About the public’s health
As alcohol abuse rises amid pandemic, hospitals see a wave of deadly liver disease: “Although national figures are not available, admissions for alcoholic liver disease at Keck Hospital of USC were up 30% in 2020 compared with 2019, said Dr. Brian Lee, a transplant hepatologist who treats the condition in alcoholics.
Specialists at hospitals affiliated with the University of Michigan, Northwestern University, Harvard University and Mount Sinai Health System in New York City said rates of admissions for alcoholic liver disease have leapt by up to 50% since March.”
Anthropogenic climate change is worsening North American pollen seasons: ”Our results indicate that human-caused climate change has already worsened North American pollen seasons, and climate-driven pollen trends are likely to further exacerbate respiratory health impacts in coming decades.”
Incorporating Baseline Breast Density When Screening Women at Average Risk for Breast Cancer: “Baseline screening at age 40 years followed by annual screening at age 40 to 75 years for women with dense breasts and biennial screening at age 50 to 75 years for women without dense breasts was effective and cost-effective, yielding an incremental cost-effectiveness ratio of $36 200 per QALY versus the biennial strategy at age 50 to 75 years.”
An accompanying editorial provides an important critique. Among the comments:
“Several aspects of Shih and colleagues' results are surprising and inconsistent with prior studies… Generally, annual screening results in a higher ratio of harms to benefits because few added deaths are averted—compared with biennial screening—whereas the added cost of annual screening is large. The screening strategy proposed by Shih and colleagues would do annual screening on 60% of women, which raises questions about how it could be cost-effective.
Breast density is an important risk factor to include in risk-based screening strategies because it is both a strong and prevalent risk factor accounting for a large proportion of breast cancers. However, we argue that breast density should be combined with age and other risk factors when developing risk-based screening strategies that optimize benefits and minimize harms. We believe that until a more robust risk-based strategy is identified, the frontier curves presented in Shih and colleagues' analyses support screening biennially from ages 50 to 74 years.”
Segregation, Poverty Tied to Worse Outcomes for Black Lung Cancer Patients: “For years, U.S. studies have documented racial disparities in lung cancer. Black Americans are less likely to receive surgery for early-stage lung cancer -- the standard of care -- and they typically die sooner.
The reasons, however, are not fully clear.
Researchers said the new study implicates residential segregation -- a manifestation of structural racism -- in the disparities.
It found that Black lung cancer patients living in the most segregated U.S. counties were 49% more likely to be diagnosed at an advanced stage, compared to those living in the least segregated counties.
And among those with early-stage lung cancer, Black patients in highly segregated areas were 47% less likely to receive surgery.”
About COVID-19
WHO team: Coronavirus unlikely to have leaked from China lab: “The coronavirus most likely first appeared in humans after jumping from an animal, a team of international and Chinese scientists looking for the origins of COVID-19 said Tuesday, saying an alternate theory that the virus leaked from a Chinese lab was unlikely.
A closely watched visit by World Health Organization experts to Wuhan — the Chinese city where the first coronavirus cases were discovered — did not dramatically change the current understanding of the early days of the pandemic, said Peter Ben Embarek, the leader of the WHO mission.”
U.S. COVID-19 cases and hospitalizations log biggest weekly drops since pandemic started: “The United States reported a 25% drop in new cases of COVID-19 to about 825,000 last week, the biggest fall since the pandemic started, although health officials said they were worried new variants of the virus could slow or reverse this progress.
New cases of the virus have now fallen for four weeks in a row to the lowest level since early November, according to a Reuters analysis of state and county reports. The steepest drop was in California, where cases in the week ended Feb. 7 fell 48%. Only Oregon, Puerto Rico, Arkansas and Vermont saw cases rise.“
Most Americans say they will continue preventive measures after COVID-19 pandemic ends: “[Iahn Gonsenhauser, MD, chief quality and patient safety officer at The Ohio State University Wexner Medical Center] and colleagues surveyed more than 2,000 adults. Results showed that after the pandemic ends:
72% plan to continue to wear masks in public;
80% intend to still avoid crowds; and
90% plan to frequently wash their hands and use sanitizer.”
The Big Number: During pandemic, heart surgeries plummeted by 53 percent: “The number comes from an analysis of national data through the end of 2020 and included information on 717,103 heart surgery patients and more than 20 million covid-19 patients. The finding was presented at a January meeting of the Society of Thoracic Surgeons.
The analysis found that adult cardiac surgery volume fell by more than half nationwide, to roughly 12,000 surgeries a month on average. The decline included 65 percent fewer elective surgeries and 40 percent fewer nonelective surgeries, with all types of heart operations experiencing a decline, including coronary artery bypass grafting, aortic or mitral valve replacement, a combination or something else.”
Understandable why elective surgeries were postponed, but a drop of 40% for non-elective procedures?
NHS Covid app prevented 600,000 infections, claim researchers: “The NHS contact-tracing app has prevented the transmission of hundreds of thousands of Covid-19 cases in England and Wales, researchers have estimated, in one of the world’s first studies of efficacy of the smartphone-based system developed in conjunction with Apple and Google. Researchers at the Alan Turing Institute and Oxford university have estimated that every 1 per cent increase in app users can reduce coronavirus cases by as much as 2.3 per cent. The app has sent 1.7m notifications to its more than 21m users telling people to isolate so far. Of those, the Turing/Oxford researchers estimate that about 600,000 cases were averted by the end of December.”
