The Morning Times: An Overview of the U.S. Health Care System During the Weak Phase of the Prevalence of Covid-19
This is the last newsletter that I’ll send before starting a book leave. I’ll be back in late January. Until then, other Times journalists will be writing The Morning, and I look forward to reading their work along with all of you.
We are in the midst of a terrible, no good, horrible season. More than 10% of deaths in the US last week were due to influenza, Covid-19 or pneumonia (both bacterial and viral), well above expected levels this time of year. We’re short on key medication in some places. We continue to experience health care staff shortages and overcrowding. Masking and bivalent Covid-19 boosters remain underutilized.
Editor’s Note: Kent Sepkowitz is a physician and infectious disease expert at Memorial Sloan There is a Cancer Center in New York. The views that he expresses in this commentary are his own. CNN has more opinion on it.
How Did Aortic Fibrilmer Get Into My Kid’s Heart? The End of the Epidemic and What Can We Do About It?
Older adults that benefit from Paxlovid are the same people who take heart and blood-thinning medications. Paxlovid prevents me from getting into a common heart rhythm problem called Aortic Fibrilmer, and when I took it in April, I knew to stop taking it. But once off the rhythm-calming drug, I promptly fell back into the unpleasant and potentially dangerous abnormal rhythm — just another example of the never-any-free-lunch M.O. that clouds all medical advances. On resumption of my cardiac medication post-Paxlovid (as recommended), my heart rhythm returned to its regular beat.
What is alarming, at least to me, is the tone of some news articles that suggest the problem is new and has somehow been overlooked until now — rather than as a “Review Topic of the Week,” as the medical journal categorizes it. In medical journal parlance, a “review” denotes a roundup of existing work synthesized into a readable whole. It’s certainly not anything new or edgy.
My assessment of the pandemic is that we were blindsided by an unprecedented catastrophe, which was met with an imperfect, politically poisoned, but ultimately effective set of interventions that saved millions of lives. We don’t know if we will be able to keep some control of the epidemic.
Maybe, just maybe, both the failures and the small successes we’ve seen in the midst of Covid-19 can lead us to a space where even more public health innovation can occur.
So, to those who may be reading this in the 22nd century, hoping to find a way to convince your comrades to behave in a socially responsible direction as Covid-63 rips through your temperate resin bunkers and stilted ocean homes, we say this: Yes, there is well-demonstrated evidence on what to do — but learning about it is not likely to help.
Rather, our collective message relies on one of the few effective and non-reviled public health messages to date: Only you can prevent the next pandemic.
New Covid-19 Variants in the United States and Europe: Convergent Evolution, Distributed Scrabble, and the Winter Winter Surge
Bq.1, Bq. 1.1, BA.4.75, and BA.2.75 are found in the United States. In Singapore, the new wave of cases appears to be caused by the rapid rise of the variant XBB in other countries. Cases are also rising in Europe and the UK, where these variants have taken hold.
According to Dr. Peter Hotez, who is co-direct of the Center for Vaccine Development at the Texas Children’s Hospital, they use letters that get high scores in a game called Scrabble in order to be considered a Scrabble variant.
As the US moves into the fall, Covid-19 cases are dropping. Normally, that would be a reason for hope that the nation could escape the surges of the past two pandemic winters. But virus experts fear that the downward trend may soon reverse itself, thanks to this gaggle of new variants.
Lumped together, the variants accounted for almost 1 in 3 new Covid-19 infections nationwide last week, according to the latest estimates from the US Centers for Disease Control and Prevention.
The federal government is promising to purchase new therapies after they are made in order to encourage the development of new anti-H1N1, says a White House Covid-19 Responseordinator.
A phenomenon known as convergent evolution involves the evolution of new branches from the same Omicron family tree.
Some experts believe that this convergence is a sign that we have entered a new phase of evolution of the virus and will see the circulation of many different versions at the same time.
According to an associate professor at the Yale School of Public Health, there are several co-circulating, semi-dominate lineages going into the winter.
“That’s because with convergent evolution, perhaps several different lineages can independently obtain similar transmissibility levels versus a single new variant taking over.
“This is what predominantly happens for most pathogens, such as the flu and RSV,” Grubaugh wrote in an email. “Now that the virus has adapted pretty well to human transmission, most of what is circulating has high fitness.”
