Posts

New Data Reveals How The End Of Covid-19 Pandemic Protocols Could Negatively Impact US Healthcare 

Whenever the Covid-19 pandemic ends, the US healthcare system may be disrupted greatly due to the amount of hospital systems who have been able to acquire new technology and resources to keep up with temporary emergency measures throughout the pandemic.  

When the many temporary emergency measures that have been implemented throughout the US’s healthcare system end, an estimated 15 million Medicaid recipients will likely need to find new coverage. Congress will need to take action in order to preserve the broad telehealth access that many Medicare users have been able to use throughout the pandemic. 

Beyond just patients, payment policies are also likely to change for doctors, hospitals, and insurers. Many are raising concerns over these issues because of their tie to the coronavirus public health emergency declaration that was made more than two years ago and needs to be periodically renewed in order to keep these protective policies in place. 

Embed from Getty Images

The state of emergency is set to end on April 16th, and it’s expected that Biden will likely extend it through July, but many healthcare workers are hoping for a more secure extension that will last longer. Juliette Cubanski is a Medicare expert working with the Kaiser Family Foundation who recently spoke on the potential consequences of stepping back from the state of emergency. 

“The flexibilities granted through the public health emergency have helped people stay covered and get access to care, so moving forward the key question is how to build on what has been a success and not lose ground.”

Medicaid currently covers 79 million people through its state-federal health insurance program which is designed to assist low income individuals. The amount of people covered by Medicaid has increased at record rates throughout the pandemic. 

The Urban Institute revealed research that estimates about 15 million people could lose their Medicaid coverage when the public health emergency ends, at a rate of 1 million individuals per month. Matthew Buettgens of the Urban Institute stated that almost all of the people losing Medicaid will likely be eligible for “another source of coverage through employers, the Affordable Care Act or, for kids, the Children’s Health Insurance Program.”

Embed from Getty Images

“But that’s not going to happen automatically. Cost and lack of awareness about options could get in the way. This is an unprecedented situation. The uncertainty is real,” said Buettgens. Chiquita Brooks-LaSure is an administrator at the federal Centers for Medicare and Medicaid Services, CMS, and she advises states to take it slow when it comes to rolling back on policies so that they have time to connect with Medicaid recipients who will be disenrolled to provide them with additional coverage. 

“We are focused on making sure we hold on to the gains in coverage we have made under the Biden-Harris administration. We are at the strongest point in our history and we are going to make sure that we hold on to the coverage gains,” said CMS Administrator Chiquita Brooks-LaSure. 

The end of the public health emergency could impact telehealth access for millions enrolled in traditional Medicare and other insurers. 

“Congress has given itself 151 days after the end of the public health emergency to come up with new rules. If there are no changes to the law after that, most Medicare beneficiaries will lose access to coverage for telehealth,” the Kaiser Foundation’s Cubanski said.

Health and Human Services Secretary Xavier Becerra recently told The Associated Press that his department is “committed to giving ample notice when it ends the public health emergency. We want to make sure we’re not putting in a detrimental position Americans who still need our help. The one that people are really worried about is Medicaid.”

Experiencing Brain Fog From Long Covid? Here’s How To Cope 

Brain fog is a term used to describe feelings of mental fuzziness which can occur due to a multitude of reasons. The idea of brain fog has become more prevalent in recent years as it’s one of the most common symptoms associated with long Covid. 

Scientists are in the beginning stages of understanding how exactly Covid affects the brain, but there’s an increasing amount of evidence supporting that even mild to moderate Covid-19 cases can cause brain damage and trigger problems with memory, concentration, and overall functioning. 

In most of the cases associated with Covid-19, the brain fog typically resolves itself naturally within a matter of weeks. However, some individuals are developing chronic brain fog that persists for months, and maybe even years. 

According to James Giordano,a professor of neurology and biochemistry at Georgetown University Medical Center, “there’s something unique about the brain fog that comes with COVID. With most of these other conditions, brain fog typically resolves when the infection clears or the treatment stops. COVID, however, seems to cause a much more intense and sometimes long-lasting, widespread inflammatory effect — and the brain fog can persist for weeks or months on end.”

Embed from Getty Images

“The brain fog people experience with long COVID is most likely a result of direct and indirect inflammatory effects on the brain.”

