COVID-19 vaccines for children younger than 5 are rolling out this week. The U.S. Food and Drug Administration and U.S. Centers for Disease Control and Prevention signed off on the shots' safety and efficacy. Like with any vaccine, though, it's possible kids may experience a few side effects.

The safety data from Moderna and Pfizer, vetted by the FDA and CDC, found potential side effects were mostly mild and short-lived.

For parents and caregivers planning to get their little ones vaccinated, pediatricians say there are a few things to watch out for — generally the same effects adults or older children might have experienced after their shots.

Most vaccine side effects are mild, short-lived

"In general, I think the most common side effects from either of the vaccines are still the most common side effects we see from pretty much any child that gets any vaccine," said Dr. Grant Paulsen, the principal site investigator for the Pfizer and the Moderna COVID-19 vaccine clinical trials for kids 6 months to 11 years old at Cincinnati Children's.

Side effects most commonly included pain at the injection site, and sometimes there was swelling or redness.

"Those are all what I would classify as pretty common side effects that most parents that have taken their children to the doctor to get their various hepatitis and tetanus vaccines and all that kind of stuff were probably pretty used to," Paulsen said.

As far as systemic or body-wide symptoms, the most common was fatigue or sleepiness. Some children had irritability or fussiness, loss of appetite, headache, abdominal pain or discomfort, enlarged lymph nodes, mild diarrhea or vomiting. But everyone got better quickly.

"It's very similar to the side effects we've seen for older kids or for adults. About 24 hours of some kids, you know, they kind of don't feel as well, they feel tired, they don't have the same appetite. But thankfully, there have not been any serious side effects of these vaccines," Dr. Ashish Jha, White House COVID-19 response coordinator said on CBS on Monday. "And again, after giving these vaccines to millions of children, it's really reassuring to know that for young kids these vaccines are exceedingly safe."

Side effects were mild to moderate and were far less frequent with this young age group than with older ages, Paulsen said.

"My big picture for parents is really [that] the side effects should not be alarming," Paulsen said.

Potential for fever

Kids were slightly more prone to get a fever with the Moderna vaccine; it happened with about a quarter of the trial participants, versus less than 10% with Pfizer. Most of the fevers were mild. Less than 1% of all participants in the trial had a fever that reached 104 degrees.

"That was rare, but I feel like if we're not honest with parents, when these things come out, that will be concerning," Paulsen said.

Because fevers were not common, Paulsen does not recommend pre-treating a child by giving them a fever-reducing medicine before the shot.

If the child develops a fever, he said, parents can give ibuprofen or acetaminophen.

"The odds are, most children are just going to do fine and have really minimal problems," he said.

No cases of myocarditis

The scientists who conducted trials on the youngest children were also watching closely to see if any of the children had problems with myocarditis, inflammation of the heart muscle, because there were a handful of cases among older children and adults. In most of those cases, the symptoms went away quickly.

But myocarditis was not found to be a problem in the trials in young children.

"Of course, we have all the mechanisms in place once we start vaccinating kids next week. If we start seeing it, all those bells and whistles will go off and bring our attention to it," said Dr. Claudia Hoyen, director of pediatric infection control at UH Rainbow Babies and Children's Hospital in Cleveland. "But we are not expecting to see that. We didn't really see it in kids who were 5 to 11, either."

'An extra layer of protection'

Because children get severe COVID-19 less frequently than adults, some parents may wonder if they should bother to get their little ones vaccinated. COVID-19, however, has been "quite common" in children, Jha said. He said almost 70% of kids have been infected at some point, but they can always get it again -- and even if it was mild the first time, that doesn't mean it will be the next time.

"Still worth getting the vaccine, it really offers an extra level of protection, an extra layer of protection. What vaccines do is they keep kids out of the hospital, and that's why they are so effective and everybody deserves that protection," Jha said.

Dr. Suchitra Rao says it's important to keep in mind that COVID-19 is now one of the vaccine-preventable diseases with the highest mortality rate.

"If we look at this age group, we will see that Covid has killed more than 200 6-month to 5-year-olds since January of 2020. And if we want to compare that to something like flu, those numbers are actually higher than what we've been seeing annually for all kids under the age of 18 for influenza," said Rao, a pediatric infectious disease specialist at Children's Hospital Colorado.

"We're getting routine vaccines against measles and against pneumococcal disease and meningitis. That this is something that's actually causing more deaths," she added. "Safety in this younger age group is actually quite, quite good and better than other groups, even."

Rao said some parents have asked her if they should be concerned about long-term side effects. She reassures them that if there were any, they would have shown up in the clinical trials.

"The FDA and then the [CDC's Advisory Committee on Immunization Practices], and all of these governing groups that make those recommendations really do an excellent job evaluating the safety and the effectiveness and go through all of the manufacturing data of these vaccines, and it's such a rigorous and comprehensive review," Rao said. "I think the fact that it took a little bit longer for the agency to authorize these shots in these younger kids is really telling, because they just had to make absolutely sure since this is such a vulnerable group."

Parent questions welcome

While Dr. Nina Alfieri, a pediatrician at Ann & Robert H. Lurie Children's Hospital of Chicago, has seen a lot of interest in COVID-19 vaccines for the youngest children, she knows parents will want to know about vaccine safety.

This year, Lurie did a survey of 5,000 Chicago parents to find out where they stood on the COVID-19 vaccine. Side effects were among their top concerns.

"It makes sense. You want to make sure what you're doing for your kids is safe," Alfieri said.

Alfieri said she hopes caregivers will be sure to ask their pediatrician questions to ease any worries.

"I really love when families come to me and they tell me they are a little bit unsure, because it gives us an opportunity to really sit down face to face, in a safe environment, and talk about their concerns," she said.

"There's going to be a lot of conversation the next couple of months, and I think all of us pediatricians are ready for it, and we're welcoming this kind of conversation because overall, this is a really exciting time for us. Because finally, this vulnerable and very young age group who has kind of been left out of one of the best protective measures is now going to be eligible to be protected."

The Food and Drug Administration announced Wednesday that state-licensed pharmacists can now prescribe Paxlovid.

The pill, developed by Pfizer, is used to treat mild-to-moderate COVID-19.

“Since Paxlovid must be taken within five days after symptoms begin, authorizing state-licensed pharmacists to prescribe Paxlovid could expand access to timely treatment for some patients who are eligible to receive this drug for the treatment of COVID-19," said Dr. Patrizia Cavazzoni, director for the FDA’s Center for Drug Evaluation and Research. 

People who have tested positive for COVID-19 must provide health records, including laboratory blood work results, when requesting a Paxlovid prescription from a pharmacist.

The patient must also be willing to inform the pharmacist of all the medications they are currently taking to make sure there are no potentially serious interactions with Paxlovid.

The drug is currently authorized for treatment in people 12 years and older, who weigh at least 88 pounds.

The highly transmissible omicron subvariant BA.5 represents at least 65% of new COVID-19 infections in the United States, according to the US Centers for Disease Control and Prevention.

Infections are rising in most parts of the country, and these numbers are almost certainly an undercount, given how many people are determining their status through home tests that are not reported.

At the same time, many people have lots of summer events planned, including weddings, birthday celebrations and casual get-togethers. What should event organizers keep in mind? How can people think about their own risk in deciding whether to attend and what precautions to follow? What if you have to attend something — for example a work function — but really don't want to bring COVID back to your family? And what about people who have already recovered from an infection — do they still have to worry about reinfection and the risks of illness, including long COVID?

Video above: BA.5 variant leads U.S. cases and sparks concerns about contagiousness

CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health helped answer these questions. She is also the author of "Lifelines: A Doctor's Journey in the Fight for Public Health."

Why is BA.5 a concern right now?

Dr. Leana Wen: BA.5 is now the dominant variant here in the United States and in many parts of the world. It appears to be the most transmissible variant yet. It also may be partially immune-evasive, meaning that people who have gotten their vaccinations or who have previously had COVID-19 may not have much protection against mild or asymptomatic infection.

However, vaccination does protect against severe illness. People who are unvaccinated should get vaccinated, and those not yet boosted should do so. Being up to date on vaccines will help to protect you from the potentially severe consequences due to COVID-19, which ultimately is the goal of vaccination.