Pfizer Withdraws Emergency Use Application of COVID-19 Vaccine in India: “Pfizer has withdrawn its application for emergency use approval of its COVID-19 vaccine in India after the country’s drug regulator requested a domestic trial.
India’s vaccine regulatory authority called for a study on safety and immune responses in its population, while Pfizer sought to have the trial requirements waived based on its currently available global phase 3 data.”
This story is a small item but raises large questions. Usually it is the US that requires domestic studies when a drug or device is approved elsewhere in the world. I suspect this turnabout has more to do with India protecting its domestic vaccine industry (the world largest) than the quality of the Pfizer vaccine.
Coronavirus Vaccine Tracker: Excellent update on the history and status of coronovirus vaccines, as well as how they work. In The New York Times, but appears to have open access. See, also: Coronavirus Variants and Mutations.
About hospitals and health systems
7 hospitals buying land for expansions: Many hospitals went ahead with scheduled building plans this past year, but buying land now for expansion is a real committment.
Rochester's Destination Medical Center forges ahead, despite COVID-19: “Steps away from the Mayo Clinic in Rochester, the steel framework of a new $45 million structure bearing big ambitions has taken shape in recent months — rising in determined fashion despite the spread of the deadly COVID-19 virus.
Once completed, Discovery Square 2 is expected to welcome innovative health care firms just like its glassy sister structure known as One Discovery Square, the cornerstone of the $5.6 billion Destination Medical Center (DMC) project.
Now in its sixth year, DMC is a public-private economic development effort unlike any other in Minnesota history. With the world-renowned Mayo Clinic leading the charge — along with the city, Olmsted County and the state — the ambitious project is intent on dramatically retooling Minnesota's third-largest city into a ‘premier destination for health and wellness.’”
About health insurance
Centene Corporation Reports 2020 Results:
—“Total revenues of $28.3 billion for the fourth quarter of 2020, representing 50% growth compared to the fourth quarter of 2019, and $111.1 billion for the full year 2020, representing 49% growth year-over-year…
—Diluted loss per share for the fourth quarter of 2020 of $(0.02), compared to diluted EPS of $0.49 for the fourth quarter of 2019. Diluted EPS for the full year 2020 of $3.12, compared to $3.14 for the full year 2019.
—Adjusted diluted EPS for the fourth quarter of 2020 of $0.46, compared to $0.73 for the fourth quarter of 2019. Adjusted diluted EPS for the full year 2020 of $5.00, compared to $4.42 for the full year 2019.”
In a related story: Centene launching organizational restructuring effort, will cull 3K employees, [and eliminate] 1.5K open jobs
Oscar Health, Inc. Announces Filing of Registration Statement for Proposed Initial Public Offering: “The number of shares of Class A common stock to be offered and the price range for the proposed offering have not yet been determined. The offering is subject to market conditions, and there can be no assurance as to whether or when the offering may be completed, or as to the actual size or terms of the offering.”
About health IT
Effect of Wearing a Novel Electronic Wearable Device on Hand Hygiene[HH] Compliance Among Health Care Workers: “The use of this device did not change HH compliance, but increased the duration of hand rubbing and volume of ABHR [alcohol-based hand rubbing] used by HCWs [healthcare workers].”
About healthcare quality
America's Best Hospitals2021 America's 250 Best Hospitals: Healthgrade’s annual ratings. Note the conspicuous absence of academic medical centers in the top lists.
Who is Responsible for Discharge Education of Patients? A Multi-Institutional Survey of Internal Medicine Residents: “Of the 613 resident responses (63% response rate), 35% reported they were unsure which member of the multidisciplinary team is primarily responsible for discharge education. Residents who believed it was either the intern’s or the resident’s primary responsibility had 4.28 (95% CI, 2.51–7.30) and 3.01 (95% CI, 1.66–5.71) times the odds, respectively, of reporting doing discharge communication practices frequently compared to those who were not sure who was primarily responsible. To improve multidisciplinary discharge communication, residents called for the following among team members: (1) clarifying roles and responsibilities for communication with patients, (2) setting expectations for communication among multidisciplinary team members, and (3) redefining culture around discharges.”
2020 CAQH [Council for Affordable Quality Healthcare] INDEX®- Closing the Gap: The Industry Continues to Improve, But Opportunities for Automation Remain: “Data from the 2020 CAQH Index found that, of the $372 billion spent on administrative complexity in the United States healthcare system, $39 billion, or 10 percent, is spent conducting administrative transactions tracked by the CAQH Index . Of the $39 billion, the industry can save $16 .3 billion, or 42 percent of existing annual spend, by transitioning to fully electronic transactions . While the industry has already avoided $122 billion annually by automating administrative transactions, meaningful opportunities for additional savings remain for both the medical and dental industries.”
About healthcare spending
Breaking the cost curve—Deloitte predicts health spending as a percentage of GDP will decelerate over the next 20 years: Consultants at Deloitte think healthcare spending, as a percent of GDP, will slow over the next 20 years and cost less than current government projections. Reasons include “a well-being dividend—the return on investment for tools, systems, or protocols that help consumers to take an active role in their health and well-being…”
They also predict that: “three major changes will likely impact incumbent health care stakeholders, driving more revenue. These include:
The end of the general hospital as we know it
The slowdown of mass-produced biopharma
A seismic shift in the way health care is financed”