Check back often as we continue to post timely updates on COVID-19.
Successful pandemic innovations: A line team takes charge of placing lines in the covid ICU.
August 5, 2022
Covid forecast: Get used to 100,000 deaths a year
Covid case and death rates reported at the end of last week were both down slightly from the previous week, with the number of new cases dipping about 1% and deaths dropping close to 5% to a seven-day average of 364. But infectious diseases and covid experts don’t see that daily death rate significantly waning any time soon, STAT reports, with 100,000 or more deaths per year in the U.S being projected. Eventually, experts believe, covid will resemble other coronaviruses as populations build up additional immunity, but that process could take 10 years. In the meantime, according to an ID physician quoted in USA Today, “We’re sitting on this horrible plateau” of covid deaths “and we’re getting used to it.” In other covid news, people who want to minimize potential transmission at social events should adopt “at the door” testing. A new study in the International Journal of Public Health finds that while testing 24 hours before an event can cut transmission by 20%, testing at the door reduces potential transmission by 40%.
Covid rebound may occur in 10%+ of patients, regardless of Paxlovid
Paxlovid rebound is again in the news, now that the President has again tested positive. That’s led some experts to question whether taking a five-day course of Paxlovid is really long enough or if the drug should instead be prescribed for seven or even 10 days. However, new preprint results in covid patients who didn’t take Paxlovid indicate that 12% experience viral rebound (defined as ≥0.5 log10 viral RNA copies/mL), while symptom rebound occurred in 10% of patients after their initial symptoms had resolved. (In the study, only between 1% and 2% of patients experienced both viral and symptom rebound.) The data were drawn from the more than 560 participants in the ACTIV-2/A5401 trial (a study that tested outpatient covid treatments) who received placebo. NBC reports that, according to Pfizer’s Paxlovid trials, 1%-2% of treated patients experienced rebound, while a White House spokesperson reported that Paxlovid rebound is occurring in 5% of patients who take it. The author of a STAT opinion piece reports that some clinicians are already prescribing Paxlovid for longer than five days, despite the lack of official recommendations.
July 31, 2022
Covid admissions rise as hospitals remain short-staffed
With covid hospitalizations again on the rise in many parts of the country, hospitals continue to struggle with persistent and widespread staff shortages, making it harder to manage this next potential surge. As Politico reports, hospitals responding to staffing shortages are implementing workarounds such as shifting workers between departments, settling for longer ED wait times and doing away with routine covid testing for all inpatients. These shortcuts and rising admissions come at a time when federal funding to manage the pandemic is running out, leaving hospitals with less money to devote to new hires. Some hospitals are dealing with staffing shortages by cutting services, with two hospitals in Cleveland ending surgical, emergency and inpatient care, while one in Massachusetts is shuttering its freestanding birth center. Hospital staffing losses are telehealth’s gains, with STAT+ (subscription required) reporting that many nurses burned out from hospital work are migrating to telehealth, drawn by flexible schedules and no commute. Many nurses who work in telehealth are helping to manage patients with chronic conditions.
One in five health care workers reports high child care stress
July 22, 2022
The latest covid surge is being met in the U.S. with a collective shrug
As cases of covid triple across Europe and Australia sees covid deaths rising due to a new outbreak of the omicron variant, covid cases continue to surge in the U.S. While public health officials took an aggressive stance toward covid two years ago, many are taking a quiet approach this time around. The New York Times says the new attitude is due in part to a lower death rate from the virus and a lack of interest by many Americans. One health commissioner said he’s waiting for the situation to get really bad before ringing the alarm bell. A report in Politico notes that even as hospitalizations and deaths are on the rise, most states haven’t changed their guidance or strategies to deal with the disease. As the report notes, most states are using the same strategies to manage 130,000 new cases a day as they used to manage 30,000 new cases a day. There was one positive development this week on the covid front: Novavax’s covid vaccine has been cleared by the FDA and the CDC. The two doses of the adjuvanted vaccine will be given three weeks apart.
July 15, 2022
Pre-pandemic, adverse events in hospitals showed “significant” declines
Between 2010 and 2019, adverse events in hospitalized patients declined “significantly,” according to new data from a study. Data from the Medicare Patient Safety Monitoring System looked at adverse events for problems like drug reactions, hospital-acquired infections, post-procedure problems and other issues including pressure ulcers and falls. For myocardial infarction, for example, the rate of adverse events dropped from 218 to 139 events per 1,000 discharges. Healthcare Dive says that despite the gains seen in the data, an accompanying editorial argued that the study provided evidence that adverse events remain “unacceptably frequent.”
July 8, 2022
Talk about a “pan-coronavirus” shot, reducing morbidity/mortality
Pfizer announced plans last week to start trials this fall of a “pan-coronavirus” vaccine that will treat all variants of covid this fall. Web MD says the goal is to create a vaccine that will get ahead of new variants before they emerge. Data on existing vaccines show that between December 2020 and September 2021, covid vaccines prevented about 27 million infections, 1.6 million hospitalizations and 235,000 deaths. MedPage Today says that a study found that during September 2021, vaccines prevented 52% of infections, 56% of hospitalizations and 58% of expected deaths. Other data show that health care workers who received two or three doses of an mRNA vaccine were less likely to develop long covid if they did get infected. MedPage Today says that a JAMA study found that among health care workers who got infected, 42% of unvaccinated people developed long covid, compared to 30% of workers with one dose, 17.4% with two doses, and 16% with three doses. And the Supreme Court announced last week that it won’t hear a challenge from health care workers in New York upset that the state’s vaccine mandate doesn’t include a religious exception. Healthcare Dive reports that workers said they shouldn’t be forced to get vaccines because they were developed using cells obtained from abortions, but that the Vatican and religious organizations have given their blessing to the vaccines because they don’t actually contain cells from abortions.
Rising case counts from BA.5 stoking concerns on both coasts
Spurred by numerous signs of an increase in covid case counts, public health authorities on both coasts are bracing for a new wave of covid fueled by the BA.5 subvariant. According to a report from WNBC in New York, a top epidemiologist in the city says that infections have stabilized at a high rate and don’t appear to be dropping, likely indicating a BA.5 wave of covid. And in Los Angeles, public health experts are seeing the highest daily case counts since February, with a seven-day test positivity rate that has doubled in a week. The trade publication Deadline reports that the city may reinstate its indoor mask mandate. And for the first time since January, covid in April became one of the top five diagnoses made via telehealth. Healthcare Dive says that Fair Health’s monthly tracking report found that every region except for the South saw covid go back into the top five diagnosis list in April.
As docs question Paxlovid, FDA allows pharmacists to prescribe it
While physicians debate the value of Pfizer’s antiviral Paxlovid, the FDA this week ruled that pharmacists can prescribe the drug for covid patients . The New York Times says the agency wants to make it easier to get Paxlovid into the hands of patients with covid as the drug has been notoriously difficult for some patients to get. A STAT report says that many physicians are anxious for more information about which patients should receive Paxlovid and on prescribing strategies for patients who experience a “rebound.” Physicians in the article say that while there seems to be relatively little information about Paxlovid, their colleagues have a wide range of opinions on how to use the drug. Pfizer last week asked the FDA to give full approval for the drug in high-risk individuals. Paxlovid was given emergency use authorization by the FDA in December of 2021.
July 3, 2022
BA.4, BA.5 now make up the majority of U.S. cases
The CDC this week announced that two omicron subvariants—BA.4 and BA.5—that were detected less than six months ago in South Africa are together producing more than 50% of the new cases in the U.S. As the New York Times reports, the subvariants are spreading faster than other versions of omicron because they can elude some of the antibodies produced by vaccinations and former infections. Evidence does not indicate, however, that BA.4 and BA.5 cause more severe disease. The U.S. is now averaging more than 100,000 new covid cases every day, although many infections go uncounted. Case counts are rising in the South and West and declining in the Northeast and Midwest. Covid hospitalizations are up 6% in the last two weeks, with about 31,000 covid patients in the hospital, while new daily deaths are below 400. An FDA panel recommended that booster shots target some new omicron variants. In other news, a new study estimates that vaccines cut the global death toll from covid by more than one-half in the first year they were available, averting nearly 20 million deaths.
June 27, 2022
No long lines to vaccinate young children
For the first time this week, children ages six months to 5 years in the U.S. have been being vaccinated against covid, a potential stress-buster for their parents. But coverage in the New York Times calls parents’ response “notably muted” and very different from when adult vaccines were first rolled out 18 months ago. A poll in April found that fewer than 20% of parents planned to vaccinate their young children as soon as a vaccine became available, while fewer than 30% of older children—ages 5 to 11—have been fully vaccinated with two shots. Because very young children face such low risk, experts think the best way for day care centers and schools to protect them is to improve air quality through HVAC upgrades and portable air purifiers with HEPA filters. According to a White House announcement this week, vaccines for the youngest children are currently available at physician offices, clinics and hospitals. The shots will soon be available at big pharmacy chains.
Less long covid seen in omicron vs. delta infections
Patients infected with omicron are less likely to experience long covid vs. those infected with the delta variant. That’s according to a study in The Lancet, based on self-reported data (through a cellphone app) in the U.K. on new or ongoing symptoms four weeks or more after acute infection. Among omicron cases, 4.5% of patients experienced long covid vs. 10.8% among delta cases. Researchers also stratified cases based on time elapsed between infection and patients’ most recent vaccination. They found that patients with omicron were less likely to experience long covid than those infected with delta across all vaccine timings—and across all age groups. In other news, new research in Current Medical Research and Opinion finds that women are 22% more likely to develop long covid than men. Women may also experience different symptoms, including neurological issues or those that affect mood or cluster around the ear, nose and throat. Men are more likely to report kidney or endocrine symptoms, including diabetes. Part of the problem in figuring out how to treat long covid is that there is no agreed-upon definition or way to diagnose it, according to Nature. Estimates of the prevalence of long covid range from 5% to 50%, although results of a June survey in the U.S. indicate that almost 20% of people infected with covid have symptoms persisting at least three months.