The reason it's a concern now is that there are high levels in many parts of the country. In areas with a lot of circulating virus, with such a transmissible pathogen, one's chances of catching COVID-19 are high.

Does that mean people should cancel in-person events?

Wen: After two and a half years of the pandemic, I don't think it's reasonable to ask that people continue to forgo weddings, birthday parties and other get-togethers. A lot of people have decided that as long as they are unlikely to become severely ill from COVID-19, they will not take precautions to avoid it.

On the other hand, a lot of people still really want to avoid COVID-19. Event organizers should take into account the wishes of those gathering.

What are some things people can do if they are organizing a get-together?

Wen: First is recognizing that any time people are gathering, especially indoors, there will be a risk of coronavirus transmission. This is especially true with a very contagious virus, and when there is so much virus around us. It's not realistic to set the expectation that no one could get coronavirus at the event, though you should try to reduce risk.

Some ways to do that include, first and foremost, trying to have the gathering outdoors. We have said this throughout the pandemic, and it remains true now that outdoors is much safer than indoors. Coronavirus is airborne, and the more air circulation you have, the better.

Ventilation also matters. A partial indoor/outdoor space where there is good air circulation will be better than one that's entirely enclosed. And one with open windows and doors and lots of spacing will be lower risk than a small, enclosed room with everyone crowded together.

Video above: Doctor talks about omicron BA.5 variant

If organizers want to reduce risk further, they could ask that everyone take a home rapid test just prior to the event. Rapid tests aren't perfect, but they are very good at detecting if someone has enough virus at that point in time that they could infect others. Providing testing at the door is an additional safeguard, in case not everyone has access to testing beforehand.

Of course, masks can also reduce virus transmission. At this point in the pandemic, it may be difficult to get people to keep masks on when most places no longer require them. I think it's more realistic to plan for an outdoor event, and, if it has to be indoors, to ask for testing instead of required masks (though masks should, of course, be an option for those who want additional protection).

What's your advice for immunocompromised individuals or folks who just really want to avoid contracting COVID-19?

Wen: When you are invited to an event, find out what precautions the organizer is taking and then gauge risks accordingly. An outdoor event, or at least one where you could stay outdoors the entire time, is quite low risk. An indoor event that requires either testing or masks is also lower risk.

What about crowded indoor events that don't require testing and masks? One-way masking with a high-quality mask — N95 or equivalent — remains protective, but your mask must be well fitting and you must keep it on the entire time. If you go, consider eating beforehand and taking off your mask only when outdoors or in a place where you are by yourself.

At the end of the day, there is no clear answer to whether you should go — it depends on how much you want to avoid Covid-19 versus the benefit you would derive from attending.

If someone has had COVID-19, do they need to worry about reinfection? What do we know about the risk of long COVID with reinfection?

Wen: Reinfection is certainly possible. Those who had pre-omicron variants like delta or alpha are susceptible to reinfection with omicron subvariants. We are even seeing reinfections with people who had the original omicron variant and are now getting BA.5.

The chance of reinfection within the first two or three months following the initial infection is pretty low but increases after that. People previously infected benefit from vaccination and boosting, which further decreases their chance of both severe illness and infection.

There is a new study, posted online but not yet peer-reviewed, that shows those with reinfection are at higher risk for long COVID and other potential consequences with each infection. These results could well prompt some people to say they want to avoid reinfection as much as possible.

A lot of people are having to travel for conferences, meetings and other work functions. What's your advice if they don't want to bring COVID-19 back to their families?

Wen: There are two options. One is to try to reduce their risk while traveling and at these functions as much as possible, including limiting time indoors with others, masking during all indoor interactions, and avoiding indoor events with food and drink -- or at least keeping a mask on during these functions and eating and drinking separately elsewhere.

The second option is to assume that you will be exposed and could contract COVID-19 during these work functions, then quarantine yourself and test before interacting with family members. Not everyone is able to do this — perhaps they have young children or other family responsibilities — but that is another option that may be right for some people.

WASHINGTON —

President Joe Biden continues to "improve significantly" despite a lingering sore throat from his coronavirus infection, according to an update Sunday from his doctor.

"The president is responding to therapy as expected," wrote Dr. Kevin O'Connor in his latest note. Biden has been taking Paxlovid, an antiviral drug that helps reduce the chance of severe illness.

O'Connor wrote that Biden still has a sore throat, though other symptoms, including a cough, runny nose and body aches, "have diminished considerably."

Biden tested positive for the coronavirus on Thursday morning. O'Connor said Saturday that the president likely became infected with a highly contagious variant, known as BA.5, that is spreading throughout the country, and Dr. Ashish Jha, the White House COVID-19 response coordinator, said Sunday, "It is the BA.5 variant."

"Thank goodness our vaccines and therapeutics work well against it, which is why I think the president's doing well," Jha told CBS' "Face the Nation."

Jha also gave a positive update on the president's health.

"I checked in with his team late last night. He was feeling well. He had a good day yesterday," Jha said.

That variant is an offshoot of the omicron strain that emerged late last year. It is believed responsible for the vast majority of coronavirus cases in the country. He has been isolating in the White House residence since then.

Administration officials have emphasized that his symptoms are mild because he has received four vaccine doses, and he started taking the antiviral drug Paxlovid after becoming infected.

The White House has not released any photos or video of Biden since Friday, when the media watched him participate in a virtual meeting with economic advisers.

Jha pledged that the White House would keep giving updates on the president's condition and whether he might have long-term symptoms.

"We think it's really important for the American people to know how well their president is doing," he said.

"Obviously if he has persistent symptoms, obviously if any of them interfere with his ability to carry out his duties, we will disclose that early and often with the American people. But I suspect that this is going to be a course of COVID that we've seen in many Americans who have been fully vaccinated, double boosted, getting treated with those tools in hand," Jha said. "The president's been doing well and we're going to expect that he's going to continue to do so.''

Biden's press secretary has said 17 people, including members of the president's senior staff and at least one member of Congress, were determined to have been in close contact with Biden when he might have been contagious. None has tested positive so far, Jha said on "Fox News Sunday."

President Joe Biden tested positive for COVID-19 again Saturday, slightly more than three days after he was cleared to exit coronavirus isolation, the White House said, in a rare case of “rebound” following treatment with an anti-viral drug.

White House physician Dr. Kevin O'Connor said in a letter that Biden “has experienced no reemergence of symptoms, and continues to feel quite well.”

In accordance with Centers for Disease Control and Prevention guidelines, Biden will reenter isolation for at least five full days. The agency says most rebound cases remain mild and that severe disease during that period has not been reported.

Word of Biden’s positive test came — he had been negative Friday morning — just two hours after the White House announced a presidential visit to Michigan this coming Tuesday to highlight the passage of a bill to promote domestic high-tech manufacturing. Biden had also been scheduled to visit his home in Wilmington, Delaware, on Sunday morning, where first lady Jill Biden has been staying while the president was positive. Both trips have been canceled as Biden has returned to isolation.

Biden, 79, was treated with the anti-viral drug Paxlovid, and tested negative for the virus on Tuesday and Wednesday. He was then cleared to leave isolation while wearing a mask indoors. His positive tests puts him among the minority of those prescribed the drug to experience a rebound case of the virus.

Both the Food and Drug Administration and Pfizer point out that 1% to 2% of people in Pfizer’s original study on Paxlovid saw their virus levels rebound after 10 days. The rate was about the same among people taking the drug or dummy pills, “so it is unclear at this point that this is related to drug treatment,” according to the FDA.

While Biden was testing negative, he returned to holding in-person indoor events and meetings with staff at the White House and was wearing a mask, in accordance with CDC guidelines. But the president removed his mask indoors when delivering remarks on Thursday and during a meeting with CEOs on the White House complex.

Asked why Biden appeared to be breaching CDC protocols, press secretary Karine Jean-Pierre said, “They were socially distanced. They were far enough apart. So we made it safe for them to be together, to be on that stage.”

Regulators are still studying the prevalence and virulence of rebound cases, but the CDC in May warned doctors that it has been reported to occur within two days to eight days after initially testing negative for the virus.

