About Covid-19
What could possibly happen over the Thanksgiving Day holiday? As you have probably read, a new strain, Omicron(B.1.1.529), emerged from South Africa and has already spread worldwide. So far, it has not been identified in the U.S., but that discovery is inevitable. The variant is highly infectious and has 50 new mutations (at least 30 on the spike protein). Below are a few thoughts about “where we are” with respect to Covid-19:
1. The emergence of mutations is inevitable and will continue
2. Mutations are more likely to develop in unvaccinated populations, which is why a global approach to control is needed.
3. The problem with global vaccination is not primarily a cost issue- it is logistics and supplies. For example, as previously reported, a shortage of syringes is a major impediment to adequate vaccination.
4. The key question now is whether current vaccines are effective in preventing infection/severe illness with the omicron strain. The answer is not yet known. Vaccine companies are studying the mutations. If a new or modified vaccine is needed, it could take a few months to produce. That timeframe is very long in a pandemic, but “lightening speed” with respect to historical vaccine development.
5. Likewise, it is not know how well current therapies (like monoclonal antibodies) will work against this variant.
6. Regardless of answers to the above unknowns, masking, vaccination and social distancing are still effective measures, regardless of current and future mutations. Fighting this pandemic is a marathon, not a sprint; a great challenge is avoiding prevention fatigue and letting our guard down.
7. Politics will, unfortunately continue to play an adverse role in control. As today’s Washington Post notes: “Two things are true. Most Republicans are vaccinated against the coronavirus. Also, most of those who aren’t vaccinated against the coronavirus are Republican.”
For a good update, see: What we know about Omicron variant that has sparked global alarm (Financial Times)
Merck says its antiviral pill is less effective than initially reported.: “The pharmaceutical company Merck said on Friday that in a final analysis of a clinical trial, its antiviral pill reduced the risk of hospitalization and death among high-risk Covid patients by 30 percent, down from an earlier estimate of 50 percent.
The lower efficacy is a disappointment for the drug, known as molnupiravir, which health officials around the world are counting on as a critical tool to save lives and reduce the burden on hospitals. It increases the importance of a similar, apparently more effective, offering from Pfizer that is also under review by the Food and Drug Administration.”
Pfizer poised to request authorization for coronavirus booster for 16 and 17 year olds: “Pfizer and its partner BioNTech are expected to ask the Food and Drug Administration in the coming days to authorize its booster shot for that age group, according to two people familiar with the situation. The regulators are expected to sign off quickly, said the individuals, who spoke on the condition of anonymity because they were not authorized to discuss the issue.”
About the public’s health
Warning on tackling HIV as WHO finds rise in resistance to antiretroviral drugs:
“A new reported issued by the World Health Organization (WHO) is warning that HIV drug resistance is on the rise, reported The Guardian.
Four out of five countries with high rates have seen success in suppressing the virus with antiretroviral treatments, according to the agency's latest HIV drug-resistance report.
However, the study found an increase in countries reaching a 10% threshold of resistance to a class of drugs which, underlining the need for a move to an alternative treatment, the WHO said. Resistance exceeding the 10% threshold was reported in 21 of 30 countries surveyed.
The report said switching from non-nucleoside reverse transcriptase inhibitors was important for children, with nearly half of infants newly diagnosed carrying drug-resistant HIV, according to surveys in 10 sub-Saharan African countries.”
Diabetes Prevention in a U.S. Healthcare System: A Portrait of Missed Opportunities: “Of the 21,448 patients identified as eligible for prediabetes screening, 13,465 (62.8%) were screened in accordance with the USPSTF recommendations. Of those patients screened, 3,430 met the requirements for a prediabetes diagnosis. Only 185 (5.4%) of patients who screened positive for prediabetes received a formal diagnosis of prediabetes, and no patients who received a diagnosis received appropriate treatment for their prediabetes. Women were more likely than men to be screened (p<0.001), and non-Hispanic Whites were less likely than non-Hispanic Blacks and Hispanics to be formally diagnosed even after screening positive (p<0.001).
CDC warns of rising flu infection rates among young people: “While flu activity is low nationally, the CDC noted that more than 90% of new cases found in the past few weeks have been among children and adults aged 5-24.
Most of the cases are of the H3N2 strain, which was last the dominant strain during the 2017-18 flu season. That season saw 710,000 flu-related hospitalizations and 52,000 flu-related deaths in the United States, the worst since the 2009 H1N1 flu pandemic.
Health experts say the strain is particularly troubling as it has a tendency to mutate more rapidly than other variants.”
About pharma
Trends in Use and Expenditures for Brand-name Statins After Introduction of Generic Statins in the US, 2002-2018: “Using 17 years of the Medical Expenditure Panel Study data, this survey study of generic competition among statins found that the end of market exclusivity was associated with $925.60 of annual savings per individual and $11.9 billion in savings for the US.”
About hospitals and health systems
Association of Rural and Critical Access Hospital Status With Patient Outcomes After Emergency Department Visits Among Medicare Beneficiaries: “In this cohort study of 473 152 matched urban and rural Medicare beneficiaries, risk-adjusted all-cause mortality after rural and urban ED visits was similar, particularly for potentially life-threatening conditions. Critical access hospitals had similar outcomes.
Meaning These findings underscore the importance of rural and critical access EDs for treatment of life-threatening conditions among Medicare recipients and have important policy implications given the continued increase in rural hospital closures.”
Association of Private Equity Investment in US Nursing Homes With the Quality and Cost of Care for Long-Stay Residents: “In this cohort study with difference-in-differences analysis of 9864 US nursing homes, including 9632 residents in 302 nursing homes acquired by private equity firms and 249 771 residents in 9562 other for-profit nursing homes without private equity ownership, private equity acquisition of nursing homes was associated with higher costs and increases in emergency department visits and hospitalizations for ambulatory sensitive conditions.” [Emphasis added]
Cleveland Clinic posts $422M profit in Q3 as staff expenses rise due to latest surge of COVID-19: “Cleveland Clinic generated $422 million in profits for the third quarter of the year as staffing costs and other expenses increased by nearly 13% compared to the same period in 2020.
The hospital system generated a total of $3 billion in the third quarter of the year compared to $2.7 billion in the third quarter of 2020. This was thanks to $2.7 billion in net patient service revenue and $148 million in operating income.”
About healthcare IT
Zero-Day Attacks: From HHS Office if Information Security, a really good overview with examples and their implications: “Collectively, a zero-day attack is a vulnerability that is exploited by threat actors before a patch is developed and applied.
Because no time exists between when the vulnerability is discovered by developers and when it is exploited by threat actors, these vulnerabilities are called ‘zero-days’”
A couple final notes:
“Mitigating zero-day attacks completely is not possible – by nature, they are novel and unexpected attack vectors
Patch early, patch often, patch completely
o Security resources like HC3 can provide insightinto active zero-days and available patches
Implementing a web-application firewall to review incoming traffic and filter out malicious input can prevent threat actors from reaching security vulnerabilities”
About health insurance
Value-based Care Report: From Humana:
”Of Humana’s individual MA [Medicare Advantage] membership, 67%, or 2.65 million, seek care from primary care physicians in value-based agreements.” Visits to the PCP were higher, and ER and hospitalizations were lower in the MA group- especially compared to Original Medicare. These behaviors resulted in an “estimated medical cost savings of 13.4% compared to Original Medicare. That percentage amounts to a $3.1 billion reduction in medical costs that would have been incurred by value-based members during 2020 had they been enrolled in Original Medicare.”