Covid is known for triggering a massive inflammatory response within the body that could potentially cause tissue damage throughout the body depending on how severe the case is. Covid-19 can also directly impact cells surrounding the brain, which creates yet another inflammatory response which could result in brain fog symptoms. 

A recent study found that even mild to moderate cases of Covid can cause damage to the brain and a potential decline in cognitive function. 

“Now we are really seeing inflammatory changes in the brain, and those inflammatory changes disrupt the functional architecture of the way brain nodes and networks are operating to control certain aspects of cognition and behavior,” Giordano said.

“That’s one of the really fascinating things about this virus: Each body that it goes into, it can affect so differently. This makes it very hard to predict who will develop brain fog.” said Dr. Mill Etienne, an associate professor of neurology and medicine at New York Medical College.

“Age seems to also play a role, as older people are more at risk for experiencing cognitive issues after COVID. But even some young, otherwise healthy people diagnosed with COVID have found themselves struggling with brain fog,” according to Giordano. 

Embed from Getty Images

“You don’t have to have a severe case of COVID in order to have this long COVID syndrome,” Etienne said.

Giordano said the “specific symptoms of brain fog also vary from person to person. Some people experience fatigue after the slightest level of physical or mental exertion. It’s not just that they feel tired; they literally feel like they can’t do this anymore — in other words, they have to stop doing anything and just kind of rest.”

So what exactly can you do if you’re experiencing some level of brain fog after being sick with Covid? Etienne says most of the time the brain fog will clear up naturally over time, but unfortunately that’s not the case for everyone. 

Giordano advised “if you’ve been battling brain fog after COVID, try to acknowledge that you have it and recognize its impact on your daily functioning and quality of life. Consult with a physician and be specific about what brain fog feels like to you. Doing so will help your doctor develop a tailored treatment plan that will help mitigate the specific effects you are experiencing. In certain instances, medications and anti-inflammatory drugs may be recommended.”

It’s also recommended in general for individuals who are experiencing brain fog to keep as physically active as they can. While it may be difficult to do so, depending on how severe of a case you have, keeping your body moving keeps your brain active and can help it build up recuperative skills. 

“Lastly, get adequate rest and stay hydrated. People usually take those things for granted, but in this particular case, it’s rather important because both rest and hydration can be very recuperative to brain metabolism,” Giordano said.

US Unlikely To End Covid Testing Rules For International Travel 

Throughout the past month many countries have made international travel a lot easier as the Covid-19 pandemic continues around the world. Vaccinated travelers have found it much easier to book and experience travel again, however, US travelers returning from abroad must still present negative Covid-19 test results before they’re able to safely return.

The US Virgin Islands became the latest territory to announce that vaccinated travelers no longer need to provide a negative test upon arrival, a move that other international countries, like the UK, have had in place for nearly a month. 

Embed from Getty Images

According to the US Centers for Disease Control And Prevention’s (CDC) last updated guidance for international travel, which was made in December, the US requires all incoming travelers over the age of 2 to submit a negative Covid test taken within one day of departure from a foreign country in order to enter the US. 

It’s become much easier to find at-home Covid-19 tests in the US, which will allow travelers to have greater access to testing in order to go abroad and return safely. The US government’s international travel guidance allows at-home tests as an accurate result for re-entry into the country. 

The provision within the guidelines also provides a list of approved at-home tests that travelers can take before and after traveling abroad. The CDC accepts Ellume, Quered, and BinaxNow at-home tests, which are some of the most commonly sold brands throughout the US. 

Embed from Getty Images

The CDC also requires that the tests are supervised by a live attendant via a video call. BinaxNow tests can even be purchased through the website eMed, which will provide an at-home test shipped directly to your home prior to your trip with instructions on how to take it with live video guidance. 

In a statement to the media, a CVS spokesperson said the company’s stores “have the ability to meet our customers’ needs with at-home test kits both in store and at CVS.com,. We have simplified the digital process so customers can order and pick up a test kit with no up-front, out-of-pocket cost or the need to submit a claim to insurance.”

Walgreens said it “worked diligently with our suppliers to ensure we have enough supply to meet customer demand at nearly all locations.”

While other countries may continue to lift certain Covid-19 protocols for international travel, the US is unlikely to follow suit anytime soon, as it is one of the nation’s with the highest rate of infection.