“Limited information currently available from case reports suggests that persons treated with Paxlovid who experience COVID-19 rebound have had mild illness; there are no reports of severe disease,” the agency said at the time.

When Biden was initially released from isolation on Wednesday, O’Connor said the president would “increase his testing cadence” to catch any potential rebound of the virus.

Patients should re-isolate for at least 5 days. Per CDC guidance, they can end their re-isolation period after 5 full days if fever has resolved for 24 hours (without the use of fever-reducing medication) and symptoms are improving. The patient should wear a mask for a total of 10 days after rebound symptoms started.”

Paxlovid has been proven to significantly reduce severe disease and death among those most vulnerable to COVID-19. U.S. health officials have encouraged those who test positive to consult their doctors or pharmacists to see if they should be prescribed the treatment, despite the rebound risk.

Biden is fully vaccinated, after getting two doses of the Pfizer coronavirus vaccine shortly before taking office, a first booster shot in September and an additional dose March 30.

While patients who have recovered from earlier variants of COVID-19 have tended to have high levels of immunity to future reinfection for 90 days, Jha said that the BA.5 subvariant that infected Biden has proven to be more “immune-evasive.”

“We have seen lots of people get reinfected within 90 days,” he said, adding that officials don’t yet have data on how long those who have recovered from the BA.5 strain have protection from reinfection.

The Biden administration is declaring monkeypox a public health emergency, Health and Human Services Secretary Xavier Becerra announced Thursday.

The action frees up federal funds and resources to combat the outbreak.

The Centers for Disease Control and Prevention (CDC) reports more than 6,000 cases of monkeypox have been detected in the U.S. Montana and Wyoming are the only states without confirmed monkeypox cases.

The CDC says monkeypox can spread in various ways:

• Direct contact with monkeypox rash, scabs, or body fluids from a person with monkeypox.
• Touching objects, fabrics (clothing, bedding, or towels), and surfaces used by someone with monkeypox.
• Contact with respiratory secretions.

There is a vaccine for monkeypox, but it's in short supply. It's currently being offered to people who are infected or considered high-risk. That includes people who have had "multiple sexual partners in the past 2 weeks in an area with known monkeypox" cases.

The Centers for Disease Control (CDC) says health care providers in several regions are seeing young patients with enterovirus D68 (EV-D68).

The virus has been associated with neurologic complications, albeit rare, involving limb weakness, primarily affecting children, the CDC stated.

An alert has been sent out to providers to watch out for EV-D68. Symptoms include cough, shortness of breath, and wheezing. Fever was reported in approximately half of the known cases, according to the CDC.

"Children with a history of asthma or reactive airway disease may be more likely to require medical care, though children without a known history of asthma can also present with severe illness," the CDC said.

The peak season for EV-D68 is late summer and early fall, the CDC warns.

To help protect against the virus, people are encouraged to routinely wash their hands and avoid close contact with people who are sick.

There is currently no vaccine or specific treatment for EV-D68.

Lalo Alcaraz still gets excited when he sees people reacting to one of his political cartoons.

"That never gets old," he said.

A tiny office is where he creates a loud message by using barely any words. 

“I’m just trying to get people to think critically," Alcaraz said.

The thing about political cartoons, he said, is that within seconds people should understand the point.

“I think political cartoons are really accessible, quick format that delivers the truth with a punch,” Alcaraz said.

His work is sometimes controversial. Alcaraz admits he's received hate mail throughout his career. 

“Bluntness. That's what makes my cartoons different. I have a lot of different cartoons I like to be direct," Alcaraz said.

Alcaraz is a Pulitzer Prize-nominated cartoonist whose daily comic strip "La Cucaracha" is the first nationally syndicated Latino political cartoon.

His art has made him an icon in the Mexican-American community.

In the pandemic, his work has carried a new meaning.

“It makes me feel good if someone tells me like, 'that really helped me to talk to my uncle about his dislike of vaccines,'" Alcaraz said. "That’s always a win for me."

He created special cartoons to fight pandemic misinformation as part of the "COVID Latino" project with Arizona State University.

The Latino community’s high reliance on social media for news is a reason why groups like Nielsen say they are at a higher risk for misinformation.

Avaaz, a nonprofit organization, found posts with misinformation in Spanish on Facebook are far less likely to be flagged— compared to posts in English.

“I think we’re all responsible to our communities we can’t expect people to come in and fix things for us and also on the ground level at some point," Alcaraz says.

Facebook has promised to do more to fact-check Spanish posts on its platform.

As the midterm elections near, Alcaraz hopes his messages can be educational.

"You know the information is out there; you have to look at it," he said. "'Use the coco that God gave you.'" That’s an old thing my mom used to say.”

BALTIMORE — Restaurants are the backbones of communities across the country. They bring us to the freshest bodies of water, different countries, and the most unique spaces without leaving the comfort of our neighborhoods. Three years after the start of the pandemic, restaurants are still fighting to stay alive.

A year ago, we visited Baltimore to check in on restaurants that never received their funds from the government's Restaurant Revitalization Fund, and now, a year later, we are checking in.

Every restaurant has something different their customers always come back for. Here in Baltimore, it's likely you'll find it to be seafood. However, those signature flavors disappear if a business can't stay afloat. The Local Oyster is one restaurant that worries about its future.

"The Local Oyster started in 2015. We have been shucking oysters and serving crab cakes for the last seven years," said Patrick Hudson, one of the owners. "We were not generating any revenue; we were simply incurring losses and debt throughout the entire pandemic."

The Local Oyster has already had to close one of its locations in Arlington, Virginia. The restaurant's last spot remains standing, but shakily.

"Thinking about business before COVID is sort of like thinking about college; it was just a haze. It's like I can't even really remember what it was like. It's just so different," Hudson said.

Hudson says they are one of the thousands of businesses who saw their approval for the restaurant revitalization fund revoked last year. Congress provided $28.6 billion in grants, but funding dried up and two-thirds of the restaurants that were approved for funding received nothing.

"What that does is it leaves the local oyster in a position where we have hundreds of thousands of dollars of debt going forward, and to be honest, I don't know how sustainable that is. I don't know if that's going to last," Hudson said.

It's been over a year since that bad news was delivered, but the ripple effects of the pandemic continue to affect them every minute, of every day.

"And it's kind of surreal and people will come up to me during service and say, 'Well, I'm really glad you survived the pandemic' and I just have to shake my head," Hudson said. "We're gonna be struggling with the impact of the pandemic for the next generation of restaurant owners."

Damye Hahn runs Faidley's Seafood just a few minutes down the road.

"It would be like equating you to having a year and a half worth of mortgage payments that you haven't been able to pay, and all of a sudden, you get a job. Well that you're gonna be able to pay your mortgage, but that year and a half of mortgage payments is still hanging out there," Hahn said. "We just felt like the hits just kept coming and once we thought everything was beginning to get better than this incredible inflation hit. And it has been difficult again."

They've been in business for more than 130 years. Yet, these last few have been unmatched.

"We've had to raise prices. We've had to cut items off the menu that we can't carry anymore because they are just too expensive," Hahn said. "Fishing, it's been terrible to try to get fish because the poor guys, all their boats are diesel, and the diesel is outrageous. Fish and seafood have gone up dramatically. Some of it two and three times what we paid in 2019."

These are the kinds of roadblocks that can change a restaurant's identity.

"We consider ourselves really ambassadors of the Chesapeake region, so we make sure that we gave local fish, local crab, local oysters, real local seafood," Hahn said.

It worries Hahn about the future of the industry.

"This industry is so important because we tell the story of the Chesapeake, but there's restaurants that tell stories of the farms and other industries," Hahn said.

It's been months since your ability to taste and smell disappeared after a COVID-19 infection. You've tried to schedule an appointment with a specialist — if you were able to find one — only to discover waiting lists of six months or longer.

Video above: Here's what researchers say about long COVID

"There was this explosion of patient calls after the pandemic started, and we couldn't see 10% of the patients that wanted to come to the clinic," said Dr. Justin Turner, associate professor of otolaryngology and head and neck surgery at Vanderbilt University Medical Center in Nashville, Tennessee.

