaigns, but public health experts said the waste is alarming considering less than half of fully vaccinated Americans have been boosted and many poorer countries still have limited vaccine supplies. "It's a tremendous loss to pandemic control — especially in the context of millions of people around the world who haven't even been able to get a first dose," said Sheela Shenoi, an infectious disease expert at the Yale School of Medicine. (Saric, Axios, 6/6; Eaton, NBC News, 6/6)

• Two new omicron subvariants, BA.4 and BA.5, are now gaining prevalence in the United States, making up 13% of all new Covid-19 cases, up from 7.5% a week prior and 1% in early May, according to new CDC estimates. According to Denis Nash, an epidemiologist at the CUNY Graduate School of Public Health & Health Policy, this trend suggests BA.4 and BA.5 could "very quickly" outcompete the two currently dominant omicron subvariants, BA.2 and BA.2.12.1. In fact, the two variants now account for more than 20% of new Covid-19 cases in certain parts of the southern United States, including Arkansas, Louisiana, and Texas. So far, data on the BA.4 and BA.5 subvariants remains limited, but evidence suggests they are more transmissible than earlier omicron variants and may be more capable of evading immune defenses. Currently, there is no evidence that these subvariant cause more severe disease, but more research is needed. In April and May, BA.4 and BA.5 fueled a new surge in cases in South Africa, where they were first detected, but it's not clear whether the United States will see a similar surge from the subvariants. "I think it's possible that we could see another wave" caused by BA.4 and BA.5, said Jeffrey Shaman, an infectious disease epidemiologist at Columbia University. However, he added that a surge, if it does occur, could be more modest than previous surges and lead to smaller increases in hospitalization and deaths. (Anthes, New York Times, 6/8; Katona, MedPage Today, 6/6)

• Between January and March, more than 26 million Americans lived in counties where Paxlovid wasn't readily available, according to a new analysis by GoodRx. For the analysis, researchers analyzed HHS data to determine the number of publicly available Paxlovid courses distributed in counties across the United States. Overall, roughly 42% of U.S. counties, which accounted for 26 million people, were "Paxlovid deserts" that did not receive any supply of the treatment. These counties were typically more rural and less populous, and many were health care and pharmacy deserts without the necessary infrastructure to distribute Paxlovid. However, the analysis noted that distribution of the treatment was relatively equitable across different racial and ethnic groups in urban populations. Since March, the federal government has made efforts to increase the availability of Paxlovid through a nationwide "test-to-treat" program where people who test positive for Covid-19 at a participating pharmacy can also receive a prescription of Paxlovid free of charge. In addition to this program, GoodRx suggested that telemedicine, mobile clinics, and delivery services could be used to further improve access to the treatment. (McQueen, GoodRx Health, 6/6; Twenter, Becker's Hospital Review, 6/7)