Covid updates for hospitalists

For more 2022 news on covid-19 and how it has affected the health care industry and hospitalists, click here: Special report: Covid-19.

December 17, 2022

Masks indoors: They’re back! 

The latest CDC report on covid community levels finds that about 14% of counties have high infection levels, including more than 10 counties that have more than 1 million residents. Public health officials in New York, Washington, Los Angeles and other areas have released guidance asking residents to use masks indoors although no mandates are yet in effect. In terms of covid, flu and RSV, Politico reports that hospitals are once again near capacity and that close to 30,000 hospitalized patients around the country are positive for covid—a 30% increase since Thanksgiving. Hardest hit are New York, Arizona and New Mexico. Flu cases are also rising while only 26% of U.S. adults as of the end of October had received a flu shot. According to public health officials, flu is the biggest threat to urgent care centers and emergency departments, but covid is still a bigger threat to ICUs. Hospitals in the U.S. and U.K. are also reporting a rise in cases of severe strep.

Have 3,500 Americans died from long covid?

A new report from the CDC claims that long covid may have contributed to more than 3,500 deaths in the U.S., based on an analysis of death certificates from January 2020 through June 2022. But as STAT points out, experts have weighed in with a range of opinions on the report. Some dismiss the findings, saying that death certificates are not reliable in terms of establishing cause of death; others believe the number of deaths to which long covid has contributed is probably higher. What does seem clear is that long covid or some variation thereof is being cited on death certificates. While more Black and Hispanic patients died from covid than whites, those groups apparently do not have long covid listed on their death certificates more frequently. According to the report, close to 57% of deaths in which long covid was cited were in patients 75 and older. For close to one-third of patients with death certificates that list long covid as a main or underlying cause, another condition such as Alzheimer’s, cancer or heart disease was also included.

December 10, 2022

Flu hospitalizations explode, and a troubling covid subvariant is on the rise

As hospitalists well know, just about every state is struggling with high levels of flu and other respiratory illness, the Washington Post reports. The CDC says that this early flu season turned much more severe after Thanksgiving and that 78,000 hospitalizations and 4,500 deaths have been recorded from flu since October. As a result of high flu activity, the hospitals in IU Health—Indiana’s largest health system—are now restricting hospital visitors to only immediate family. The good news on viruses is that RSV may have peaked and those cases are leveling off across the country. But the bad news: The omicron subvariant XBB, which has been found in 35 countries, may make an end run around neutralizing antibodies, according to a new study in The Lancet. The subvariant has been detected in California and New York and now accounts for about 5% of cases nationwide. That percentage may be higher locally. And in what could be ominous news for covid hospitalizations next year: Kaiser Health New reports that free Paxlovid, compliments of the HHS, is coming to an end. Nearly 6 million patients in the U.S. have taken the drug, which has prevented many covid hospitalizations. The U.S. government paid $530 for each course of Paxlovid, but that reflects a discount for buying 20 million doses. The fear is that the drug’s retail price may be so high that many patients won’t be able to afford it and will suffer more severe disease.

November 18, 2022

Good news about bivalent vaccines, but not long covid

There’s mixed news about covid: While worldwide deaths from the pandemic are down 90% since February, recent data from the World Health Organization show that deaths around the world showed a 2% rise for the first time since mid-July. Those data may be behind the U.S. government’s decision to consider covid a public health emergency through January. HHS said it will give 60 days’ notice before it lets the emergency period expire. The decision comes amid reports about the effectiveness of the current crop of bivalent vaccines. Pfizer said its bivalent vaccine triggers a stronger response than a fourth dose of its original vaccine and offers the strongest protection for people over 55 years old. Data from Moderna say its bivalent booster offers better protection against omicron variants than its original vaccine. Some of the news about long covid is less encouraging, like a study that found getting covid a second time doubles your chance of dying and triples the likelihood of being hospitalized in the following six months. Another study concluded that nearly 60% of people who had covid were experiencing at least one symptom two years after being infected. That applied to both patients who had and who had not been hospitalized because of covid.

November 5, 2022

Will this fall and winter turn into a pediatric version of March 2022?

As viral infections spread among U.S. children, experts are looking ahead to a long fall and winter. A report in The Atlantic says that the U.S. may be headed toward the “worse pediatric-care crisis in decades” as huge numbers of children are being hit with not only RSV, but flu, rhinovirus, enterovirus and SARS. An NPR report says that the high number of RSV hospitalizations so early in the season—the wave started in the late summer months in some parts of the country—is already pushing hospitals to capacity. Experts seem to agree that children are being hard hit by viruses in part because of the lifting of pandemic precautions, which likely tamped down transmission and possibly immunity. One physician said she suspects an entire generation of children may have missed out on critical exposure to viruses that helps build immunity. The surge is coming at a particularly bad time given that hospitals around the country have been closing their inpatient pediatric units, often because of economic factors. An editorial in MedPage Today by a pediatric hospitalist says that in New England, there are often no available PICU beds, leaving children to be cared for by staff who don’t necessarily have that level of expertise. He points out that just as pediatricians were asked to pitch in during the height of the pandemic, physicians who typically care for adults may have to step up and help care for children.

October 30, 2022

“Tripledemic” is the word of the week

A new model out of the University of Washington predicts that covid deaths this winter will plateau around 335 a day in the U.S. That mortality rate is an almost eight-fold decrease from covid death rates last winter—but it still means an additional 30,000 deaths from covid in the U.S. before Feb. 1. Flu cases are already much higher than they were at this time in 2021, the New York Times reports, while RSV cases are spiking several months earlier than expected, putting a strain on pediatric hospitals in several states. That triple threat has experts worried about a “tripledemic” in which hospitals may be swamped. Public health officials point out that the pandemic disrupted infection patterns due to masking and social distancing. Now that people are no longer using such precautions, viruses are circulating again.

The impact of pandemic visitation restrictions

How did visitor restrictions during the pandemic affect families and caregivers? Researchers writing in the Journal of Hospital Medicine looked at EHR data on communications between medical teams and caregivers for 100 cancer and heart failure patients before the pandemic and 100 after. Caregivers under restricted visitation communicated less frequently with medical teams (29% of hospital days vs. 37% prerestrictions), fewer received discharge counseling (37% vs. 52%) and more had no contact at all with a medical team (36% vs. 17%). The authors say that the findings have implications for rural patients transferred to centers where providers and family members have to communicate virtually. They recommend quality improvement programs to increase how frequently communications are scheduled and the use of video conferencing. In a STAT opinion piece, an intern recounts his father’s death from covid in an ICU in December 2020; he and his family weren’t allowed to visit in person until it was clear his father was dying. “(I)f my family had the opportunity to see the severity of my Dad’s clinical condition days earlier,” the author wrote, “we likely would have transitioned him to comfort care.” The author notes that many ICUs continue to restrict visitors, particularly for covid patients.

October 21, 2022

Experts warn of a swarm of emerging subvariants

Wave after wave of single variants have caused havoc across the globe for more than two years. But this fall and winter could bring something unprecedented: a host of new subvariants that emerge at the same time. The Washington Post reports that many of the new mutations are different versions of omicron. Of particular concern, according to coverage from The Hill: BQ.1 and BQ.1.1, which each made up about 6% of total cases in the U.S. late last week. Experts worry that the number of BQ.1.1 cases is doubling every week. The subvariant may also elude monoclonal antibodies and be less susceptible to vaccines and boosters. In other news, the CDC is warning about a potentially tough flu year, saying the level of flu and other respiratory illnesses is already higher than normal. That is particularly true in the South and in New York City and Washington, D.C.

October 7, 2022

Boosters could save lives, but how many Americans know about them?

A very successful covid booster campaign this fall could save close to 100,000 American lives, according to a new analysis from the Commonwealth Fund. But such predictions may be sabotaged by a lack of awareness that a new booster targeting omicron variants is now available. If 80% of eligible Americans got boosted by the end of this year, the analysis claims that about 90,000 lives would be saved and more than 936,000 hospitalizations averted. Under another scenario—with covid booster coverage hitting the same level as flu vaccination levels during the 2020-21 flu season—more than 75,000 lives would be saved and 745,000 hospitalizations prevented. If, however, booster uptake continues at its current pace, a winter covid surge in the U.S. could result in 16,000 hospitalizations and 1,200 deaths per day by March 2023. Survey data from Kaiser Family Foundation indicate that while about one-third (33%) of those surveyed have heard or read “some” about the new booster, another one-third (31%) have heard or read only “a little” and 20% aren’t aware of it at all. While experts debate whether the U.S. will see a fall covid surge, newly-positive patients in the U.K. (where cases are on the rise) are reporting that their first symptom is a sore throat, not the fever or loss of taste or smell that many expect. As a result, fewer people may be testing themselves for covid. In other vaccine news, about half (49%) of Americans in a new survey say they plan to get a flu shot this year.

SCOTUS lets hospital vaccine mandate stand

The Supreme Court this week refused to hear a challenge to a ruling that upheld a mandate for covid vaccination among health care workers in facilities that receive federal funding. That challenge was brought by 10 states—Alaska, Arkansas, Iowa, Kansas, Missouri, Nebraska, New Hampshire, North Dakota, South Dakota and Wyoming—that wanted to appeal the former ruling. Healthcare Dive reports that the Supreme Court earlier this year also upheld the health care vaccine mandate, saying that the CMS had the authority to enforce such requirements among health care facilities that participate in Medicare and Medicaid. At that time, the court struck down an OSHA vaccine mandate that targeted large employers.

October 1, 2022

CDC drops universal masking in counties with low transmission rates

The CDC’s decision last week to drop its universal masking guidelines for health care workers in parts of the country has left some hospitals and health care workers frustrated. A MedPage Today report said that hospital leaders in New York and California plan to follow state guidelines, which call for universal masking. That report quoted sources worried that people would misunderstand and think that masks are no longer necessary in health care settings in all parts of the country. The CDC is still recommending masking in areas of the country that have high transmission rates. Currently, about 75% of Americans live in areas of the country with high transmission rates, so under CDC guidelines, only about 25% of the country should go maskless in health care settings. A Fierce Healthcare report says that the CDC also recommends masks for anyone who has a suspected or confirmed respiratory infection, has had close contact with someone with covid in the last 10 days, or who works in a facility experiencing a covid outbreak.

Public health experts wonder what covid and flu will look like this fall

As much of the country seems to be letting down its guard against covid, public health experts are bracing for a surge in the fall and winter. A CNN report questions whether rising covid cases in the UK are a harbinger of things to come in the U.S. (The U.S. often sees covid trends a month or so after the UK.) While the UK has been seeing a downward trend in covid cases for the last two months, cases have spiked up by 30% in the last week. A FierceHealthcare report says that a major concern is that subvariants and sub-subvariants of Omicron are reproducing “exponentially,” leading some to worry that the virus will outmaneuver our best vaccines and treatments. And a Becker’s Hospital Review report says that fears of a twindemic—a simultaneous surge in covid and the flu—are escalating now that masking and other preventive measures are falling out of favor. Public health experts note that Australia has just experienced its worst flu season in five years in part because of those reasons.

September 26, 2022

Was Biden more right than he knew? Signs of pandemic fatigue stack up

President Biden may not have been literal when he said the pandemic was over, but his remark illustrated the fatigue that many in the U.S. feel toward covid. The virus may be killing hundreds of people a day, but some experts say there’s some truth to the idea that pandemics are basically over when society says they are. Fears about the “twindemic” of influenza and covid hitting at once seem more and more distant, and manufacturing issues leading to shortages of the Moderna vaccine don’t seem to have many people in a panic. Even research into cures for covid has fallen off, although not necessarily because of a lack of enthusiasm by researchers. One report says that fewer severely ill covid patients are now in ICUs, making it hard for trials to enroll subjects for possible treatments. And the patients who are now hospitalized for covid are more likely to be immunocompromised, have serious preexisting conditions or be unvaccinated. One group, however, seems to need no reminder of the seriousness of the pandemic: A group of protesters suffering from long covid marched in front the White House on Monday of this week, miffed that President Biden appeared to be caving into pandemic fatigue. “Many of us are going to be so sick tomorrow,” one of the long-covid patients standing in front of the White House told a reporter.

September 16, 2022

Is the end of covid in sight?

This week, the WHO director general announced that the worldwide weekly death toll from covid was the lowest since the pandemic began in March 2020. This week’s global death rates were down 22% from the previous week while the number of new cases dropped 28%, according to AP coverage. Another sign of a potentially easing covid burden: The Wall Street Journal (subscription required) reports that Johns Hopkins is scaling back how often it updates its COVID-19 data dashboard due to a drop in data reporting. That site has garnered more than 800 million page views since it debuted in January 2020. But while caseloads and covid admissions in the U.S. are falling, some experts point to worrying signs. For one, wastewater data from Biobot Analytics shows increasing covid concentrations in the Northeast.

September 9, 2022

Studies take a look at covid’s toll on children, hospital visits

As the White House tries to prepare Americans for the idea of an annual covid shot, several studies released this week take a look back at covid’s toll in the early days of the pandemic. A study in JAMA Pediatrics says that 10.5 million children around the world have lost a parent or caregiver to the pandemic. The authors of the paper point to a program for AIDS-orphaned children that could be used to support children affected by covid-related loss. Additionally, a study in the Journal of Hospital Medicine looking at visitation restrictions during covid found that caregivers communicated less frequently with the medical team, received less discharge counseling, and disproportionately had no contact at all with the medical team. Researchers also said that visitation restrictions produced emotional distress, increased conflict and decreased perceptions of quality among both patients and caregivers. In one piece of good covid news, the FDA recently took N95 respirators off its medical device shortage list. Healthcare Dive reports that the respirators were one of the first medical devices placed on the shortage list in the early days of the pandemic.

September 2, 2022

Covid case counts dropping, but life expectancy still sinking

While the CDC last week reported a fifth straight week of declines in covid cases, hospitalizations and deaths, average life expectancy for Americans dropped for the second year in a row. As of Aug. 26, the CDC said that the rate of new covid cases was down 6.7% from the previous week. During the same period, hospitalizations fell 6.6% and the seven-day death average dropped 11.6%. That good news, however, was offset by the CDC’s announcement that the country had seen its sharpest two year decline in life expectancy in nearly 100 years. An analysis from the CDC found that someone born in 2021 had a life expectancy of 76.1 years. Someone born before the pandemic in 2019, by comparison, had been given a life expectancy of 79 years.

Next generation vaccines are approved, but will anyone care?

The FDA this week authorized covid vaccines that target the original strain and the omicron BA.4 and BA.5 subvariants. MedPage Today reports that the shots from Pfizer/BioNTech and Moderna received emergency use authorization to be given two months after a first vaccine or booster. Pfizer’s new vaccine is authorized for people 12 and up; Moderna’s shot is for people 18 and over. An analysis by Eric Topol, MD, looks at the pros and cons of the new boosters. He says that while “we’re long overdue for an updated covid vaccine,” there are no data on how the boosters work in humans, only mice. An article in The Hill looks at the challenges of selling these vaccines to a “checked-out public.” And Healthcare Dive notes another obstacle to the new vaccines will come as federal funds that have made vaccines free begin to run out. Experts say that could happen as early as January 2023.