June 18, 2022
FDA greenlights vaccines for children 5 and under
The FDA this week authorized covid vaccines in children as young as six months, with the CDC expected to approve that authorization this weekend. That means that young children may be able to get vaccinated as early as next week. The Washington Post reports that the FDA gave the nod to the Moderna vaccine (two doses, four weeks apart) in children ages six months to 5 years and to Pfizer-BioNTech (three doses, the first two three weeks apart and the third at least two months later) for those ages six months to 4 years. Many parents see the vaccines as key to being able to maintain daycare arrangements. However, a recent survey from the Kaiser Family Foundation indicated that only 18% of responding parents planned to get their children vaccinated as soon as vaccine was available, while 27% said “definitely not” to having their children vaccinated against covid at all. While neither vaccine was tested against any of the omicron subvariants, experts expect the vaccines to effectively prevent covid hospitalizations in young children.
Should you save Paxlovid for high-risk patients?
Covid care: How does your state rank?
Hawaii and Massachusetts led states in health outcomes during 2020, while Mississippi, Oklahoma and West Virginia had the lowest performance. That’s according to a scorecard and report from the Commonwealth Fund, which ranked states on more than 50 health measures including seven related to covid care. Covid metrics used in the report included vaccination rates, hospital and ICU capacity, and excess mortality from the beginning of the pandemic through March 2022. Some findings: Since the beginning of the pandemic, all states have reported higher numbers of excess deaths. But those figures varied fivefold across states, ranging from 110 per 100,000 in Hawaii to 596 per 100,000 in Mississippi. The report also found that premature deaths from treatable causes—diabetes and heart disease—grew at an unprecedented rate in 2020, particularly among Black, Latino and Indigenous populations and in the South and parts of the Midwest. Drug overdose deaths also hit record highs in almost every state in 2020 and 2021, particularly in West Virginia and the Southeast.
June 11, 2022
As hospitalizations fall in the Northeast, they’re rising in the South
In the past two weeks, the number of covid hospitalizations has jumped 16%. But according to the New York Times, hospitalizations are declining in the Northeast, with Vermont seeing a 40% decrease in those figures and Massachusetts a 20% drop. But hospitalization rates are rising in other regions, including in Southern states where hospitalization rates for covid in Alabama and Louisiana have risen 70%. The CDC has announced that two omicron subvariants—BA.4 and BA.5—now represent 13% of all new U.S. cases, up from 1% in early May. As for the summer covid forecast, experts expect cases to drop, then rise again in the fall and winter.
New nurses? Welcome to the new normal
The pandemic roiled nurse staffing, with many older nurses leaving the profession (or at least the hospital) and younger nurses hitting the road for high traveling-nurse salaries. New data now indicate that the median length of time that nurses have worked 12-hour shifts for their current organization has dropped over the last year from 3.6 years to 2.8, a 19.5% decrease. Across U.S. regions, the West saw the largest decline in median nursing tenure, falling more than 30%, while the South had the lowest. All regions saw a jump in the number of 12-hour shifts being filled by nurses hired within the previous 30 days, with the West and the South having the biggest rise in the numbers of new nurses. The findings, according to an announcement from the company that issued those data, highlight “the need for organizations to invest in retention and onboarding programs for nurses.” The data were released by Epic Research, Epic System’s public benefit corporation.
June 3, 2022
Faulty oxygen readings delay covid care for people of color
Studies have for years pointed out that pulse oximeters overestimate oxygen levels in darker-skinned patients. Now, a new study makes it clear that faulty readings have real-world consequences. The research found that Black as well as Hispanic and Asian patients had higher rates of inaccurate oxygen measurement with pulse oximeters, leading to a failure to identify patients who could benefit from covid therapies and to initiate such therapies. In the study, pulse oximeters overestimated oxygen levels in Asian patients by 1.7%, 1.2% among Black patients and 1.1% in Hispanic patients. As a result, Black patients were 29% less likely than whites to have their treatment eligibility recognized, while Hispanic patients were 23% less likely. The study used data on more than 7,000 patients seen at five Johns Hopkins hospitals. According to STAT coverage of the study, one author noted that Black and Hispanic patients presenting to the ED with covid were more likely than white patients—because of inaccurate oxygen readings—to be sent home. Such inaccuracies, the authors wrote in the study, could explain disparities in covid outcomes and may have treatment implications for other respiratory diseases.
Covid roundup: what may be coming
Both the Mayo Clinic and the CDC have released worrisome forecasts of possible covid developments this month. Mayo models project that the number of new daily covid cases will jump more than 80% in the next two weeks, while the CDC (based on composite modeling from 16 different sources) expects the number of hospitalizations and deaths to also increase over the next month, although projected admissions and mortality are far lower than at the height of omicron. In other news, analysts say that repeat infections may be the new normal. “Experts think the typical SARS-CoV-2 infection is likely to get less dangerous, as population immunity builds and broadens,” The Atlantic reports. “But considering our current baseline, ‘less dangerous’ could still be terrible—and it’s not clear exactly where we’re headed.” As for immunocompromised patients: A new preprint based on VA data indicates that those patients given tixagevimab/cilgavimab (Evusheld) during the omicron wave saw markedly reduced mortality, hospitalization and infection rates.
May 29, 2022
As cases and hospitalizations rise, medicines take center stage
With covid cases expected to surge between a low of 39% to a high of 130% by Memorial Day in 10 states, and facing hospitalization rates that are up by more than 50% in 12 states, public health officials are bracing for the worst. Children continue to be hit hard by the pandemic, with pediatric cases passing 100,000 a week for the first time since February. The FDA is expected to review data on giving three doses of Pfizer’s vaccine to children under 5 in the next couple of weeks. In adults, a study found that vaccinated people who got Omicron have more protection against covid than people who are vaccinated and get a booster shot. Finally, a report from the American Thoracic Society’s meeting says that all six covid therapies being tested in one large study all failed. One of the therapies was terminated early for harm, while others showed only “weak trends” toward working.
Paxlovid rebound gets attention from CDC, ID doc meeting
While Paxlovid has been shown to be almost 90% effective in preventing covid hospitalizations, stories of rebound cases have physicians wondering whether they should bother prescribing the drug and what to do if it fails. While STAT says no one knows exactly how common Paxlovid rebounds are, the CDC this week told physicians to not give an additional course of the antiviral for patients who experience a rebound. The agency instead urged physicians to monitor those patients and instruct them to re-isolate for at least five days. The CDC also urged rebound patients to wear a mask in public for 10 days after the reappearance of symptoms. The CDC noted it has seen no reports of severe disease from rebound cases and added that most patients feel better on average in three days. Other issues surrounding Paxlovid include a fear that it will interact with other medications, which is why the IDSA released a guide to the drug’s interactions with commonly used medications. At the IDSA meeting this week, ID physicians said that most antiarrhythmics are contraindicated, and so is sildenafil (Viagra, Revatio) when the drug is used to treat pulmonary hypertension.
Researchers look for clues to long covid’s causes, prevalence
Long covid has been in the news this week as experts examine its prevalence and try to get a handle on its causes. The New York Times reports that more than one in five adults under 65 who had covid has experienced at least one health issue that could be considered long covid. A second New York Times article reported that more than three-quarters of Americans with long covid were never hospitalized for their initial covid infection. The study found that patients between 36 and 50 were the most likely to develop long covid, with patients in that age group accounting for slightly more than one-third of all cases. NPR reports that an Annals of Internal Medicine study was not able to identify any factors that made patients more likely to develop long covid, with the exception of anxiety. Researchers, however, worry that people who hear of a link between long covid and anxiety will think the condition is psychological. Finally, the NIH is launching a new study following about 20,000 covid patients. Experts hope the research will pinpoint some of the causes of long covid.
May 23, 2022
States say “No” to hospital bans on visitors on during pandemics
Some state lawmakers are trying to make sure that hospitals don’t limit visitors during the next pandemic. A Healthcare Dive article says that such laws have been passed this year in Colorado, Florida, Illinois and Missouri. Laws were passed and signed into law last year in Arkansas, North Carolina and Oklahoma. The No Patient Left Alone Act in Florida, for example, allows patients to designate someone an “essential caregiver” who is guaranteed a visit of at least two hours a day. The Florida law also restricts hospitals from requiring designated caregivers to show proof of vaccination. It does, however, let hospitals set infection prevention policies that can require visitors to be screened and to wear protective gear. The article points out that some “blue states” have adopted similar measures.
Data find 25-year spike in firearm homicides during the pandemic
Another new grim health statistic emerged this week from the pandemic: In 2020, homicides involving a firearm climbed to the highest rate in more than 25 years. New data from the CDC found that firearms were involved in 79% of all homicides in 2020, a 35% jump from the year before. The data found the largest increases occurred among non-Hispanic Black males ages 10-44 and non-Hispanic American Indian or Alaska Native males ages 25-44. Firearm homicide rates were higher in areas with higher levels of poverty. The authors suggest that possible causes include increased economic, social and psychological stress from the pandemic and disruptions in health, social and emergency services. They also point out the homicides occurred at a time when firearms purchases were surging.
