About the public’s health
Differential Effects of Intervention Timing on COVID-19 Spread in the United States: Here is the study reported in many media outlets today that calculates how many lives could have been saved if social isolation were implemented a week earlier. “Specifically, nationwide, 61.6% [95% CI: 54.6%-67.7%] of reported infections and 55.0% [95% CI: 46.1%-62.2%] of reported deaths as of May 3, 2020 could have been avoided if the same control measures had been implemented just one week earlier. We also examine the effects of delays in re-implementing social distancing following a relaxation of control measures. A longer response time results in a stronger rebound of infections and death.”
COVID-19: The CIDRAP Viewpoint: This third-in-a-series report is from the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota. It is an excellent review of the process necessary for effective population testing and test interpretation for SARS-CoV-2. One major criticism is lack of systems coordination of all efforts. An important recommendation is that:
“The US secretary of Health and Human Services (HHS) should appoint by July 1, 2020, a blue- ribbon panel of national experts. The panel should include representatives from public health, clinical laboratory, and medicine; the laboratory testing research and development, marketing, and product support industries; ethicists; legal scholars; and elected officials. We have identified eight key objectives for the blue-ribbon panel to address.”
Majority of practices seeing patients in person again: “In a poll of more than 1,000 practice leaders conducted by the Medical Group Management Association MGMA), 89 percent of practices surveyed indicated they were seeing patients in person again.” And a related article: The Impact of the COVID-19 Pandemic on Outpatient Visits: A Rebound Emerges, looks at actual patient volume increase.
Will government mandate COVID-19 vaccinations?: Recall that pre-COVID-19, many states were changing immunization requirements for children because of measles outbreaks. Now the question arises; When we have a vaccine for SARS-CoV-2, will vaccinations be mandated by federal/state/local governments?
‘It’s something I have never seen’: How the Covid-19 virus hijacks cells: “A deep dive into how the new coronavirus infects cells has found that it orchestrates a hostile takeover of their genes unlike any other known viruses do, producing what one leading scientist calls ‘unique’ and ‘aberrant’ changes.
Recent studies show that in seizing control of genes in the human cells it invades, the virus changes how segments of DNA are read, doing so in a way that might explain why the elderly are more likely to die of Covid-19 and why antiviral drugs might not only save sick patients’ lives but also prevent severe disease if taken before infection.”
The original article in Cell concludes: ”Cell and animal models of SARS-CoV-2 infection, in addition to transcriptional and serum profiling of COVID-19 patients, consistently revealed a unique and inappropriate inflammatory response. This response is defined by low levels of type I and III interferons juxtaposed to elevated chemokines and high expression of IL-6. We propose that reduced innate antiviral defenses coupled with exuberant inflammatory cytokine production [emphasis added]are the defining and driving features of COVID-19.”
In other words, SARS-CoV-2 reduces some antiviral responses while magnifying a harmful response.
Wuhan bans eating wild animals as coronavirus drives a crackdown in China: The headline speaks for itself. It took 2 pandemics (SARS and SARS-CoV-2) to make it happen.
HHS overrides states, lets all pharmacists give COVID-19 tests:”HHS decided May 19 that the Public Readiness and Emergency Preparedness, or PREP, Act preempts state laws restricting pharmacists' ability to order and administer COVID-10 diagnostic tests.”
How COVID-19 Spreads: This information is the latest CDC update. It emphasizes the primacy of person-to-person contact in transmission and measures to lessen that possibility.
Americans Who Rely Most on White House for COVID-19 News More Likely to Downplay the Pandemic: This research from the Pew Research Center for Journalism & Media is a MUST READ to gauge the harmful influence the White house has on dealing with the COVID-19 pandemic.
GOP fronts ‘pro-Trump’ doctors to prescribe rapid reopening:”Republican political operatives are recruiting “extremely pro-Trump” doctors to go on television to prescribe reviving the U.S. economy as quickly as possible, without waiting to meet safety benchmarks proposed by the federal Centers for Disease Control and Prevention to slow the spread of the new coronavirus.