Hospitals brace for toughest times since beginning of pandemic

While covid appears to be moderating, at least for now, hospitals’ finances are worse now than they were in the early days of the pandemic. A report from Kaufman Hall found that hospitals’ operating room times and outpatient revenue fell from June to July, and that length of stay increased during the same period. A Healthcare Dive article said that demand for medical care postponed during the pandemic has dried up just as federal funding to help stabilized hospitals financially is fading. The trend is disappointing because hospitals had begun to see signs of hope earlier in the year. A Kaiser Health News report looks at several hospitals that have cut jobs and services to offset rising costs, and a Becker’s Hospital Review report looks at hospitals that are making cuts to executive teams to slash costs.

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

How stressed out about child care have health care workers been during the pandemic? Results from a large new survey indicate that just about one in five (21%) experienced high stress around child care during the pandemic—a finding associated with much higher odds of mental health issues and burnout. Writing in JAMA Network Open, researchers surveyed more than 58,000 health care workers across more than 200 organizations. Respondents included nearly 16,000 physicians (1,300 were hospitalists) and 11,000-plus nurses. Those reporting high child care stress were found to have 91% greater odds of reducing their work hours because of that stress and 28% greater risk of planning to quit their jobs. Child care stress was more prevalent among women than men and also more among racial and ethnic minorities than whites. To mitigate stress, the authors recommend that institutions bolster their child care resources, including providing onsite care for sick children or even onsite schools. In other news that might complicate child care: The Kaiser Family Foundation reports that covid vaccinations for children under age 5 peaked within two weeks of those vaccines becoming available. As of July 20, only 2.8% of children under 5 had received their first dose of covid vaccine vs. 18.5% of those between the ages of 5 and 11 at the same point in the vaccine rollout for that age group.

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?

Pfizer this week announced that it was halting its study of Paxlovid in patients at only standard risk of severe disease, saying the drug in that population wasn’t significantly reducing patients’ covid symptoms. Further, due to the small number of hospitalizations in the study, the results showed no statistically significant benefit in reduced hospitalizations among vaccinated patients taking Paxlovid. According to STAT coverage, “The data in no way invalidate earlier results that show that Paxlovid prevents hospitalizations and saves lives in patients at high risk of severe Covid.” (The drug was originally tested in patients who were both at high risk and unvaccinated.) But this week’s announcement left experts puzzled as to whether to prescribe Paxlovid for patients at moderate risk—or if a larger study might have found more benefit for those patients. The FDA authorized the use of the antiviral in patients with at least one risk factor including high blood pressure or diabetes. Reuters reports that an Israeli trial recently found that Paxlovid reduced hospitalizations and deaths in both vaccinated and unvaccinated patients ages 65 and older but not in younger patients. Other studies, however, have found some benefit to low-risk patients. So far, more than 1.2 million Paxlovid courses have been administered in the U.S.

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

When it comes to therapies to treat covid, there’s mixed news about monoclonal antibodies. While a new study says monoclonal antibodies can produce “neutralizing activity” against the BA.2 subvariant of omicron, it notes that substantially higher concentrations are needed. A New England Journal of Medicine study found that two therapies—casirivimab/imdevimab and tixagevimab/cilgavimab—were able to inhibit BA.2, but to achieve a 50% reduction in infectious foci, researchers needed to dramatically increase the titer levels. With tixagevimab/cilgavimab, for example, the needed titer was up to 8.1 times higher than what is used for other variants of covid. For casirivimab/imdevimab, the titer needed to be up to 143 times higher than what is used for other covid variants. A MedPage Today article notes that researchers also found BA.2 showed susceptibilities similar to other covid variants to antiviral therapies like redmdesivir. Another covid therapy, convalescent plasma, has not fared so well. While early data seemed to demonstrate some benefit, more recent data haven’t been able to show that convalescent plasma is useful in treating covid. A news analysis in JAMA, which reviews much of the evidence behind the therapy, says one researcher hypothesizes that the therapy needs to be administered to patients early on to be effective, before the virus produces massive inflammation.

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.

December 24, 2021

First covid pills get nod from FDA

The FDA this week issued an emergency use authorization for Pfizer’s Paxlovid, a first-of-its-kind: an oral antiviral to treat high-risk covid patients. The agency also issued an EUA for a second pill that patients can take at home, Merck’s molnupiravir. Both antivirals are designed to prevent serious illness and hospitalization in infected patients at highest risk of progression, including those who are older or have conditions like heart disease or obesity. Merck’s pill is a five-day course compared to Paxlovid, which is taken for three days. While studies have found molnupiravir to be less efficacious than Paxlovid, some officials believe it will be helpful as omicron continues to spread. STAT reports that initial supplies of Paxlovid may be limited, with only 180,000 courses now available internationally. Federal officials expect to receive as many as 70,000 courses, and they plan to ration those out to hard-hit areas of the country. In other treatment news, a randomized study in NEJM establishes remdesivir—which is given through an IV—as another important outpatient treatment option. Among patients at high risk of progressing to severe disease, a three-day course of remdesivir vs. placebo delivered an 87% lower risk of hospitalization or death.

About those holiday plans…

Don’t even think of attending large gatherings this holiday season, even if you are boosted. That’s according to Anthony Fauci, MD, who has this advice: Spend the holidays at home with family as long as everyone is vaccinated, and consider getting yourself tested before get-togethers as another layer of protection. The New York Times reports that more than 3,000 Christmas Eve and Christmas Day flights have been canceled due in part to the spread of omicron. As for those who are able to still stick to their travel plans, experts have these tips for trying to stay healthy: get boosted, get tested as close to any gathering as you can, and consider the worse-case scenario and what you can do to mitigate that. The last recommendation may motivate you to wear an N95 instead of a cloth mask or to get a hotel room instead of staying with family and friends. And one note of good cheer: All employees at Park City Hospital in Park City, Utah, have access to free meals and groceries thanks to a pop-up store set up inside the hospital that’s funded by contributions from residents and donors. Medscape reports that the hospital is now using about $10,000 a month in donations to keep the store stocked. “The hospital store is evidence,” one ICU nurse is quoted as saying,” that we are valued.”

December 22, 2021

Administration: More emergency personnel will be deployed to hospitals

The Biden administration this week unveiled plans to help combat omicron. Those strategies rely on staffing help for hospitals, free at-home tests and new vaccination sites. According to the Washington Post, the president plans to send emergency medical teams to six states—Arizona, Indiana, Michigan, New Hampshire, Vermont and Wisconsin—where hospitals have been overrun with covid cases. The administration also plans to deploy 1,000 additional health care personnel including doctors, nurses and paramedics to medical centers in the next two months, as needed. FEMA has been directed to work with states and territories to set up more hospital beds before predicted surges, while the administration plans to distribute a half-billion free at-home tests in January, setting up a Web site where people can order them. The federal government is also setting up new testing sites including one in New York City this week. It also plans to establish hundreds of family vaccination sites, as well as launch mobile vaccination clinics.

December 21, 2021

Omicron reigns supreme

In an astonishingly short amount of time, omicron has become the dominant covid strain circulating in the U.S., accounting for 73% of all new cases in the week that ended Dec 18. According to Reuters, that percentage was only 13% the week before and local prevalence is running even higher, with omicron accounting for virtually all (more than 95%) new infections in parts of the Northwest and the Southeast. The fast-spreading strain is also wrecking havoc with standard covid therapeutics. Some hospitals have suspended the use of monoclonal antibody combinations—including bamlanivimab/etesevimab and casirivimab/imdevimab—because they’re not effective against omicron. Instead, the Washington Post reports, public health officials are stockpiling sotrovimab, the one monoclonal antibody that appears to work against the variant. Hospitalizations are up 20% over only a few weeks ago, with doctors and nurses reporting working in a “constant crisis.” Some hospital clinicians are now pleading with the public to mask up and get vaccinated via videos and ads taken out in local newspapers. For more on omicron in mid-December, visit UCSF’s Omicron in mid-December grand rounds.

December 15, 2021

How prevalent is omicron in the U.S.?

So far, the numbers are small, but experts expect them to rise—and fast. The CDC this week announced that the omicron variant accounts for 2.9% of all the covid cases sequenced in the U.S. during the week ending Dec. 11. To put that number in perspective, none of the cases sequenced the previous week were found to be omicron. That national average, however, doesn’t accurately reflect local and regional prevalence. STAT reports that the CDC director stated this week that omicron is causing about 13% of cases sequenced in New Jersey and New York. In the U.S., the delta variant is driving virtually all covid hospitalizations and deaths. Further, a major study out of South Africa this week confirms that while the omicron variant is more resistant to vaccine (or at least to two doses of Pfizer) than previous strains, it causes less severe disease. But European officials are sounding the alarm about how fast omicron is spreading and becoming the dominant strain in their countries—and that omicron seems to be spreading faster than the delta variant did earlier this year.

December 14, 2021

The vaccination program turns one

This week marks the first anniversary of when vaccines first became available in the U.S. to health care workers and other first responders. What has the impact of that program been? The authors of a new issue brief published by The Commonwealth Fund write that, without the vaccination program, 1.1 million more Americans would have died this past year while more than 10 million more patients would have been hospitalized. Most of the deaths and hospitalizations averted would have occurred in the late summer and early fall of 2021, as the delta variant spread. “If no one had been vaccinated,” the authors write, “daily deaths from COVID-19 could have jumped to as high as 21,000 per day—nearly 5.2 times the level of the record peak of more than 4,000 deaths per day recorded in January 2021.”

Pfizer posts good news about its antiviral pill

So far, the results have been delivered only via press release and need to be fully vetted. But STAT reports that Pfizer’s new oral antiviral—named Paxlovid—demonstrated 89% efficacy at preventing hospitalization and death in a study of more than 2,200 high-risk patients. That’s welcomed news after Merck recently announced that its therapeutic—also an antiviral pill—was showing only a 30% efficacy at preventing hospitalization and death. In the Pfizer study, patients were considered high risk because they weren’t vaccinated and they had at least one underlying medical condition or characteristic including being over 65, overweight or having cardiovascular disease. If the drug is approved, its demand may rapidly outstrip supply, with Pfizer announcing that it has 200,000 courses available this year, with production ramping up to 80 million doses next year.

December 13, 2021

One in 100 older Americans has died of covid

As the U.S. closes in on 800,000 covid deaths, the CDC paints a stark picture of the impact of covid on Americans age 65 and older. Three-fourths of all deaths from covid in the U.S., according to the CDC, have occurred in that age group, the New York Times reports. That works out to about one in every 100; for those younger than 65, the ratio is more like one in every 1,400. Among those age 65 and older, covid is now the third leading cause of death after heart disease and cancer. In other news, hospitals around the country are again running out of beds as cases due to the delta variant, predominantly among the unvaccinated, continue to surge. Geisinger Health System, which is one of the largest in Pennsylvania, no longer has any available inpatient or ICU beds in any of its nine hospitals, and patients presenting to that system’s EDs have had to wait up to 20 hours.

Covid targets, infects fat cells

It’s been clear since the pandemic began that patients who are overweight or obese run a higher risk of more severe disease. Now, researchers writing in a preprint say their study provides the first in vivo evidence that covid infects fat tissue and elicits an inflammatory response. As New York Times coverage points out, the findings may suggest new treatments that target fat tissue. According to the study, fat cells act as a type of reservoir for the virus—and infected fat cells may be implicated in long covid where patients continue to experience symptoms for weeks or even months. Study results also suggest that weight or obesity should be considered when using covid treatments or vaccines

December 10, 2021

A vaccine milestone and a terrible holiday forecast

This week marked an important vaccination milestone: Two hundred million Americans have now been fully vaccinated, according to the AP. The bad news: That adds up to only 60% of the population, as hospitalizations due to the delta variant are up 25% over last month and 1,600 daily deaths continue. The COVID-19 Forecast Hub run by UMass Amherst now projects 829,200 American deaths by Jan. 1, with 35,000 more deaths taking place within the next three weeks. (The current death toll is around 793,000.) Estimates for the same time period from the University of Washington’s IHME aren’t much better. Boston Medical Center’s Good Grief Program, which helps find resources for grieving children, has seen a 50% increase this year in the number of families asking for services, with 10% of those requests due to the loss of a family member from covid. And as if things weren’t bad enough, some school districts want to return to virtual teaching on Fridays to try to help stave off burnout among teachers.

Long haulers lack diagnostic and treatment plans

A new chronic illness is taxing both the health system and the government safety net, with many patients who suffer from long covid no longer able to work or to access health care coverage. The Washington Post reports that while there are no firm data on how many Americans are living with long covid, some specialists estimate that between 750,000 and 1.3 million patients are so debilitated with the condition that they’re no longer able to work. Long covid has no established treatment plan, while some insurers won’t cover the cost of testing for the syndrome and even patients who can secure long-term disability coverage have a hard time receiving benefits. So far, protocols for testing for and treating long covid haven’t been established, due to a lack of definitive research. As Wired points out, the federal government has given $1.5 billion to the NIH to study the syndrome over the next four years. But the fact that patients can suffer from one or more of 200 different symptoms is part of the reason why it’s so hard to define a research agenda. A new preprint study finds that covid both targets and infects fat cells—and that infected fat cells may be implicated in long covid.

December 8, 2021

Omicron and immunity

Preliminary results (that aren’t yet peer-reviewed) on how omicron interacts with vaccine-induced antibodies provides both good and bad news. On the down side, study authors found that the variant isn’t as susceptible to immunity as other strains. That leaves previously-infected patients at higher risk of reinfection, while those who are vaccinated run a greater risk from omicron of breakthroughs. But as the Washington Post reports, the research—which tested the efficacy of the Pfizer vaccine against omicron—did find the vaccine offered some protection. The research suggests that vaccine boosters could have a significant impact against the strain, results also found in Pfizer’s own lab studies, according to a company press release. In other news, U.K. experts have detected a “stealth” mutation that can’t be detected as omicron with routine PCR testing. While test results on the mutation will show patients to be positive for covid, the strain can be identified as omicron only through genomic testing.

December 7, 2021

The CMS puts its vaccine mandate on hold

In response to legal challenges, the CMS has suspended its vaccine mandate for all health care workers in facilities that participate in the Medicare and Medicaid programs. HealthLeaders reports that the CMS has appealed two federal injunctions granted in late November that affect mandatory vaccinations for health care workers in all states. The CMS points out, however, that hospitals are free to pursue voluntary vaccination requirements among their workers. Meanwhile, OSHA has also suspended its mandate requiring employers with 100 or more employees to mandate either vaccination or regular testing, and that agency has extended the public comment period on the requirement.