Source: https://www.cnn.com/2022/10/20/health/variants-covid-winter-surge/index.html
The Covid-19 campaign is underway: vaccines for the Omicron subvariant and a vaccine to prepare for the coming change in severity
Maria Van Kerkhove, the Covid-19 response technical lead for the World Health Organization, said Wednesday that the large mix of new variants was becoming more difficult for WHO to assess because countries were dialing back on their surveillance.
We have to be prepared for this. To deal with increases in cases and possibly to deal with increases in hospitalizations, a country must be in a position to conduct surveillance. We do not feel that a change in severity is imminent. She said that the vaccines remain effective, but they have to remain vigilant.
The Omicron subvariant BA.5 holds the top spot for now in the US. According to CDC estimates, it caused about 68% of new infections in the US last week, but it is quickly being outcompeted by several new sublineages – notably BQ.1 and BQ.1.1.
Fauci told CNN that most people feel that in the middle of November, they will have bumped BA.5 off the top spot as the dominant variant.
These variants are different from BA.4 and BA.5, but they’re descended from those viruses, the result of genetic drift. They share a lot of their genes with that virus.
Their changes aren’t on the scale of what happened when the original Omicron arrived on the scene in November 2021. The strain of the virus that came out of left field left researchers and public health officials scrambling to catch up.
We have a vaccine called a BA.5 bivalent updated vaccine that we are pushing people to get. It’s matched against the still-dominant variant, which is BA.5, and almost certainly will have a reasonably good degree of cross-protection against the BQ.1.1 and the others, and yet the uptake of these vaccines, as we are already in the middle of October, is disappointing,” he said.
The bivalent booster vaccine, authorized in September, protects against the original strain of the coronavirus as well as the BA.4 and BA.5 subvariants.
The CDC reports that fourteen million people have gotten an updated bivalent booster six weeks into the campaign. Less than 10% of the population is eligible to get one.
Source: https://www.cnn.com/2022/10/20/health/variants-covid-winter-surge/index.html
Will Covid-19 be big or small? Mark Zeller’s warning on vaccines, disease and age: Implications for vaccine development and the vaccine market
Mark Zeller, a project scientist who is monitoring variant at the Scripps Research Institute, thinks the wave is going to be bigger than the BA.5 wave. But Zeller says he doesn’t expect this winter’s surge to reach heights of January’s Omicron wave.
The genetic changes these variants share appear to help them escape the immunity created by vaccines and past infections – a recipe for reinfections and breakthrough infections, particularly for people who haven’t had an updated booster.
Drugs, disease or age can hurt immune function in people and that’s where antibody therapies are important. These are the same people who do not respond well to vaccines.
The truth is that if we want monoclonals to protect high- risk people, the US government should be a big player in that. The market can’t do it on its own.
The administration has been thinking about ways to commercialize some parts of the Covid-19 response – to get out of the business of buying vaccines and therapies – ultimately passing the costs on to consumers and insurers. The process must be guided by the needs on the ground and the realities of the virus.
He says current realities require that the government continue to incentivize the production of new therapies, and he expects that the Biden administration will again try to ask Congress to pass more funding to do that.
Study of the potential use of the antiviral drug Paxlovid for the prevention of long COVID-19 in the U.S.
The antiviral drug stops the virus from replicating in cells. “We know that one of the key factors that predict long COVID is detectable virus in the bloodstream at the time of infection,” Dr. Peter Chin-Hong, an infectious disease physician at the University of California, San Francisco, wrote in an email. “So it stands to reason that interventions that prevent the virus from making more copies of itself would therefore lead to a lower risk of long COVID.”
The drug, which has been available in the U.S. for almost a year, is provided for free by the federal government at pharmacies across the country. Patients who have COVID-19 need a prescription in order to start it.
Experts do not believe that the study is the first step in exploring the potential uses of Paxlovid. The VA study was observational, based on data entered into patient health records – in Sax’s view, “the imprecision of the [long COVID] diagnosis makes definitive conclusions from this study challenging, especially with a retrospective review.”
The study is a preprint, meaning it was shared publicly before being reviewed and vetted by outside researchers. But experts who were not involved in the study tell NPR the findings make sense, given how Paxlovid works.
