Check back often as we continue to post timely updates on COVID-19.
Learning from Covid: How one health system reduced the use of daily tests for covid inpatients
March 25, 2023
What will change in health care as the pandemic winds down?
With the White House poised to end the public health emergency in May, U.S. health care is looking ahead at what will change. A HealthLeaders report said that nursing homes will likely have to meet higher standards for training, and Medicare will put more limits on the care provided by NPs and PAs. Another change is that costs for covid vaccines, at least from Moderna, are going to explode. The company plans to raise its price from $26 to $130 per dose, a move that Democrats say is unconscionable because the vaccine was developed with nearly $2 billion in taxpayer money. Moderna CEO Stephane Bancel told a Senate committee this week that the price hike was justified in part because the company was losing lucrative contracts with the U.S. government. The volume of those contracts, Bancel said, allowed Moderna to charge less per dose.
What can we learn from looking at early days of the pandemic?
When it comes to the pandemic, not everyone is looking ahead. That was clear from several stories in the news this week. The White House, for example, signed into law a bill that will declassify information on the origins of covid. While analysts say the White House hopes the move shows there is no strong evidence that the virus was a lab creation, politicians are fishing for data that show the virus was manmade. For the first time, scientists this week released detailed data they say helps make the case that covid was spread by illegally traded wild animals. (Think raccoon dogs.) And in a nod to the challenges that public health officials faced during the pandemic, the New York Times published a report looking at the chaos and despair that permeated the CDC during the early days of the pandemic. Agency officials described struggling as they were pressured by political operators to downplay the pandemic and avoid issuing guidance that could have saved lives. Also this week, PBS aired a documentary on Antony Fauci, MD, that looks back at his 40-plus-year “career of crises,” including his handling of covid.
March 17, 2023
A new push to identify the origins of covid
Interest in the origins of covid appears to be on the upswing. Congress this week sent a bill to the White House requiring the U.S. to declassify intel its agencies have on the origins of covid. The bill was passed by all House members who were in attendance. It also passed the Senate unanimously. Also this week, the Director-General of the World Health Organization said that identifying the origins of covid is a “moral imperative.” The WHO spent three weeks in China in 2021 trying to track down covid’s origins, but it ended its investigation by concluding that more information is needed. China, however, has ruled that there is no need for any further visits from investigators. Interest in covid’s origins may have something to do with the Energy Department’s announcement a few weeks ago that “confirmed” a classified report that covid had escaped from a lab. Multiple other U.S. government agencies have come to a different conclusion, but the Energy Department report received significant attention. Finally, a new report released yesterday said researchers have found genetic evidence that covid may have crossed over to humans through “racoon dogs” being sold at a Wuhan market. Chinese authorities closed the market where the dogs had been sold to stop the spread of the virus, but researchers were able to collect genetic material by swabbing floors, walls and empty cages.
March 12, 2023
States look at loosening pandemic regs in health care settings
As states plan to lift covid rules in health care settings, several are looking at dropping masking and vaccination requirements. A Becker’s Hospital Review report noted that Oregon and Washington state officials have announced that they plan to lift masking requirements in health care facilities. California plans to drop those requirements in early April. The California Nurses Association is unhappy about the state’s plan to relax masking and vaccine requirements, warning that it will ultimately exacerbate the workforce shortage plaguing health care. A MedPage Today report said that a notable exception to the relaxing of pandemic regulations is the city of San Francisco, which will continue to require masks and vaccinations for health care workers. City health officials ended the public health emergency and rescinded most pandemic restrictions for the general population, however, in part because of the high vaccination rates among residents.