CDC approves boosters for kids 5-11, says to mask and test before travel
With some public health experts warning that the U.S. is facing a covid wave that may resemble omicron, the CDC this week told the one-third Americans living in areas rife with covid to return to masking. The CDC also told people who are travelling domestically to first get a covid test and recommended boosters of the Pfizer for children ages 5-11. Two therapies to treat people who already have covid had a bad week. Fluvoxamine was shot down by the FDA as a cheap way to treat early covid, and inhaled interferon didn’t do well in a pivotal clinical trial. A study found evidence that mRNA vaccines fight many variants of covid better than viral vector vaccines, and there’s new evidence that people who get vaccinated after getting covid have lower odds of developing long covid.
May 15, 2022
As cases rise, public health experts look at ways to boost more U.S. seniors
With the U.S. reaching the 1 million mark in terms of covid deaths, public health experts are keeping a close eye on rising cases and hospitalizations, which are up 20% in the last two weeks. They are also talking about ways to convince more older Americans to get a booster shot. While under half of all Americans have gotten boosted, approximately one-third of Americans 65 and older haven’t received their first covid booster shot. A Kaiser Health News report says that number baffles researchers, given that people 65 and over account for about 75% of covid deaths in the U.S. public health expert say failure of this group to get boosted has resulted in tens of thousands of unnecessary deaths.
Deaths from overdoses and alcohol use surged during the pandemic
Two new reports say that the pandemic continues to drive up overdose deaths and alcohol-related deaths in the U.S. Data from the CDC say that more than 107,000 Americans died from drug overdoses last year, setting another record. A STAT report says those data mean that there’s one overdose death every five minutes in this country. A report in JAMA found that death rates linked to alcohol use disorder jumped 25% in 2020 and 22% in 2021 compared to projected rates. People between the ages of 25 to 44 showed the biggest jump in alcohol-related deaths.
Leapfrog report says pandemic has hurt hospitals’ quality, safety ratings
The latest report from the Leapfrog Group says that the pandemic has taken a toll on hospitals’ ratings. The report, which grades hospitals on safety and quality, found that the responsiveness of hospital staff dipped from 67% before the pandemic to 63% in the middle of the pandemic. The report found a similar dip in how hospital staff communicate about medicines, with those ratings dropping from 64.1% before the pandemic to 61% at the midpoint of the pandemic. Coverage from Healthcare Dive says Leapfrog found that in its overall rankings, 33% of U.S. hospitals received an A. Another 24% were given a B, 36% received a C, 7% earned a D and less than 1% received a failing grade.
As covid funding wanes, travelling nurses see their paychecks shrinking
What a difference 12 months makes. It wasn’t that long ago that the sky-high wages being offered to travelling nurses were the subject of news reports and Congressional inquiries. But now that covid funding from the government is drying up, those high-paying contracts are disappearing. A report from Kaiser Health News says one staffing company found that demand for travel nurses dropped by 33% in late February and early April. The report also notes that one large health system in Oregon lost funding for nearly 100 travel nurses and had slashed its pay for some remaining nurses by half. Another hospital that was paying $175 an hour for travelling nurses at the peak of the pandemic is now paying $100 an hour—and trying to negotiate that rate down. By comparison, that hospital pays its staff nurses $30 per hour.
May 6, 2022
Moderna applies for pediatric use, ramps up production of omicron booster
With covid cases rising more than 50% and hospitalizations up 18% over the last two weeks, Moderna last week asked the FDA to authorize a low-dose version of its covid vaccination for children younger than five. NPR reports that the company released data from a study that found two doses of the vaccine given 28 days apart to children between six months and six years old produced levels of antibodies equivalent to levels that are protecting older children and adults. Moderna also said it expects to have “large quantities” of booster doses to combat the omicron variants available by the fall. According to a report in The Hill, the company last month announced that its booster shot was more effective against all known variants than its current vaccine.
Researchers looking into rebound cases of covid after Paxlovid
An article in Bloomberg says that concerns about rebound cases of covid in patients who have received a five-day course of the antiviral Paxlovid are now getting the attention of government researchers. Little is known about rebound cases after treatment with the therapy. One case was reported in a preprint released last week, but anecdotal reports have been making the rounds on social media. There have been reports of rebound cases from high-profile, respected physicians like Paul Sax, MD, an infectious disease expert at Harvard.
With covid aid about to vanish, hospitals are struggling
With billions in the federal aid to help hospitals offset the costs of covid care about to disappear, hospitals are facing big demand for uncompensated care from people who put off care for a variety of conditions while they tried to wait out the pandemic. The New York Times says that demand is stretching the already thin margins of most hospitals, which are still trying to recover financially from the pandemic. The backlog of mostly uncompensated care at one hospital includes untreated diabetic wounds, broken bones that healed improperly and chronic asthma that is now acute. Making matters worse is a report that says hospitals posted negative operating margins for the third consecutive month in April. According to Becker’s Hospital Review a report from Kaufman Hall says that many hospitals will face a “long haul” to get back to any kind of profitability. The one piece of good financial news is that hospitals saw a rise in patient volumes in March.
A look at hospitals that are relaxing their masking rules
Why are some hospitals relaxing their mask standards? An article in Fierce Healthcare says that a small number of hospitals are making a “cautious and calculated decision” to reduce mask requirements in certain situations in a nod to weary staff and visitors. The Midwest’s UnityPoint Health, for example, will soon make masking optional for most patients and visitors within most of its facilities in Iowa. Employees must still wear masks when providing care, and patients with respiratory symptoms and those who are unvaccinated or have had a recent positive covid test or exposure to the virus will have to mask. Houston Methodist earlier this month relaxed its mask rules for employees and visitors in public areas like lobbies and cafeterias. Masks are still required in clinical areas.
April 29, 2022
Apparently, we have (almost) all been infected
New CDC data contain these startling estimates: At least 60% of Americans in the past two years have been infected with covid, a figure that rises to 75% among children and adolescents. Those data were drawn from blood samples analyzed every four weeks between September 2021 and February 2022, and they’re a testament to the infectiousness of omicron. The CDC reports, for instance, that one-third of all positive cases in children and adolescents occurred since December 2021. Speaking of children, the FDA has authorized remdesivir to treat children with covid ages one month and older, making it the first therapy authorized in those 12 and younger. To be eligible, children who have tested positive must weigh at least seven pounds and be hospitalized or at high risk of developing severe covid.
ICU visitor restrictions are linked to family PTSD
While it’s well-known that ICU stays stress patients and families, new research underscores the impact of restricting visitors in ICUs during the pandemic. Publishing in JAMA Internal Medicine, authors surveyed 330 family members of covid patients admitted to ICUs across 12 hospitals (eight academic centers and four community hospitals) in five states between Feb. 1 and July 31, 2020. Patients’ families were called three to four months after those ICU admissions—and close to two-thirds of respondents (64%) reported significant PTSD symptoms. STAT notes that previous research indicates that such symptoms emerged in about 30% of family members of non-covid ICU patients before the pandemic. Family members with higher scores also exhibited more distrust of clinicians, which in turn could drive greater stress-related disorders. “(E)stablishing rapport with family members in creative and innovative ways,” the researchers write, “may help to offset the physical distance.” The authors note that other factors besides visitation policies—such as the need to work at home or provide childcare during the pandemic—may have contributed to family members’ isolation and stress.
April 27, 2022
Covid visitor restrictions in the ICU linked to PTSD among family members
While it’s well-known that ICU stays stress patients and families, new research underscores the impact of restricting visitors in ICUs during the pandemic. Publishing results in JAMA Internal Medicine, the authors surveyed 330 family members of covid patients admitted to ICUs across 12 hospitals (eight academic centers and four community hospitals) in five states between Feb. 1 and July 31, 2020. Patients’ families were called three to four months after patients’ ICU admission—and close to two-thirds of respondents (64%) reported significant PTSD symptoms. STAT notes that previous research indicates that such symptoms emerged in about 30% of family members of non-covid ICU patients before the pandemic. Family members with higher scores also exhibited more distrust of clinicians, which in turn could drive greater stress-related disorders. “(E)stablishing rapport with family members in creative and innovative ways,” the researchers write, “may help to offset the physical distance.” The authors also note that other factors besides visitation policies—such as the need to work at home or provide child care during the pandemic—may have contributed to family members’ isolation and stress.
April 26, 2022
Covid hospitalization rates creep up
The number of covid hospitalizations is on the rise, up 8.2% from the previous week as of April 19. That’s the second consecutive week that hospitalization rates have increased, Becker’s Hospital Review reports. The seven-day average for new covid cases last week jumped more than 35% to 42,605. According to the AP, the use of the antiviral paxlovid—which can reduce hospitalizations and deaths by 90% in high-risk patients if administered within five days of symptom onset—has doubled in the past several weeks, with supplies increasing, even though pharmacies report having supplies but few prescriptions for them. The Biden administration has ordered 20 million pills, enough to last several months, and it’s putting together a direct-to-pharmacy ordering system to expand the drug’s availability.
April 23, 2022
What’s happening with case rates? Does anyone really know?