The study points out promising pathways for more research, says Dr. Monica Gandhi, an infectious disease physician at UCSF. “It’s hypothesis-generating,” she says, “It’s exciting and hopeful [to think] that if you reduce the viral load… down to undetectable [early in the illness], maybe you can prevent post-COVID symptoms” altogether – a theory she thinks researchers could pursue.
“This study is pushing me to use Paxlovid in people who are over the age of 65, because it’s likely going to have other benefits beyond preventing hospitalization,” she says.
How to Get a Prescription for COVID: A Comparison of Online Prescription Methodologies and the FDA’s Use-By Dates
And it’s a global phenomenon. There is an anticipated surge in carbon dioxide this winter and Pfizer signed an agreement to import the drug to China.
Even if you’re eligible you might have to convince a doctor to prescribe the drug. “A lot of doctors in the community and even major academic centers are reticent to prescribe [Paxlovid] out of concern that there are going to be drug interactions or think that a patient can just ride out the virus,” says Dr. Priya Nori, an associate professor of medicine at the Albert Einstein College of Medicine in New York City.
Some Paxlovid patients worry about a metallic mouth taste, which could discourage them from getting a prescription, and it’s also related to stomach distress.
But, says Michael Ganio, director of pharmacy practice and quality at the American Society of Health System Pharmacists, “a bad taste for five days is a small price to pay for a drug that can save your life.”
But it’s not that hard to test for COVID. The do-it-yourself home antigen tests are free in the US and you can request them via an online request. And insurance still covers the cost of eight kits for per month for every person covered in the household.
What’s more, the FDA recently extended the use-by dates for some COVID tests that have reached their expiration. You can find out what the tests you have on hand by looking at this chart.
You can find a test to treat locator on the federal government’s website, where you can be tested for free and leave with the drugs if you test positive. Spots include community health centers and some pharmacies. But even though pharmacists have been able to prescribe the drug since July, pharmacies generally don’t issue prescriptions unless they have an inhouse medical clinic run by a nurse practitioner or doctor. Getting your prescription from a pharmacist requires bloodwork done in the past year.
Pharmacies may also send the pills to your home for prescriptions the doctor calls in. Walgreens is giving out Paxlovid delivery for free with Door Dash and other delivery services, though they will have to pay for it.
Is PAXLOVIDID THE BEST THOEF THE BEST TREATMENT IN THE U.S. During COVID-19 Season?
For those who like to plan ahead – just in case COVID were to strike – you can make life easier by keeping an up-to-date list of any drugs you take, including dosages.
No doctor? If you have to go to the ER, Dr. Nori says you should avoid it unless you have to obtain a prescription and could be exposed to other viruses.
If you’re wanting to visit your doctor over the internet, there are other options. Check your insurer’s website to see if they partner with one.
For now, Paxlovid is free for everyone in the U.S. but that could change next year, says Jen Kates, senior vice president and director of Global Heath at the Kaiser Family Foundation. There’s no shortage. Dr. Ashish Jha, White House COVID-19 response coordinator, said at a press conference on Thursday that he expects there will be plenty of Paxlovid to take the U.S. through this winter.
Source: https://www.npr.org/sections/goatsandsoda/2022/12/16/1142586058/coronavirus-faq-is-paxlovid-the-best-treatment-is-it-underused-in-the-u-s
How Many Tests Have Been Available During the First Three Years of the Covid-19 Epidemic Crisis? Questions and Answers from Fran Kritz
We regularly answer frequently asked questions about life during the coronavirus crisis. If you’d like us to consider a question in the future, send us an email with the subject line: “Weekly Coronaviruses Questions.” We have an archive of our FAQ.
Fran Kritz is a health policy reporter in Washington, D.C. and regularly contributes to NPR. She also reports for the Washington Post and Verywell Health. Find her on Twitter: @fkritz
Editor’s Note: Dr. Megan Ranney is the deputy dean at the School of Public Health at Brown University and a professor of emergency medicine at the university’s Warren Alpert Medical School. The views expressed in this commentary are her own. Read more opinion on CNN.
On Thursday, President Joe Biden announced that the US Postal Service will once again be sending four Covid-19 tests to every household that uses covidtests.gov.