Florida hospital receives death threats over pandemic care report
Not everyone is ready to move on from the pandemic. Becker’s Hospital Review reported that after three “medical freedom” candidates were elected to the board of Florida’s Sarasota Memorial Hospital, the board demanded that the hospital investigate the care of covid patients. In part, board members wanted to know why therapies like ivermectin were not more widely used to treat covid. When a 70-person panel concluded that the hospital “performed strongly” during the pandemic and its care helped covid patients recover, staff began receiving abusive messages that included death threats. Hospital officials said that most of the commenters are from outside of the state. Retired Lt. Gen. Michael Flynn, the Trump administration’s first national security advisor, attended the board meeting. He weighed in by saying that the investigation was akin to letting a “fox inside the henhouse.” In related news, if patients want a prescription for ivermectin or hydroxychloroquine to help with their covid, they need look no farther than Stella Immanuel, MD, another controversial figure associated with the former president. A MedPage Today report found that in 2021, Dr. Immanuel wrote more than 69,000 scripts for hydroxychloroquine and 32,000 scripts for ivermectin. By comparison, rheumatologists prescribing hydroxychloroquine for autoimmune diseases write an average of about 561 scripts for the drug a year. One physician interviewed for the report said that giving patients a drug with zero benefits and the potential for harm “verges on malpractice.”
March 5, 2023
New data revive controversial theories about covid
Several recent reports have breathed new life into some of the most controversial theories about covid more than three years after the pandemic began. News reports this week indicated that the Energy Department had confirmed that a classified report determined that covid had escaped from a lab. Officials acknowledged that they had “low confidence” in the evidence used to support that conclusion, and analysts pointed out that multiple other agencies have a different view of the pandemic’s origins, but the announcement reinvigorated anti-maskers and anti-vaxxers. One news article said that covid skeptics are seeing the report as evidence that they were right all along and that mainstream science can’t be trusted. The Energy Department report came on the heels of a meta-analysis looking at mask mandates from the well-respected Cochrane Library in late January. That analysis found insufficient evidence that masking reduces viral infections at the population level, but analysts noted that the data weren’t clear cut. And while the study conceded that “there is uncertainty about the effects of face masks,” anti-maskers and anti-vaxxers touted it as irrefutable evidence that masking is completely ineffective—and that scientists and physicians had gotten everything about the pandemic wrong. Finally, a physician group pushing another discredited theory—using ivermectin to treat covid—has found a new angle for the drug: treating the flu and RSV. While the CDC says there are no clinical data from humans to support using ivermectin to treat these infections, the Front Line Covid-19 Critical Care Alliance is offering “treatment protocols” to support using ivermectin for not only covid, but the flu and RSV. The group says that to date, its “protocols” have been downloaded more than a million times.
February 24, 2023
New covid infection? Expect 10 months of immunity
A meta-analysis that looks at the protection conferred by covid infections finds that most patients have a strong immunity to reinfection (as well as to symptomatic disease and severe disease) for at least 10 months. The analysis, which appears in The Lancet, looked at 65 studies that contained data from 19 countries. The authors found that patients infected with an earlier strain than omicron had lower immunity to omicron in terms of reinfection and symptomatic disease (less than 55%) but protection against severe disease from the omicron variant remained high. “(T)he level of protection” from past infection, the authors wrote, “appears to be at least as durable, if not more so, than that provided by two-dose vaccination with the mRNA vaccines.”
February 17, 2023
Looking for a softer landing as covid emergency ends
With the covid public health emergency set to end in May, providers are getting a handle on which telehealth and other health care waivers and exemptions will continue and which may be over. Congress has extended through 2024 some waivers issued during the emergency period, including the one for Medicare’s hospital at home program. But payment parity for telehealth services for Medicare patients is expected to end as will the waiver allowing providers to prescribe controlled substances without an in-person visit. Axios reports that a recent analysis found providers are particularly worried about ending the waiver that allows Medicare patients to be eligible for SNF services without a three-day hospitalization, which has been credited with shorter acute care stays. It remains to be seen if Congress over the next several weeks will target measures to extend more waivers. Speaking of endings: R.I.P. to the Johns Hopkins covid dashboard, which is ceasing operations on March 10. The influential tracker, which debuted March 3, 2020, helped inform public health and business decisions and has garnered more than 2.5 billion views.