UK Fighting against Covid-19

UK To Roll Out Additional Covid-19 Vaccines For Vulnerable People And Elderly 

The UK announced this week that it will be rolling out an additional Covid-19 vaccine for the elderly and clinically vulnerable populations. Adults over the age of 75, nursing home residents, and anyone who’s immunocompromised will be given an extra dose of a Covid vaccine in the spring. 

Britain’s Joint Committee on Vaccination and Immunization (JCVI) said the rollout is a part of a “precautionary strategy for 2022,” adding that individuals over the age of 18 will be offered Pfizer/BioNTech or the Modernas vaccine for the spring dose, while 12 to 18-year-olds will be given Pfizer/BioNTech exclusively. 

Embed from Getty Images

“An extra booster shot will be given 6 months after an eligible individual’s most recent dose. For older people in the U.K., this will be the fourth vaccine dose they have been offered. For people with a severely weakened immune system, it will be the fifth vaccine shot they have been offered. The bulk of the population has been offered three shots, two vaccinations and one booster,”  the JCVI said.

“There remains considerable uncertainty with regards to the likelihood, timing and severity of any potential future wave of Covid-19 in the U.K.”

“There may be a transition period of a few years before a stable pattern, such as a regular seasonal wave of infection, is established,” the JCVI said.

A majority of the UK’s oldest, and most vulnerable, adults received their most recent Covid vaccine in September or October. The JCVI noted that “the immunity this group gained through their booster shot may wane substantially before the fall, when we plan to roll out a wider booster program.” 

Embed from Getty Images

Details on the fall program have not been published yet. 85% of those aged 12 and older in the eligible population of UK residents have received their two doses of a Covid-19 vaccine, and two-thirds of that group has received a booster shot.”

UK Prime Minister Boris Johnson is also preparing to announce and end to all remaining Covid-19 restrictions in England, a move which many medical professionals have criticized. 

Most of England’s Covid restrictions have already been lifted. The legal requirement to self-isolate after testing positive for the virus is one of the few requirements still in place. 

Johnson is also planning to announce that access to free Covid tests will be scaled back, even though the nation recorded 25,696 new cases this Sunday alone. About 508 individuals per 100,000 people are currently infected with Covid-19 in England. 

“Thanks to our COVID-19 vaccination rollout, we are already the freest country in Europe. It has saved countless lives, reduced pressure on the National Health Service, and is allowing us to learn to live with the virus,”  U.K. Health Secretary Sajid Javid said in a statement on Monday.

Hawaiian Airlines

Hawaii Likely To Tighten Travel Restrictions In 2022

Covid-19 cases are once again on the rise in the US due to the highly contagious Omicron variant and lack of vaccination throughout the nation. Restrictions on inbound international travel have already begun to tighten, as travelers need to show proof that they’re fully vaccinated with a negative test result that’s no more than one day old. 

The state of Hawaii already has limited on-island medical centers and resources, so they’re considering strengthening their own requirements for those arriving to the islands. Hawaii’s Lieutenant Governor Josh Green is pushing for tighter travel restrictions to be implemented in the near future. 

“The recommendation should be that you’re either boosted or tested, real straightforward, and I think that will come in the New Year.”

Embed from Getty Images

Throughout the entire pandemic Hawaii has implemented some of the strictest interstate entry requirements. 

After Hawaii launched its Safe Travels program, the state was met with a large number of tourists who were looking to escape to the islands. Governor David Ige responded to this uptick in travel by pleading with visitors to delay their visits so the hospitality industry could recover from the past summer. 

With the sudden and rapid increase in Omicron infections, Hawaii-bound travelers may find themselves facing stricter restrictions in the coming weeks. 

According to Jessica Lani Rich at the Visitor Aloha Society of Hawaii (VASH), there’s been an “increase in calls coming in from visitors who test positive while they’re already in the destination. The new CDC guidance has encouraged some such infected vacationers to ride out their on-island isolation period and then salvage the remainder of their trip, rather than just returning home.”

“The majority of our visitors do not have the funds to spend an extra two weeks during the holidays and so, for those visitors, they are happy that the CDC has changed the rules,” she told local KITV4 News.

Outgoing National Institutes Of Health Director Tells Americans To Focus On Covid As The Real Enemy 

“I get upset because people point to anecdotes of somebody who got sick even though they had been vaccinated and say, ‘There, you see, it doesn’t work,’ That’s way too simplistic,” said Dr. Francis Collins on his last day as director of the National Institutes of Health. 