How to keep clinicians in the workforce

The pandemic has not only caused providers an unprecedented level of burnout and exhaustion, but it’s subjected them to harassment and distrust due to vaccine misinformation and misinformation. To meet those challenges and to preserve the health care workforce, opinion writers in Annals lay out a 10-point manifesto they call on hospitals and organized medicine to help implement. “(T)he entities that employ us,” they write, “must move beyond suggesting stress-reduction activities, such as yoga and meditation, to provide the tactical support clinicians need.” Among other necessary actions, that support includes ensuring clinicians’ on-the-job safety through vaccine mandates, PPE, and ventilation; providing professional development to help clinicians manage anger when dealing with unvaccinated patients; extending support to parents in the form of flexible scheduling; offering free and confidential mental health resources; removing all questions about mental and physical health diagnoses from credentialing and employment applications; and implementing suicide prevention strategies, including wellness check-in for clinicians in hard-hit areas.

December 6, 2021

Omicron: more contagious but less severe?

With omicron now confirmed in more than a dozen states, very early data contain possible clues about its transmissibility and severity. A report from South Africa on one district’s early experience there indicates that most patients hospitalized with the variant didn’t require supplemental oxygen or ICU-level care. News items point out, however, that the report is based on a small patient sample, while experts do note how rapidly caseloads in South Africa are rising. That hints at omicron’s greater transmissibility vs. delta’s. Another early indication: Reinfections with omicron may be more frequent than with previous variants. The Atlantic lays out both the worst- and best-case scenarios of the new variant. The author argues that a strain that causes broad infection but causes only mild symptoms might be a good thing.

December 3, 2021

mRNA vaccine safety—and which one is the winner

More evidence that mRNA vaccines—or at least the Pfizer vaccine—are safe among older patients: French researchers in a nationwide study find no jump in the number of heart attacks, strokes or pulmonary emboli among patients ages 75 or older in the two weeks after each vaccine dose. The authors looked at close to 3.9 million people. As for the efficacy of mRNA vaccines, an NEJM study comparing the effectiveness of the Pfizer and Moderna vaccines finds that Moderna’s performed better in preventing infection, hospitalization and death. The research followed close to 450,000 veterans over six months. Compared to those receiving Pfizer vaccine, those given Moderna’s had a 21% reduced infection risk and a 41% lower risk of being hospitalized. An editorial, meanwhile, points out that Moderna’s edge in that research makes it only “marginally more effective” and reaches this conclusion: “The message is that the best vaccine is the one that’s available.”

If antivirals are the next frontier, how will patients access them?

An FDA advisory panel this week (narrowly) recommended authorization of Merck’s molnupiravir, which if approved would be the first oral antiviral to fight covid. While recent manufacturer results give molnupiravir an only 30% relative risk reduction in covid hospitalizations or deaths, not the 50% originally indicated, the drug—if authorized—could appreciably reduce the number of covid patients in hospitals. But patients would need to receive it within the first few days of experiencing symptoms, and the author of a new MedPage Today opinion piece points out that 25% of patients in the U.S. don’t have a primary care physician. To ensure adequate delivery, he recommends expanding access to telehealth; he is a chief medical officer of a telehealth company, as well as a PCP. He also recommends allowing nonphysicians to prescribe molnupiravir and any other approved antivirals and fast-tracking antivirals so they can be sold over the counter.

December 1, 2021

Omicron arrives in California, Minnesota (updated Dec. 3)

U.S. officials this week confirmed the omicron variant in a patient in California, the first case of the South African strain to be detected in the U.S. (It’s pronounced with a short o: aa-muh-krann.) That patient, STAT News reports, was fully vaccinated and had returned from South Africa on Nov. 22, testing positive with mild symptoms on Nov. 29. Additional patients with omicron have now been confirmed in several states. Studies are underway on omicron’s many and worrisome mutations, with 32 in the virus’s spike protein alone. News coverage in Israel, where cases have also been confirmed, notes that omicron infections in vaccinated people there have so far been mild, and very early data indicate that those who are fully boosted within six months have decent protection against the strain. As part of its response, the CDC now says that every American 18 and older should get a booster after six months of a two-dose course of Pfizer or Moderna vaccine and after two months post-J&J vaccine. As for covid cases driven by the delta variant, caseloads are up in the Northeast, Midwest and Mountain West, with more than 80,000 new U.S. daily cases being reported.

Staff shortages force cutbacks in elective procedures

Massachusetts this week began requiring hospitals in that state to reduce non-urgent elective surgeries and procedures. That’s not due to hospitals being overwhelmed with covid patients, but to try to manage staffing shortages and to preserve capacity for non-covid patients. FierceHealthcare reports that, according to state guidance, Massachusetts’ hospitals now have 500 fewer med/surg and ICU beds, due to being short-staffed. The requirement won’t affect urgent or necessary procedures. In other news about hospital staff, facilities in Florida must now contend with conflicting vaccine mandates. The CMS earlier this month began requiring all hospitals that participate in Medicare and Medicaid programs to mandate covid vaccinations for their workers. But the Florida legislature two weeks later passed a bill prohibiting vaccine mandates in the state. Meanwhile, a federal judge has blocked enforcement of that vaccine mandate in 10 rural states until a court decides whether the federal government has the jurisdiction to issue it.

Who deserves hero pay?

State and local governments are struggling to decide which frontline workers should be eligible for hazard pay due to the risks they took in their jobs in the months before covid vaccines became available. As part of a pandemic relief package, the federal government made funds available for “hero pay” and suggested various occupations—including farm and child care workers, truck drivers and janitors—that should be eligible for it. According to PBS coverage, interim federal rules allow relief funds to pay essential workers up to $13 an hour, with each worker receiving no more than $25,000. The state legislature in Minnesota, for instance, has $250 million to disburse, but lawmakers can’t agree how to distribute it. Republicans in the state senate there want to give those funds as bonuses to workers who took very high risk, including nurses, long-term care staff and first responders. Democrats, however, want the funds to be more broadly distributed including to food-service and supermarket employees. Some unions, meanwhile, are pressuring state governors to give some money to all essential workers in both public and private sectors who worked during the pandemic pre-vaccines

November 30, 2021

Omicron arrives in North America

Officials in Ontario this week announced that the omicron variant—a highly-mutated covid strain first detected in South Africa—has been confirmed in two cases there, both in travelers who tested positive after being in Nigeria. The variant is causing concern because of mutations that could make the strain more transmissible and allow it to avoid immune responses, including ones produced by vaccines. Some countries have already imposed travel bans and closed their borders. Studies are underway on the variant’s many mutations, with 32 in the virus’s spike protein alone. According to coverage in Israel, where cases have also been confirmed, omicron infections in vaccinated people have so far been mild.

November 19, 2021

Why are so many health care workers leaving their jobs?

An Atlantic article takes an in-depth look at why nearly one in five health care workers have quit their job since the pandemic began. The report talks about the “deep psychological scars” that health care workers have suffered from witnessing death “on a scale” they had never seen before. And since so much of that death and suffering has become preventable because of vaccines, many people feel a lack of compassion that is sending them to the exits. The article also notes that typical covid patients are changing, with some becoming increasingly belligerent and vocal and resisting basic medical procedures. One of the article’s conclusions: “Health-care workers aren’t quitting because they can’t handle their jobs. They’re quitting because they can’t handle being unable to do their jobs.”

Overdoses and eating disorders rose during the pandemic

Two new side effects of the pandemic came to light this week: a record-breaking number of overdoses and a rise in eating disorders in hospitalized patients. Fierce Healthcare reports that CDC data found more than 100,000 Americans died of a drug overdose between April 2020 and April 2021. That’s a whopping 28% increase in overdose deaths compared to the previous one-year period. It’s also the first time the country has seen 100,000 overdose deaths in a one-year period. Public health experts say the jump is in part due to a spike in fentanyl overdoses, which saw a 50% increase during that period. And a study in JAMA Network Open found that inpatient stays for eating disorders rose during the pandemic. The number of inpatients receiving care for eating disorders doubled in May 2020 from 0.3 per 100,000 people to 0.6 per 100,000 people. The increase was seen in patients with anorexia nervosa, bulimia nervosa, and other eating disorders.

As cases begin to surge, boosters take on a higher profile

With cases of covid rising and raising fears about a winter surge, public health officials are expanding their focus on the role booster shots can play in staving off a new wave of infections. An NPR report says that growing outbreaks in the Northeast and Midwest are fueling the rising numbers even in well-vaccinated areas. In response to these numbers, public health agencies are moving to authorize boosters for all adults, not just people who are over 65 or facing a higher risk of infection. The New York Times reports that the CDC is meeting today to examine data on the Pfizer vaccine and is expected to expand the number of Americans who are eligible for the shot. And the FDA is also scheduled to meet today to discuss making booster shots of the Moderna vaccine available for all adults. A number of states like Arkansas, California, Colorado and New Mexico have already opened up boosters to most adults, deciding not to wait for a green light from public health agencies. While public health officials would like to raise overall vaccination rates around the country, Anthony Fauci, MD, this week said that booster doses are vital in changing covid from a pandemic to an endemic. A Medscape report quoted Dr. Fauci as saying that expanding the availability of boosters to everyone could help meet that goal by the spring of 2022. Data published in the American Journal of Infection Control found that 70% of U.S. health care providers are fully vaccinated, with the highest vaccination rates in children’s hospitals (77%) and people in metropolitan counties (71%). Researchers noted that vaccination rates increased quickly between January of 2021 (36%) and April of 2021 (60%), but that the increase in rates has slowed since then.

Patient concerns about vaccine effects down, but misinformation is up

In the struggle to fight covid misinformation, doctors around the world are reporting good news and bad news. A survey by the social media company Sermo of physicians around the world has found that fewer patients are concerned about the side effects of the covid vaccine than six months ago (59% vs. 72%), but more patients are coming to them with vaccine misinformation than six months ago (53% vs. 45%). Common misperceptions include the idea that the vaccine modifies patients’ DNA; it causes infertility; it contains a microchip; and it gives you covid. The survey also found that most physicians (62%) say their patients are asking for the Pfizer vaccine, that most patients are more reluctant to vaccinate their children than themselves, and more physicians believe that the biggest hidden consequence of covid will be the long-term financial impact on the health care system.

November 6, 2021

The battle over vaccine mandates heats up in health care

With the Biden administration announcing that health care workers at facilities that accept Medicare must be vaccinated by Jan. 4, the vaccine mandate wars are heating up. One news report says that Kaiser Permanente is denying the vaccination exemptions based on religious beliefs because of “similar or nearly identical” language used to describe the requests for an exemption. The health system heard reports that employees were having “open discussions” on how to misuse the religious exemption to get out of the vaccine mandate. Kaiser was in the news last week thanks to a nurse who posted a viral video of her being escorted out of a hospital after refusing to get vaccinated. In the video, which has the title, ” Kaiser-Permanente goes full Nazi: Fires nurse for not taking experimental shot,” the nurse claims she’s being deprived of her freedom because the health system won’t honor her religious beliefs. The U.S. Supreme court last week turned away a group of nine health care workers from Maine seeking a religious exemption to their state’s vaccine mandate. A Reuters report says that six members of the court voted to deny the request, but that three of the conservative justices sided with the health care workers. Maine voters last year rejected a referendum that would have overturned the state’s vaccine mandate for health care workers. But in Louisiana, a state appeals court ruled that a health system can’t fire or discipline workers for refusing the vaccine while the mandate is being hashed out in the courts. An AP report says that if the ruling holds, it could eventually affect the enforcement of mandates across the state.

Post-infection vaccines give big boost to immunity

New data from the CDC say that people who have had covid but never got vaccinated are five times as likely to get infected again when compared to fully vaccinated people who were never infected. MDedge coverage says that researchers concluded that for at least six months, vaccination can provide higher, stronger and more consistent level of immunity against covid than being infected. Another study in Cell Reports also shows that getting vaccinated after a covid infection will help ensure a “robust” immune reaction. Getting vaccinated after an infection, researchers found, offers more protection than two vaccine doses give people who haven’t ever had covid.

Two studies examine mental health fallout of the pandemic

Two new reports provide a look at how the pandemic is affecting the mental health of physicians and frontline clinicians. A study of just over 5,000 physicians in Italy, Spain and the UK in the spring of 2020 and the early winter of 2020 found reports of anxiety and depression were worse in female and younger physicians. A Medscape report says those symptoms were more prevalent in physicians who felt vulnerable or exposed at work, and in physicians who reported normal/below-normal health. Physicians in Italy, for example, where physicians reported some of the worst shortages of PPE, had the highest levels of moderate anxiety and moderate/above moderate depression. Because the levels of these symptoms didn’t decrease between the two surges, researchers concluded that they are likely “persistent.” A prospective study of 50 health care workers in the New York City area found significant mental health affects of the pandemic in emergency medicine physicians, nurses, residents, nurse practitioners and physician assistants who served on the front lines during the pandemic. Another Medscape report says the study found that 48% of subjects were positive for acute stress, 37% were positive for depressive symptoms, and 30% were positive for anxiety symptoms. Researchers also found no significant differences in these symptoms among housestaff, attendings and nurses.

Hospitals struggle to keep fully staffed, beds open

Facing their own version of the Great Resignation, hospitals around the country are trying to cope with an exodus of employees by raising wages, but smaller hospitals often find themselves at a disadvantage. A HealthLeaders report says that smaller hospitals often can’t compete in bidding wars for employees not only when it comes to pay and benefits packages, but retention strategies. Nursing shortages—spurred in part by higher wages offered by travelling positions—have forced some Mississippi hospitals to close beds. A Mississippi Public Broadcasting report notes that the state’s emergency management agency brought in contract nurses for 60 days, but that expired at the end of last month.

“Vax” named the 2021 word of the year

One of the most controversial aspects of the covid pandemic has captured the attention of linguists. The Oxford English Dictionary has named “vax” its word of the year for 2021. “A relatively rare word in our corpus until this year, by September it was over 72 times more frequent than at the same time last year,” the dictionary said in a statement. “No word better captures the atmosphere of the past year than vax.” To accompany its announcement, the publication has released a report on the language of vaccines. The dictionary last year chose dozens of terms for its word of the year honor. That list featured several pandemic-related words including “coronavirus,” “lockdown” and “social distancing.”
November 3, 2021

Covid hurting the finances of PCPs and hospitals

Two new reports say that the financial crisis in health care caused by the pandemic is showing no signs of letting up for PCPs and hospitals. A new survey by the Primary Care Collaborative found that less than one-third of practices said they are financially healthy and 32% said their practice revenue has yet to recover from the pandemic. Perhaps even more alarming, 52% of practices reported that pandemic-related strain is now severe/near severe. (A survey conducted in May/June of 2020 found that same level of strain.) While some physicians have reported in other surveys that telemedicine has helped them weather the financial storm by bringing in new revenue, 21% of practices said they had to pull back on telemedicine because of reduced payments for the technology, and 25% worried that telemedicine would weaken primary care over time. On the hospital side of the equation, finances are also looking shaky. The National Hospital Flash Report from the consulting firm KaufmanHall found that hospitals are financially strapped from a combination of rising expenses and sagging volumes compared to pre-pandemic levels. HealthLeaders reports that between August and September of this year, the median operating margin at hospitals dropped 18%. Hospitals in areas hit the hardest by covid took the biggest hit to their operating margins in part because they’re treating sicker patients who are staying longer.

Payment delays, denials heating up in covid?