Four tests is not much for a family. They are illustrative of ongoing wins against Covid-19 that should be celebrated and looked at closely for lessons learned.
It may be impossible to remember but it wasn’t until the spring of 2021 that at- home testing became available to the public. Then, they were expensive and difficult to find. Huge differences in use were observed in the early months. The elderly and low-income people were less likely to use them.
But thanks to the flexibility that a public health emergency declaration provided to the US Food and Drug Administration (FDA) in early 2020, along with the federal government’s connections and buying power, hundreds of at-home Covid-19 tests have now received emergency use authorization, and there is ample availability.
Insurers will reimburse you for up to eight tests per month. The ICATT, or the Increasing Community Access To Testing program was developed to provide free community testing at more than 15,000 sites (including pharmacies, libraries, and grocery stores) across the United States. According to one government official, more than 50% of tests performed through this program are for uninsured individuals. Similar programs have been put in place with food banks, schools, federally qualified health centers and low-income senior housing.
The FDA still doesn’t have an approved home test for seasonal flu or respiratory syncytial coronaviruses. Additionally, oseltamivir (commonly known as Tamiflu) is not as effective as Paxlovid, and there are no good treatments for RSV. Moreover, telehealth has already been shown to increase over-prescription – and unnecessary prescription – of some treatments, such as antibiotics; any wider scale test-to-treat program would have to be careful to make sure it doesn’t further worsen overuse of antivirals and antibiotics. And as opposed to payment for Covid-19 tests and treatment, access to other types of telehealth and medications is largely dependent on one’s insurance – or ability to pay out of pocket.
These barriers are not static. The change that we have learned during Covid-19 is possible when we all insist on it. Indeed, personal experiences with Covid-19 increased Americans’ commitment to changing structural barriers to equitable care – such as the ICATT and test-to-treat programs.
At the same time, we also have developments to celebrate this holiday season. There are some amazing new tools that can help reduce disease and severe illness, and they are available to everyone.
The first two years of Covid-19: Beijing’s public health problem and its impact on the country’s community health system in the first 20 days of December
Beijing will soon distribute Pfizer’s Paxlovid to the city’s community health centers, according to state media.
The state-run China News Service reported Monday that after receiving training, community doctors will administer the medicine to Covid-19 patients and give instructions on how to use them.
A worker at a community health center in Beijing said the drugs were not clear when they would arrive.
China’s official Covid case count has become meaningless after it rolled back mass testing and allowed residents to use antigen tests and isolate at home. The asymptomatic reporting cases have been stopped because it was no longer possible to track the number of infections.
The sudden lifting of restrictions sparked panic buying of fever and cold medicines, leading to widespread shortages, both at pharmacies and on online shopping platforms. Long lines have become routine outside fever clinics and hospital wards overflowing with patients in the capital Beijing and elsewhere in the country.
Four doctors in Beijing couldn’t afford to eat or drink because there was no time to do it, according to the People’s Daily. He said they have been seeing a lot of patients.
The emergency room doctor told the newspaper he had worked despite his symptoms. “The number of patients is high, and with fewer medical staff, the pressure is multiplied,” said the doctor.
In a sign of the strain on Beijing’s medical system, hundreds of health professionals from across China have traveled to the city to assist medical centers.
In the first 20 days ofDecember, an estimated 250 million people in China have caught Covid, accounting for 18% of the country’s population.
As Chinese people return to their hometowns for the lunar new year, experts warn that the disease could potentially spread through China’s vast rural areas, where vaccination rates are low and medical resources are poor.
Vaccination in the communities: Bringing COVID-19 to people who live, work and play in New York City, and what it can do to prevent underuse
Daniel Griffin, an infectious-disease physician at Columbia University in New York City, says there is misinformation about the drug which leads to underuse.
Such concerns have led health officials to point to hesitancy to explain why use of the drug has fallen short. Anne Sosin is a public-health-policy specialist at Dartmouth College in New Hampshire.
To remedy these disparities, she says she would like to see health officials mount an ‘all hands on deck’ approach to ensure that everybody has equal access to the drug by engaging local communities and expanding access to testing centres. In order to decrease the number of people who received their primary COVID-19 vaccination series who lived in different areas, health officials brought the vaccine to people in the areas that they live, work and play.