Around 50 million Americans still haven’t received even their first dose of Covid-19 inoculation, and with the omicron variant causing a major surge in new cases throughout the US, Collins made his frustration in those still refusing to get vaccinated evident. 

Embed from Getty Images

“How did that happen? How did we get all of this so mixed up with social media, misinformation, and political insertion into the discussion? This is the thing for me on my last day as NIH director that I find particularly frustrating.”

An investigation performed by NPR revealed that vaccination rates are substantially lower in US counties that were in support of former president Donald Trump. Individuals living in counties that had a 60% or higher approval rating for Trump are three times more likely to die from Covid-19 due to the lack of inoculations. 

“We’ve got to remember, Covid is the enemy. It’s not the other people in the other political party. It’s not the people on Facebook who are posting all sorts of crazy conspiracies. This is the enemy,” Collins exclaimed. 

“We in this country have somehow gotten all fractured into a hyper-polarized, politicized view that never should have been mixed with public health. It’s been ruinous and history will judge harshly those people who have continued to defocus the effort and focus on conspiracies and things that are demonstrably false.”

Embed from Getty Images

Collins also warned that with its dozens of mutations, “the omicron variant has the properties to potentially be evasive of the vaccines. I urge the 60% of Americans who are eligible for a booster shot but haven’t gotten one to take action.”

Dr. Anthony Fauci spoke to the media this week as well, explaining that the omicron variant is particularly concerning because of its “extraordinary transmissibility. It has a ‘doubling time’ of just 2-3 days. That’s the time it takes for the number of coronavirus cases to double.” 

Data from South Africa, where the omicron variant first emerged, shows that it leads to less severe symptoms and does require less hospitalization, but that could also be due to the fact that “South Africa’s population has so much experience with prior infections that it might be underlying immunity that’s making it look like it’s less severe.”

“And even if omicron does turn out to be less severe than delta, the sheer number of expected omicron infections is likely to overcome the “slight-to-moderate diminution in severity. U.S. hospitals are going to be very stressed with people,” Fauci said.

Omicron Forcing Colleges To Increase Safety Measures By Requiring Boosters

For some students, the haunting idea that they never may get a “true” college experience is becoming more likely every passing day. With the country now facing the rising threat of the Omicron variant, universities have started restoring back to tightened preventative measures.

Boston College, the University of Notre Dame, Georgetown University, and Syracuse University are just some of the 20 colleges that now require students to receive a booster shot before the spring term begins, while others are considering implementing the mandate.

Adults are eligible for a booster either two months after a single dose vaccination or six months after a double dose vaccination.

Embed from Getty Images

In addition to boosters, colleges are extending mask mandates and limiting social gatherings. Online classes, which have slowly decreased, are expected to continue and will likely become more frequent – or, once again, become the only form of learning permitted.

Some campuses are already experiencing current Omicron outbreaks. Cornell University moved all final exams to online after 700 students tested positive over the course of just three days. Its President, Martha Pollack, called the actions “dispiriting.”

Speaking to Inside Higher Ed, American College Health Association COVID-19 task force co-chair Gerri Taylor explained that while it’s hard to swallow, institutes bringing back their tightened measures would help to curb the spread of Omicron due to how successful they are.

“Colleges have done an even better job than many organizations in controlling cases on their campuses because they put into place all of these great strategies. They have mask requirements, vaccine requirements, physical distancing — they’ve done work on their air filtration.”

Taylor also suggested universities that have the ability to do so engage in genome sequencing, a lab procedure that allows researchers to tell the difference between the Omicron strain and other strains of COVID-19.

While Taylor applauded colleges’ efforts, there are signs that the implementations are coming up very short, which could lead to more outbreaks down the line. According to a study by the Covid States Project — made up of researchers from schools like Northwestern and Harvard — only 49% of students accurately understood their college’s vaccination policies.

The study, which was conducted with 1,000 students back in August and September, noted that complexities within the policies have contributed to the misunderstandings, while some students took advantage of vague language and even filed

Embed from Getty Images

Northwestern professor of political science and study researcher David Lazer said that the amount of uncertain and unvaccinated students at universities with vaccine mandates should “set off some alarm bells.”

