About Covid-19
Evolution of neurologic symptoms in non-hospitalized COVID-19 “long haulers” Of the 52 patients completing this study: “Non-hospitalized COVID-19 ‘long haulers’ continue to experience neurologic symptoms, fatigue, and compromised quality of life 14.8 months after initial infection.”
As reports of ‘Paxlovid rebound’ increase, Covid researchers scramble for answers “Almost 90% effective at preventing hospitalizations from Covid-19, Pfizer’s antiviral pill has quickly become one of the most powerful additions to the pandemic arsenal since the advent of mRNA vaccines. But as it’s become more widely available, a growing number of people have found the drug only temporarily effective…
Already, there’s been debate over how to address a rebound. Pfizer’s CEO, Albert Bourla, has suggested that patients who experience one take another course of the drug, while the Food and Drug Administration has put out guidance telling physicians the opposite. On Tuesday morning, the Centers for Disease Control and Prevention issued its first official guidance, reiterating the FDA’s advice against re-treatment and telling rebounding patients to isolate for at least five days and mask for at least 10, as the agency currently advises for new infections.”
About health insurance
Independence at Home Demonstration Performance Year 7 Results “The IAH Demonstration tests a payment incentive and service delivery model for home-based primary care for Medicare fee-for-service (FFS) beneficiaries with multiple chronic illnesses. The Demonstration tests whether home-based primary care that is designed to provide comprehensive, coordinated, continuous, and accessible care to high-need patients and to coordinate health care across all treatment settings reduces preventable hospitalizations, readmissions, and emergency department visits; improves health outcomes commensurate with beneficiaries’ stage of chronic illness; improves the efficiency of care; reduces the cost of health care services; and achieves beneficiary and family caregiver satisfaction…
In Performance Year 7 of the Demonstration (January 1, 2020 – December 31, 2020), the Centers for Medicare & Medicaid Services (CMS) found that the expenditures for IAH practices’ applicable beneficiaries were approximately 18.0 percent (equating to $42.3 million) below their spending targets, an average reduction of $6,585 per beneficiary. All 10 IAH participants (nine practices and one consortium) reduced the per-beneficiary-per-month (PBPM) expenditures relative to the practice’s PBPM spending target…
All 10 IAH participants met three or more of the six quality measures; three of those practices met the performance thresholds for all six quality measures.”
These findings were a change from the previous 6 years: “Mathematica’s evaluation of the first six years of IAH provided no compelling evidence that the IAH payment incentive reduced Medicare spending or hospital use for high-need patients of practices participating in the demonstration. When examining dually eligible beneficiaries who received home-based primary care from any provider, Mathematica’s analysis found lower expenditures on institutional care and higher expenditures on home-based services—but no reduction in total Medicare or Medicaid spending.”
About the public’s health
Births: Provisional Data for 2021 From the CDC: “The provisional number of births for the United States in 2021 was 3,659,289, up 1% from 2020 and the first increase in the number of births since 2014. The general fertility rate was 56.6 births per 1,000 women aged 15–44, up 1% from 2020 and the first increase in the rate since 2014. The total fertility rate was 1,663.5 births per 1,000 women in 2021, up 1% from 2020. Birth rates declined for women in age groups 15–24, rose for women in age groups 25–49, and was unchanged for adolescents aged 10–14 in 2021.”
And in a related article: Temporal Trends in Adverse Pregnancy Outcomes in Birthing Individuals Aged 15 to 44 Years in the United States, 2007 to 2019 “Adverse pregnancy outcomes (APOs) (hypertensive disorders of pregnancy [HDP], preterm delivery [PTD], or low birth weight [LBW]) are associated adverse maternal and offspring cardiovascular outcomes. Therefore, we sought to describe nationwide temporal trends in the burden of each APO (HDP, PTD, LBW) from 2007 to 2019 to inform strategies to optimize maternal and offspring health outcomes…
In aggregate, APOs now complicate nearly 1 in 5 live births. Incidence of HDP has increased significantly between 2007 and 2019 and contributed to the reversal of favorable trends in PTD and LBW. Similar patterns were observed in all age groups, suggesting that increasing maternal age at pregnancy does not account for these trends. Black–White disparities persisted throughout the study period.”
