One year into the covid-19 pandemic, a significant number of patients have reported prolonged symptoms following their acute infections. Some of the symptoms can be mild but others have been reported as debilitating. 

The immunological mechanism for these symptoms remains unknown. Therefore, a concern raised during vaccination was whether administering a coronavirus vaccine to patients with these "long covid" symptoms might worsen the persistent symptoms. On the other hand, some people have suggested that vaccination might actually improve those symptoms. 

Now, a case series published in the  Annals of Internal Medicinesought to describe outcomes among vaccine recipients with post-covid-19 symptoms. The case series included 44 out of 163 patients who had previously been admitted to a single hospital in the United Kingdom with covid-19, eight months prior. Every 12 weeks, the patients were surveyed regarding their health and mental well-being. Patients who remained symptomatic eight months after illness and who received either the Pfizer/BioNTech or Oxford-AstraZeneca vaccines were included in the analysis. One month following vaccination, surveys were again completed, including questions on whether vaccine recipients perceived that their symptoms had worsened or improved. In order to reduce bias, vaccination status was not confirmed to researchers until after symptoms were assessed. 

Of the 44 individuals who had received a single vaccine dose, 82 percent reported at least one persistent symptom with fatigue, breathlessness, insomnia and ENT symptoms being the most common out of 159 listed symptoms. Subjects reported a median of 4 symptoms each and overall reduced quality of life scores. However, around a month post-vaccination, almost a quarter of the patients reported improved symptoms while just under 6 percent reported worsening symptoms. Quality of life and mental well-being did not worsen after vaccination. Similar to others vaccinated, many reported transient fevers (44 percent), myalgias (22 percent) and headaches (19 percent) shortly after vaccination. Vaccine type did not influence any of the results. Importantly, vaccine administration did not worsen quality of life or mental well-being for those with persistent symptoms and in many cases coincided with improvements. 

These findings should provide some reassurance to those hesitant about vaccination due to persistent symptoms from a prior covid-19 illness. That said, symptom improvement could have been all or in-part due to the passing of time since the patients' initial infections, 9 months prior. Therefore, this case series does not prove the coronavirus vaccines directly cause symptom improvement. However, these coinciding improvements are cause for optimism.

The data are quite clear that early on in the covid-19 pandemic, the United States was lacking, at best, when it came to testing for SARS-CoV-2. Over many months the federal government worked to both expand its testing footprint and lower the barriers to using clinic-based and at-home kits to truly understand the scope of the virus's spread. To further augment these efforts, this week the US Department of Health and Human Services (HHS) announced new funding to support testing among the uninsured population. 

As has been the case for many aspects of the American Rescue Plan, details have been emerging on a rolling basis for specific programs. In this instance, the funding amounts to a pledging of an additional $4.8 billion to cover testing for uninsured individuals. 

Initially funded through the Family First Coronavirus Response Act, the Paycheck Protection Program, and Health Care Enhancement Act, to date over $4 billion have been dispersed to healthcare providers who have administered tests to patients without insurance. While cases and hospitalizations are on the decline, testing remains an important cornerstone of the ongoing pandemic response and our ability to monitor for breakthrough variants of concern. Various.