At the time, the study found that students who went to public schools were not as subjected to mandates as those who attended private schools. The study also looked at other factors, such as the political party of the student’s state governor – students with Democratic governors were more likely to have vaccine and mask mandates.

Colleges have gotten creative when it comes to incentivizing — or forcing — students to get a vaccination. Some had dunk tanks, therapy dogs, and raffles with highly valued prizes like free tuition as rewards for those who received a shot. Other schools chose to charge students for being unvaccinated.

Travel Ban

Omicron Variant Forces New Travel Restrictions and Protocols Across Globe

In what has seemingly become an ever-expected piece saying, the travel industry will once again be heading towards new restrictions – this time due to the rise of the Omicron variant.

In order to curb the spread of the variant, the Biden Administration initiated travel bans on Nov. 29 against South Africa — where the strain was first identified back in late November — Lesotho, Malawi, Mozambique, Zimbabwe, Namibia, Botswana, and Eswatini. The State Department also issued a “do not travel” advisory for citizens.

Embed from Getty Images

This past Monday, new requirements were introduced for inbound travelers, which includes U.S. citizens. Air travelers are required to present airlines with proof of a negative COVID test that was taken one day before departure. This is lowered from the previous three days.

Meanwhile, tests that are accepted still include antigen and nucleic acid amplification tests (NAAT). Travelers are not required to take an additional COVID test upon landing. So far, general tests have been able to detect Omicron, and should “remain adequate.” Currently, 19 states have detected an Omicron variant, as have 50 countries.

The United Kingdom has instituted similar testing protocol, along with banning travel to multiple African countries – Nigeria just became the 11th country added to their red list.

Like every other governmental action during the pandemic, the South Africa ban has had controversial aspects. The New Yorker pointed out that before the restrictions went into effect, strains were also detected in the U.K., Germany, and the Czech Republic – yet,  travelers are still currently free to enter and leave those countries.

Meanwhile, South Africans have expressed displeasure. “I think the government’s decision is wicked, unfair and a heavy financial burden,” a Nigerian man living in the U.K. told the BBC in regards to the government’s restrictions that force a paid-quarantine for residents returning to the country.

Despite numerous countries’ efforts, it might not be any good in the long run. Speaking with NPR, Yale Institute of Global Health director Saad Omer said these bans have “very little utility.” “From what we know about the epidemiology of SARS-CoV-2 and the epidemiology of this variant, the horse has probably left the barn,” Omer said, while also agreeing with the belief that variant-identified countries should not be exempted from restrictions.

Embed from Getty Images

Thankfully, it doesn’t seem like you may have to worry about your own holiday travel plans being flushed down the drain just yet. Appearing on a CNN Global Town Hall, Dr. Anthony Fauci explained that “if you have a vaccinated situation, your family is vaccinated, enjoy the holidays indoors with your family.”

While Fauci did say that traveling always opens up the risk of infection, travelers can help to further protect themselves by continuing to wear masks and getting booster shots that are becoming available to more and more people.

It seems travelers share these sentiments to an extent. According to MarketWatch, a survey found that 87% of travelers are still planning on following through with their Christmas trips, while 10% have cancelled their trips and 3% ended up changing their destination. 79% of the survey respondents expressed concern about Omicron, however.

Dr. Fauci Says Early Reports On Omicron Covid-19 Variant Are Encouraging 

US health officials stated this Sunday that while the omicron variant is rapidly spreading throughout the world and country, early reports suggest it may be less dangerous than the delta variant, which is continuing to impact hospitalization rates across America. 

Dr. Anthony Fauci, President Joe Biden’s chief medical adviser, told the media that scientists do need more information before drawing any concrete conclusions about omicron and its severity. 

South Africa, where the variant initially emerged, reported that it is becoming the dominant strain for its citizens, but also suggested that their hospitalization rates haven’t increased exponentially like they did with delta initially. 

Embed from Getty Images

“Thus far, it does not look like there’s a great degree of severity to omicron, but we have really got to be careful before we make any determinations that it is less severe or it really doesn’t cause any severe illness, comparable to delta.”

Fauci also explained how the Biden administration is considering lifting travel restrictions between the US and noncitizens from several African countries. Initially, the US imposed heavy restrictions once the omicron variant first appeared. 