Reuters reports that the seven-day moving average of covid cases at the end of last week was just shy of 35,000—a more than 20% jump over the previous week. Moreover, more than 90% of those cases were caused by BA.2 and its sublineage BA.2.12.1. But given the milder symptoms associated with omicron subvariants and the sharp rise in at-home testing, experts say that caseloads may be grossly undercounted. According to CNN coverage, the University of Washington’s IHME estimates that only 7% of the positive cases in the U.S. are being detected. To stay on top of disease burden, the CDC is now going by hospitalization rates and virus levels in wastewater, not new case numbers. In testing news, the FDA has authorized a breathalyzer covid test, the first of its kind. The test delivers results in three minutes and detects 91% of positives, 99+% of negatives. Here’s the catch: The test can’t be done at home but must be administered by a trained operator. Experts say it could potentially be used to screen people at large events.
April 18, 2022
U.S. re-ups public health emergency for covid
The HHS this week extended the nation’s covid public health emergency for at least three months, Reuters reports, giving Americans continued access to free covid testing, treatments and vaccines. Policy experts point out, however, that this may be the last time the emergency period is extended. When the public health emergency ends, patients who don’t have insurance will once again have to pay copays or other costs of covid treatment and testing, while millions could lose Medicaid coverage. According to the HHS statement, the agency will give states 60 days’ notice before the public health emergency is terminated or allowed to expire.
April 11, 2022
Cases are rising—again—but hospitalizations stay low
CDC data released last week indicate that the national covid caseload is once again rising for the first time in three months, up almost 5% from the previous week. BA.2 represents more than 70% of those cases but both hospitalizations and deaths continue to decline, 10% and 22% respectively from the previous week’s figures. The New York Times reports more dramatic case spikes in the Northeast, with New York City’s number of new cases rising 60% and Washington, DC’s case rate doubling. Meanwhile, Canada is reporting a couple of handfuls of cases of the XE variant, a genetic combination of BA.1 and BA.2 that is believed to be 10% more transmissible than BA.2. Forecasters with the University of Washington’s IHME are tracking rising caseloads but are not predicting a big jump in hospitalizations or deaths with this wave. In the “it could have been way worse” department: The Commonwealth Fund estimates that, between December 2020 when vaccines first became available in the U.S. and the end of March 2022, vaccination nationwide averted more than 2.2 million deaths, 17 million hospitalizations and $900 million in health care spending.
Will telehealth regs, lifted during the pandemic, tighten once again?
A fight may be brewing between telehealth proponents, who were able to take advantage of the loosening of regulations around telemedicine during the pandemic, and those who believe the widespread use of telehealth threatens physician-patient relationships. HealthLeaders reports, for instance, that bills introduced in the Alabama state legislature would mandate an in-person visit with a provider every year for patients who have four or more telehealth visits that year. The same bills would also require an in-person visit for providers to prescribe a controlled substance. Telehealth supporters argue that clinicians should decide when in-person visits are called for, and they claim that the lifting of restrictions during the pandemic improved access and outcomes.
April 9, 2022
Number of hospitalized covid patients hits new low
AP last week reported this good news: Fewer patients are now hospitalized with covid than at any time since the very early days of the pandemic, with the number of hospitalized covid patients tumbling more than 90% in two months. During the last week in March, the average number of covid hospitalizations fell to under 12,000, the lowest since summer 2020; the peak number, which was set in mid-January, was 145,000. As for the number of ICU covid patients, that has fallen to below 2,000 nationwide. In terms of in-hospital deaths of covid patients, an analysis in the Journal of Hospital Medicine finds that, among close to 250 covid patients who died while hospitalized in one tertiary medical center, nearly 60% had advanced, serious illness before they were hospitalized and were expected to die within 12 months. Only 40% of the covid deaths in the hospital were classified as unexpected, suggesting that covid was the primary contributor.
Study: Clot and bleeding risks spike for months, even with mild covid
The risk of blood clots and bleeding stays elevated for months after infection, even in patients with only mild cases of covid. That’s the conclusion of a new BMJ study from Swedish researchers who looked at the medical records of 1 million infected patients and compared those to the records of 4 million who weren’t infected. Their conclusions: Bleeding risk remains high for 60 days post-infection, while DVT risk remains elevated for 70 days and patients’ risk of PE stays high even longer, up to four months or more. “Our findings,” the authors write, “arguably support thromboprophylaxis to avoid thrombotic events, especially for high risk patients.” As Bloomberg news reports, covid patients’ risk of bleeding was found to be almost twice as high as that of controls within the first month after infection, while DVT risk was close to five times higher. As for PE risk, that was 10 times higher among patients who tested positive than among those who didn’t. Incidence rates rose with age and with severity of illness. While it’s well-known that covid raises VTE risk, it’s been unclear how long that risk lasts.
Diabetes risk may rise 40% after infection
Even mild covid raises patients’ risk of developing diabetes post-infection beyond 30 days compared to those never infected, according to a study published in The Lancet Diabetes & Endocrinology. The authors used VA data on patients who survived covid between March 2020 and September 2021. Compared to two control groups, which each numbered around 4 million, the excess burden of diabetes among patients with covid at 12 months was about 13 per 1,000, Nature reports, with covid patients about 40% more likely to develop diabetes within a year than controls. Given the number of patients infected, according to study authors, “these absolute numbers might translate into substantial overall population level burdens and could further strain already overwhelmed health systems.”
Biden administration brings new urgency to long covid research
Responding to criticism that federal research into long covid has stalled, the White House this week announced plans to accelerate studies, including improving the pace of enrollment in a major NIH study that was funded more than a year ago. Also announced: A new task force will be created to coordinate long covid research across federal agencies. According to the Washington Post, the government will issue a report within the next several months outlining available long covid support and services. The administration also plans to expand a network of long covid clinics that are being run by the VA, as well as launch an initiative to get feedback from long covid patients about clinic services. In a report issued last month on living with covid, experts recommended elevating long covid to “a national priority on par with vaccines and antiviral therapeutics” and called on the administration to appoint a long covid point person to coordinate—and accelerate—both research and social support systems for long covid patients.
Covid surges caused bedside costs to skyrocket
In a typical quarter, Philadelphia’s University of Pennsylvania Health System spends between $9 million and $10 million on overtime, bonus pay and agency staffing. But in the last quarter of 2021, those costs rose five-fold to $49 million, pushed that high in part by the omicron surge. According to an article in the Philadelphia Inquirer, UPenn still produced an operating profit of $152-plus million in the last half of 2021—but that was $200 million less than in the last six months of 2020. The article, which looked at the financial hit regional hospitals and health systems took as a result of successive delta and omicron waves, found that giant systems—like UPenn, Jefferson and Temple—eked out a profit in the last two quarters of 2021. However, smaller systems including Tower Health and Main Line Health did not. A reprise from omicron is allowing area hospitals to regroup, reduce their number of travel nurses and target their spending. When Temple’s Fox Chase Cancer Center realized, for instance, that turnover was particularly high among nurses with between one and three years of experience, those nurses were given a 15% raise. Supply costs for Philadelphia health systems also rose sharply, with Main Line Health reporting a 16% jump in those costs in the six months ending Dec. 31, while patient revenue rose only 11%.
April 4, 2022
What major health care disruptions loom once the pandemic ends?
For burned-out health care workers, the end of the pandemic can’t come soon enough. But experts in an Associated Press article warn that major turbulence may affect U.S. health care once the pandemic is finally over. Along with crushing caseloads, the pandemic ushered in new flexibility, due in large part to streamlined or suspended regulations. However, many of those new policies may sunset this summer. (Experts believe the Biden administration will extend the covid public health emergency, which is set to expire in mid-April, through mid-July.) Fifteen million patients enrolled in Medicaid during the pandemic may need to find new coverage, for instance, while the CMS will have to decide whether to continue to pay for telehealth for Medicare FFS recipients who don’t live in rural areas. It’s unclear whether insurers will continue to pay for covid treatments, tests and vaccines, while the additional fees that hospitals are being paid to treat covid patients may be phased out. Another potential problem for hospitalized patients: During the pandemic, Medicare waived its three-day hospital stay requirement before covering post-acute care. The CMS may reinstate that requirement once the public health emergency ends.
March 30, 2022
BA.2 strain now dominates in the U.S.
For the week ending March 26, CDC data indicate that the BA.2 omicron subvariant accounted for 55% of all new covid cases in the U.S. While BA.2 is responsible for a covid surge in Europe, Becker’s Hospital Review points out that experts here expect caseloads to rise but don’t believe a major surge is likely. As for how BA.2 stacks up against the BA.1 omicron strain that drove so many cases this winter, a comparison chart included in a Substack post from cardiologist and researcher Eric Topol, MD, points out that BA.2 is 30% more infectious and delivers a nearly two-fold greater viral load. According to that same post, the newer subvariant is “especially concentrated in the Northeast where genomic surveillance shows it to be the first region that has become BA.2 dominant.”
FDA green-lights second booster for those age 50 and older
The FDA this week authorized a second booster for patients age 50 and older to be given at least four months after their first booster shot. The Washington Post reports that the FDA announcement this week also included updated vaccination information for immunocompromised patients who are also now eligible for a second booster after a series of three vaccinations and one booster shot, for a total of five shots. Among patients 65 and older, one-third now are fully vaccinated but have not received their first booster, which is likewise true for about 40% of Americans between the ages of 50 and 64. Evidence for the benefits of a second booster are based largely on data from Israel where those 60 and older have been able to receive a second booster. Some experts in the U.S. argue that the cutoff for a second booster here should likewise be 60 and older. As for what the booster strategy should be for those younger than age 50, some experts believe there should be a fall campaign that coincides with annual flu shots.
Is the NIH slow-walking research into long covid?