Unfortunately, that's still the case, leaving many who have yet to recover their sense of smell and taste struggling to find help, said rhinologist Dr. Zara Patel, who is a surgeon who focuses on treatment of the nose and sinuses.

"One of the big problems we realized at the beginning of the pandemic is that almost no one other than a few specialists knew anything about smell loss and how to go about diagnosing or treating it," said Patel, a professor of otolaryngology and head and neck surgery at Stanford University School of Medicine in California.

Both Stanford and Vanderbilt have established clinics to treat and research smell loss, two of a handful in the United States.

"The sad and most common thing I hear from patients in my clinic who have seen multiple physicians before they get to me is that they were told: 'There's really nothing you can do. You'll just have to see if your smell will come back with time,'" Patel said.

"When in reality, the sooner we start any definitive intervention, the more likely we are to be able to bring back smell."

To address the issue, Patel said she gathered 50 experts to create a 600-plus-page consensus that combined vetted scientific knowledge and medical best practices on smell loss.

"It's the first peer-reviewed compendium of its kind on olfaction," Patel said. "And it's open access — not just for physicians, but for patients, for anyone to read."

Video below: Teen shares medical condition developed after battle with COVID-19

The guidelines, published in the journal International Forum of Allergy & Rhinology, lay out a plan of action for general practitioners on how to examine, diagnose and treat smell loss — including when to make referrals to a specialist.

Patel encourages people with smell loss to print out the clinical assessment (see below) and take it to their doctor.

"We wrote this as a resource for patients to advocate for themselves — and for physicians who simply just don't have the training or the expertise in this area," Patel said. "They don't just have to say, 'Oh, there's nothing that you can do.' They can use this and learn about the different options for treatment."

A trip to the doctor

The clinical assessment outlines a recommended order for the diagnosis of smell loss from any cause, not just COVID-19.

Patient history: A physician should take a detailed patient history, according to the guidelines. That will include questions about onset, severity and psychological impact of the loss of smell, along with possible culprits such as exposure to toxic chemicals, injuries or surgery to the head or nose, and radiation for cancer.

Headaches, chronic sinus issues, autoimmune disorders, some medications and vitamin or mineral deficiencies can be associated with smell loss as well as the common cold, flu and other viral illnesses such as COVID-19.

Age also can play a factor — all of us partially lose our sense of smell as more olfactory nerves fail to regenerate. People with Parkinson's disease, Alzheimer's disease and multiple sclerosis often have smell loss due to their illness's impact on the brain.

Smell test: The doctor should administer a verified smell test. However, be aware some tests may not be sensitive enough to pick up subtle nuances in loss of smell, possibly leading a doctor to say nothing is wrong.

Some patients had that experience early in the pandemic when about 60% of people who had the Alpha and Delta variants complained of smell and taste loss, Turner said.

"When those patients started to be objectively tested, that positivity rate went way up — around 80% or even 90% of patients had some form of dysfunction if you really tested them," Turner said.

It can also work in reverse, with many people unaware of nuances in smell recovery, said Dr. Eric Holbrook, an associate professor of otolaryngology and head and neck surgery at Harvard Medical School in Boston.

"There's been papers showing that humans have difficulty assessing gradual change in their sense of smell," Holbrook said. "Testing can differentiate a little bit, and it can be encouraging for some people to see that there has been a change."

Physical workup: A full physical exam should be done, including a nasal endoscopy and an examination of cranial nerves. If the patient history shows evidence of a neurological disorder or chronic sinus inflammation, further testing should be ordered, the guidelines note.

If tests are positive, the patient should be referred to a specialist to treat that specific disorder. For example, a person with chronic sinusitis would be referred to a rhinologist.

If a specialist is needed, Patel suggested using the American Rhinologic Society's website to find one in your area.

Potential treatments

The guidelines recommend various treatments, depending on the cause of the smell loss.

Underlying disorder: If the loss of smell is due to an underlying disease, such as chronic sinusitis or neurological condition, the guidelines suggest physicians refer the patient to a specialist and provide treatment options.

Surgery and trauma: If the loss is due to skull surgery, treatment with omega-3 fatty acids is recommended. If trauma such as a car accident is the cause, oral zinc and topical vitamin A are options.

"Using the term 'options' means that either there is very low level data that it may help," Patel said, "or there are conflicting studies where some show it helps and some do not, but there is no data to suggest harm."

Viral infections: If the smell loss is a result of a viral infection such as COVID-19 or the flu, a recommended treatment is smell training, a process in which patients practice smelling scents twice each day for at least six months.

"We start with four odors that are in different categories of smell so that they will stimulate different types of olfactory receptor neurons in your nose: lemon, rose, eucalyptus and clove," Patel said.

Another recommendation is the use of steroids via a squeeze bottle nasal irrigation device similar to a neti pot, Patel said. Steroid nasal sprays don't reach far enough up into the nose to reach the olfactory nerves.

"We add a topical steroid to the saltwater rinse and that allows you to bathe the neurons in the nose with a potent anti-inflammatory medication," she said.

Safety studies on the use of steroids for chronic sinusitis patients have shown the body absorbs few steroids this way, she added: "So you don't run into all those side effects that people get when they take steroids systemically by mouth or by injection."

Other treatment options (not fully supported by research) for viral-induced smell loss may include topical vitamin A and omega-3 fatty oil supplements, the guidelines note.

The consensus also specifies which medications and treatments have little to no science supporting their use, such as systemic vitamin A, oral or nasal zinc, oral steroids or steroid nasal sprays, and platelet-rich plasma nasal injections.

When smells are nasty

People with smell loss can suddenly begin smelling vile odors: Food and drink smell rotten, decayed, metallic or chemically pungent. Doctors call the condition parosmia, caused when smell receptors fail to deliver accurate information to the brain. Distorted smell can occur after head trauma, neurological conditions or viral infections such as COVID-19.

"Parosmia is something that we have always seen with post-viral smell loss," Patel said, "but not nearly to the same extent as we see it with COVID-19-related smell problems."

The good news is that experts think parosmia is a sign of recovery. The guidelines consider smell training and certain medications as treatment options.

"Some people may respond to medications we call neuro-modulating agents — gabapentin, pregabalin, amitriptyline — medications that modulate the nerve signal back to the brain," Patel said.

Emotional fallout

Finally, the guidelines state that your physician should discuss the emotional impact that a loss of smell can have and offer referrals to therapists or specialists as needed.

Some people manage fine without a sense of smell, Patel said. For others, it can lead to depression and malnutrition, especially if smell is distorted.

"Imagine you went to go eat and the food smelled and tasted like rotting flesh," Patel said. "People end up with wild fluctuations where they lose a ton of weight, then they gain a ton of weight by finding some bland but highly fatty or starchy-type food that is safe for them."

Groups such as Fifth Sense and the Smell and Taste Association of North America have mobilized to help, offering affirmation and hope, tips on smell training and even recipes to bolster appetite.

"A lot of our enjoyment of our environment is actually through our sense of smell," Turner said. "Simple things like the smell of spring flowers, the smell of your child and your spouse or your significant other are ingrained in our minds."

WASHINGTON (AP) — The COVID-19 pandemic spared no state or region as it caused historic learning setbacks for America’s children, erasing decades of academic progress and widening racial disparities, according to results of a national test that provide the sharpest look yet at the scale of the crisis.

Across the country, math scores saw their largest decreases ever. Reading scores dropped to 1992 levels. Nearly four in 10 eighth graders failed to grasp basic math concepts. Not a single state saw a notable improvement in their average test scores, with some simply treading water at best.

Those are the findings from the National Assessment of Educational Progress — known as the “nation’s report card” — which tested hundreds of thousands of fourth and eighth graders across the country this year. It was the first time the test had been given since 2019, and it’s seen as the first nationally representative study of the pandemic’s impact on learning.

“It is a serious wakeup call for us all,” Peggy Carr, commissioner of the National Center for Education Statistics, a branch of the Education Department, said in an interview. “In NAEP, when we experience a 1- or 2-point decline, we’re talking about it as a significant impact on a student’s achievement. In math, we experienced an 8-point decline — historic for this assessment.”

Researchers usually think of a 10-point gain or drop as equivalent to roughly a year of learning.