“Hopefully we’ll be able to lift that travel ban in a quite reasonable period of time. We all feel very badly about the hardship that has been put on not only in South Africa but the other African countries,” Fauci said.

According to reports the omicron variant has been detected in about a third of the US state’s as of this past Sunday. The Northeast, South, Great Plains, and West Coast have all reported omicron cases with Wisconsin, Missouri and Louisiana being the most recent states to confirm cases. 

Embed from Getty Images

Delta continues to remain the dominant variant in the US, as it’s currently driving a surge of hospitalizations in the North, and makes up about 99% of the confirmed Covid cases. The National Guard has been sent out to help overwhelmed hospitals throughout the Northeast, and many hospitals are rescheduling non-urgent surgeries to cope with the increase in Covid patients. 

A majority of these cases are among unvaccinated individuals as well, so US officials are working hard to continue to urge people to get vaccinated, receive their booster shots, and take all the necessary precautions when out in public. 

The World Health Organization’s (WHO) epidemiologist Dr. Maria Van Kerkhove told the media this week that even if the omicron variant continues to be less dangerous than the delta variant, it’s existence alone is still a major issue. 

“Even if we have a large number of cases that are mild, some of those individuals will need hospitalizations. They will need to go into ICU and some people will die. … We don’t want to see that happen on top of an already difficult situation with delta circulating globally.”

We are now about two years into the pandemic, and during that time about 780,000 Americans have died, and deaths remain at a rate of 860 per day, proving we still have a long way to go before we can consider this pandemic even close to being beaten. With more than 86,000 infections being reported per day, experts are encouraging all Americans to remain safe during the upcoming holiday season, and keep all travel to a minimum. 

Food Bank

Food Banks Struggle To Feed The Hungry As Prices Rise

For food banks, the COVID-19 pandemic continues to be a hard-hitting obstacle that threatens the well-being of families across the countries. Now, there are more hills to climb in the forms of rising food prices and supply chain issues that could cause massive havoc as the always-busy holiday season approaches.

As the Associated Press notes, the surging costs and the subsequent scarcity could equate to families in need receiving smaller portions or substitutes for favorite foods. Some food banks even worry they won’t be able to provide classic servings such as cranberry sauce or stuffing for Thanksgiving and Christmas.

Embed from Getty Images

Speaking to the AP, Feeding America chief operating officer Katie Fitzgerald explained that while food distribution numbers have seen a decrease, they’re still at almost 55% over the totals from the pre-pandemic times, and that an increase in food insecurity is still very possible “if too many shoes drop.”

The 200 food banks that work with Feeding America — which distributes around 4.3 billion meals per year — saw a 31% increase in the amount of food distributed in the first quarter of 2021 when compared to the first quarter of 2020. Many of the food banks expanded due to the increased demand.

During the first year of COVID, food distribution continually rose as many who had never required a food bank before suddenly needed assistance. 1.1 billion pounds of food were shipped off in the first quarter of 2020, which rose to 1.6 billion in the second quarter, a 42% increase. The third quarter had a slight increase of 5%, and distributions began to decline at the end of 2020.

The surging transportation costs are to blame for donated food being more expensive. Meanwhile, labor shortages and backlogs at factories and ports are heavily contributing to the lack of availability when it comes to food and supplies.

Embed from Getty Images

According to AP, the Alameda County Community Food Bank in California is now spending an extra $60,000 a month on food, while also spending $1 million a month in order to distribute 4.5 million pounds of food. The costs of various types of servings are up anywhere from 6% to 17%.

In addition to food banks, government food assistance programs such as Supplemental Nutrition Assistance Program (SNAP) — also known as food stamps — saw increased usage by hungry families as well. SNAP users bumped up by 7 million from 2019 to 2021, which brought the total amount to 42 million. The program also had a benefits increase of 25% in October, which means the average monthly per-person benefits rose from $121 to $157.

It’s not just the absence of food supplies and costs that are interfering with food bank operations, however – the lack of volunteers is also an alarming factor. In San Francisco, one food bank only has seven to 10 volunteers working a shift despite needing to serve over 50,000 families per week. The number of volunteers down from 30-80 volunteers pre-pandemic.

According to the San Francisco Examiner, one reason for the absence of volunteers is the uprise in remote work. Companies are opting not to send employees in to assist anymore on paid-volunteering days, which has left pantries scrambling to rework their inner organizations.