The NIH is taking heat from researchers and patient advocates who charge that the agency is not bringing the level of urgency needed to the issue of long covid. While Congress more than a year ago granted the NIH more than $1 billion to research long covid, the agency has so far enrolled only 3% of the patients it plans to recruit, STAT reports. Successful research into long covid may help reduce the burden of the pandemic world-wide and inform the treatment of other post-viral diseases. However, “the NIH will have to walk the fine line between responsibly designing large-scale research … and making sure the effort doesn’t buckle under the weight of bureaucracy,” according to STAT. Reuters reports that long covid is attracting a lot of interest among researchers and drug companies; that’s because the population affected by long covid could rival the number of patients dealing with heart disease or diabetes. However, fewer than 20 clinical trials right now are testing potential therapies.
March 25, 2022
Feds no longer paying for covid testing and treatment of the uninsured
With covid funding drying up, the federal government this week stopped accepting claims to pay for covid testing and treatment, and it will stop accepting vaccination claims for uninsured patients on April 5. Healthcare Dive reports that the Biden administration is requesting $22.5 billion in additional covid funding. Lawmakers want information about how previous pandemic funding has been spent before they’ll authorize more funds. In a statement, the White House said, “Waiting to provide funding once we’re in a surge will be too late.” Becker’s Hospital Review says that the American Hospital Association is urging Congress to provide more covid relief, although not necessarily in the form of additional funding. The group is asking for actions that include an extension on the deadline to spend relief funds that have already been distributed and an extension of covid waivers that give health care organizations flexibility to respond to the pandemic.
Law honoring a physician funds mental health resources
The federal government is funding mental health resources for frontline health care workers through the Dr. Lorna Breen Act, which President Biden signed into law last week. The legislation, named in honor of a New York physician who killed herself in the early days of the pandemic, will in part create grants to train clinicians to reduce and prevent suicide, burnout, substance abuse and other mental health conditions. HealthLeaders reports that Dr. Breen refused to get help for the stress she was under out of concerns that she would place her career in jeopardy. And Wisconsin has passed a law that makes it a felony to threaten health care workers in the state. Healthcare Dive reports that Wisconsin already has a law that makes it a felony to assault nurses, emergency care providers or staff in emergency departments. The report notes that the nursing union National Nurses United doesn’t support the Wisconsin legislation because people who threaten health care workers are often vulnerable patients.
Alcohol-related deaths surged by 25% in first year of covid
A new study found that the number of Americans who died from alcohol-related causes rose sharply during the first year of the pandemic. Research in JAMA found that between 2019 and 2020, deaths involving alcohol jumped by 25.5%. By comparison, deaths from all causes rose during that time by 16%. Alcohol-related deaths accounted for 2.8% of all deaths in 2019 and 3% in 2020. The New York Times reports that study authors suspect that people who were in recovery when the pandemic hit lost access to support and relapsed. The study also found that among adults under 65, alcohol-related deaths outpaced deaths from covid.
March 20, 2022
Hospital pharmacies plagued by shortages of saline, staff
Covid shortages are hitting the pharmacy departments of the country’s hospitals. In the last few months, the growing shortage of saline has hospitals scrambling to find alternatives for the salty liquid. Bloomberg reports that the surge of omicron has exacerbated a previous shortage not only because so much is used to treat patients, but because saline production facilities have been crippled by sick workers. One pharmacist told Bloomberg that her hospital can get only about 70% of the saline she needs. Hospital pharmacies are also experiencing a shortage of staff. Becker’s Hospital Review reports that in a recent survey, about 10% of hospitals said they had lost at least 41% of their pharmacists and pharmacy techs. Most pharmacies said they had lost at least 21% of pharmacy staff, and nine out of 10 said they had asked pharmacists to do tasks usually performed by techs. The good news was that three-quarters of pharmacy administrators had offered raises in the previous 11 months for pharmacy techs, and most offered off-cycle pay raises and other incentives to attract and retain staff.
Pfizer and Moderna are pushing another booster. Is it a good idea?
With covid infections spiking in Europe, omicron BA.2 now accounting for about one-quarter of covid variants in the U.S., and a new variant recent discovered in Israel, there’s a lot of talk about the wisdom of getting a fourth covid vaccine. Both Pfizer and Moderna have now asked the FDA to authorize a second booster of their vaccine, according to the New York Times. Medscape says that while data show a benefit of a fourth shot of the Pfizer vaccine, many experts say there’s not a big sense of urgency to get another booster. An article in the Atlantic says that too many boosters of the same type of vaccine may reduce the body’s response to the virus, and experts warn that getting a booster now may preclude people from getting another shot (think of an omicron-specific booster) that could be right around the corner.
White House scaling back covid plans because of lack of funds
The White House is scaling back plans to purchase monoclonal antibodies and to vaccinate and treat uninsured covid patients for the disease. NPR reports that the move comes after Congress refused to add $20 billion to fight covid. Representatives opposed to the additional funding claim that the Biden administration isn’t being transparent enough in how trillions in covid money have already been spent and how much of those funds remain. Becker’s Hospital Review says a lack of new funding will mean the government also won’t be able to buy adequate doses of boosters and variant-specific vaccines, and it will have to scale back plans to buy preventive treatments for immunocompromised patients. A piece in STAT quotes experts who are worried that the move could leave the country “stuck again in a cycle of under-preparedness.”
March 11, 2022
Covid’s effects on subpopulations: more drug overdoses, maternal deaths
While the global death toll from covid topped 6 million this week, several new reports show how the pandemic has hit certain subpopulations the hardest. A study in JAMA Psychiatry found that while there’s been a well-documented surge of drug overdoses during the pandemic, people of color have suffered more than the rest of the population. Mortality rates for American Indians and Alaska Natives were 30.8% above mortality rates for whites, and mortality rates for Black people were 16% higher than for white people. Researchers concluded more lethal drugs and lower tolerance levels among formerly incarcerated individuals were behind the numbers. A report from the CDC found that maternal mortality rates in the U.S. surged in 2020, with the highest spikes in Black and Hispanic women. Researchers found that overall maternal deaths in this country jumped from 658 in 2018 to 861 in 2020. (The study defined maternal deaths as the death of a woman during pregnancy or within 42 days of the end of pregnancy from any cause “related to or aggravated by the pregnancy or its management.”) While the increased maternal death rate from 2019-2020 was “significant” for Black and Hispanic women, it was not significant for non-Hispanic White women. Finally, a Lancet study looking at the indirect fallout of covid found that between March 2020 and September 2021, women were more likely to be out of work, to drop out of school, and to suffer gender-based violence. The study found that the pandemic intensified pre-existing gender-based inequities.
Two covid-focused hospitals reduced patient mortality
When a health system in Minnesota converted two of its hospitals to specialize in covid care, it saw the mortality rate for patients treated there drop. A study in JAMA Network Open, which looked at data from March 2020 through June 2021 collected in 11 hospitals owned by M Health Fairview, found that total mortality was 11.6% for its two covid hospitals, compared to 8.0% at its nine other mixed-use hospitals. But when researchers risk-adjusted mortality rates to factor in the higher acuity of covid patients, they found mortality rates were actually 22-25% lower for patients treated at the two hospitals specializing in covid. Complications for patients at those two hospitals were also 19% lower than at the mixed-used hospitals. A report in MedPage Today says that researchers think the evidence-based covid-specific therapies used in the two covid-focused hospitals helped lower the mortality rate. Another study in JAMA Network Open found that while hospitalizations for non-covid illnesses plummeted during the pandemic, mortality rates for those non-covid conditions spiked during several periods of the pandemic. Mortality rates for non-covid conditions were 17%-28% higher in the final nine months of 2020; 6% higher from April-June 2021; and 17% higher from July-September 2021. Researchers noted that these rates contrasted with reports of improved mortality for covid patients during these same time periods. The title of an accompanying editorial summed up the findings by saying that the covid pandemic “strikes again and again and again.”
Mixed news for monoclonal antibodies to treat BA.2
March 4, 2022
As feds relax covid restrictions, critics worry it’s too much too fast
New policies from the federal government loosening up covid rules have some critics wondering if the country is relaxing too quickly. The CDC late last week introduced new mask guidance based on community-level risk of severe infection and hospital capacity, not case counts. Fierce Healthcare says that because severe infection risk is “generally lower” in many communities, the agency felt it was safe to relax its mask guidance. The article notes that the CDC will also revise its mask guidance for communities when data show that hospitalizations and deaths are likely to spike in an area within three to six weeks. Earlier this week, the Biden administration followed that announcement with an updated plan to combat covid. The 96-page plan, which the president mentioned during his State of the Union address, aims to prevent shutdowns of schools and the economy and to increase vaccination rates in other countries. Fierce Healthcare says administration officials pointed out that they had already ordered 20 million courses of antiviral therapy and plan to open hundreds of new “test-to-treat” centers this month. Skeptics, however, say that while falling numbers of cases, hospitalizations and deaths mark a good time to loosen up covid restrictions, the administration’s new plan is putting too much emphasis on the roles that individuals play in preventing a return of a pandemic. An Atlantic article quotes critics who complain that the new strategy is abandoning public health recommendations for communities and putting the onus on individuals, particularly people who face the highest risk of severe illness from covid. As one public health expert explained, it’s the duty of public health officials to protect everyone in society, not just healthy people who are vaccinated.
