About Covid-19
Fauci says FDA could authorize Pfizer’s Covid vaccine for kids under 5 in the next month: “Fauci said younger children will likely need three doses, because two shots did not induce an adequate immune response in 2 to 4 year olds in Pfizer’s clinical trials.”
Senior citizens are fuming that Medicare won't pay for Covid-19 tests at retailers: “Asked why Medicare is not paying for the home tests, the Centers for Medicare and Medicaid Services said that Medicare pays for Covid-19 tests performed by a laboratory at no cost when the test is ordered by a physician or other health care provider. The agency noted that enrollees can also visit free testing sites or order free home tests through the federal program at covidtests.gov.”
Why the US is seeing more COVID-19 hospitalizations than other high-income countries: “The U.S. has reported more COVID-19 hospitalizations than other high-income countries during the omicron surge, according to Our World in Data…
What could explain the higher hospitalization rates in the U.S.? According to the same data, vaccination rates are lower in the U.S. than the other countries included in the analysis. The U.S. is reporting the lowest proportion of its population fully vaccinated — 62.5 percent compared to more than 70 percent for all others — and also the lowest rate of booster shots given.”
How many health care workers are vaccinated? It’s anyone’s guess: “As of the end of December, about three in four hospital workers — 77.6 percent — were fully vaccinated, the Centers for Disease Control and Prevention said, but those figures, which include non-medical staff such as custodial and cafeteria workers, come from only about 40 percent of the nation’s hospitals. About four out of five nursing home staffers are fully vaccinated, according to the CDC.
Nursing homes have been required to submit weekly data since last May and roughly 90 percent do so, according to an agency spokesperson.
Hospitals, however, won’t have to submit data until May 15 under a federal rule released by CMS in August.”
Persistent T cell response to omicron after infection and vaccination: “The omicron variant can partly evade the antibody response provided by vaccination or infection with previous variants of SARS-CoV-2. However, T cells still recognise omicron, scientists at Karolinska Institutet in Sweden report in a study published in the journal Nature Medicine.”
The best T cell response was in those who were vaccinated- even better than in those who had the disease.
Some good news about the short term effects of Covid-19 infection:
Rapid vigilance and episodic memory decrements in COVID-19 survivors: “Reassuringly, COVID-19 survivors performed well in most abilities tested, including working memory, executive function, planning and mental rotation. However, they displayed significantly worse episodic memory (up to 6 months post-infection) and greater decline in vigilance with time on task (for up to 9 months). Overall, the results show that specific chronic cognitive changes following COVID-19 are evident on objective testing even amongst those who do not report a greater symptom burden. Importantly, in the sample tested here, these were not significantly different from normal after 6–9 months, demonstrating evidence of recovery over time.”
Longitudinal Assessment of Cardiac Outcomes of Multisystem Inflammatory Syndrome in Children Associated With COVID‐19 Infections: “Our short‐term study suggests that functional recovery and coronary outcomes are good in multisystem inflammatory syndrome in children. Use of sensitive deformation parameters provides further reassurance that there is no persistent subclinical dysfunction after 3 months.”
6 states where delta is lingering: “The omicron variant accounts for 99 percent of new COVID-19 cases nationwide, but some states are still seeing delta variant proportions as high as 43 percent, according to the Walgreens COVID-19 Index, an interactive tracking tool the company launched Jan. 19…
Based on data analyzed Jan. 18, the six states with the highest delta case prevalence are:
Maine — 43.5 percent
Kansas — 36.5 percent
Iowa — 29.2 percent
New Mexico — 25.2 percent
Oklahoma — 24.2 percent
Indiana — 23.6 percent
Utah — 23.5 percent”
About health insurance
Trends in Small-Group Market Insurance Coverage: Some findings from this Urban Institute study:
“Health insurance enrollment among small-firm employees remained relatively stable from 2013 to 2019, hovering between 8.9 and 9.6 million enrollees.
The rate at which small firms offer health insurance coverage decreased by just 2.6 percentage points from 2013 to 2020. For comparison, it declined by 10.6 percentage points from 2002 to 2012. Steady offer rates likely reflect consistent demand for employer-sponsored coverage from small-firm employees and greater stability in health insurance costs resulting from ACA reforms…
Annual premium growth in the employer-sponsored insurance (ESI) market was similar across all firm sizes; premiums for single coverage grew by an average of 3.2 percent per year in the small-group market and by 3.7 percent in both the medium- and large-group markets. Nongroup premiums were significantly more unstable during this period, which may have affected small employers’ decisions to maintain coverage.
The share of establishments offering a self-insured plan grew from 13.2 percent in 2013 to 16.0 percent in 2020.”
122 organizations stand against California single-payer coverage proposal: “In a letter to the state's Assembly Appropriations Committee, the organizations claim the pair of proposals would "create a new and exorbitantly expensive government bureaucracy" controlled by the government and kill jobs.
The organizations claim the proposals would unsustainably raise taxes on individuals and businesses and dramatically expand the state's budget and ultimately only cover the 6 percent of Californians without coverage — a group comprised largely of undocumented immigrants and one that is soon to be covered under Gov. Gavin Newsom's budget proposal.”
Humana's CenterWell Senior Primary Care to expand to 12 state markets: “Humana subsidiary CenterWell Senior Primary Care, the largest senior-oriented primary care provider in the nation, is expanding its reach to 12 states.