It’s no surprise that children are behind. The pandemic upended every facet of life and left millions learning from home for months or more. The results released Monday reveal the depth of those setbacks, and the size of the challenge facing schools as they help students catch up.

Education Secretary Miguel Cardona said it’s a sign that schools need to redouble their efforts, using billions of dollars that Congress gave schools to help students recover.

“Let me be very clear: these results are not acceptable,” Cardona said.

The NAEP test is typically given every two years. It was taken between January and March by a sample of students in every state, along with 26 of the nation’s largest school districts. Scores had been stalling even before the pandemic, but the new results show decreases on a scale not seen before.

In both math and reading, students scored lower than those tested in 2019. But while reading scores dipped, math scores plummeted by the largest margins in the history of the NAEP test, which began in 1969.

Math scores were worst among eighth graders, with 38% earning scores deemed “below basic” — a cutoff that measures, for example, whether students can find the third angle of a triangle if they’re given the other two. That’s worse than 2019, when 31% of eighth graders scored below that level.

No part of the country was exempt. Every region saw test scores slide, and every state saw declines in at least one subject.

Several major districts saw test scores fall by more than 10 points. Cleveland saw the largest single drop, falling 16 points in fourth-grade reading, along with a 15-point decline in fourth-grade math. Baltimore and Tennessee’s Shelby County also saw precipitous declines.

“This is more confirmation that the pandemic hit us really hard,” said Eric Gordon, chief executive for the Cleveland Metropolitan School District. To help students recover, the school system has beefed up summer school and added after-school tutoring.

“I’m not concerned that they can’t or won’t recover,” Gordon said. “I’m concerned that the country won’t stay focused on getting kids caught up.”

The results show a reversal of progress on math scores, which had made big gains since the 1990s. Reading, by contrast, had changed little in recent decades, so even this year’s relatively small decreases put the averages back to where they were in 1992.

Most concerning, however, are the gaps between students.

Confirming what many had feared, racial inequities appear to have widened during the pandemic. In fourth grade, Black and Hispanic students saw bigger decreases than white students, widening gaps that have persisted for decades.

Inequities were also reflected in a growing gap between higher and lower-performing students. In math and reading, scores fell most sharply among the lowest-performing students, creating a widening chasm between struggling students and the rest of their peers.

Surveys done as part of this year’s test illustrate the divide.

When schools shifted to remote learning, higher-performing students were far more likely to have reliable access to quiet spaces, computers and help from their teachers, the survey found.

The results make clear that schools must address the “long-standing and systemic shortcomings of our education system,” said Alberto Carvalho, superintendent of Los Angeles schools and a member of the National Assessment Governing Board, which sets the policies for the test.

“While the pandemic was a blow to schools and communities, we cannot use it as an excuse,” he said. “We have to stay committed to high standards and expectations and help every child succeed.”

Other recent studies have found that students who spent longer periods learning online suffered greater setbacks. But the NAEP results show no clear connection. Areas that returned to the classroom quickly still saw significant declines, and cities — which were more likely to stay remote longer — actually saw milder decreases than suburban districts, according to the results.

Los Angeles can claim one of the few bright spots in the results. The nation’s second-largest school district saw eighth-grade reading scores increase by 9 points, the only significant uptick in any district. For other districts, it was a feat just to hold even, as achieved by Dallas and Florida’s Hillsborough County.

Testing critics caution against putting too much stock in exams like NAEP, but there’s no doubt that the skills it aims to measure are critical. Students who take longer to master reading are more likely to drop out and end up in the criminal justice system, research has found. And eighth grade is seen as a pivotal time to develop skills for math, science and technology careers.

For Carr, the results raise new questions about what will happen to students who appear to be far behind in attaining those skills.

“We want our students to be prepared globally for STEM careers, science and technology and engineering,” she said. “This puts all of that at risk. We have to do a reset. This is a very serious issue, and it’s not going to go away on its own.”

WASHINGTON —

President Joe Biden rolled up his sleeve and got his updated COVID-19 booster shot Tuesday, as he urged millions of people who have yet to be boosted to do so by Halloween, if possible, so they can gather safely with family and friends this holiday season.

“Get vaccinated,” he said, noting that it's free. “Not enough people are getting it.”

Biden also called on Congress to provide the billions of dollars the administration has requested to buy additional vaccines, tests and treatments. Some lawmakers have balked at the request for more than $20 billion in new coronavirus funding.

Biden, who was flanked by his COVID-19 response team, declared that the fight against the spread of the virus is global in nature and the “funding we seek is critical” to that effort.

Over 20 million people, including nearly 1 in 5 older adults, have gotten the updated COVID-19 booster, the White House said. The vaccine has been reformulated to target the BA.4 and BA.5 subvariants of omicron, the most dominant strains in the United States.

Biden said more people need to get the vaccine as winter approaches and they will be spending more time indoors and potentially spreading sickness. He added that the vaccine is available free of charge within 5 miles of where most people live.

He urged people to get the coronavirus booster at the same time they get an annual flu shot. He said a COVID-19 booster will become an annual event.

“For most Americans, one COVID shot each year will be all they need,” Biden said at the White House. “And if you get it, you'll be protected. And if you don't, you're putting yourself and other people at unnecessary risk.”

“I'm calling on All Americans ... all Americans to get their shot, just as soon as they can,” he said.

A member of the White House Medical Unit gave the shot to Biden in his left arm. He had to delay getting his booster, in accordance with federal health guidance, because he was infected with COVID-19 over the summer.

Biden again called on businesses, schools and civic leaders to help, including by holding on-site vaccination clinics and giving employees time off to get boosted. Most deaths from COVID-19 are now preventable, he said.

Three respiratory viruses are currently circulating in the U.S: the flu, COVID-19 and RSV, respiratory syncytial virus, said Dr. Ashish Jha, leader of the White House response.

Jha said during morning TV appearances that the combination of a flu shot and updated COVID booster will help people avoid serious illness and stay out of the hospital as they get ready to celebrate Thanksgiving and other holidays with friends and family.

RSV has been affecting children, and there is no shot available to treat it, though companies are working to develop one, he said.

“So if people went out and got their vaccines, we could really get through this without getting into a lot of trouble,” Jha said Tuesday on “CBS Mornings.”

“If you’re relying on your old vaccine from nine months ago or an infection from a year ago, that’s probably not going to be good enough and that’s one of the reasons we’re urging all Americans — but particularly older Americans, particularly seniors — to get the new updated COVID vaccine, because I do think it’s going to make a really big difference," Jha said on “Today” on NBC.

Biden had to wait a few months to get his updated COVID booster because he was infected, then reinfected, with COVID-19 over the summer.

WASHINGTON —

U.S. officials released an intelligence report Friday that rejected some points raised by those who argue COVID-19 leaked from a Chinese lab, instead reiterating that American spy agencies remain divided over how the pandemic began.

The report was issued at the behest of Congress, which in March passed a bill giving U.S. intelligence 90 days to declassify intelligence related to the Wuhan Institute of Virology.

Intelligence officials under President Joe Biden have been pushed by lawmakers to release more material about the origins of COVID-19. But they have repeatedly argued China's official obstruction of independent reviews has made it perhaps impossible to determine how the pandemic began.

The newest report angered some Republicans who have argued the administration is wrongly withholding classified information and researchers who accuse the U.S. of not being forthcoming.

John Ratcliffe, who served as U.S. director of national intelligence under former President Donald Trump, accused the Biden administration of “continued obfuscation.”

“The lab leak is the only theory supported by science, intelligence, and common sense,” Ratcliffe said in a statement.

There was newfound interest from researchers following the revelation earlier this year that the Department of Energy's intelligence arm had issued a report arguing for a lab-related incident.

Video below: US doctor on latest COVID-19 vaccine recommendations

But Friday’s report said the intelligence community has not gone further. Four agencies still believe the virus was transferred from animals to humans, and two agencies — the Energy Department and the FBI — believe the virus leaked from a lab. The CIA and another agency have not made an assessment.

Located in the city where the pandemic is believed to have began, the Wuhan Institute of Virology has faced intense scrutiny for its previous research into bat coronaviruses and its reported security lapses.