Two antiviral therapies may soon be easier to find
Two antiviral therapies for mild to moderate covid that have been in short supply since they were approved by the FDA in December may now be a little easier to find. NBC News reports that 500,000 doses of the Pfizer drug Paxlovid and 1.8 million doses of the Merck drug molnupiravir have been shipped to the states. Pfizer has a contract to provide a total of 20 million doses of Paxlovid by the end of the summer; Merck has said it has already provided 3.1 million doses of molnupiravir. (A chart of the drug’s distribution can be found online.) Public health officials say increased availability of the drugs, combined with the administration of vaccines, may help move the country to a time when covid isn’t a crisis, but a disease that can be managed. In other news about covid therapies, the American College of Physicians has opted to not change its recommendations on using remdesivir in hospitalized covid patients. In its final update on remdesivir, ACP continues to recommend using the therapy for five days to treat hospitalized covid patients who don’t need invasive ventilation or ECMO. According to a report in MDedge, ACP also recommends continuing the therapy for up to 10 days for patients who develop a need for invasive ventilation or ECMO within a five-day course of remdesivir.
New guidelines for timing of elective surgeries after covid
Guidance for when patients should undergo surgery after a covid infection has changed. According to a joint statement issued by the American Society of Anesthesiologists and the Anesthesia Patient Safety Foundation, unvaccinated patients who get covid should delay elective surgery for at least seven weeks. Previous guidelines from the two organizations recommended a delay of at least four weeks between a covid infection and elective surgery, but those guidelines didn’t address patients’ vaccination status. A Medscape report says the new recommendations are based on a study of more than 140,000 unvaccinated surgery patients that found an increased risk of poor outcomes post-surgery for six weeks after a covid diagnosis. The Medscape article says that there is currently no consensus on the timing of surgery for fully vaccinated patients who experience a breakthrough covid infection.
February 25, 2022
In health care’s “big quit,” where is everyone going?
A much-repeated statistic first announced in October 2021 has caused a lot of concern: Close to one in five health care workers quit their jobs during the pandemic. But several labor officials, as reported by Becker’s Hospital Review, say that doesn’t really give a full picture of what’s happening in the health care workforce. Instead, they say that the close to 20% who quit haven’t left the profession but have taken other jobs in health care. Bedside nurses, for instance, are taking bedside positions at other hospitals—for more money. While the turnover rate among staff RNs in 2020 was 18.7%, that was only a 2.8% increase over that rate in 2019. Many nurses have joined travel and staffing agencies, an option some doctors are choosing as well, according to the article. However, agency executives say that doctors are signing on with staffing companies to find new jobs, not to become long-term locum physicians. Moreover, many of the health care workers who left their jobs worked in nursing homes, while data from the Bureau of Labor Statistics indicate that the hospital workforce is down only 1.8% from February 2020.
February 23, 2022
How long should immunity with boosters last?
Earlier this month, the CDC announced this pretty depressing news: The effectiveness of boosters to reduce infected patients’ risk of hospitalization seemed to wane after four months. But as a New York Times article points out, that pertains to only antibodies—while several other parts of the immune system, including T and B cells, may be activated for far longer, providing protection for months or perhaps years. After the 2003 SARS epidemic in Asia, scientists have discovered that the T cells of infected patients have lasted more than 17 years. Moreover, an mRNA covid booster leads to the production of a wide range of antibodies, which could prove effective against future strains. In related news, the AP reports that more than 70% of Americans may now be immune to omicron, given the numbers of people who have been vaccinated, infected or both. The estimate, which is from the Institute for Health Metrics and Evaluation at the University of Washington, holds that 73% of the U.S. population is now immune, a figure that could rise to 80% by mid-March. Meanwhile, CNBC reports that the number of new omicron cases has fallen 90% from the record number set five weeks ago.
February 22, 2022
New research gives thumbs-down to ivermectin for covid
In a new JAMA study researchers in Malaysia find that a five-day course of ivermectin did not reduce covid patients’ risk of progressing to severe disease. Those results confirm previous studies in which the anti-parasitic medication didn't prove= effective in either treating or preventing covid. In the new open-label trial, about half of 500 high-risk covid patients across 20 hospitals received ivermectin in addition to standard care, while the other half did not. Among those receiving ivermectin, 22% progressed to more severe disease vs. 17% among those not given the drug, a difference that wasn’t statistically significant. Regardless, legislatures in close to a dozen states are trying to pass bills that would stop state licensing boards from acting against doctors who prescribe ivermectin or hydroxychloroquine for covid, BuzzFeed reports. Such bills have already become law in Tennessee and North Dakota.
February 21, 2022
Does BA.2 cause more severe disease?
Preprint findings from Japanese researchers suggest that, based on lab studies, the BA.2 subvariant may cause more severe disease than its omicron cousin, making it more similar to the delta variant. CNN reports that BA.2 looks to be 30% more contagious than omicron, but real-world data in countries where BA.2 is now dominant are mixed. In some countries, like South Africa and the U.K., hospitalizations are declining. But in Denmark where BA.2 is behind most new infections, hospitalizations and deaths are on the rise. In animal studies, the preprint authors found that BA.2 made animals sicker with poorer lung function than BA.1 (omicron).
Wanted: more epidemiologists
A new report highlights another severe health care shortage: Big cities are in dire need of epidemiologists to help combat current and future health risks. The report was prepared by Big Cities Health Coalition and the Council of State and Territorial Epidemiologists, two nonprofits that surveyed health departments in 30 U.S. cities. (Those cities make up about about one-fifth of the U.S. population). In 2021, they found 177 open positions for epidemiologists, more than two times the 83 positions open in 2017. Because of those vacancies, the report points out, local health departments are diverting key staff from other public health crises, like gun violence and the opioid epidemic, to combat covid. In other public health news, an epidemiologist who served as a senior health advisor to New York City’s mayor in 2020 and 2021 believes that public health officials—like city health commissioners—should be elected, not appointed. In a STAT opinion piece, he points out that more than 300 state and local public health officials in the U.S. have resigned, retired or been fired during one year of the pandemic. One reason why: Those officials’ scientific findings clashed with the needs of the politicians who appointed them. Electing public health executives, he writes, “would ensure that health officials are both accountable to the population they serve and independent from interference by other elected officials.”
February 18, 2022
FDA green-lights a monoclonal antibody to fight omicron
The FDA has authorized a monoclonal antibody to be used in covid patients at high risk of severe disease to hopefully keep them out of the hospital. Developed by Eli Lilly, the therapy—bebtelovimab—works against omicron. That is good news for providers, especially because two antibody therapies used extensively earlier in the pandemic have proven to be ineffective against that strain. STAT points out that the government has purchased 600,000 bebtelovimab courses and plans to ship half imminently. Bebtelovimab’s manufacturer maintains that the therapy is also effective against the BA.2 subvariant. Sotrovimab, another antibody treatment, likewise works against omicron, but is in such short supply that the federal government is shipping only 50,000 courses a week. In other therapy news, Gilead Sciences announced that remdesivir, which was approved for nonhospitalized covid patients at high risk of severe disease as well as for hospitalized covid patients, also works against omicron and its subvariants. In 2021, hospitals spent more on remdesivir than on any other drug.
The high price of being unvaccinated
How many patients in the U.S. have died because they chose to not be vaccinated? New preprint findings give an estimate of 135,000 deaths among unvaccinated Americans ages 18 and older—an incomplete tally, the authors point out, because they looked at data only between the end of May 2021 and the beginning of December 2021. Many excess deaths due to not being vaccinated occurred both before and after that time frame. The largest percentage of deaths (35%) were in patients ages 65-79. In related news, the CDC announced that since the beginning of the pandemic, the U.S. has recorded more than 1 million excess deaths. While most are due directly to covid, the deaths rates are also higher than expected for heart disease, hypertension, dementia and other conditions.
Will covid end up being like the flu?
Not according to an author in The Atlantic who compares the likely health care burden and death toll of endemic covid not to seasonal flu but to smoking, saying that both are preventable outcomes. According to the analysis, the new normal may continue with high covid death rates among unvaccinated patients, perhaps reaching the same number of deaths—more than 400,000—that smoking claims in the U.S. every year. “In either context,” the author writes, “public-health campaigns must reckon with the very difficult task of changing people’s behavior.” Long-term actions to promote vaccination and bring down covid hospitalization and death rates may include higher insurance premiums, which smokers face. Smoking costs the U.S. health system $225 billion a year, the type of price tag that American health care may need to incur to treat covid among unvaccinated patients long term.
February 12, 2022
Smaller hospitals stand to lose in staffing wars
It’s not news that hospitals are bleeding staff, particularly nurses. What is news is the lengths that some health systems and staffing agencies may go to entice new hires or keep present employees—a competition that smaller hospitals with fewer resources may lose. Kaiser Health News reports that one health system in South Dakota is offering $40,000 in sign-on bonuses to veteran nurses who agree to work for at least two years, while a Missouri health system last year spent more than $25 million in raises to keep their employees on board. A traveling-nurse staffing agency has placed a billboard near one hospital in Wisconsin, advertising its outsized hourly rates for RNs and LPNs, while a health system in that state has filed a lawsuit against another to prevent workers from switching employment.
February 9, 2022
900,000 and counting
Another unfathomable milestone: Late last week, the number of deaths in the U.S. from covid surpassed 900,000. The latest 100,000 deaths have occurred in less than two months, a testament to the power of the omicron surge and to the numbers of Americans who choose to not be vaccinated. As for the death toll going forward, the CDC estimates that it could total between 933,000 and 965,000 by Feb. 26. Even though seven-day averages for new cases and for hospitalizations are falling, the death toll—about 2,300 a day—continues to rise.
So who really needs to be boosted?