Between 2022 and early 2023, CenterWell will create an additional 26 care centers and enter Arizona, Kentucky and Tennessee for the first time, according to the Jan. 20 news release.”
About hospitals and healthcare systems
Community Health Systems, Inc. Announces Offering of $1,535.0 Million of Senior Secured Notes Due 2030: “The Issuer intends to use the net proceeds of the Notes Offering to redeem all of its outstanding 6.625% Senior Secured Notes due 2025 (the “2025 Notes”) and to pay related fees and expenses.”
About pharma
New Tool Assesses Evolutionary Risks of Antibiotics: “Giving one drug to a patient often causes bacteria to evolve resistance against it. Fortunately, some of these resistant mutants become more susceptible to a second drug, which allows doctors to successfully treat the infection. However, doctors can’t always be sure when and if evolution will take this fortunate course. Even worse, resistance against the initial drug can backfire and cause an increase in resistance against the second drug, leaving the doctors without any further treatment options.
University of California San Diego scientists have now developed a way that can help doctors calculate the odds of the fortuitous outcomes for different drug pairs and thereby boost the odds of a successful treatment. As described in the journal eLife, graduate student Sarah Ardell and Assistant Professor Sergey Kryazhimskiy developed a mathematical model that can calculate the risk of resistance evolution for various drug pairs.”
In a related article: Antibiotic resistance kills over 1m people a year, says study: Put into perspective, that number is more than annual deaths attributable to AIDS or malaria. This excellent article is from the Financial Times.
Mark Cuban Cost Plus Drug Company's Online Pharmacy Launches with Lowest Prices on 100 Lifesaving Prescriptions: “Mark Cuban Cost Plus Drug Company (MCCPDC) today officially launched its online pharmacy [www.costplusdrugs.com]…
Because the company refuses to pay spread prices to third-party PBMs in order to be allowed to process insurance claims, the online pharmacy will be a cash pay venture. However, its model means patients can immediately purchase a broad array of medications at prices often less than what most insurance plans' deductible and copay requirements would total.”
The announcement has some lower-cost examples.
BMS Becomes 12th Big Drugmaker to Reject 340B Drug Discount Program: “In exchange for participation in Medicare and Medicaid, the 340B program requires drugmakers to offer discounts to hospitals and clinics that treat significant numbers of low-income patients. But over the past year, drugmakers have stopped participating, defending their withdrawal from the program by saying that duplicate orders and faulty rebates in the system, among other factors, justified their actions.”
The characteristics of patents impacting availability of biosimilars: An excellent research paper in Nature Biotechnology. Unfortunately it is subscription-only. The US biosimilar approval process is slowed by factors having little to do with the patent on the actual chemical entity. The article argues for a more streamlined approval approach.
“As of June 2020, only 24 of 177 (14%) approved biologics had approved biosimilars or biosimilars in development. Of the remaining 153, 125 were patent-protected and 28 were off-patent. As of 1 December 2021, the FDA had approved 31 biosimilars for 11 originator products, of which 21 had been marketed for use. By contrast, the European Medicines Agency (EMA) had approved 75 biosimilars under its abbreviated pathway, which was created 6 years earlier than the BPCIA [Biologics Price Competition and Innovation Act (BPCIA), which was part of the 2010 ACA]…
Among patents asserted in US biosimilar litigation, only 6% covered the active ingredient in the biologic drug, while the vast majority covered uses or peripheral features of the drug, such as its manufacturing processes or delivery devices. The median time of patent filing was more than a decade after approval of the originator biologic, and one-fifth of the patents had no equivalents — either patents or patent applications — in the European Union, Canada or Japan.
These findings provide insight into the role of the US patent system in biosimilar competition.”
About the public’s health
National Trends of Mental Health Care Among US Adults Who Attempted Suicide in the Past 12 Months: “In this cross-sectional analysis of 484 732 National Survey of Drug Use and Health respondents, the rate of suicide attempts among US adults has increased within the past decade. However, past-year receipt of mental health services did not increase significantly among those who made suicide attempts.
These findings suggest a need to expand service accessibility and/or acceptability, as well as public and population-wide prevention efforts.”
Comment: While telemedicine has increase accessibility for behavioral health services, more professionals are needed to handle case loads. Also, those who require services must be aware they need care and know how to access it.
About healthcare IT
Quantitating and assessing interoperability between electronic health records: “Electronic health records (EHRs) contain a large quantity of machine-readable data. However, institutions choose different EHR vendors, and the same product may be implemented differently at different sites. Our goal was to quantify the interoperability of real-world EHR implementations with respect to clinically relevant structured data…
We defined and demonstrated a quantitative measure of interoperability between site EHR systems and within/between implemented vendor systems. Two sites that share the same vendor are, on average, more interoperable. However, even for implementation of the same EHR product, interoperability is not guaranteed. Our results can inform institutional EHR selection, analysis, and optimization for interoperability.”
Negative Patient Descriptors: Documenting Racial Bias In The Electronic Health Record: “We analyzed a sample of 40,113 history and physical notes (January 2019–October 2020) from 18,459 patients for sentences containing a negative descriptor (for example, resistant or noncompliant) of the patient or the patient’s behavior….Compared with White patients, Black patients had 2.54 times the odds of having at least one negative descriptor in the history and physical notes. Our findings raise concerns about stigmatizing language in the EHR and its potential to exacerbate racial and ethnic health care disparities.”