The lab genetically engineered viruses as part of its research, the report said, including efforts to combine different viruses.

But the report says U.S. intelligence “has no information, however, indicating that any WIV genetic engineering work has involved SARS-CoV-2, a close progenitor, or a backbone virus that is closely-related enough to have been the source of the pandemic.”

And reports of several lab researchers falling ill with respiratory symptoms in fall 2019 are also inconclusive, the report argues.

U.S. intelligence, the report said, “continues to assess that this information neither supports nor refutes either hypothesis of the pandemic's origins because the researchers' symptoms could have been caused by a number of diseases and some of the symptoms were not consistent with COVID-19."

Responding to the report, the Republican chairs of the House Intelligence Committee and a select subcommittee on the pandemic jointly said they had gathered information in favor of the lab leak hypothesis. Reps. Mike Turner and Brad Wenstrup, both of Ohio, credited the U.S. Office of the Director of National Intelligence for taking a “promising step toward transparency.”

“While we appreciate the report from ODNI, the corroboration of all available evidence along with further investigation into the origins of COVID-19 must continue,” Turner and Wenstrup said.

But Alina Chan, a molecular biologist who has long argued the virus may have originated in the Wuhan lab, noted the public version of the report did not include the names of researchers who fell sick or other details mandated by Congress.

The bill requiring the review allowed intelligence officials to redact information publicly to protect agency sources and methods.

“It’s getting very difficult to believe that the government is not trying to hide what they know about #OriginOfCovid when you see a report like this that contains none of the requested info,” Chan tweeted.

Millions of families will gather for Thanksgiving. It's a significant shift from the height of the pandemic when families remained isolated out of fear of spreading COVID-19.

The virus has not gone away. However, Americans are more protected than ever due to vaccines and prior infections.

The Centers for Disease Control reports about 289,000 weekly cases of COVID-19. At the same time last year, that number was more than double. Hospitalizations are also down dramatically this year compared to 2021.

Health officials still recommend getting vaccinated or boosted to protect against the virus. In addition, they are warning about the spread of flu and RSV. There is a vaccine to protect against the flu, but there is no vaccine for RSV.

To avoid spreading potentially-dangerous germs, the CDC recommends:

• Cover your coughs and sneezes with a tissue or your upper shirt sleeve, not your hands
• Wash your hands often with soap and water for at least 20 seconds
• Avoid close contact, such as kissing, shaking hands, and sharing cups and eating utensils, with others
• Clean frequently touched surfaces such as doorknobs and mobile devices

Germs from other people aren't the only things to worry about on Thanksgiving. The USDA says people should follow basic steps
to protect against foodborne illnesses.

• Clean and sanitize
• Avoid cross-contamination
• Thaw the turkey safely (Never thaw your turkey in hot water or leave it on a countertop.)
• Cook food thoroughly
• Avoid stuffing turkey as it often leads to bacteria growth
• Don’t leave your food sitting out too long (Refrigerate all perishable foods sitting out at room temperature within two hours of being cooked, or one hour if the temperature is 90 F or above.)

The hunt begins in darkness. Les Giese and his son Thor make their way through a public forest in Annandale, New Jersey to a tree stand where they’ll wait for dawn and if they’re lucky — a deer. We settle in, 25 feet above the ground, watching the sun rise through the trees. 

NEWSY'S SAM EATON: So what's the secret? You just. It's a matter of just waiting?

THOR GIESE: It's getting in between where they live and where they eat.  

After about four hours and no deer, we call it a day. We meet again on the trail with Thor’s dad, Les, who also came up empty. 

"They’re either running through the woods like a freight train or they’re like a ninja, you know," said Thor Giese. 

Les Giese and his son aren’t hunting deer for themselves. They’ve already filled their freezer with enough venison for the year. Any deer they get from now on will instead feed families in need. It’s a program run by the New Jersey chapter of Hunters Helping the Hungry and Giese is the president. 

"Right now, we're doing roughly 25,000 pounds of venison a year. Pretty close to 100,000 meals across the various food banks and pantries of New Jersey," said Les Giese. 

In the two and a half decades since he founded the non-profit with friends, Giese says it’s become one of the top three game meat donation programs in the country. But he says it’s not just about providing food for the hungry. It’s also about saving these forests. 

"A forest, a healthy forest like you see behind me here can handle 15 deer per square mile. This particular forest has probably got close to 150 deer, 10 times the carrying capacity of this forest," said Les Giese. 

And with one in 10 U.S. households struggling to feed their families Giese says hunting more deer as a source of lean, healthy protein is a no brainer. It’s also become a lifeline for New Jersey food banks. 

The problem of deer overpopulation in the forests of states like New Jersey is getting worse, but so is hunger. And it's places like this where the solutions to those two crises come together. 

Shannon Williams is interim director of Norwescap Food Bank in Phillipsburg, New Jersey. She says the warehouse we visited distributes two million pounds of food a year to food banks, soup kitchens and homeless shelters all over the state.  

SEE MORE: Inflation, Surge In Prices Impacting Food Banks

"This is the Norwescap Food Bank. This is our warehouse," said Williams. "And this is some of the venison that we received through the processors and through hunters helping the hungry and that we distribute to our agencies." 

Williams says the venison is in high demand, especially as the cost of providing meat to families has soared. 

"With the pandemic and now with the food inflation and the costs rising on everything, it's been very difficult and the need has just continued to rise. And we're we're doing our best to to keep food coming in and out as quickly as we can," she continued.  

From the rockies to New England and the deep South, white-tailed deer populations have exploded in recent decades. After being decimated by hunters in the 1930s, deer have made a stunning recovery, increasing one-thousand-fold in less than a hundred years. 

But the process has imperiled the same ecosystems that have sustained their recovery. 

Jay Kelly is a biologist at Raritan Valley Community College. He says more and more deer squeezing into smaller and more fragmented forests is sending the entire ecosystem into free fall. 

"So this is a typical forest in central New Jersey. What you see here, you'll find pretty much throughout the region. And what's noteworthy is the absence of any living things in the understory." 

"[At} about 15 [deer] per square mile regeneration starts to decline. The, you know, waist high seedlings will begin to disappear. And above 20 per square mile, everything begins to shut down in the forest with loss of bird populations, all components of the vegetative understory, arthropod, amphibian densities and so forth," said Kelly.  

In New Jersey deer densities usually exceed a hundred per square mile, creating what Kelly calls a zombie forest. Not only is the biodiversity lost, the only thing replacing the older trees as they die are invasive species like this Japanese angelica tree. 

"The canopy of leaves will come out of these angelica trees are these enormous compound leaves that have thorns on the stems of the leaf thorns and the leaf leaves and leaflets themselves. It's just armed with all sorts of defenses on every inch of the tree. It's really incredible," said Kelly. 

The good news is that once deer populations are reduced, the forest recovers.  

Duke Farms Nature Preserve in Hillsborough, New Jersey is a stark example of how quickly that change can happen.  

"So what you see here is about 15 to 17 years worth of regeneration since deer were initially managed aggressively at the site," said Kelly

Kelly says deer densities here reached 250 per square mile. After installing deer fencing and maintaining deer populations at much lower densities, the invasive species disappeared and the forest regenerated. 

"The trees that you see growing up, these are ash trees. There are hickory trees and oaks all growing in this understory," said Kelly. 

Kelly says short of reintroducing predators like wolves to these forests, hunting is the most effective means of reducing deer populations. But the number of hunters in the U.S. has been in steady decline since its peak in the 1980s. 

And in order to process the meat for food banks you need USDA certified butchers like J.B. Person’s family-owned Game Butchers in Lebanon, New Jersey. 

Person says his father started the business back in the 1960s.  

SEE MORE: Hunters Keep Food Pantries And Stomachs Full

"It's a pretty unique business — unfortunately. It's a dying trade," said Person.  

With grants now covering the cost of butchering for food banks, Person hopes more butchers will come online to help the program expand. In the meantime, he struggles to keep up. 

"And it doesn't last long. I mean, they come, they come pick up the meat — it sits in in their freezers for only maybe a week or two. And it's distributed and it's gone," said Person. 