While the CDC continues to recommend vaccine boosters for everyone age 12 and older, new CDC data indicate that while adults 65 and older (as well as those who are immunocompromised or living in congregate settings) benefit substantially from being boosted, “the new numbers for younger Americans were less compelling,” the New York Times reports. For those younger than 65, the data did reveal a benefit to being boosted, but to a far smaller degree than the effect of being vaccinated vs. not being vaccinated in terms of avoiding hospitalization or death. As for patients who are moderately to severely immunocompromised, the CDC is now recommending that they get a fourth vaccine dose three months after their booster. That guidance applies to those who are 18 or older and got Moderna vaccine or 12 and older for those given Pfizer vaccine.
One in 10 hospitalized patients may develop long covid
Results published in JAMA Network Open found that about one in 10 patients who were hospitalized with covid but weren’t ventilated developed long covid symptoms or conditions. Diagnoses made during medical encounters between 31 and 150 days after patients’ initial testing included shortness of breath, fatigue, cognitive dysfunction, heart rate abnormalities and type 2 diabetes, among others. “(N)ew symptoms,” the authors write, “can be long-lasting.” They also found that patients’ long-covid symptoms and conditions increased if their covid infection was more severe. In a study in The Lancet Child & Adolescent Health, Danish researchers looked at long covid in adolescents ages 15-18.
February 4, 2022
Coming back to work? Five days in isolation likely not enough
New preprint (non-peer-reviewed) data pushes back on CDC recommendations that infected workers can come back to work without a negative rapid antigen test after five days of isolation as long as they have improved symptoms. University of Chicago researchers followed 260 infected health care workers at that medical center over 10 days in early January 2022; all those workers were trying to return to work. Rapid antigen testing found that 43% were still positive between days 5 and 10, with 58% of them positive when taking their first test on either day 5 or 6. (Among those returning on days 8 or 9, by comparison, only 26% were positive.) The authors note that the CDC guidance about when to exit isolation was based on data collected before omicron. “However,” they write about the omicron surge, “reports showing much earlier onset of symptoms, coupled with our own results here demonstrate that the relationship between symptom onset and peak virus load has changed.” In related news, health care workers at a California medical center successfully fought temporary state guidelines—which sunsetted Feb. 1—allowing infected but asymptomatic employees to return to work without any period of isolation or testing. The guidelines were designed to counteract staff shortages and the relatively high number of breakthrough infections with omicron among vaccinated and boosted health care workers.
BA.2 is detected in 30 states and dozens of countries
While death tolls continue to rise, the number of new covid cases across the U.S. is falling—just in time for an omicron subvariant that is apparently more infectious than omicron classic (BA.1). Newsweek reports that the BA.2 subvariant has now been detected in 30 states, while BA.2 caseloads are rising rapidly in other countries, particularly Denmark and India where it’s now the predominant strain. (According to the WHO, the BA.2 subvariant has also spread across Africa.) As of Feb. 1, BA.2 in the U.S. accounted for only 200 cases, but experts put its U.S. prevalence at 8%. While the BA.2 subvariant is considered more transmissible, it does not appear to cause more breakthrough infections than the original omicron strain in vaccinated people.
Insurers eye benefits of paying for broadband
A lasting legacy of the pandemic may well be the dramatic expansion of telehealth. But all the venture capital being invested in telehealth can’t fix a lack of access to technology and connectivity. STAT reports that close to a quarter of U.S. adults don’t have broadband at home and that much of rural America doesn’t have enough bandwidth for video calls. To begin to turn that around, some Medicare Advantage plans are now offering low-cost broadband benefits, paying up to $1,000 a year for data plans, for instance, or giving members debit cards with $125 per month to pay for utilities, including Internet. Both federal and state health programs are also looking into ways to start covering Internet access, with Medicaid programs alerting members to apply for federal subsidies and credits. One encouraging trend toward better coverage: Internet access is increasingly being viewed as a social determinant of health, a necessity like food and housing that ensures not only access to health care but to better education and employment as well.
February 2, 2022
U.S. death rate far higher than in other wealthy countries
We’re No. 1! A New York Times analysis of several national and international databases confirms that the covid death rate in the U.S. far surpasses that of other large, wealthy countries, both throughout the pandemic as a whole and during the omicron surge. In this current surge, for instance, the daily death rate among Americans is close to double that in Britain—and four times higher than the mortality rate among Germans. Well-known reasons are driving that large gap: Fewer Americans have gotten vaccinated, while even fewer with two doses of vaccine (or one of J&J) have sought to get boosted, while rates of obesity and diabetes—clear risk factors—are much higher. “The only large European countries to exceed America’s Covid death rates this winter have been Russia, Ukraine, Poland, Greece and the Czech Republic, poorer nations where the best Covid treatments are relatively scarce,” according to the New York Times. One possible factor that might reduce the gap going forward between the U.S. and other wealthy countries: So many infections have occurred in the U.S. (at the price of so many deaths) that, added to the percentage of the population who is vaccinated and boosted, America may soon have the same level of protection as European nations.
January 31, 2022
Covid death counts are climbing
The CDC reported last week that seven-day averages for both new cases (close to 600,000) and covid hospitalizations (more than 19,000) were falling, compared to the previous week’s. However, true to other covid surges, the number of deaths was rising sharply, up 25.1% over the prior week. The CDC noted that the omicron variant accounts for 99.9% of covid cases in the U.S. and that the seven-day average for new cases ending Jan. 25 was down 19.9% from the week before while the number of hospitalizations fell 8.8%. The CDC also announce that the omicron subvariant known as BA.2. is circulating in close to half of all U.S. states and that it is even more transmissible than the original omicron. Early data, however, suggest that the new subvariant doesn’t cause any more severe disease than omicron, while public health agencies in the U.K. say that current vaccines seem to work against the BA.2. subvariant.
California health care workers push back against return-to-work policies
Health care workers at a California medical center have successfully pushed back against new state guidelines, which claimed that infected but asymptomatic employees could return to work without any period of quarantine or isolation or any need for testing. The state had issued that revised guidance in early January, claiming the policy was meant to address staff shortages; the policy was set to sunset Feb. 1. Still, union members at the medical center last week held a rally to highlight what they said were the guidelines’ possible effects on worker safety. Several state-wide and regional unions objected to the temporary guidance, including those for nurses and health care workers.
January 29, 2022
As patients hunt for Evusheld, one hospital raffles off doses of the drug
While the FDA is recommending against most monoclonal antibody therapies, the drugs continue to offer hope for immunocompromised patients trying to stay safe during the pandemic. But the reality is that there simply aren’t enough doses of the therapy like Evusheld, sending patients on what a report in STAT calls a “Hunger Games” type of hunt for lifesaving medications. While 7 million Americans have impaired immunity and could be eligible for Evusheld, only 1.2 million doses have been ordered by the federal government. The STAT report profiles patients who have been considering traveling to other states to get an injection (like Florida) and others who are trying to play by the rules of their local health systems. In a bid to find a “fair” way to divvy up doses of Evusheld, one Boston hospital has taken to raffling off doses of the drug. An NPR report says that Massachusetts General Hospital has created three tiers of patients to rank people by their need and then put patients in the top tier in a raffle to give them all an equal shot at getting the drug. The NPR report notes that the federal government allocates doses of the drug to the states based on total population, not medical need of the state’s population.
Medical ethicists weigh in on unvaxxed kicked off the transplant list
With yet another story in the news of a patient who has been refused an organ transplant because of his refusal to get a covid vaccination (this one at Brigham and Women’s Hospital in Boston), some medical ethicists are now coming out in support of these decisions. A STAT article notes that transplant programs typically choose recipients who have the greatest chance of survival. And for transplant patients, who often have multiple comorbidities and must take immunosuppression drugs so they don’t reject their new organs, severe illness from covid is a real possibility. One study found that mortality among covid patients who were recipients of solid organ transplants was about 20%. Ethicists in the STAT article point out that transplant programs typically require “lifestyle behaviors” (think smoking cessation) and other vaccines for patients on their transplant lists, so mandating a covid vaccine is just the latest in a long list of requirements.
These clinicians are posting on TikTok to counter misinformation
The Atlantic offers a profile of medical professionals taking to TikTok to combat misinformation, helping to slow what the report says is “the bleeding of trust that institutions have suffered over the past two years.” Many of the TikTokers started posting during the early days of the pandemic, trying to combat conspiracy theories and misinformation about the pandemic. Several featured in the profile have since moved on to giving followers the confidence and information to talk to people in their own communities. They are also working on building long-term relationships to deliver information beyond the pandemic. Some are collaborating under the umbrella of Team Halo, a U.N.-backed social media campaign created to counter misinformation about the pandemic. Most remain anonymous and use pseudonyms to protect themselves from online harassment and trolling.
January 27, 2022
Close to one in four hospitals is short-staffed
While covid hospitalizations at many hospitals are now hitting an all-time high, about 23% of hospitals in the U.S. are short-staffed. That’s according to the American Hospital Association (AHA), which notes that shortages are due to staff either being out sick with omicron or considering leaving health care altogether. Newsweek reports that the shortages are delaying care for some patients and leading more hospitals to look outside the U.S. to recruit staff. A recent New York Times editorial chalked staff shortages and the resulting burnout up to hospital greed, saying that too many hospitals have longed refused to lower the number of patients that nurses are expected to treat. Meanwhile, federal lawmakers and the AHA are calling for a federal investigation into price gouging by nurse staffing agencies, while UPMC in Pittsburgh announced that it is establishing its own travel staffing agency.
