A group of infectious disease experts argue that universal masking in healthcare settings is no longer necessary, the Biden administration announced a new program to cover COVID-19 vaccinations for uninsured individuals, and more in this week's roundup of COVID-19 news.

• People who have had COVID-19 have a significantly higher risk of being diagnosed with diabetes than those who were never infected, according to two new studies. In one study published in JAMA Network Open, researchers analyzed data from over 125,000 individuals who tested positive for COVID-19 in 2020 and 2021 and compared their diabetes diagnoses to over 500,000 individuals who had not been infected. Overall, the researchers found that adults who tested positive for COVID-19 were 17% more likely to develop diabetes within a year compared to those who did not. Compared to women, men had an increased risk of being diagnosed with diabetes. People who were hospitalized for COVID-19 were over twice as likely to develop diabetes, and people who were admitted to the ICU were over three times as likely. In a second study, also published in JAMA Network Open, researchers analyzed records from nearly 24,000 patients who had at least one COVID-19 infection and were treated at  Cedars-Sinai between 2020 to 2022. In adjusted models, the researchers found that a history of COVID-19 infection was associated with a 58% increased risk of developing new-onset diabetes compared to another benchmark condition. This risk was even higher among unvaccinated patients, who had a 78% increased risk of developing diabetes within 90 days of their initial infection. According to Alan Kwan, a cardiologist at the  Smidt Heart Institute at Cedars-Sinai and the study's lead author, one plausible explanation for the association could be "persistent inflammation contributing to insulin resistance," but the specific "mechanisms contributing to post-infection diabetes risk remain unclear." (Rabin, New York Times, 4/18; Henderson, MedPage Today, 3/29)
• FDA on Tuesday authorized a second round of bivalent COVID-19 booster shots for adults ages 65 and older and immunocompromised individuals. According to the agency, people ages 65 and older may get a second bivalent booster four months after their last dose, while immunocompromised individuals can get a second shot two months after their last dose. In addition, FDA said that unvaccinated individuals may get one dose of the bivalent vaccine as their primary series rather than two doses of the original monovalent vaccines, which are no longer authorized for use in the United States. "At this stage of the pandemic, data support simplifying the use of the authorized mRNA bivalent Covid-19 vaccines and the agency believes that this approach will help encourage future vaccination," said Peter Marks, director of FDA's  Center for Biologics Evaluation and Research. On Wednesday, CDC endorsed FDA's decision, recommending a second bivalent booster for older adults and immunocompromised individuals. With CDC's endorsement, around 60 million Americans are now eligible for an additional booster. (Jewett, New York Times, 4/18; Branswell, STAT, 4/18; González, Axios, 4/18; Moreno, Axios, 4/19; Mandavilli, New York Times, 4/20)
• In an editorial published in the Annals of Internal Medicine, several infectious disease experts argue that the time for universal masking in healthcare settings "has come and gone" as the COVID-19 pandemic "transition[s] to endemicity." According to Erica Shenoy, from  Harvard Medical School and  Mass General Brigham, and colleagues, universal masking in healthcare settings was initially implemented as a "critical protective measure" during the pandemic, but this precaution may longer be necessary since conditions "have changed dramatically and favorably" since then. In addition, the authors argue that the "potential incremental benefits [of universal masking] ... need to be weighed against increasingly recognized costs." For example, masking hinders communication, and there could be disproportionate challenges among patients who are hard of hearing or speak a language other than English. In the future, "pandemics or significant localized outbreaks may justify more widespread or targeted masking policies, respectively, as part of a bundled response," the authors wrote. "High-quality epidemiologic data with frequent updates and regular reevaluation are needed to inform scale-up or scale-down decisions." (Henderson, MedPage Today, 4/17)
• The Biden administration on Tuesday announced a new program to offer free COVID-19 shots for uninsured Americans as vaccines transition to the commercial market later this year. Through the initiative, which will cover around 30 million people, the government will partner with pharmacy chains and pay any administrative costs associated with the doses. Both Pfizer and Moderna have committed to providing the shots at no cost for those without insurance through similar patient assistance programs. Aside from vaccines, the new program will also cover some costs of COVID-19 treatments for those who are uninsured. "Covid is not over," said Ashish Jha, the White House COVID-19 response coordinator. "And while we are transitioning out of the public health emergency and all of the flexibilities it provided, we're committed to making sure that we continue to fight Covid. And that means making sure people have access to vaccines, treatments and tests." (Stolberg/Weiland, New York Times, 4/18)
• According to new research from the United Kingdom, the risk of developing long COVID may be lower after a second infection compared to a first infection. In an ongoing study from the U.K.'s  Office of National Statistics (ONS), survey responses from almost 270,000 people were collected over a four-week period ending March 5. Overall, 4% of respondents reported COVID-19 symptoms that persisted at least four weeks after their first infection. In comparison, only 2.4% of respondents said they experienced persistent symptoms after a second infection. According to Daniel Ayoubkhani, a statistician at ONS, the findings suggest that the risk of long COVID is "significantly lower the second time around." However, he added that the risk is "still not negligible" and that it's "not impossible to develop long COVID the second time if you didn't develop it the first time." Although the researchers did not examine why there would be a reduced risk of long COVID after a second infection, immunity from previous infections may play a role, or people who did not get long COVID after their first infection could be predisposed against the condition. (Stein, "Shots," NPR, 4/14; Carbajal, Becker's Clinical Leadership & Infection Control, 4/14)