Further hurting the finances of hospitals and physicians is what a new report is calling a “revenue grab” by insurance companies. A Medscape report says that even though insurers have reported record profits during the pandemic, they are delaying payment on claims and putting up more barriers to any form of payment for more complex claims. One practice consultant said that complex claims (those with -25 modifiers) now routinely generate requests for more information, which slows down payments. And an internist interviewed by Medscape said that multiple payers are now asking for documentation for prepayment review for higher-level claims for established and new patients. One academic system recently made a complaint against Anthem in which it said that the insurer is requiring itemized bills for any claims over a certain dollar limit, asking for detailed medical records for even clean claims, and requiring the system to upload documents to a Web portal that has technical issues and loses claims. The complaint says that the insurer owes $171 million in claims that are over 90 days old.

October 29, 2021

Hospitals face increasing lawsuits and threats over ivermectin

The fight over the use of the anti-parasitic drug ivermectin to treat covid continues to heat up around the country. In Montana, a Helena hospital is accusing three high-ranking officials from the state government of threatening and harassing physicians who refused to give the drug to their covid patients. A MedPage Today report says that the hospital has not named the three, but the state attorney general’s office claims that officials got involved at the request of covid patients who were denied ivermectin. A state senator admits that she contacted the hospital (although denies making any threats), saying that if the patient was “circling the drain,” she should be allowed to “take responsibility” for her medical care as “a free American adult.” Around the country, at least two dozen lawsuits have been filed seeking to force hospitals to give the drug to covid patients. A Medscape report says that several of the lawsuits have been filed by one western New York lawyer, and that results have been mixed. In at least two of the cases, the patients received the medication and survived to be discharged. Finally, an article in the Atlantic looks at 30 reports that support the use of ivermectin to treat covid. Reporters found that some of the papers have been withdrawn and that research methodologies in other reports are so “shoddy” that the results probably should be withdrawn. Registration may be required to read the piece, but it’s worth a look.

Immunity from covid infections could fade in as little as 3 months

Modeling says that natural immunity from being infected with covid will fade quickly. A study in The Lancet Microbe used modeling to project how much protection immunity covid infection may actually offer. Researchers estimated that reinfection could occur in a median of 16 months after peak antibody response, but the lead author said reinfection could reasonably happen within three months. Becker’s Hospital Review says the study predicts that reinfection will become “increasingly common” as covid transitions into an endemic disease.

October 22, 2021

It’s official: the FDA OKs Moderna, J&J boosters

The FDA this week gave the green light to booster shots for those originally vaccinated with Moderna and J&J vaccines. The extended EUA for Moderna is for the same vaccinated populations as were approved earlier for a Pfizer booster: those 65 and older, those 18 and older at high risk of severe covid, and those 18 and older with frequent institutional or occupational exposure—like health care workers. The Washington Post reports that the J&J booster was authorized for anyone 18 and older, and patients will be eligible for that booster two months after their original single dose. As for the Moderna booster, which is half the dose of the primary series, people need to wait at least six months after their second original dose. While the FDA also endorsed a “mix and match” strategy, allowing people to access a different vaccine booster than the one they originally received, the agency had no recommendations as to the best vaccine-booster combination.

Is another cold weather spike on the way?

Southern states including Georgia and Florida are finally seeing some relief with falling case rates, hospitalizations and deaths. But cases in cold spots are on the rise, the same pattern seen last year. CNN reports that, based on data from Johns Hopkins, five states this week saw case rates rise 10% over last week’s: Iowa, Oklahoma, Alaska, Vermont and New Hampshire. The New York Times reports that while Alaska now has the highest number of new cases per capita, five other states have the fastest rising caseloads: Vermont, Colorado, New Hampshire, Michigan and Minnesota, all states where the weather has turned cold. Experts chalk rising caseloads up to people staying indoors, poor ventilation and the lack of mask mandates in schools. They warn that it’s too soon to do away with mitigation strategies like masking and social distancing, even in areas with high vaccination rates.

Study: Overweight, obesity linked to worse symptoms

Previous findings have found that patients who are overweight or obese are at higher risk of severe covid outcomes including ICU admission, ventilation or death. A new study now finds that overweight and obese patients have a greater range and number of symptoms, even in mild covid, and they experience those symptoms longer. In the prospective study, which appeared in Influenza and Other Respiratory Viruses, 59% of overweight and obese covid patients were symptomatic vs. 49% of those who were not, while overweight and obese patients experienced three vs. two symptoms. Further, they had significantly higher coughing, shortness of breath and altered taste. In study coverage, MedPage Today reports that adolescents who were overweight or obese were significantly more likely to be symptomatic than those who weren’t (67% vs. 34%) and to have a higher median number of days with respiratory symptoms (seven vs. four).

October 18, 2021

FDA panel green-lights J&J booster

An FDA advisory panel last Friday endorsed a booster shot for those who received J&J’s one-dose vaccine. Further, the panel noted that those people could get a booster dose only two months after their initial one—an opinion that had experts pointing out that, probably, J&J should have been administered as a two-dose vaccine all along. The New York Times notes that, according to the company’s own data, a booster raises the vaccine’s efficacy against mild to severe disease to 94% vs. 74% for a single dose. However, other data find that a J&J booster within two months of an initial dose raises efficacy to 74%, up from 66%. Preliminary (non-peer reviewed) data also indicate that those who received an initial J&J vaccine may get better immunity with an mRNA booster. A final decision from the FDA on both the Moderna and J&J boosters may come in a few days.

Surge seen in nursing school enrollment

While the pandemic is burning out nurses, particularly those in hospitals, nursing schools report a spike in enrollment. News reports indicate that enrollment in nursing programs—bachelor’s, master’s and doctoral—rose 5.6% in 2020 from 2019 figures. While enrollment figures for the 2021-22 year aren’t yet available, the University of Michigan received 1,800 applications for its 150 slots available this year, up from 1,200 applications in 2019. But increased enrollment is coming up against the fact that many senior nurses—including those in faculty—are retiring or burning out as a result of the pandemic. In related news, experts say that nurses in hospitals don’t need wellness resources from administrators and leaders. Instead, they need trauma support.

Possible new mRNA side effect?

A French monitoring report highlights Parsonage-Turner syndrome as a possible side effect of mRNA vaccines, even though the effect is very rare. According to coverage of the report, the syndrome has shown up in six patients who received the Pfizer vaccine, with four of those cases occurring in the first two weeks of September, and in two patients who received the Moderna vaccine. The condition, which is more common in men than women, is characterized by severe and sudden-onset shoulder pain followed by arm paralysis. The flu vaccine has also been implicated in some reports of the syndrome.

October 15, 2021

Moderna booster and the mix-and-match vaccine strategy

An FDA panel this week recommended a Moderna booster for many of those who received that vaccine six months or more out from their second dose. The panel’s endorsement was for a half-dose booster for those 65 and older or younger people at high risk due to their medical conditions or employment. The FDA this Friday is also considering findings from a new NIH study, released in preprint, that indicate that mixing and matching vaccines—using a different type of booster than the original vaccine given—not only works but appears to be safe. News outlets report that study subjects were divided into groups based on their original vaccinations, then given a booster of either Pfizer, Moderna or J&J. Their antibodies were measured at both two and four weeks. Those who got two doses of Moderna originally and then a Moderna booster had the highest level of antibodies, followed by those with Pfizer originally and a Moderna booster, than by Pfizer/Pfizer. Significantly, those originally given J&J got the best antibody response when receiving either a Pfizer or Moderna booster. For the study, researchers used full-dose vaccines as boosters, although the Moderna booster the FDA is considering is only half dose.

Delta’s deadly September

Case and death rates continue to drop in the U.S. from the delta surge that swamped parts of the country in August and September. New data now indicate that during September, covid was the second leading cause of death in the U.S. overall (at 1,899 deaths per day), trailing only heart disease (2,078 per day)—but it was the No. 1 cause of death in the country among people ages 35 to 54. One indication of how lethal delta has been: In July 2021, before the delta surge, covid had fallen to the No. 7 leading cause of death overall in the U.S. The highest covid death toll occurred in December 2020 and January 2021 before mass vaccination was available; during those periods, covid was the country’s leading cause of death. The data were part of an analysis published by the nonprofit Peterson Center on Healthcare and the Kaiser Family Foundation.

October 14, 2021

Violence in hospitals may be on the rise

Hospitals have always been a dangerous place to work, particularly in the ED where patients with psychiatric and substance use disorders first present. But Kaiser Health News reports that the pandemic is exacerbating that problem in hospitals, just as it is in school board meetings, sports stadiums and on airplanes. According to the coverage, patients are threatening to bring guns to the hospital if visitor restrictions aren’t waived, while covid patients can become confused from low oxygen, then combative. Part of the problem is that thinly-stretched staff don’t have the time to recognize conflict in the making and de-escalate it. Hospitals are responding by beefing up security staff, installing cameras, teaching de-escalation techniques and even bringing in guard dogs, as well as giving individual workers panic buttons to put on their badges. National nursing unions are asking Congress to pass laws that require hospitals to draw up violence-prevention plans. In related news, scientists who speak out about covid are also facing threats. A feature in Nature reports on a survey in which more than 300 scientists across several countries who had spoken to the media or posted on social media about covid were asked about any harassment or abuse. The findings: 15% had received death threats, while more than 20% had reported threats of physical or sexual violence, and more than 40% admitted to emotional or psychological distress because of threats they’d received.

October 8, 2021

Multidisciplinary review committee slashes discharges to SNFs

Given how dangerous covid infections can be for SNF patients, clinicians at Illinois’ NorthShore University Health System last year set about to reduce the number of patients being discharged to SNFs. Their solution: creating a multidisciplinary committee that met one hour a day, six days a week, to review possible SNF discharges. Results, which were published by the Journal of Hospital Medicine, indicate that implementation of that review saw total SNF discharges fall from 25.5% of discharges to 12.8%, while the number of new SNF discharges tumbled from 17.5% to 5.8%, a better than two-thirds reduction. The authors also saw no increase in readmissions or in patients’ length of stay, and they estimate that the steep drop in discharges to SNFs helped prevent one covid infection every 5.6 days of the intervention. The review committee consists of physicians (half are hospitalists and half are outpatient—case managers), social workers, physical and occupational therapists, and the director of the health system’s home health agency.

FCC telehealth disbursement program: There’s plenty more

If you applied to the FCC’s covid-19 telehealth program for funds but missed out on the latest round of approvals, take heart: mHealth Intelligence reports that remaining applicants can revise their proposals and try again. The FCC last month awarded more than $41 million to more than 70 health care organizations to help them expand their telehealth platforms. Those awards came on top of close to $42 million awarded to 62 health care organizations earlier this summer. But the FCC’s telehealth program, which received a budget of close to $250 million from Congress for this year, still has more than $160 million to disburse. The FCC program functions via reimbursements, with providers having to submit invoices and supporting documentation to be paid for eligible telehealth services and expenses.

October 6, 2021

The four stages of pandemic emotion

First, there were last year’s horror, which gave way this spring and summer to hope as Americans rushed to be vaccinated and normal life again seemed possible. But that turned into rage this summer as the delta variant tore through unvaccinated populations, filling hospitals and morgues once again. Now, according to a STAT article, some experts are cautiously optimistic that case rates and hospitalizations will continue to trend down and that high-enough percentages of the population will either be vaccinated or previously infected, stopping further catastrophic spread. However, article sources point out that “moving on” looks very different for college students, for instance, who are back to normal with some restrictions than for health care workers, many of whom are either angry or numb. And some public health officials warn that it’s way too early to celebrate, noting how often the pandemic’s end has been predicted prematurely.

October 4, 2021

More milestones passed: 700,000 dead in the U.S., 5 million worldwide

Late last week, the U.S. tallied 700,000 dead from covid, while the global death toll surpassed 5 million. Reuters reports that while it took more than a year for the death toll worldwide to hit 2.5 million, the second 2.5 million deaths have occurred in less than eight months. With covid now the deadliest pandemic in U.S. history, experts estimate that close to 200,000 deaths in the U.S. could have been prevented if those patients had been vaccinated. Some good news, however: New U.S. cases have dropped by more than one-third in the past month, another example of what New York Times coverage is calling a two-month covid cycle, with cases surging for two months than declining for the same amount of time. Explanations for what drives those cycles include seasonality as well as the social distancing and precautions people take in response to high local case- and death rates. Over the past month, the number of covid hospitalizations has dropped 25%, while the number of deaths in the past two weeks has declined 10%.

Vaccine mandates much riskier for rural hospitals

The question of whether a vaccine mandate will work in your hospital and not cause a brutal exodus of staff has a lot to do with where your hospital is located. That’s according to the Washington Post, in an article describing how the stakes for rural hospitals in terms of staff quitting or being fired over mandates are much higher than in urban or suburban facilities. Across Virginia, several hundred health care workers have already been suspended or fired. But rural hospitals in the state are harder hit because more staff in rural areas have vaccine hesitancy or resistance, and those hospitals don’t have larger staffs to cushion the blow of losing some members. The article contrasts two health systems in Virginia: Inova in northern suburban Virginia, and Ballad Health, which has several rural hospitals in the southern part of the state (as well as in Tennessee). With a mandate in place, Inova lost less than half of one percent of its staff—and the health system finds that having a vaccine mandate in place helps to recruit new staff to fill those slots. But the CEO of Ballad Health says that if the health system put a mandate in place—which it hasn’t—it might lose up to 5% or even 10% of its staff. That’s too much of a hit for the health system to take, particularly because it’s much harder for rural hospitals to recruit new staff than in urban or suburban ones.

October 1, 2021

Sign of the times: individual panic buttons on the wards

A hospital in Missouri this year is issuing hundreds of panic buttons to its ED and inpatient staff, having staff members attach them to their ID badges and use them to call security if they need to. The move comes in response to the number of assaults, which have tripled over the past year, on staff by patients in the hospital. Business Insider reports that the hospital in 2020 logged 123 assaults, up from 40 in 2019, and that injuries among staff from assaults in 2020 numbered 78 vs. 17 the year before. The hospital’s health system piloted the use of the buttons at another of its hospitals. The distress calls will be displayed through the nurse-call system. In response to increasing incidents, The Guardian notes, some hospitals are limiting their number of public entrances and are training staff in de-escalation techniques.

Breakthrough infections in hospitals: Don’t let up

In July, Israeli researchers published findings about early breakthrough infections among health care workers in their medical center, the largest in Israel. Their conclusion: Breakthrough infections were rare. In a new NEJM correspondence, several of the same authors point out that their earlier research looked at breakthrough infections caused by the alpha variant. With the delta variant now circulating, many more fully vaccinated workers in their center over the summer came down with breakthrough infections and 71% were symptomatic, although none needed to be hospitalized. “These findings,” they write, “call for further rigorous preventive measures, such as booster vaccinations, in-hospital social distancing, extensive use of personal protective equipment, judicious out-of-hospital behavior, and frequent molecular testing after the occurrence of symptoms or known exposure to infected contacts.” (The authors found that rapid tests missed many positives.) In some bright news, the CDC this week predicted that the number of covid deaths in the U.S. will decrease over the coming month—for the first time since June. The CDC forecast also called for fewer new covid hospitalizations. Currently about 2,000 people are dying per day, CNN reports, and 114,000 new daily cases are being detected.