That venison ends up at food banks. Flemington Area Food Pantry Executive Director Jeannine Gorman says they’re busier now than they’ve ever been. 

"We see anywhere from 50 to 70 clients, which pretty much means since COVID. And now in the height of financial inflation and everything else, we can see on average a person every three minutes," said Gorman.  

Cars line up to load pre-ordered food items. This is what the food insecurity crisis in America looks like. Bob Flanagan is one of them.  

"I'm self-employed, I'm a contractor. The bottom fell out after I got COVID because I can't work. I couldn't work," said Flanagan. 

Flanagan also used to hunt. But since COVID wrecked his lungs, forcing him to carry an oxygen tank with him at all times, he’s had to rely on the donations. 

"There's the venison. This is hamburger. I'll mix it up with the tomato sauce and make a spaghetti," said Flanagan.

It’s a rare thing for one crisis to help solve another. But Les Giese hopes the partnership he’s created between the state, the hunters, the butchers and the food banks offers a glimmer of hope. 

"We're trying to make the herd healthier. We're trying to make the forest healthier. We're trying to make some of the less fortunate people have some protein, low fat meat. Win win all the way around," said Les Giese. 

That night Giese, his family and friends gather to grill venison backstrap and share a meal.  

He says he grew up on a dairy farm in Illinois where sharing with neighbors was a way of life. And as the forests suffer, and more of his neighbors struggle to feed their families, Giese hopes that spirit of sharing will catch on. 

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With the winter months and holiday season on the horizon, you’re likely doing everything in your power to stay healthy. But sometimes getting sick is inevitable and knowing exactly what you’ve come down with becomes the priority to get proper treatment and avoid passing it along to others. The flu and COVID-19 are likely high on your radar, but you should also be aware of 24-hour flu.Believe it or not, even though it's called "the 24-hour flu," it has nothing to do with the flu or flu virus at all. The 24-hour flu is a misnomer because influenza is an upper respiratory tract virus that does not involve the gastrointestinal tract, explained Nicholaos Bellos, MD, an infectious disease expert and the national medical director of extended care services at Quest Diagnostics. People who have the 24-hour flu are actually experiencing a condition known as gastroenteritis, also often referred to as the stomach flu, he says. Gastroenteritis is commonly known as the 24-hour flu because the symptoms it causes may only last a day or two. That's not always true, though, since GI issues caused by this condition can sometimes take up to 14 days to go away, Bellos said.When it comes to the 24-hour flu, you don’t want to mess around. Here’s everything you need to know about this stomach bug, according to doctors. So, what causes the 24-hour flu?“Adult cases are usually caused by norovirus, also known as the winter vomiting bug, rotavirus, or food poisoning,” Bellos said. The virus or contaminated food causes your stomach and intestines to become irritated and inflamed, leading to gastroenteritis and the associated symptoms, he explains.Both the norovirus and rotavirus are spread through coming into contact with someone who has the virus or their unwashed hands (especially after going to the bathroom or changing a diaper) or touching contaminated surfaces. Food poisoning, on the other hand, occurs when someone consumes contaminated food or water, Bellos said.That said, the 24-hour flu is typically not airborne (caused by coughing, sneezing, or laughing), according to Natasha Chhabra, M.D., a gastroenterologist at Gastroenterology Associates of New Jersey. “People can get it through ingestion of contaminated foods, but usually more rapid spread is in crowded areas and more through direct contact rather than respiratory.”What are the symptoms of the 24-hour flu?Symptoms usually appear within four to 48 hours after coming in contact with the virus or eating contaminated foods. They can include abdominal pain, diarrhea, cramps, nausea, vomiting, and sometimes fever, said Dr. Bellos. You may also have body aches, loss of appetite, or extreme fatigue, and dehydration is common if you're throwing up or going to the bathroom a lot. The tricky part is symptoms can be similar to those of the flu or COVID-19. “COVID-19 can cause gastrointestinal symptoms, even when breathing problems are not present, so it’s important to look at other more severe health conditions when experiencing symptoms,” Bellos said. But simple tests can rule out COVID-19, the flu, or bacterial infections.And while anyone can get the 24-hour flu, those with a weakened immune system are at a higher risk, Chhabra said. Young children, elderly people, and anyone who is immunocompromised or taking medications that suppress their immune system are more likely to develop severe symptoms. Does the 24-hour flu really go away in a day?Unfortunately, no. “For most people, the illness goes away in a few days, and you can be contagious from a few days to two weeks or more, depending on which virus caused the gastroenteritis,” Bellos said.However, in the case of the norovirus, you may still be contagious a few days after you recover. The 24-hour flu is very contagious, so the best way to avoid getting others sick is to limit contact, disinfect all surfaces (counters, door handles, faucets, etc.), and practice good hand washing (that means rinsing with soap and water for at least 20 seconds), Bellos said.The virus can also remain in your stool for up to two weeks after recovery, so hand washing after using the bathroom is absolutely essential, he added.How do you treat the 24-hour flu?Most cases go away on their own with rest and plenty of fluids, but Chhabra recommends hydrating with electrolytes, such as drinking Vitamin Water, Gatorade or even Pedialyte. If you’re struggling to keep anything down, drink small amounts of water or electrolyte fluids (two to four ounces) every 30 to 60 minutes, Bellos added. You should also stick to bland foods like bread, crackers, or rice, and avoid anything heavy or flavorful. “Sometimes antidiarrheals like Imodium can be used, but that should be discussed with your doctor before using in case there is an infection that requires more specific treatment like an antibiotic,” Chhabra said.A probiotic supplement may also be helpful to restore the gut flora, which can be thrown off when you’re dealing with an infection or virus. “There's not one probiotic that’s considered much better than others, but a probiotic in general supplies you with good bacteria and can help mitigate symptoms,” Chhabra added.You may not feel the effects of the probiotic right away, but you’ll notice (and feel!) a difference over time. When should you see a doctor?If you have diarrhea that lasts more than several days or notice blood in your stool, then you need to seek medical care, Chhabra said. Prolonged nausea that lasts more than one to two weeks is also a sign that it’s time to check in with your doc. Dehydration is another major concern with the 24-hour flu, so if you feel lightheaded, dizzy, delirious, or have dry mouth, lips, or eyes, then you need to go to the emergency room or urgent care ASAP, Chhabra said.

The COVID-19 pandemic sent Heidi Whitney’s daughter into a tailspin.

Suddenly the San Diego middle schooler was sleeping all day and awake all night. When in-person classes resumed, she was so anxious at times that she begged to come home early, telling the nurse her stomach hurt.

Whitney tried to keep her daughter in class. But the teen’s desperate bids to get out of school escalated. Ultimately, she was hospitalized in a psychiatric ward, failed “pretty much everything” at school and was diagnosed with depression and ADHD.

As she started high school this fall, she was deemed eligible for special education services, because her disorders interfered with her ability to learn, but school officials said it was a close call. It was hard to know how much her symptoms were chronic or the result of mental health issues brought on by the pandemic, they said.

“They put my kid in a gray area,” said Whitney, a paralegal.

Schools contending with soaring student mental health needs and other challenges have been struggling to determine just how much the pandemic is to blame. Are the challenges the sign of a disability that will impair a student’s learning long term, or something more temporary?

It all adds to the desperation of parents trying to figure out how best to help their children. If a child doesn’t qualify for special education, where should parents go for help?

“I feel like because she went through the pandemic and she didn’t experience the normal junior high, the normal middle school experience, she developed the anxiety, the deep depression and she didn’t learn. She didn’t learn how to become a social kid,” Whitney said. “Everything got turned on its head.”

Schools are required to spell out how they will meet the needs of students with disabilities in Individualized Education Programs, and the demand for screening is high. Some schools have struggled to catch up with assessments that were delayed in the early days of the pandemic. For many, the task is also complicated by shortages of psychologists.

To qualify for special education services, a child’s school performance must be suffering because of a disability in one of 13 categories, according to federal law. They include autism, attention-deficit/hyperactivity disorder, learning disabilities like dyslexia, developmental delays and “emotional disturbances.”

It’s important not to send children who might have had a tough time during the pandemic into the special education system, said John Eisenberg, the executive director of the National Association of State Directors of Special Education.