The plan was discussed in a May 11 conference call with a senior staffer for the Trump reelection campaign organized by CNP Action, an affiliate of the GOP-aligned Council for National Policy. A leaked recording of the hourlong call was provided to The Associated Press by the Center for Media and Democracy, a progressive watchdog group.”
Prostate Cancer Incidence 5 Years After US Preventive Services Task Force [USPTF] Recommendations Against Screening: “For all races/ethnicities combined, incidence for local-stage disease declined beginning in 2007 in men aged 50-74 and ≥75 years though the decline stabilized during 2013-2016 in men aged ≥75 years….In contrast, incidence for regional- and distant-stage disease increased in both age groups during the study period.” The USPTF had recommended eliminating routine PSA testing for men over 75. After that recommendation there was less early stage disease and more late stage disease. These findings raise the questions about the ability to pick up early disease and the high risk of false positives. The long-term solution would be a better test for prostate cancer.
Nasal Gene Expression of Angiotensin-Converting Enzyme 2 in Children and Adults: SARS-CoV-2 has an affinity for ACE2 receptors. This study of 305 people under age 60 shows an “age-dependent expression of ACE2 in nasal epithelium, the first point of contact for SARS-CoV-2 and the human body. Covariate-adjusted models showed that the positive association between ACE2 gene expression and age was independent of sex and asthma.” This finding may account for the fact that children account for less than 2% of identified cases of COVID-19.
READ: CDC reopening guidance: The latest version of this guidance.
Global regulators commit to cooperate on observational research in the context of COVID-19: At a conference co-organized by the European Medicines Agency (EMA) and Health Canada, international regulators agreed to enhance cooperation on three priority areas of observational research during the COVID-19 pandemic: pregnancy research, medicines used in clinical practice and vaccine safety and effectiveness monitoring.
About healthcare IT
Apple and Google launch contact tracing API for COVID-19 exposure: “Apple and Google's exposure notification application programming interface (API) will now be available to states, public health agencies and governments to build apps that will notify people via smartphone if they've come into contact with someone with the coronavirus…” The API became available yesterday “through a new software update in the Android and iOS operating systems…” This technology presumably can be used to track other illnesses, like influenza.
Different Approaches to a Coronavirus Vaccine: This article provides a really good explanation of the different methods being used to prepare vaccines.
Researchers: Nearly Half Of Accounts Tweeting About Coronavirus Are Likely Bots: Researchers at Carnegie-Mellon University “culled through more than 200 million tweets discussing the virus since January and found that about 45% were sent by accounts that behave more like computerized robots than humans. It is too early to say conclusively which individuals or groups are behind the bot accounts, but researchers said the tweets appeared aimed at sowing division in America.”
About pharma
7 things to know about startup drugmaker Phlow: As previously reported, “President Donald Trump this week signed a four-year, $345 million contract with Phlow, a little-known generic drugmaker that was founded less than six months ago, to manufacture drugs for the national medication stockpile.” This article provides more information about this company. In a related story, check: How Civica helped under-the-radar Phlow nab a $354M COVID-19 manufacturing deal.
Coverage for Biosimilars vs Reference Products Among US Commercial Health Plans: “This study found that, in 2019, US health plans covered biosimilars as preferred in only 14% of decisions. It also revealed biosimilar coverage differences across health plans. Reasons for this variation are unknown but may include more successful negotiation of rebates at some plans than others. Because rebate agreements are not publicly disclosed, however, it was not possible to examine this hypothesis empirically…The slow uptake of biosimilars in the US has been attributed to factors such as patent disputes and reference product manufacturer tactics to delay biosimilar market entry. This study suggests that a lack of preferred coverage among health plans may also be delaying uptake.”
About hospitals
States with the Highest Hospital Expenses: Considering that most of hospital costs are personnel and benefits, the order of states here is surprising.
100 great hospitals in America | 2020: The list is from Becker’s Healthcare.