Short on nurses? LPNs can fill the gaps

According to a HealthLeaders article, Pittsburgh’s Allegheny Health Network is easing the nursing shortage in its hospitals by once again hiring licensed practical nurses (LPNs; also referred to as licensed vocational nurses or LVNs). Over the last decade, LPNs have been squeezed out of acute care, as hospitals moved to hire nurses with bachelor’s degrees and LPNs gravitated to nursing home and other post-acute care settings. Now, however, Allegheny is piloting programs with LPNs in the hospital as part of “blended” bedside teams led by RNs; those teams include LPNs and nursing assistants. So far, the bedside teams have delivered lower hospital lengths of stay and have been successfully integrated in med-surg units, rehab floors and orthopedics. The health system plans to roll out the nursing team model in the ED. In a Philadelphia Inquirer commentary, several nurses shared their experiences working through the pandemic. One veteran ICU nurse retired after weeks of seeing several patients a day die from covid, while others report unprecedented turnover rates and brand-new nurses having to take on many more—and much sicker—patients than is safe.

A good fit, but telehealth in rural America isn’t getting off the ground

While the use of telehealth has exploded since the beginning of the pandemic, rural America is largely being left behind. The lack of access to high-speed Internet remains a huge barrier, but an article in STAT highlights other challenges: poor reimbursement, interstate licensing rules and a lack of trained clinicians. While telehealth has made major inroads in suburban and urban settings, the disparity in access to telemedicine in rural areas is exacerbating other inequities in income and infrastructure. Some telehealth companies are trying creative solutions, partnering with rural schools to provide care to children via their school computers and putting telehealth kiosks in rural grocery stores.

September 29, 2021

CDC: Third-dose side effects mirror second-dose ones

If you experienced no adverse effects from your second covid vaccine dose, chances
are you won’t after your third dose either. That’s according to early data from the CDC, which were drawn from 12,500 submissions to the CDC’s smartphone-surveillance network from people receiving a third dose of either the Pfizer or Moderna
vaccine. (Submissions were made over five weeks in August and September and came from immunocompromised patients receiving a third dose of either vaccine.) In a report, the CDC notes that 79% of those administered a third dose experienced local or systemic reactions vs. 78% of those who had similar reactions after their second dose, and “no unexpected patterns of adverse reactions were observed.” As of Sept. 19, the CDC said, more than 2.2 million people in the U.S. had received additional vaccine doses after their primary series. In other vaccine news, Pfizer this week submitted data on the efficacy of its vaccine in children ages 5 through 11 to the FDA. The AP reports that, if the FDA does authorize the use of the vaccine in young children, shots may not be available until November.

September 27, 2021

Vaccine mandate: Time’s up for unvaxxed New York health care workers (Vaccine mandates may be working- updated Oct. 1) 

It was crunch time for health care workers in New York this week, with workers in that state needing to have at least  one dose of covid vaccine or face possible termination. The mandate appears to be effective, with the New York Times= reporting that vaccination rates (with at least one shot) among health care workers in New York jumped this week to 92% vs. only 82% of nursing home workers and 84% of hospital workers just one week ago. To offset potential staff shortages, New York’s governor declared a state of emergency, allowing the state to deploy National Guard members to fill staff positions. The governor also waived licensing requirements to allow health care workers from other states to come to New York. According to Fierce Healthcare, hospitals and health systems around the country with vaccine mandates have seen better than 90% compliance. In other vaccine news, the CDC announced that, according to early data, most people receiving their third dose of covid vaccine are having similar side effects to the ones they had after their second dose. And while Pfizer submitted data to the FDA this week on the efficacy of its vaccine in children ages 5 through 11, news organizations indicate that, if the FDA does authorize vaccine in young children, shots may not be available until November. And Merck today announced this first: Trial results for its antiviral pill, molnupiravir, indicate that the treatment reduces patients’ risk of hospitalization and death from covid by close to half. The  company plans to seek emergency authorization for the pill from the FDA.

Delaware judge backs hospital in ivermectin case

Headlines in August noted that hospitals were being sued by patients or family members insisting on having covid treated with ivermectin in the hospital—and that courts were siding with those patients. However, a Delaware judge in a similar case has ruled in a hospital’s favor, refusing to order the hospital to administer the drug and saying that patients can’t compel providers to use ivermectin outside the standard of care. According to coverage in U.S. News & World Report, the judge’s ruling noted that “the right of self-determination” in health care allows patients to accept or refuse treatments but not to dictate specific treatment outside care standards. While ivermectin has inhibited the growth of covid cells in a lab, the NIH has announced that patients would need to take doses up to 100-fold higher than have been approved in humans to achieve the same effect. In New Mexico, state health officials last week announced that two people in that state have died of ivermectin toxicity.

September 24, 2021

Pfizer boosters get nod from FDA and CDC, others make their case

The FDA and CDC this week signed off on booster shots of the Pfizer vaccine, although for slightly different populations. The FDA gave the green light for Pfizer boosters for people 65 and over and for individuals over 18 who have a high risk of severe covid because of medical conditions or where they work. Last night, the CDC’s Advisory Committee on Immunization Practices (APIC) approved boosters for adults age 65 and older and residents of long-term care facilities and adults 18-64 with an underlying condition that may increase their risk if they get infected. Unlike the FDA, the CDC committee did not approve boosters for adults who live or work in a place where the risk of transmission is high, a group that includes health care workers. This morning, CDC director Rochelle Walensky, MD, reversed that position, aligning CDC policy with the FDA’s by endorsing boosters for people at risk because of their jobs. In other vaccine news, a CDC study published last Friday found that the Moderna vaccine offered longer protection than the Pfizer vaccine over time. The study found that over a four-month period, the efficacy of the Pfizer vaccine in preventing hospitalization fell from 91% to 77%. During that same time period, the efficacy of the Moderna shot remained statistically the same. Finally, J&J unveiled data showing that its vaccine is more effective when given as a two-dose regimen. Two doses of the vaccine prevented 75% of moderate to severe cases of covid, up from 53% after one dose. (The J&J vaccine was originally estimated to be 66% effective in preventing moderate to severe covid, but that number was updated last week.) J&J has not announced that it has applied to the FDA for authorization for a second dose, but that move is expected soon.

Hospitals billing average of $320,000 for complex covid care

New data: Remdesivir reduces hospitalization in high-risk outpatients

New data show that remdesivir can reduce the risk of hospitalization from covid by 87% in high-risk patients who are diagnosed early and not hospitalized. The data, which were published this week by Gilead in a press release, also found that the therapy was associated with an 81% reduction in medical visits due to covid. STAT notes that the administration of remdesivir is challenging because it must be given intravenously, which can be difficult for patients who aren’t sick enough to be hospitalized. While remdesivir has FDA approval to treat covid and is widely used, not all studies have found that the drug helps covid patients. An EU study released last week found that the drug offered little benefit to covid patients who had been admitted to the hospital for COVID-19, were symptomatic for more than 7 days and required oxygen support. And a large trial led by the World Health Organization found the drug offered little benefit in preventing covid deaths.

September 21, 2021

This hospital has a high bar for vaccine exemptions based on religious beliefs

There are signs that hospitals are going to make employees who want an exemption from covid vaccines work for it. An Arkansas health system is requiring staff who want a religious exemption from a vaccine also promise to forgo basic medications like Tylenol, Tums and Preparation H. Becker’s Hospital Review reports that Conway Regional Health System decided to act when it noticed a jump in requests for vaccine exemptions that cited the use of fetal lines in the development and testing of vaccines. The health system created a list of 30 medicines that make use of fetal cells and asked employees requesting a vaccine exemption to attest that they won’t use those the medications on the list—and others like them. Conway’s CEO told Becker’s that the goal of the form was not only to make sure people requesting exemptions were sincere in their beliefs, but also to raise general awareness about how fetal cells are used in testing and developing common medicines. Employees who are granted exemptions are also told they may need to be periodically tested for covid and could be reassigned to a new position to protect patients and staff.

Researchers taking a close look at long covid

The NIH is studying the lingering symptoms of long-haul covid, which can be debilitating for people recovering from covid. A Medscape report says early research shows that about one-third of people infected with covid will go on to have symptoms for months once they’ve recovered from the acute phase of covid. A recently published review found that symptoms persist for one to two months after initial diagnosis in 13% of patients, but 4.5% experienced symptoms beyond two months and 2.6% had symptoms for three months or longer. A MedPage Today report says the found that fatigue, headache and dyspnea were the most common symptoms, but cough, chest pain, anxiety/depression and loss of smell and taste were also recorded in significant numbers of long haulers. The review, which covered 143 reports published through May, also found that less common symptoms included concentration/memory deficits, tinnitus and sensory neuropathy.

September 17, 2021

Vaccine mandates have hospitals worried about staffing

The Biden administration’s vaccination mandate for health care workers has hospitals worried that requiring vaccinations will have the unintended consequence of making it impossible to get fully staffed. Under the plan, the CMS will require health care facilities that participate in Medicare or Medicaid to vaccinate their estimated 17 million workers. Fierce Healthcare says that while the American Hospital Association supports the widespread vaccination of nurses, it also worries that the mandate will exacerbate the already difficult task of hiring nurses. (The article also notes that a large nursing union is accusing hospitals of deliberately understaffing nurses to boost profits. Several large health systems have said they’re struggling with labor costs.) Becker’s Hospital Review points out that hospitals in Texas will face an even bigger challenge, since the governor of that state has issued an executive order banning public hospitals from enacting vaccine mandates. One rural hospital in Texas estimates it will lose 25% of its workforce if it enforces a vaccine mandate, and a potential loss of its Medicare/Medicaid funding—about 80% of its budget—if it doesn’t. Vaccinations for staff are such a hot-button issue in some parts of the country that some health systems were until recently using a lack of a vaccine mandate as a recruitment tool before the Biden administration unveiled its mandate.

Inpatient costs of treating preventable covid tripled in August

A new report from the Kaiser Family Foundation says that the country has spent $5.7 billion on covid hospitalizations that could have been prevented by vaccinations—and that $3.7 billion of that spending occurred in the month of August. The report notes that in August alone, U.S. hospitals cared for 187,000 cases of covid that could have been prevented by vaccines. In June, by comparison, the nation treated 32,000 preventable cases, and in July the number was 68,000. Fierce Healthcare reports that Kaiser estimates that each case of covid costs $20,000. That number is based on studies that found the inpatient costs of caring for a single covid patient ranged from $17,000 to $24,000. But because that estimate doesn’t include outpatient or follow-up costs, the report says it is probably underestimating the true financial impact of the virus.

Conspiracy theorists flood Chicago hospital with calls for ivermectin

Last week we offered a glimpse into harassment medical workers face from anti-maskers and anti-vaxxers. This week, there’s a new wrinkle in the abuse being directed at people working in health care: medical conspiracy theorists harassing them via the phone and in person. MedPage Today says that a Chicago hospital treating a well-known anti-vaxxer was flooded with hundreds of calls—including several to 911—from the patient’s supporters. The callers demanded that the hospital provide alternative forms of care including the antiparasitic ivermectin. A well-known lawyer used his Instagram account to tell his followers to “go to war” against “medical tyranny.” When the patient died from covid, the lawyer branded it a “medical murder.” Reports say that 20-30 cars with supporters showed up at the hospital. One staff member called the police when an “irate” supporter wouldn’t leave the hospital property.

September 16, 2021

Will the U.S. give boosters? The debate heats up

With the FDA scheduled to review the evidence behind booster shots of the Pfizer covid vaccine today, the debate among scientists and public health officials has heated up. New York Times coverage says that a series of “dueling reviews” of evidence released this week are taking opposite stances on the data on booster shots. A study published in the New England Journal of Medicine offers data from Israel that show that those who received boosters were less likely to develop severe covid than people who had received two shots. But a review by FDA staffers released this week says that while the vaccines’ effectiveness may have faded somewhat, they are still protecting against severe disease and death. And a Lancet article written by two of the FDA’s top vaccine scientists says that there’s no evidence that the effectiveness of covid vaccines in protecting against severe disease significantly wanes over time. The New York Times article notes that the Biden administration’s plans to roll out boosters as soon as next week has been endorsed by eight physicians in charge of the nation’s public health agencies. However, the administration’s plan needs a green light not only from the FDA, but also the CDC, which is scheduled to convene a panel next week. A Medscape poll indicates that U.S. physicians and nurses are divided about need for boosters, with 75% of physicians and 66% of nurses supporting an extra vaccine.

September 12, 2021

What led to a summer outbreak among San Diego health care workers?

A research letter in the New England Journal of Medicine examines the factors that led to a resurgence of covid among a group of vaccinated health care workers at the University of California San Diego Health. While 87% of the staff were vaccinated by July, infections spiked up during that same month, and more than half of the 227 who tested positive had been vaccinated. For health care workers vaccinated in January or February, the “attack rate” was 6.7 per 1,000 people. For workers who were vaccinated later (March through May), the rate of infection was 3.7. Among the unvaccinated, the attack rate was 16.4. A report in Medscape quotes one of the of the letter’s authors as saying that while covid vaccines are still protecting the vaccinated, the waning effectiveness of the shots along with the spread of the delta variant and loosened mask rules all worked together to help reduce the effectiveness of the vaccines from 94.3% to 65.5%. (Cases in San Diego spiked shortly after California loosened its mask mandates.) The authors of the letter say the case illustrates the need not only for vaccinations, but nonpharmaceutical interventions like indoor masking and intensive testing strategies.

September 10, 2021

Tensions bubbling up between traveling, permanent nurses

While nurse burnout has been growing since the beginning of the pandemic, there’s a new source of frustration building among the nation’s RN workforce. A report in Healthcare Dive says that there is tension between the core nursing staffs at hospitals and the traveling nurses, in part because traveling nurses are typically paid much more than their permanent colleagues. But a survey of a small—and limited—number of nurses found that the issues go beyond money. While permanent nurses often work mandatory overtime, traveling nurses are typically not required to work beyond the hours specified in their contracts. Permanent staff said that they often view traveling nurses as outsiders, while half of the traveling nurses felt they were treated poorly by permanent staff and assigned heavier caseloads. The survey found that both groups are suffering from burnout and that nearly one-quarter of all nurses surveyed were considering leaving nursing altogether.

September 9, 2021

Amid stretched resources, rationing hits Idaho hospitals

The crush of covid patients has hospitals in Idaho rationing care to stretch their already-stretched supply of hospital staff and beds. AP reports that Idaho public health officials announced this week that they had activated “crisis standards of care,” which allow 10 hospitals and health care systems in the state to allot resources like ICU beds to the patients most likely to survive. Patients who can’t be placed in an ICU bed will still receive care, but they might go without some life-saving medical equipment or wait for full ICU care. As of Sept. 1, more than 500 people in the state were hospitalized with covid; half of them were in the ICU. Public health experts predict that if the current covid surge continues, the state could be facing 30,000 new covid cases a week by mid-September. The AP report says that other states are considering similar measures. Hawaii last week released hospitals and health care workers from legal liability if they need to ration care.