“That’s not what it was designed for,” he said. “It’s really designed for kids who need specially designed instruction. It’s a lifelong learning problem, not a dumping ground for kids that might have not got the greatest instruction during the pandemic or have major other issues.”

In the 2020-2021 school year, about 15% of all public school students received special education services under federal law, according to the National Center for Education Statistics.

Among kids ages 6 and older, special education enrollment rose by 2.4% compared with the previous school year, according to federal data. The figures also showed a large drop in enrollment for younger, preschool-age students, many of whom were slow to return to formal schooling. The numbers varied widely from state to state. No data is available yet for last year.

While some special education directors worry the system is taking on too many students, advocates are hearing the opposite is happening, with schools moving too quickly to dismiss parent concerns.

Even now, some children are still having evaluations pushed off because of staffing shortages, said Marcie Lipsitt, a special education advocate in Michigan. In one district, evaluations came to a complete halt in May because there was no school psychologist to do them, she said.

When Heather Wright approached her son’s school last fall seeking help with the 9-year-old’s outbursts and other behavioral issues, staff suggested private testing. The stay-at-home mom from Sand Creek, Michigan, called eight places. The soonest she could get an appointment was in December of this year — a full 14 months later.

She also suspects her 16-year-old has a learning disability and is waiting for answers from the school about both children.

“I hear a lot of: ‘Well, everyone’s worse. It’s not just yours,’” she said. “Yeah, but, like, this is my child and he needs help.”

It can be challenging to tease out the differences between problems that stem directly from the pandemic and a true disability, said Brandi Tanner, an Atlanta-based psychologist who has been deluged with parents seeking evaluations for potential learning disabilities, ADHD and autism.

“I’m asking a lot more background questions about pre-COVID versus post-COVID, like, ‘Is this a change in functioning or was it something that was present before and has just lingered or gotten worse?’” she said.

Sherry Bell, a leader in the Department of Exceptional Children at Charleston County School District in South Carolina, said she is running into the issue as well.

“In my 28 years in special education, you know, having to rule out all of those factors is much more of a consideration than ever before, just because of the pandemic and the fact that kids spent all of that time at home,” said Bell.

The key is to have good systems in place to distinguish between a student with a lasting obstacle to learning and one that missed a lot of school because of the pandemic, said Kevin Rubenstein, president-elect of the Council of Administrators of Special Education.

“Good school leaders and great teachers are going to be able to do that,” he said.

The federal government, he noted, has provided vast amounts of COVID relief money for schools to offer tutoring, counseling and other support to help students recover from the pandemic.

But advocates worry about consequences down the line for students who do not receive the help they might need. Kids who slip through the cracks could end up having more disciplinary problems and diminished prospects for life after school, said Dan Stewart, the managing attorney for education and employment for the National Disability Rights Network.

Whitney, for her part, said she is relieved her daughter is getting help, including a case manager, as part of her IEP. She also will be able to leave class as needed if she feels anxious.

“I realize that a lot of kids were going through this,” she said. “We just went through COVID. Give them a break.”

We’ve gotten to the point in the COVID-19 pandemic where you’re probably not stressed every single day about getting the virus—the wide availability of COVID-19 vaccines and effective treatments have thankfully made that possible. And, with that, you likely have some tests around your place for the just-in-case that may have been sitting there for a while.

Here’s the thing, though: They can expire. Yep, there is a COVID-19 test expiration date printed on your package that you may not even realize is there.

Many COVID-19 tests last for just a year or so, but the odds are high that you’ll need to use yours at some point. That may or may not be before the expiration date stamped on your package passes.

So, do expired COVID-19 tests work, or do you need to toss what you thought was a perfectly good test? It’s actually a little complicated. Here’s what you need to know.

So, do expired COVID-19 tests work?

Yes and no. To fully understand that, it’s important to explain how COVID-19 tests get an expiration date in the first place.

“When tests are developed, the company will assess the test over time to make sure it’s performing with the quality standards intended,” says Thomas Russo, M.D., a professor and the chief of infectious diseases at the University at Buffalo in New York. “Whatever time frame they assess it for is the expiration date that will go on that test.”

This “doesn’t necessarily mean that the test won’t perform for a longer period of time,” Russo says—it’s just the amount of time that the test has been assessed for and what is authorized or approved by the Food and Drug Administration (FDA).

Older tests are more likely to have shorter expiration dates because there were time pressures to get tests out earlier in the pandemic, when they were first developed, and only so much time since they had been created to test how long they were good for, Russo says. “However, companies kept assessing the tests over time,” he says.

As a result, “many manufacturers have received shelf life extensions by the FDA,” says infectious disease expert Amesh A. Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security.

The FDA has a list online of authorized home COVID-19 tests, along with links to “updated expiration dates” so you can check to see if your test’s expiration date has been extended.

“If you have a test and it’s ‘expired’ based on what the package says, it may or may not be the most correct expiration date,” Russo said.

What happens if you use an expired test?

Again, the expiration dates are a reflection of how long the company that manufactured the test found that it was good for—or the period of time in which they were able to assess the test. With that, there’s a chance that your test will still be good beyond the expiration date listed.

“Most tests will still perform past their expiration date for several weeks,” Adalja said.

If the test has truly expired “you are more likely to get a false negative,” said Jamie Alan, Ph.D., associate professor of pharmacology and toxicology at Michigan State University. “The test might be negative because the reagents or ‘ingredients’ are past their shelf life and are not working as they should,” she said. “They are likely good past their expiration date, although how long I cannot say with any degree of certainty.”

If you have symptoms of COVID-19 and the only test you have at home is expired, Alan says you could try it.

“If you get a positive, you are probably positive,” she says. “If you get a negative, it would be good to follow up with another test, either a PCR test or another rapid at-home test.”

Why do COVID-19 tests expire?

COVID-19 tests contain specific reagents that react with the virus, or lack thereof, from your swab, Alan explains.

“These ingredients do not work forever,” she says. “This is true for medications, lab materials, and food.”

How do I know if my BinaxNOW is expired?

BinaxNOW is one of the most popular home tests out there, and it typically has an expiration date stamped on the back of the box. But, again, that may not be the most up-to-date expiration date for your test.

If you have a test with an expired date on the package, check out the FDA’s list of updated expiration dates for BinaxNOW tests to see if it’s been extended. Just keep in mind that you’ll need to have your box’s lot number handy.

But, if your test is expired—both on the box and per the FDA’s updated dating—and you want to be sure you’re getting an accurate reading, Russo says it’s “probably best to not use that test.”

La Dallas Mitchell is working overtime to care for her daughter.

"It's just been nonstop," Mitchell said. "She's probably been sick like five times."

At the same time, parenting means working around that sickness.

The U.S. is the only developed country that does not guarantee any paid sick leave, according to the Center for Economic Policy and Research, though some states like New York, New Jersey and California have laws with requirements.

Medical experts say the surge of viruses right now highlights the need for paid sick time off.

"With RSV, COVID and the flu, this is very taxing to the health care system but also taxing to our families," said Dr. Willie Underwood, with the American Medical Association. "People get sick and ill; they can't work. They have increased health care costs. It's detrimental to us."

In October, a record high 104,000 Americans missed work due to "childcare problems," according to the Bureau of Labor Statistics.

A recent Robert Wood Johnson Foundation report found workers lost $28 billion in wages during 2020 to 2022. Women, Latino, and Black workers felt the brunt of it. It also found people making less than $25,000 a year were about 2.5 times more likely to not have paid sick leave compared to someone making $100,000.

Epidemiologist and research director Mona Shah worked on the foundation report.

"For a family member who had to take off a week of work to take care of themselves or their child, that meant they lost an average of $815 in wages," Shah said. "That would have huge implications for paying for food, housing, health care, gas and other essentials."

SEE MORE: Doctors: Get Your Flu, COVID Vaccines Now To Be Safe During Holidays

Shah says when someone works while they or a loved one is sick, it impacts more than that single household.

"They're working when they're sick, and they're potentially impacting the people that they come across, whether at work or at school, and so it's really a compounding effect," Shah said.

She said that's why paid time off is important for a community to stay healthy, especially during busy holiday seasons.

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