February 10, 2023
Covid hospitalizations drop while a new antiviral shows promise
It’s been a tough winter with close to 40% of American households over the holidays affected by one of several viruses. According to a Medscape write-up, survey results indicate that 27% of households had someone sick with the flu while one in 10 households had someone sick with covid or RSV. Now, covid admissions continue to fall while flu positivity is also in decline. Orthrus may be the next covid variant of concern, one that already accounts for about one-fourth of all new cases in the U.K. (In the U.S., that variant caused fewer than 2% of new cases in January.) On the bright side, a new antiviral is showing promise in cutting covid hospitalizations. Scientific American reports that one injection of pegylated interferon lambda given to patients within seven days of developing covid symptoms cut their risk of being hospitalized or having to go to an ED by 51%. As for excess mortality due to covid, a JAMA Internal Medicine research letter finds that American physicians suffered 622 more deaths than expected between March 2020 and December 2021—although doctors had substantially lower level of excess mortality than the general population.
February 3, 2023
The covid health emergency will end this spring
The Biden administration announced this week that the national and public health emergencies declared for covid will end May 11. According to STAT, that means that the federal response to covid going forward will be handled through normal agencies and channels. As for fallout to ending the public health emergency, covid vaccine prices may soar as high as $130 a dose once vaccines purchased by the federal government run out. In addition, at-home covid tests will no longer be free and hospitals will no longer be paid extra for treating Medicare patients with covid. AP reports that many Americans (estimated at between 5 million and 15 million) may lose Medicaid coverage, although many should be eligible for low-cost ACA plans. Another big pandemic-era benefit is ending even sooner: The Washington Post writes that some SNAP (Supplemental Nutrition Assistance Program) benefits, which were expanded during the pandemic, will expire in March. Benefit advocates say that paring those benefits back will put participants, particularly seniors, at higher risk of food insecurity and translate to a loss of as much as $3 billion in food purchases.
January 28, 2023
Tripledemic threat wanes but covid deaths remain high
The threat of a tripledemic—covid, flu and RSV—peaked in early December, with both hospitalizations and ED visits for each of those conditions declining before the end of the year. According to the latest CDC figures, flu activity continues to fall, with this year’s flu season producing 25 million cases, 270,000 hospitalizations and 17,000 deaths so far. But experts warn that flu seasons often have two peaks and that the XBB.1.5 covid subvariant, a highly transmissible strain now dominant in the Northeast, may spread throughout the country. Meanwhile, the New York Times reports that the covid death rate in the U.S. continues to top 500 per day. Preliminary data suggest that covid was the third leading cause of death (behind heart disease and cancer) in 2022 for the third year in a row. And a new JAMA Network Open research letter points out that as many as 80% of the results of home covid tests aren’t publicly reported.
Pandemic survey: 55% of emergency workers report trauma symptoms
While results of a survey conducted in early 2021 found that 5.5% of health workers surveyed met criteria for probable post-traumatic stress disorder, a much larger group—55%—had subthreshold PTSD symptoms. Those symptoms, according to the study, put the workers experiencing them at higher risk of health and sleep problems. The authors surveyed members of emergency departments affiliated with the University of Pittsburgh Medical Center as well as members of EMS agencies in several states. Among all the job categories surveyed, doctors and APPs reported the fewest physical health problems, while nurses and patient support staff reported the most sleep problems. HealthLeaders reports that nurses and patient support staff were also more likely to report subthreshold PTSD symptoms than ambulance workers and those in transport services. The study was printed in the Journal of Psychiatric Research.
January 20, 2023
XBB grows (again) in the U.S., more clues about long covid
As XBB.1.1.5 last week grew to account for nearly half of covid cases in the U.S., a Lancet study concludes that hybrid immunity—a combination of vaccination and previous infection—offers the greatest protection, and might allow those people to extend the intervals between boosters. There was some good news in an analysis of China’s wave of covid that suggested the infection has probably peaked, but researchers say that a lack of data makes it impossible to say that with certainty. But there was less good news in a preprint that found certain socioeconomic and demographic factors make people more likely to suffer from long covid. Put simply, long covid was linked to people who were recently unemployed, experiencing financial hardship and feeling anxious and depressed. Even worse, another study found that pregnant women are seven times more likely to die from covid and three times more likely to be rushed to the ED compared to uninfected pregnant women. And in related news, more than a year after New York State began requiring that health care workers be vaccinated, a state Supreme Court judge struck down the mandate. A Becker’s Hospital Review article said the judge ruled that the state’s governor and department of health overstepped their authority because the covid vaccine is not included in the state’s public health law.