September 8, 2021

Booster shots show promise in Israel, on FDA docket next week

The idea of giving a third shot of the covid vaccine got a boost from Anthony Fauci, MD, who last week said that Israeli efforts to stem the current wave with a third shot of the Pfizer vaccine are encouraging. MedPage Today reports that after giving 1.1 million Israelis a third dose of the Pfizer vaccine, researchers in the country saw a “greater than tenfold diminution” in confirmed covid infections and severe disease. In the U.S.,the FDA is holding a Sept. 17 advisory meeting that will examine the idea of giving a third of shot of the Pfizer vaccine. Fierce Healthcare says that Pfizer has submitted data that people who received a third shot five to eight months after their second shot generated three times as many antibodies than after their second dose. If the FDA and the CDC give their approval, the White House plans to begin administering third doses of the Pfizer vaccine in late September. The plan has been criticized by public health officials and physicians who question the science behind the decision. Coverage from STAT examines questions about the science behind the rationale for a third shot. It also questions whether the shot should even be called a booster, with some arguing that it should be more accurately described as a third and final shot in the covid vaccine series.

September 7, 2021

Threats against health care workers grow in number, intensity

Remember the good old days when you were considered a hero for saving lives during the pandemic? In some parts of the country, health care workers are now just as likely to be considered a villain. The Texas Tribune reports that the number of attacks—both verbal and physical—on health care workers has been growing. At hospitals in the state, attacks have included screaming and cursing, broken bones and noses, and knives being pulled. Many of the incidents revolve around masks and screening protocols that patients and family members vehemently disagree with and don’t have to follow outside of health care settings. Tempers are also running high because of understaffed and overwhelmed health care facilities. In Georgia, things have gotten so bad that the state’s health commissioner has joined Governor Brian Kemp in urging residents to stop harassing, threatening and bullying health care workers giving covid vaccines. Becker’s Hospital Review reports a mobile vaccine site in north Georgia had to be closed when an organized group of anti-vaxxers showed up to harass and ridicule the people staffing it. Perhaps the most unsettling example of health care workers being threatened can be seen in a video on Twitter of anti-maskers in Nashville harassing medical professionals after a school board meeting shows protesters shouting things like, “You will never be allowed in public again! We know who you are! You can leave freely, but we will find you!”

September 3, 2021

Patients suing for—and winning—their right to invermectin

Despite warnings from the CDC against using the horse dewormer invermectin to treat or prevent covid, patients are suing hospitals to force them to administer the medicine—and some are winning. Newspaper coverage reports that an Ohio judge has ruled that a hospital must give invermectin to a covid patient who has been in the ICU for several weeks with covid. The patient’s wife found a physician who claims he’s an “expert” on using the drug to treat covid to write a prescription, but the hospital balked at fulfilling it. The judge ruled that the hospital must give 30mg of invermectin to the patient daily for three weeks. MedPage Today reports that more hospitals are being sued by patients demanding the drug, which has been promoted by media figures on conservative news outlets like Fox News.

Shortages of tocilizumab grow, but bamlanivimab/etesevimab is back

As one covid treatment inches toward critical shortages, another therapy that was put on hold is making a (limited) comeback. Amid rising shortages around the world of the arthritis drug tocilizumab around the world, the World Health Organization is pressuring its maker, Roche, to help other companies manufacture the drug to bolster supplies. The WHO is also calling for the drug to be distributed equitably to all countries. Forbes magazine notes that the drug is already in short supply in U.S. hospitals and that shortages are expected for at least the next several weeks. Roche responded to the WHO by saying that it will not enforce its patent rights on the drug in low- and middle-income countries. In other news, Eli Lilly’s antibody combo bamlanivimab and etesevimab is now back on the market in states where variants that can evade the drug account for less than 5% of covid cases. Fierce Healthcare reports that the FDA’s reauthorization of the combination therapy means it will be available in 20 states, including Colorado, Connecticut and Ohio. The therapy cannot be used in states with big covid caseloads like Florida and Texas.

Rates for four infections rose during the pandemic

Rates for four routinely tracked healthcare-associated infections rose at significant rates during the pandemic, reversing years of progress in reducing their numbers. Research published in Infection Control & Hospital Epidemiology found major increases in four types of infections from 2019-2020: central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated events and antibiotic resistant staph infections. These infections likely increased during the pandemic because of the number of patients who required more frequent and longer use of catheters and ventilators, along with staffing and supply challenges. A statement from the Association for Professionals in Infection Control and Epidemiology says the report shows that U.S. health care has lost nearly a decade of progress in reducing incidence of these infections.

CDC’s APIC panel debates the need for boosters

As the debate over booster shots for covid heats up, the CDC appears to be considering a “risk-based” strategy that would target people with severe disease and critical infrastructure jobs. MedPage Today reports that during a meeting of the agency’s Advisory Committee on Immunization Practices this week, the panel reviewed evidence showing that covid vaccines offer weakened protection against the delta variant, but there wasn’t exactly consensus on how to respond. Some on the panel argued that getting unvaccinated Americans to get the shot would be more effective than moving onto boosters, but others pointed out that the two strategies aren’t mutually exclusive. The Biden administration’s decision to start authorizing booster shots for certain people beginning in late September has unleashed a fury of criticism from multiple sources. STAT reports that some worry that endorsing booster shots before the FDA has weighed in with a review of the evidence is causing confusion.

August 30, 2021

Covid takes a bigger toll on teens, children

As the pandemic grinds on, it’s taking an outsized toll on children and teenagers. Medscape reports 16- and 17-year-olds now have the highest infection rates of all age groups. While that age group accounts for 2.5% of the U.S. population, it now accounts for 2.6% of all covid cases. In total, nearly 800,000 16- and 17-year-olds have been infected with covid. Children are also accounting for a huge percentage of covid. In the week of August 131-19, there were just over 180,000 cases of children becoming infected. That number represents a 48% increase over the number of pediatric cases reported the week before and the second highest jump in pediatric cases since January of this year.

August 27, 2021

Tracking covid in the U.S. by the numbers

If you’ve been trying to track just how bad the latest wave of covid in the U.S. has become, it’s been a busy week. The Washington Post reports that for the first time since Jan. 30, more than 100,000 Americans are hospitalized with covid. The numbers are highest across the South. Florida alone has nearly one-fifth (17,000) of the country’s covid patients. Texas is next with more than 14,000. On a national level, three-quarters of ICU beds are full. According to The Hill, 28% of patients in those beds have covid. Almost half of U.S. states say their hospitals have exceeded 75% capacity of their ICU beds. And a record number of 30-somethings are hospitalized with covid. The hospitalization rate for 30- to 39-year-olds reached 2.5 per 100,000 people last week, beating the previous record of 2 per 100,000 back in January. MDedge reports that new admission for this group reached an average of 1,113 a day last week. That number had been 908 in the previous week. To combat the latest surge, more than 5,000 military medical personnel have been deployed to 14 states to help care for covid patients. MDedge says that while the focus of a similar effort last year was the coastal states (New York, California and New Jersey), attention has shifted to the southern states.

Survey: Most nurses vaccinated, support mandates

August 25, 2021

The high price of treating the unvaccinated

A new report estimates that covid surging among unvaccinated Americans led to 113,000 unnecessary hospitalizations—just in June and July. That report, which was issued by Kaiser Family Foundation, also found that those preventable hospitalizations cost U.S. health care $2.3 billion. Other findings from Kaiser Family Foundation indicate that covid hospitalizations and treatment are becoming more expensive for some individual patients: Among the two largest private health insurers in each state and the District of Columbia, 72% are no longer waiving out-of-pocket costs for treating covid. Kaiser Health News reports that about half of all the monoclonal antibody shipments since mid-July have gone to Florida, Texas, Mississippi and Alabama—states with some of the lowest vaccination rates in the country. The cost of each infusion dose (being picked up, at least for now, by the federal government) is about $1,250, while each dose of each vaccine dose costs about $20.

Doctors issue personal appeals

Physicians in covid hotspots around the country are appealing directly to the public, asking those who are unvaccinated to consider the devastating impact of that decision on their larger communities, including health care workers. Several dozen emergency physicians and physician assistants in Eugene, Ore., released an open letter this week, describing the torturous hospitalizations from covid among younger, healthier patients who aren’t vaccinated. The clinicians point out that their hospitals are running out of beds to treat other patients with serious or life-threatening conditions. Their call was backed up by the Oregon chapter of the American College of Emergency Physicians. In Florida, more than 70 physicians, nurses and executives from five competing hospitals in Palm Beach County issued an emotional plea at a press conference, describing their physical and psychological exhaustion and the need to protect the children in their community. In an opinion piece posted this week, a hospitalist at Tampa General Hospital notes that her facility is currently treating three times as many covid patients as it was last summer. “I haven’t said anything about what’s going on with #COVID here in FL,” that doctor wrote earlier in a tweet, “bc I haven’t had the words to describe it.”

August 24, 2021

FDA warning: Don’t self-dose with ivermectin

The FDA is again warning the public about the dangers of self-dosing with ivermectin to treat or prevent covid. Mississippi now reports a spike in phone calls to its poison control centers due to individuals buying ivermectin at livestock supply centers—the drug is used to deworm horses and livestock—and ingesting animal formulations. Those formulations, which are much more concentrated for large animals, can be toxic to humans. A recent study from the U.K. noted that several clinical trials are now ongoing to test the use of ivermectin (in human formulation) in covid. However, the FDA has not approved the drug as a covid therapeutic, and the agency notes that ivermectin can interact with other medications including anticoagulants. In tablets, the drug has been approved to treat intestinal strongyloidiasis and onchocerciasis, while the FDA has also approved topical forms for external parasites like head lice and for some skin conditions.

August 23, 2021

Full approval for Pfizer

The FDA today announced full approval for the Pfizer covid vaccine, the first such approval to be granted in the U.S. That approval is for people age 16 and older, while the emergency use authorization for the Pfizer vaccine for those between ages 12 and 15 remains in effect. The New York Times reports that the move is expected to unleash an avalanche of vaccine requirements for employees as well as for 1.3 million active-duty troops. The approval was based on data that Pfizer supplied to the FDA on 44,000 clinical trial participants from around the world, which showed that the vaccine was 91% effective against infection. A recent poll indicates that three out of every 10 Americans who are holding off on being vaccinated are more likely to do so if the vaccine has full approval. Moderna has also submitted data to the FDA, seeking full approval for its vaccine; that decision is expected in several weeks. In the meantime, the FDA hasn’t given the Moderna vaccine emergency authorization for use in adolescents between the ages of 12 and 17. The Washington Post reports that the FDA continues looking at data on the risk of myocarditis with the Moderna vaccine in younger patients, particularly males.

August 20, 2021

Hospitals scramble to find beds

Hospitals in covid hotspots are shipping critically ill covid patients across state lines, in a desperate attempt to find beds. While the number of covid patients now hospitalized is below that during the winter surge, patients during this wave are competing with other ED and surgical patients for beds. As a result, urban academic centers have few beds to give smaller hospitals for transfers. The search for beds is even more challenging, given the staffing shortages—particularly in nursing—being reported nationwide. Mississippi, which is hard hit, isn’t able to use close to 1,000 of the beds in that state because they aren’t staffed. In Georgia, the governor this week announced that the state will spend another $125 million on hospital staffing, in addition to the $500 million it already allocated to fund 1,300 staff members at close to 70 hospitals in the state. One in five ICUs around the country has either reached or is surpassing 95% capacity.

August 18, 2021

Booster shots and vaccine effectiveness: Does Moderna best Pfizer against delta? (updated Aug. 20)

The administration this week announced that, pending the FDA’s review and decision, it would begin offering third vaccine shots in September to people eight months after they received their second dose of either the Pfizer or Moderna vaccine. That means that those vaccinated in the earliest days of the vaccine roll-out—which includes health care providers, nursing home residents and some seniors—should be eligible for booster shots beginning the week of Sept. 20. Some scientists pushed back against the announcement, claiming it’s based more on anxiety than on science. New research quantifies how much vaccine effectiveness is waning over time, with one new preprint finding that the effectiveness of both the Moderna and Pfizer vaccines fell after seven months in terms of preventing infection—but fell further for Pfizer than for Moderna. (Comments on MedPage Today about the study indicate that the study cohorts “received at least one” vaccine dose, suggesting that some may have not received both doses.) Another large study, this one from the U.K., compared Pfizer’s effectiveness to that of AstraZeneca. The conclusion: “By roughly 4 1/2 months after the 2nd dose, Pfizer’s shot will probably be about on par with Astra’s at preventing infections with a high viral burden.” By comparison, Pfizer’s effectiveness against high viral loads at 14 days after the second dose was 92% vs. 69% for AstraZeneca. Health Affairs reports that vaccines delivered in the early months of the rollout—through May 9—may have prevented close to 140,000 covid deaths.

Babies and toddlers are worse spreaders at home than teens

A large Canadian study that looked at household transmission reached this conclusion: Teens bring the virus home more often than young children do, but it’s babies and toddlers who are more likely to spread the virus to other household members. Why? Family members provide much more hands-on care to very young children who aren’t able to self-isolate. According to New York Times coverage of the study, the research doesn’t resolve whether infected children are as contagious as adults. But experts quoted in the article say the results underscore the importance of protecting children against infection as they return to school and day care. In the study, an infected child didn’t transmit the virus to other household members. But in 27% of the households studied, other residents became ill when a child was the index infection.

August 17, 2021

Weekly cases come close to pre-vaccine levels

More than 900,000 new covid cases were counted in the U.S. over the last week, the
Washington Post reports, the highest weekly tally since January. For the week ending Aug. 15, more than 911,000 cases were reported across the country, with a daily average of more than 130,000 new cases. According to CNBC, the average number of new cases hit record highs in five states: Florida, Oregon, Mississippi, Louisiana and Hawaii. However, Oregon and Hawaii have much higher vaccination rates so are seeing many fewer hospitalizations than in Florida, Mississippi and Louisiana. ICUs are filling up
again, with one in five ICUs around the country either reaching or surpassing 95% capacity.

August 13, 2021

After a brutal year and a half, health care workers are now confronting a new problem: “compassion fatigue,” which is kicking in at least for some when treating patients who’ve refused to be vaccinated but are now sick with covid. That’s according to Chavi Eve Karnowsky, MD, an OB in New York City, writing in The Atlantic. Doctors see plenty of evidence of the bad choices their patients make, she writes, but choosing to remain unvaccinated in the face of a deadly virus is different and “much more personally threatening to my colleagues and me.” Some of her colleagues also find it maddening to see people who doubt the science behind vaccines then expect the best care science can provide once they are sick. After so many losses—of lives, jobs, the education for tens of millions of American children—health care workers are risking another: the loss of the belief that this society can come together to solve the problem.