FDA revises authorizations for two monoclonal antibodies
The FDA this week revoked its authorizations of two popular monoclonal antibodies, saying those should be used only to treat susceptible covid variants—and that does not include omicron. Both treatments (bamlanivimab and etesevimab, taken together, and casirivimab and imdevimab that is marketed as REGEN-COV) “are highly unlikely to be active” against omicron, the agency pointed out, a conclusion the antibodies’ manufacturers agree with. (Sotrovimab is the one monoclonal antibody found to be effective against omicron, but it is in very short supply.) The move set off the latest political-therapeutic skirmish, with Florida officials particularly defending being able to continue to distribute the now unauthorized therapies, which are still being used in a dozen states. In other treatment news, the AP reports that the FDA has expanded its approval of remdesivir to allow it to be used in nonhospitalized patients. That treatment regimen, however, entails administering three infusions to adults and children at high risk of being hospitalized with covid.
January 21, 2022
Omicron spiking here, plateauing there, causing chaos everywhere
While omicron is showing signs of plateauing in parts of the Northeast, the latest covid variant is wreaking havoc on hospitals around the country—and setting new records for caseloads and hospitalizations. Becker’s Hospital Review reports that earlier this week, a record 154,335 people were hospitalized with covid, which beat the previous high of 142,273 just over a year ago. The CDC is predicting 62,000 Americans could die from covid in the next month and that there could be up to 48,000 new hospitalizations by Feb. 4. CNN reports that more states are cutting back on non-urgent care such as elective surgery, and that some states are training National Guard members as certified nursing assistants to work in hospitals and nursing homes. That report says that 19 states have less than 15% ICU capacity. The Washington Post says that patients and physicians alike report a “deep sense of dismay, frustration and worry” about delayed care, with doctors noting that having to call patients to postpone a surgery is one of the hardest parts of the pandemic for them. Some patients waiting for joint replacements, for example, can’t sleep or perform basic functions because of pain and immobility. A MedPage Today report says that in patients who have another condition besides covid that’s putting them in the hospital, the virus is serving as a tipping point and making those conditions worse. Physicians theorize that some of these patients, many of whom present with heart disease and heart failure, didn’t get the care they needed earlier in the pandemic and are now facing the consequences. And while hospitals are packed with patients and short on staff, problems with staffing at home health agencies are exacerbating inpatient bottlenecks by forcing patients to stay in the hospital for longer while they wait for an outpatient placement. A home care industry official told MedPage Today that finding placements for these patients outside of the hospital is “kind of like musical chairs.”
After court victory, CMS adjusts rollout of its vaccine mandate
The fallout from the Supreme Court’s decision to OK the Biden administration’s vaccine mandate for health care facilities that accept federal funding is rippling through the industry. The CMS is poised to enforce the mandate in all 50 states, although Fierce Healthcare notes that there are two sets of vaccine deadlines. In the 25 states that did not contest the mandate, all staff at facilities that accept federal funding must have received at least one dose of a vaccination by Jan. 27. Staff at those facilities must be fully vaccinated by Feb. 28. In the states that fought the vaccine mandate, all staff at facilities participating in federal health programs must be at least partially vaccinated by Feb. 14 and fully vaccinated by March 15. The Supreme Court decision has prompted a number of organizations to revisit their vaccination policies. Becker’s Hospital Review reports that Cleveland Clinic will now require staff to meet CMS vaccination deadlines after pausing its vaccination policy on Dec. 2. Healthcare Dive reports that health organizations are worried that enforcing the mandate will exacerbate staff shortages, particularly at long-term care facilities, which have low vaccination rates. That segment of the industry has lost 15% of its staff since the pandemic began.
New data on previous infection vs. vaccine in preventing delta
A new CDC report may cause some confusion about the effectiveness of getting infected in warding off repeat cases of covid. A study of adults in New York and California from May through November of 2021 found that people who already had covid had more protection from a repeat infection than people who had been vaccinated but not had an infection. That news has public health experts concerned that the data will be used by some as evidence that vaccinations aren’t necessary. Analysts in a STAT report, however, are warning that the data don’t support the idea of forgoing a vaccine before or after becoming infected. For one, the data showed that people who had been infected with covid and also got a vaccine had the highest protection levels of all. Analysts also point out that the study data cover a period when vaccines in many people were beginning to wane, but before booster shots really took hold, so they don’t give a full picture of how much protection patients with three shots had against infection. And the data look at the experience of infection with the delta variant, which has already been supplanted by the very different omicron variant. Finally, the data confirm what vaccine proponents have been saying for over a year: people in the study who weren’t vaccinated and hadn’t been infected had the highest case rates and hospitalizations of any group.
Surfaces of patient rooms show few signs of contamination
Some good news this week for hospitals trying to survive covid: Room surfaces in patient rooms in covid units show a fairly low contamination rate of the virus. A study in Clinical Infectious Diseases found that less than 6% of the 347 samples collected from the patient rooms of a covid unit were positive, and only one demonstrated cytopathic effect (CPE). In a Medscape report, researchers acknowledged the caveat that the presence of covid genetic material is not necessarily an indicator of the presence of a live virus, and that it’s not clear how much covid-tainted genetic material could be considered infectious. Of the samples that came back positive for covid, nine were from bedrails, four were from sinks, four were from computers in the room, and one was from the handle on the door to the hallway. Researchers warned that their results might not apply to other hospital rooms, particularly parts of the hospital that don’t undergo the rigorous cleaning regimens in place in many covid units.
Instagram post explains how docs are paid to vaccinate children
This week’s misinformation update concerns how physicians are being paid—or not—to pressure their youngest patients into getting vaccinated, although not necessarily for covid. An Instagram post from December of last year states the following: “Blue Cross Blue Shield pays your doctor a $40,000 bonus for fully vaccinating at least 100 patients under the age of two.” The post goes on to explain that physicians who fall even one patient short miss the entire bonus, so parents’ decision to vaccinate their child could be worth $40,000 to their physician. The post was flagged as part of Facebook’s efforts to combat misinformation on its platform and highlighted by the fact-checking site PolitiFact. That site explains that while Blue Cross Blue Shield does in fact have performance incentives for its physicians based on evidence-based best practices, which could include administration of a flu vaccine, none of its affiliates base all of a bonus on vaccines. PolitiFact rated the claim false.
January 14, 2022
As covid cases surge, so does spending on inpatient care
With the U.S. reaching a record 1.35 million new covid cases in one day this week, hospitalizations have also reached a record high. Just over 145,000 Americans are in the hospital with covid, double the number just two weeks ago and more than the previous peak of 142,000 a year ago. In addition, one recent study found that in 2020, the total cost for treating covid inpatients was just over $11,000, with a median per-day cost of $1,772. Becker’s Hospital Review says that the median LOS during that time was six days, and that the average cost dropped by 26% between April 2020 and December 2020. In related news, data released late last year found that from June 2021 to November 2021, health care systems spent just under $14 billion caring for adult covid patients who had not been vaccinated. HealthPayerIntelligence reports that in one month—August 2021, when delta peaked—those costs came to $4 billion.
What rising caseloads mean for short-staffed hospitals
With about one-quarter of U.S. hospitals reporting “critical staffing shortages” and desperately trying to stay on top of both covid cases and non-covid cases—which can turn into “incidental” covid cases—public health officials are ringing alarm bells about the state of the nation’s health care system. Some in the media have turned their attention to the toll the current surge has taken on hospitals. Here’s an overview of three reports published this week:
- STAT. Some of the sources interviewed by STAT say the current surge is so challenging because in addition to covid, hospitals are treating patients with all kinds of other conditions. Hospitals were short-staffed before omicron, and with covid-related staffing shortages piled on top, staff are scrambling to fill holes by taking on other people’s jobs. That added work only contributes to the overall, pervasive sense of burnout being felt by hospital staffers. It’s not helping matters any that a scarcity of outpatient therapies like the antiviral Paxlovid is driving patients into the hospital.
- Kaiser Health News. Health leaders interviewed by Kaiser say that while many omicron infections are relatively mild, the sheer volume of people sick with covid—combined with the exploding volume of “incidental” infections—may be the tipping point for understaffed, overstressed hospitals. Hospital officials report that treating covid in patients who need other medical care requires different protocols, further stressing clinical staff. In some systems, for example, “incidental” covid patients can’t be put into the covid units because they need specialized care for other conditions. As a result, staffers in non-covid units must take special precautions (beefed up PPE, for example) that add to their stress.
- The Atlantic. Health care workers from 11 states say that the current covid surge is pushing them to the limit, and that the volume and the stress will only get worse as the surge in cases turns into a surge in hospitalizations. As one hospitalist in the piece explained, there are a lot of chronically ill people in the U.S., and it feels like they’re all coming into the hospital at the same time because their health issues are being exacerbated by covid.
Vaccine mandate OK for health care, but not for large employers
The Supreme Court handed the Biden administration a split decision on vaccine mandates yesterday, blocking it from enforcing its mandate for larger employers but allowing the mandate to require vaccinations for staff working at health care facilities that accept federal funding. Fierce Healthcare says that the Centers for Medicare and Medicaid Services can withhold funds from health care facilities that do not meet its guidelines for vaccinating the 17 million staff they employ. The Biden administration also announced yesterday that it would purchase and distribute an additional 500 million covid tests, doubling the previous commitment, and send 120 military personnel to hospitals in six states that have been particularly hard hit by the virus. The New York Times says it is unclear when the tests will actually be delivered.
Today’s Hospitalist has been reporting on covid-19 since January 2020. Click here for earlier updates.