Commentary: The FDA needs more information on supplements. Consumers’ safety is at risk “A national survey conducted for The Pew Charitable Trusts showed about half of adults overestimate the regulatory scrutiny that dietary supplements receive. The reality is that the FDA doesn’t know for certain what products are on the market or what’s in them. This is a serious challenge — one that Congress can address by passing Senate Bill 4090, known as the Dietary Supplement Listing Act of 2022, a bill recently introduced by U.S. Sen. Dick Durbin, D-Ill., and co-sponsored by Sen. Mike Braun, R-Ind…
[F]rom 2007 to 2019, the FDA found almost 1,000 products masquerading as dietary supplements that actually contained active and potentially harmful pharmaceutical compounds from prescription drugs, most commonly erectile dysfunction treatments, steroids and weight loss drugs — including one that was removed from the market in 2010 because it significantly increased risk of heart attack and stroke.”
Plasma Donation Rules Relaxed by FDA to Boost Blood Supply “People with blood pressure measurements outside of the normal range may still donate plasma without first getting a medical exam, the FDA said Monday in draft guidance.”
Screening for Impaired Visual Acuity in Older Adults “The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in older adults. (I statement).
And in a related article: Screening for Primary Open-Angle Glaucoma “The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for primary open-angle glaucoma in adults. (I statement).”
Monkeypox likely isn't much of a threat to the public, a White House official says “Dr. Raj Panjabi, Senior Director for Global Health Security and Biodefense at the National Security Council, says the fewer than 10 cases seen in the United States so far have not been severe — ‘flu-like symptoms and a rash which can be painful but resolves in two to four weeks’ — and aren't likely to get much worse…
The virus usually spreads from person to person through sustained, skin-to-skin contact with someone with rashes or lesions.”
And in a related story: CDC releasing some smallpox vaccine doses for monkeypox “Jennifer McQuiston, the deputy director for the CDC’s Division of High Consequence Pathogens and Pathology, said during a press briefing that more than a thousand doses of the Jynneos smallpox vaccine are currently available in the U.S., with more doses expected to become available as production ramps up…
Apart from Jenneos, more than a million doses of the older-generation ACAM2000 smallpox vaccine are available, though CDC officials noted on Monday that this shot has some potential side effects that warrant discussion before widespread use.”
About healthcare IT
New AWS Healthcare Accelerator focuses on health equity “To help tackle health disparities, Amazon Web Services (AWS) is announcing the next AWS Healthcare Accelerator cohort—this time with a focus on health equity. The accelerator is one more way we are harnessing the power of the cloud to make access to healthcare equitable. It builds on other efforts we’ve launched in this area, including the AWS Health Equity Initiative, a $40 million, three-year global commitment designed to support innovations in this space. Both the Health Equity Initiative and the Healthcare Accelerator are part of AWS for Health, an offering of AWS services and AWS Partner Network solutions designed to help organizations increase the pace of innovation, unlock the potential of health data, and develop more personalized approaches to therapeutic development and care.”
The Era of Borderless Data Is Ending “Nations are accelerating efforts to control data produced within their perimeters, disrupting the flow of what has become a kind of digital currency…
France, Austria, South Africa and more than 50 other countries are accelerating efforts to control the digital information produced by their citizens, government agencies and corporations. Driven by security and privacy concerns, as well as economic interests and authoritarian and nationalistic urges, governments are increasingly setting rules and standards about how data can and cannot move around the globe. The goal is to gain ‘digital sovereignty.’”
A fascinating article in today’s The NY Times.
About healthcare personnel
New Surgeon General Advisory Sounds Alarm on Health Worker Burnout and Resignation “There is a Projected Shortage of More than 3 Million Essential Low-Wage Health Workers in the Next Five Years and a Projected Shortage of Nearly 140,000 Physicians by 2033…
Topline recommendations to address burnout in the Surgeon General’s Advisory include:
Transform workplace culture to empower health workers and be responsive to their voices and needs.
Eliminate punitive policies for seeking mental health and substance use disorder care.
Protect the health, safety, and well-being of all health workers. [For example:]
Provide living wages, paid sick and family leave, rest breaks, evaluation of workloads and working hours, educational debt support, and family-friendly policies including childcare and care for older adults for all health workers.
Ensure adequate staffing, including surge capacity for public health emergencies, that is representative of the communities they serve. This is critical to protect and sustain health workers and communities.
Reduce administrative burdens to help health workers have productive time with patients, communities, and colleagues.
Prioritize social connection and community as a core value of the healthcare system.
Invest in public health and our public health workforce.”