Pandemic fallout: NPs are in hot demand, while doc salaries fall

Hospitals struggle with severe nursing shortage

Not news to most hospitalists: Hospitals are reporting dire nursing shortages, one that’s making it impossible to staff hospital beds even as inpatient medicine volumes rise and hospitals in the Southeast are overwhelmed with covid cases. The Texas Tribune reports that hospitals in that state have both historically low staffing numbers and “skyrocketing” covid cases, with pandemic burnout cited for why nurses are leaving the profession as well as the high wages traveling nurses are being offered to hit the road. To entice new hires, one hospital in Arkansas is offering a $25,000 sign-on bonus, while executives with Jackson Memorial Health System in Miami say that nurses in their health system are being lured to other hospitals that offer two or three times the nurses’ current salary. Hospitals in that system are now giving retention bonuses to nurses as well as time-and-a-half for working extra 12-hour shifts—and a $500 bonus per shift.

Pediatric hospitals sound the alarm

It remains unclear whether the delta variant is causing more severe infections among children. What is clear, however, is that children’s hospitals, particularly in the South, are seeing their highest number of covid cases yet, even as children in that region are getting ready to go back to school. According to a report from the American Academy of Pediatrics, “child cases have steadily increased since the beginning of July,” with almost 94,000 new cases emerging in the first week of August. While the report notes that severe illness remains uncommon among children, the rise in pediatric cases indicates that the variant is hypertransmissible and may suggest a more rapid progression of more severe disease.

August 10, 2021

More data on breakthrough infections

New research out of the U.K. sheds more light on the differences between vaccinated and unvaccinated patients infected with the delta variant. Researchers looked at covid tests drawn for more than 98,000 people between June 2021 and the end of July. Vaccinated people who were positive were 59% less likely to have symptomatic infection, with unvaccinated infected patients 25 times more likely to be hospitalized. As for differences in viral loads, epidemiologist Katelyn Jetelina, MD, explained that vaccinated people in the study were found to be no longer infectious after nine days while those who weren’t vaccinated remained so for 16 days. “This confirms the higher rate of breakthrough cases than we anticipated,” Dr. Jetelina writes. “But the breakthrough cases continue to be far more mild than unvaccinated cases.”

Is post-vax myocarditis more common than previously thought?

According to a new JAMA research letter, myocarditis and pericarditis post-vaccination remain rare. But the conditions may be happening more frequently than previously reported. They also constitute two separate syndromes, MDedge reports, with myocarditis occurring in younger patients, usually after the second dose, and pericarditis turning up in older patients after either dose. The authors looked at the electronic health records of more than 2 million people vaccinated within the Providence health care system. The case rate they found was 1.0 per 100,000 for myocarditis and 1.8 per 100,000 for pericarditis. By contrast, the CDC, which has lumped pericarditis stats with myocarditis, has reported 4.8 cases per 1 million.

August 9, 2021

More good news for covid patients taking statins

Researchers publishing in PLOS ONE find that covid patients taking statins due to hypertension or heart disease may face lower mortality odds. The authors looked at data on more than 10,500 covid patients treated last year in 100-plus U.S. hospitals. Among those patients, 42% were found on admission to be taking either statins alone or in combination with anti-hypertensives. The use of statins, the analysis found, was associated with a more than 40% mortality reduction and a better than 25% reduction in developing severe covid. The authors point out that other studies had produced similar results but that those other studies were smaller or regional. “These observations support the continuation and aggressive initiation of statin and anti-hypertensive therapies among patients at risk for COVID-19,” they write, “if these treatments are indicated based upon underlying medical conditions.” The researchers also point out that randomized trials are already underway to see if statins can benefit covid patients even when patients don’t have underlying indications for taking the medications.

August 6, 2021

Trials identify covid patients who benefit from full-dose heparin

Can therapeutic heparin dosing (vs. a prophylactic dose) boost mortality in hospitalized covid patients? It can, according to new data published in NEJM—except not in critically ill patients or those with severe covid. In one study, which was conducted internationally, therapeutic dosing among hospitalized patients with moderate covid increased their probability of survival and lowered their need for cardiovascular or respiratory organ support. But that was not the case for critically ill patients, the same investigators reported in a separate trial. The author of an accompanying editorial suggested a reason for that difference, writing that inflammatory and thrombotic damage may be too far advanced in those with critical illness to be affected by therapeutic dosing. The editorial also urged physicians to weigh the benefits and risks of heparin, even in patients with moderate disease.

Time to reform evaluation, licensure of physicians with mental illness

Medicine is notorious for penalizing providers who seek help for mental illness. One resident with bipolar disorder has openly detailed his struggles, writing in an account last year about checking himself into a psychiatric hospital because of suicidality. Now, in a JHM perspective, he describes the process he had to undergo to return to work; that process included month-long outpatient treatment, a review by his institution’s physician well-being committee and a formal fitness-for-duty evaluation. That evaluation, he writes, went too far, mandating additional treatment in addition to the medications and therapy he was already undergoing. He and his co-authors recommend that fitness-for-duty evaluations instead be limited in scope and that any “return-to-duty” contracts that include treatment and monitoring should be crafted in collaboration with the physician and her or his treating clinician. They also write that such evaluations should include psychiatrists, independent oversight and an external appeals process. Further, they recommend state and federal changes including having state licensing boards limit licensing questions to any current impairment due to mental illness or substance use disorder.

August 4, 2021

U.S. passes 70% vaccination milestone, but cases are still rising sharply

It took an additional month, but the Biden administration—which aimed to hit this target by July 4—reported this week that 70% of all U.S. adults have now received at last one dose of vaccine. Further, the pace of vaccinations, including that for people getting their first dose, is accelerating, in response to rising infection rates. The New York Times is reporting a seven-day average of new daily cases in the U.S. of more than 80,000, while the number of hospitalizations as of last Saturday had risen 44% over the previous week and deaths were up 25%. One in three new cases in the country over the past week occurred in Florida and Texas.

Pfizer vaccine may get full approval by Labor Day

The FDA is speeding up its timeline to grant full approval to the Pfizer vaccine, according to the New York Times, with that approval possible by early next month. The hope is that full approval would convince some who are hesitating to be vaccinated to finally get off the fence. Also, full approval would make it easier for employers as well as cities, universities, hospitals and the defense department to mandate vaccine. Poll results published in June by the Kaiser Family Foundation found that three out of every 10 people who weren’t vaccinated said they were more likely to agree to be vaccinated if it received full approval. Moderna has also applied for approval for its vaccine, while J&J plans to later this year. In other vaccine news, the debate over getting a booster shot is heating up, with MedPage Today reporting that doctors are considering getting a third shot for themselves, their families and their patients out of concern for waning antibody levels. The CDC is warning people that antibody tests should not be used to gauge immunity post-vaccination. However, the WHO is calling for a moratorium on booster shots in developed countries until the end of September, urging that vaccine supplies go instead to low-income countries where vaccination rates are dangerously low.

August 2, 2021

CDC sounds the Delta alarm: “The war has changed”

Documents first circulated within the CDC, then publicly released, are sounding the alarm on the Delta variant, saying the strain is as contagious as chicken pox and so transmissible that it’s being likened to a novel coronavirus. The agency looked at data on an outbreak in Providence, R.I., in early July in which three-quarters of the infections were among fully vaccinated patients. Further, MedPage Today reports that nearly 80% of all infections in the outbreak were symptomatic. Among 469 infections, however, only five people were hospitalized (four of whom were fully vaccinated) and no one died. (The town manager has since reported that more than 800 positive cases have been identified in the outbreak.) The data formed the basis for the CDC updating its guidance last week, calling on everyone—including those who are vaccinated—to use masks when indoors in public and for vaccinated patients to be tested if they’re exposed to someone with covid. According to the CDC, 35,000 symptomatic infections every week are cropping up among 162 million Americans who have been vaccinated.

Baricitinib gets expanded emergency use as a solo agent

The FDA last week expanded its EUA for baricitinib, allowing the agent to be used alone and not in combination with remdesivir. The FDA’s first EUA for the drug was issued in November, but that was for a baricitinib-remdesivir combo to treat adults and pediatric patients age 2 and older hospitalized with covid who require noninvasive oxygen, ventilation or ECMO. The expanded EUA is based on results of a trial, which have not yet been published. The research found that baricitinib significantly reduced all-cause mortality and progression to a ventilator when administered along with standard of care (vs. placebo and standard of care). In the trial, 79% of the patients were given steroids while 19% had remdesivir, and some patients had both.

July 30, 2021

Is another surge about to happen?

A former CDC director had made this frightening prediction: The U.S. may within weeks again see the number of new daily covid cases climb to 200,000, a level not seen since January. Thomas Frieden, MD, who headed up the CDC during the Obama administration, says the number of daily cases may quadruple over the next four to six weeks due to the transmissibility of the Delta variant and the number of Americans who refuse to be vaccinated. According to Dr. Frieden, soaring numbers of new cases may not translate into more deaths, given that many older, more vulnerable Americans have already been vaccinated. At the same time, experts are puzzled over why case numbers in the U.K., where the Delta variant is completely dominant, have been falling, not rising as previously predicted. The Washington Post reports that experts have put forward three theories as to why: testing and tracking may be working; people may have stopped being tested because they don’t want to quarantine if positive; or the U.K. may have hit herd immunity, with more than 70% of adults fully vaccinated. Israel is launching a booster-shot campaign for adults older than 60 who received their last dose of vaccine at least five months ago. And new preprint results indicate that the efficacy of the Pfizer vaccine falls to 84% (from 96%) over six months, suggesting that efficacy drops 6% every two months post-vaccine.

HHS earmarks $100-plus million to fight burnout, promote wellness

The HHS plans to dedicate more than $100 million over the next three years to fight burnout and improve mental health among health care workers. According to Healthcare Finance, the funding is designed to support the implementation of strategies in health care organizations to help their workforce avoid burnout and promote wellness and resilience. Three separate funding opportunities are now accepting applications: The Promoting Resilience and Mental Health among Health Professional Workforce program will give out 10 awards to organizations to expand a wellness culture; the Health and Public Safety Workforce Resiliency Training program will grant 30 awards to educational and nonprofit institutions to help train early-career providers; and the Health and Public Safety Resiliency Technical Assistance Center will grant one reward for HRSA workforce resiliency programs. Applications are due Aug. 30.

July 28, 2021

CDC to (many) vaccinated people: Mask up!

The CDC this week issued updated mask guidance, calling for everyone—including those who are fully vaccinated—to once again use masks indoors when in public in areas of the country with widespread transmission. The update reverses CDC guidance issued only two months ago, and it comes in response to new concerns about the transmissibility of the Delta variant, which is now the country’s predominant strain. According to STAT, the Delta variant is causing breakthrough infections among vaccinated patients at higher rates than expected. Given the higher viral loads associated with that variant, even infected patients who are vaccinated are at risk of transmitting the virus. As to which areas have widespread transmission, the CDC’s Covid Tracking Web site breaks down community transmission by county, with people being urged to mask up indoors when in public in those areas that are either orange on the CDC county maps (designating substantial transmission) or red (high transmission). Because high transmission is linked to low vaccination rates, New York Times coverage makes this point: “The parts of the country that would benefit most from a new crackdown on Covid-19—including more frequent mask wearing—are also the places least likely to follow C.D.C. guidance.”

July 27, 2021

Vaccine mandate: The VA puts down the hammer

The VA yesterday became the first federal agency to issue a covid vaccine mandate, announcing that all of its 115,000 front-line health care workers will need to be fully vaccinated within the next two months. According to the New York Times, the mandate will apply to doctors, RNs, dentists, physician assistants and some specialists, all of whom must be vaccinated within the next eight weeks or face penalties or even the loss of their jobs. Several VA centers around the country have had recent outbreaks, even though about 70% of the VA health care workforce is already vaccinated. Workers will be able to appeal for religious or medical reasons. In related news, several dozen health care organizations and societies—including SHM, ACP and the AMA—are calling for universal vaccination among all health care and long-term care workers. At the same time, GOP lawmakers around the country are working to restrict public health measures including the use of mask mandates. And seven states have already passed legislation restricting the ability of public schools to either mandate vaccinations for returning students or documentation of vaccine status. Those states include Alabama, Arkansas, Florida, Indiana, Montana, Oklahoma and Utah.

July 23, 2021

To boost vax rates, one hospital is offering to jab the hesitant in secret

This is how bad things are getting in Missouri: To convince the vaccine-hesitant to take the plunge and get the shot, Ozarks Healthcare in West Plains, Mo., is offering to vaccinate people on the down low if that will help boost immunization rates. In a statement, the system said “If you are afraid of walking into a public area where you might be seen getting your vaccine, we will work to accommodate even more of a private setting for you to receive your vaccine.” The health system noted that for some people, getting the vaccine may mean losing friendships and respect in the community. The offer seemed to have some effect last week, when its pharmacy gave twice as many vaccines one day as usual. Unfortunately, Ozarks is also seeing its largest number of covid cases since earlier this year.

Two covid treatments being questioned

The results of one of the largest trials of the drug ivermectin have been withdrawn by the online journal that first published them. MedPage Today reports that study, which had presented positive data about the drug’s ability to treat covid, was withdrawn because of concerns about plagiarism and data anomalies. Those data were used in two recent meta-analyses that received widespread attention because of their positive results. Also this week, new research on the antiviral remdesivir found that the drug didn’t significantly improve survival in VA patients but was associated with more days in the hospital. MedPage Today notes that CDC and IDSA guidelines recommend the use of remdesivir.

Spread of covid among hospital roommates hits 39% in one study

Research in Clinical Infectious Diseases found that among 31 inpatients who were exposed to covid via an diagnosed roommate, 39% tested positive for the virus within 14 days. In MedPage Today, the researchers explain that the only factor that was significantly associated with transmission was the roommate’s viral load, with PCR cycle thresholds of ≤21 considered the smoking gun. They noted that high transmission rates in these patients occurred despite the fact that inpatients are typically at least six feet apart and that hospitals have fairly good ventilation systems. It’s also evidence that the virus can be transmitted by respiratory aerosols and minimizes the importance of physical contact. The researchers suggest pairing vaccinated patients in a room, using portable HEPA filters between patient beds, and increasing testing of patients.

Will the J&J vaccine require a second shot to protect against variants?

More bad news emerged for the J&J vaccine this week when it comes to the shot’s ability to fight variants like Delta. A study published by the online journal bioRxiv found that the vaccine’s effectiveness was “significantly decreased” over time and that people who have received the vaccine may need a booster shot to stay protected against variants like Delta and Lambda. The New York Times notes that the research contradicts earlier smaller studies that were published by J&J, which found that the vaccine remained effective against variants up to eight months after the shot was given. But the new data are consistent with studies that show a single dose of the AstraZeneca vaccine has an efficacy rate of about 33% against the Delta variant. That’s significant because the AstraZeneca vaccine has a similar architecture as the J&J vaccine. The Times article quotes one virologist who pointed to several studies that have shown that the J&J vaccine is more effective when two doses are given.