January 14, 2023
Doc harassed for fake tweet about covid vaccines posted in her name
A Miami critical care physician found herself in the crosshairs of the antivaxxer community after someone published a fake tweet in her name. Natalia Solenkova, MD, had built a Twitter following of 30,000 by talking about covid and her work in underserved areas. That following may be why someone released this tweet in her name: “I will never regret the vaccine. Even if it turns out I injected actual poison and have only days to live. My heart is and was in the right place. I got vaccinated out of love, while antivaxxers did everything out of hate. If I have to die because of my love for the world, then so be it. But I will never regret or apologize for it.” A CNBC report says that one clue that the tweet was a fake was that it was 53 characters over Twitter’s 280-character limit. That didn’t stop antivaxxers from flooding Solenkova. It also didn’t stop podcasters like Joe Rogan from talking about it. (When Rogan found out it was fake, he apologized for discussing it.) One analyst said the episode may point out the desperation of antivaxxers to have something or someone to demonize.
XBB.1.5 surges and warnings about Evusheld, further spread
As RSV and the flu show signs of fading, the XBB.1.5 strain of covid is continuing to spread “like a rocket” in some parts of the country. The FDA is warning that Evusheld may not be able to neutralize XBB.1.5 but notes that it is waiting on more information. The WHO is urging travelers to wear masks, to prevent the spread of the variant, and a growing number of U.S. schools are bringing back mask mandates. ID physicians are warning that the new variant is so contagious that both people who have and haven’t had covid will likely become infected. In an op-ed in The Washington Post, Eric Topol, MD, warns that public health agencies should be reinvesting in new vaccines to combat the variant. A new BMJ study found that for most mild infections, symptoms of long covid cleared after a year. A STAT article quotes the researchers as saying they were surprised that most symptoms cleared in that time frame.
January 6, 2023
As XBB.1.5 dominates U.S., public health emergency will continue
With the Omicron subvariant XBB.1.5 estimated to account for 40% of cases of covid in the U.S. and up to 75% of cases in the Northeast, public health authorities are warning of a winter surge that could rival the spike seen over the summer. Experts are also keeping an eye on the outbreak in China, although reliable information is hard to find. While the Chinese government has protested the testing of Chinese citizens travelling abroad as not based on science, news reports from Italy say that half of arrivals from two recent flights from China tested positive. And back in the U.S., the federal government is expected to continue the public health emergency past Jan. 11. Extending the emergency for a 12th time will allow the government to continue to pay for covid tests, vaccines and treatments. When the emergency is rescinded, therapies like Paxlovid will no longer be free. Some say that will cause sticker shock among health care providers and patients alike.
Covid misinformation is hanging on as stubbornly as the virus itself
Covid isn’t the only thing that won’t go away. Neither, apparently, will misinformation and disinformation about the virus. A New York Times report said that Twitter’s decision to cut processes responsible for reining in inaccurate and dangerous information is contributing to the spread of covid misinformation. Between Nov. 1 and Dec. 5 of last year, researchers gathered more than 500,000 English-language tweets containing phrases like “deep state,” “hoax” and “bioweapon” that had more than 1.6 million lies and 580,000 retweets. A Kaiser Health News report looks at how covid misinformation has possibly hurt other public health efforts, like pediatric flu vaccines (down 3.7%) and flu vaccines in pregnant women (down 18%). And for a final example of the ridiculousness of covid misinformation, consider the flood of tweets that tried to link the cardiac arrest a Buffalo Bills player suffered on the field—and on live TV—earlier this week. A Washington Post article says that “anti-vaxxers and right-wing provocateurs” tried to blame the injury on the covid vaccine. A long-running narrative has said that “hundreds” of pro athletes have dropped dead on playing fields because they got a covid vaccine.
Today’s Hospitalist has been reporting on covid-19 since January 2020. Click here for earlier updates.