Pfizer and AstraZeneca offer better protection against Delta

The news was somewhat better for two other vaccines when it comes to fighting off the Delta variant. A study published in the New England Journal of Medicine found that while the Pfizer and AstraZeneca vaccines give up some efficacy in combatting the Delta variant, they still offer significant protection. Researchers found that two doses of the Pfizer vaccine showed 88% efficacy against the Delta variant, while two doses of the AstraZeneca vaccine offered 67% efficacy. A Medscape article points out that the Pfizer vaccine is 94% effective against the Alpha or UK variant, while the AstraZeneca was 74% effective against it. One dose of either vaccine didn’t fare very well. One dose of the Pfizer vaccine was offered 49% efficacy, while one dose of AstraZeneca was only 31% effective. And the first large study to take a look at vaccine efficacy outside of the confines of a clinical trial found very good news about the two mRNA vaccines from Pfizer and Moderna. Research in in Annals of Internal Medicine found that among people who received two shots of an mRNA vaccine, efficacy was above 95% regardless of any patient characteristics.

July 16, 2021

Survey: Half of 12- to 15-year-olds not getting vaccinated

While only a quarter of U.S. children aged 12-15 have been vaccinated, immunization rates among that group are plunging and cases for all children are rising. A Medscape article says that just over one-third of 12- to 15-year-olds have gotten at least one dose of vaccine, which may correlate to the rising caseloads among that group. According to an American Academy of Pediatrics report, there were 19,000 new cases of covid for the week ending July 8. The week before, that number was 12,000; two weeks before, it was 8,000. A survey of nearly 2,000 adolescents and their parents found that about half of both groups didn’t plan to have their child vaccinated or weren’t sure whether they would. Common reasons for vaccine hesitancy or outright refusal centered on concerns about safety and efficacy. A Medscape report notes that the decision to vaccinate can be an issue when divorced parents disagree.

Will we need booster shots to fight covid variants?

With covid surging in 46 states and the Delta variant accounting for half of those cases, the conversation early in this week was focused on whether a booster shot will be needed. Pfizer employees met with Biden administration officials on Monday to discuss the need for boosters, and while there was much public enthusiasm on social media for a third shot, public health officials have taken a more muted tone. A joint statement from the CDC and FDA, for example, said that fully vaccinated Americans don’t currently need a booster and placed the focus on continuing to expand the number of people who get the vaccines that are already available. And the director general of the World Health Organization criticized manufacturers that want to develop a booster shot, saying they should instead focus on delivering vaccines to underserved parts of the world, stating that “we’re making conscious choices right now not to protect those in most need.” An article in STAT said the official also pointed out that there are not yet any data indicating that a booster is needed.

With Delta, getting two mRNA shots is critical

Some relatively good news on the covid front: A preprint in Nature found that both shots of either the Pfizer or AstraZeneca vaccine neutralized the Delta variant in 95% of cases. One dose of either vaccine, however, “barely inhibited” Delta. The study echoes other data, which have found that getting a second shot can double the effectiveness of the vaccine. An English study, for example, found that the efficacy of the Pfizer vaccine jumped from 33% to 88% after the second dose. The data are significant because CDC this week announced that nearly 15 million Americans, or 10%, have missed their second dose of the covid vaccine. A MedPage Today report says that in June, 88% of people eligible for a second dose got their second shot. That number is down from the 92% completion rate earlier in the year. At the time the data were released, another 2 million people were eligible for their second shot but had not received it yet.

J&J vaccine linked to rare instances of Guillain-Barre Syndrome

Earlier this week, the FDA warned that J&J’s covid vaccine may trigger a rare neurological condition in a small number of people. The agency said there were about 100 preliminary cases of Guillain-Barre Syndrome out of the 12.8 million doses of vaccine that have been administered in the U.S. A STAT article says that of the cases reported, most developed about two weeks after the shot and were most common in older males. European health officials issued a warning last week saying that a similar condition may be linked to the AstraZeneca vaccine, but it said that the data could not establish a clear link between the vaccine and Guillain-Barre Syndrome.

July 9, 2021

How well do the vaccines protect against the Delta variant?

A new study released this week says that the quick rollout of the covid vaccine in the U.S. saved about 279,000 lives and prevented 1.25 million hospitalizations. But how well will covid vaccines handle the surge in cases from the Delta variant? Pfizer yesterday released data showing that a third “booster dose” of its vaccine given six months after the second shot increased the strength of the antibodies against the original virus and the Beta variant by five- to 10-fold. A New York Times article says the company also announced that it was developing a version of its vaccine to target the Delta variant and will begin clinical trials in August. Israeli data on the Pfizer vaccine found that while it has lost some of its effectiveness, possibly because of the Delta variant, it remains effective at preventing serious illness. A Reuters report says the Pfizer vaccine’s effectiveness in preventing overall infection and symptomatic disease has fallen to 64%, but that it is 93% effective in preventing hospitalizations and serious illness. Johnson & Johnson offered some good news in an announcement that its covid vaccine offers protection against the Delta variant. A New York Times article says that while the vaccine is slightly less effective against the variant compared to the original virus, it is also more effective against the Delta variant than it was against the Beta variant.

Low vax rates sending case rates surging in hot spots

The emergence of the Delta variant as the dominant strain of covid combined with a lack of vaccinations is leading to surging covid caseloads in some parts of the country. A state-by-state analysis by Johns Hopkins University and NPR has found that in parts of the country with low vaccination rates, infections are exploding. In Ottawa County, Okla., for example, where the vaccination rate is 23%, cases have surged by 828%. While the CDC reports that 67.1% of American adults have received at least one dose of a vaccine, immunization rates in some rural parts of the South and Midwest are as low as 30%. A Becker’s Hospital Review article says those low rates are fueling a rise in covid hospitalizations in 17 states and a 5% jump in cases nationally. CoxHealth, a large rural health system, has already begun diverting patients to larger systems because of surges in covid patients and problems with nursing staffing. In a HealthLeaders article, the system’s CEO warns that covid surges could appear much more quickly than they did last fall, adding that health care systems “should get ready now.”

FDA withdraws authorization for some respirators

If your hospital is using KN95 respirators imported from China, your facility needs to make sure it’s meeting federal regulations. The FDA has started to withdraw some of the emergency approvals it made during the early days of the pandemic for respirator masks and hardware used to clean and re-use them. A Fierce Healthcare article says that because supplies of respirators approved by the National Institute of Occupational Safety and Health have rebounded, the FDA is instructing health care facilities to stop using nonapproved respirators. Emergency use authorizations for those devices expired June 30.

Acute stroke care in U.S. remained strong during covid

A seemingly rare piece of good news related to the pandemic:  Acute stroke care in the U.S. suffered relatively few disruptions during the pandemic. A study in Stroke found that among patients participating in a stroke registry, rates of IV alteplase and endovascular therapy remained strong during the pandemic. In addition, researchers found that door-to-CT times, door-to needle times and door-to-endovascular therapy times all showed no signs of slipping. Researchers did find that the number of patients presenting with stroke symptoms dropped 15% beginning in March 2020. A MedPage Today article notes that the results contradict another recent study that found a decline in stroke care around the world because of the pandemic.

July 8, 2021

NIH report: Covid surges drove spikes in mortality

An NIH study has concluded that covid surges raised mortality rates at the nation’s hardest hit hospitals. The research, which was published in Annals of Internal Medicine, found that high surge hospitals experienced a two-fold greater mortality than hospitals not experiencing surges. The data showed that nearly one in every four deaths, or a total of about 6,000 deaths, could possibly be attributed to the strain on hospital resources produced by covid surges. A HealthLeaders article says researchers examined the records of nearly 150,000 patients admitted to 558 hospitals between March and August of 2020. Researchers concluded that surging caseloads “potentially eroded” the benefits offered by emerging treatments.

July 6, 2021

Covid cases starting to grow again, fueled by Delta

Before the holiday weekend, CDC Director Rochelle Walensky, MD, warned that the daily count of new covid cases had started to climb, marking a 10% increase in new cases from the week before. A Medscape article says that hospitalizations and deaths remain low and the country’s covid caseload is still down 95% from the U.S. peak earlier this year, but hot spots are popping up in various parts of the country. Covid cases in Florida, for example, are up 42% from the previous week, and new cases in Los Angeles County doubled from the previous week. Johnson & Johnson offered some good news in an announcement that its covid vaccine offers protection against the Delta variant. A New York Times article says that while the vaccine is slightly less effective against the variant compared to the original virus, it is also more effective against the Delta variant than it was against the Beta variant. Israeli data similarly found that the Pfizer vaccine has lost some of its effectiveness, possibly because of the Delta variant, but that it remains effective at preventing serious illness. A Reuters report says the Pfizer vaccine’s effectiveness in preventing overall infection and symptomatic disease has fallen to 64%, but that it is 93% effective in preventing hospitalizations and serious illness. In the United States, officials are particularly concerned about states in the South and the Midwest, where vaccination levels in some counties hover around 30%. In a Healthcare Dive article, the CEO of a large rural health system says he is already having to divert patients to larger systems because of surges in covid patients and problems with nursing staffing. He warns that covid surges could appear much more quickly than they did last fall, and that health care systems “should get ready now.”

July 2, 2021

EDs in the Pacific Northwest reeling from the heat, violence

The heatwave gripping the northwest part of the United States is stressing the region’s emergency departments, adding to the existing challenges of overcrowding and understaffing. A MedPage Today article says that in Oregon and Washington, patient volumes have spiked because of a surge in heat-related illnesses. And because the wards in many hospitals are full, in part because of the lingering effects of covid and in part because of injuries that are the result of a spike in violent crime, the ED has nowhere to send patients who need to be admitted. The Medscape article notes that some patients presenting with heat-related issues can appear to be suffering from cardiac arrest. In related news, a survey of workers at an urban academic medical center found that nearly one-third have been physically assaulted at work and one-third have suffered verbal abuse. The problems are so constant and so expected that most victims didn’t bother to report the abuse or even mention it to colleagues.

The impact of India’s pandemic crisis on U.S. physicians

As covid ravages India, physicians in that country and in the United States are feeling the effects. In a STAT news article, three U.S. physicians of Indian origin discuss how the pandemic in their “motherland” is affecting them. Via a constant stream of messages platforms, such as WhatsApp, and social media postings, physicians of Indian origin working in the United States are learning about the struggles families and friends in India are facing. Physicians here are hearing status updates of relatives who have the virus, and they’re receiving pleas for help to find basic supplies like oxygen, hospital beds and even ambulance transport. The authors point out that the situation in India can affect the United States. Besides the obvious implications of the Delta variant leaving India and gaining traction in the U.S., nearly 40% of U.S. prescription medications come from India.

How soon after covid is it safe for elective surgery?

Surgeons are struggling to know when it’s OK to give patients who have had covid the green light for elective surgery. As a result, the lingering effects of covid are keeping some patients out of elective surgery for months, even in individuals who had relatively mild cases of the infection. A Kaiser Health News story says that a March study found that waiting at least seven weeks after a covid infection significantly reduced the mortality risk of surgery, but the mortality rate was still double that of surgery patients who never had covid. That same study concluded that for patients with lingering symptoms of covid, elective surgeries should be delayed even longer. The American Society of Anesthesiologists and the Anesthesia Patient Safety Foundation have issued guidelines saying surgery is OK four weeks after covid for patients who were asymptomatic or had mild, non-respiratory symptoms, but they also say that surgery should not happen for at least 12 weeks in people who were in an ICU because of covid.

One in three workers at larger hospitals not vaccinated

One in four hospital workers who have direct patient contact have not yet received a covid vaccine. At larger hospitals, that number is closer to one in three. A Medscape article says that the picture of exactly who in health care is vaccinated is murky because reporting on vaccination rates is voluntary, and only about half of U.S. hospitals have provided that information to the government. But the article also says that its projected vaccination rate in U.S. hospitals mirrors the vaccination rates of the general population. About 24% of Americans don’t plan to get the vaccine, and 12% plan to get vaccinated but want to wait. In a poll of health care workers conducted in May, about 12% of physicians said they were hesitant to get the shot.

June 25, 2021

Doctor’s mental health: Collateral damage

It’s a longstanding crisis that, with covid, has taken on new urgency: Medicine is “a profession that punishes some doctors from getting mental health care,” as Vox reports in a new article. For physicians, structural barriers to mental health services are still in place and enforced by many physician groups, hospital credentialing systems and licensing boards; those stop doctors from getting help, for fear of jeopardizing their license and practice. Article sources note that part of the problem is that half of U.S. physicians work as independent contractors, falling outside labor law protections, and that doctors fall prey to chronic understaffing and traumatic experiences. The field also attracts “perfectionists who put tremendous pressure on themselves to succeed.” The Physician Support Line that was set up during the pandemic for doctors and medical students and is staffed with psychiatric volunteers has seen “explosive demand.” Article sources who have sought help say they’ve gone out of state to do so or have paid out-of-pocket so their mental health services aren’t reported to insurers or employers. In other news: When the pandemic began, The Nocturnists—the story-telling collaborative of health care professionals based in San Francisco—asked clinicians to record pandemic audio diaries. Those more than 700 sound diaries have now been donated to the Library of Congress.

Inflammation “extremely rare,” but mRNA vaccines get new warning

The FDA has decided to add a warning to the labels and fact sheets of both the Pfizer and Moderna vaccines about heart inflammation in young adults. But while CDC and ACIP officials this week noted a “likely association” between the cardiac issues and the mRNA vaccines, they also noted that myocarditis and pericarditis are “extremely rare.” A benefit-risk presentation finds that close to 500 cases of myocarditis among people younger than 30 have been reported, with more than 300 hospitalized. (Close to all have been discharged.) Most cases are in males, and most problems emerge within four days of receiving the second vaccine dose. According to an ACIP work group, “Currently, the benefits still clearly outweigh the risks for COVID-19 vaccination in adolescents and young adults.” In other news, younger Americans and African-Americans are increasingly at the highest risk of dying from covid.

June 23, 2021

U.S. will miss its original July 4 vaccine mark

The administration acknowledges that the U.S. will miss its ambitious vaccine goal of having 70% of American adults vaccinated by July 4. Instead, it’s set another goal that should be achieved by that date: 70% of those age 27 and older. NPR reports that the country will miss the original 70% goal by only a few percentage points, with 65% of the population having at least one shot right now and 56% fully vaccinated. The pace of vaccinations has slowed considerably from earlier this year, with fewer than 1 million shots being administered per day. The CDC points out that the states with the lowest adult vaccination rates (under 50%) are Mississippi, Louisiana, Wyoming and Alabama. At the other end of the spectrum, more than 80% of adults in Vermont, Hawaii and Massachusetts have been vaccinated.

With N3C, the U.S. finally centralizes some health data

Some of the best covid studies have come from the U.K., in large part because researchers there can access centralized NHS patient data. But in the U.S., patient data are trapped in a maze of proprietary systems behind a firewall of privacy protections that often contradict each other. According to an article in MIT Technology Review, that impasse led NIH researchers to create the National Covid Cohort Collaborative (N3C), a database now collecting information on millions of U.S. patients. That database contains records on 6.3 million patients, including more than 2 million Americans infected with covid. Those data are coming from more than 50 institutions around the country, with patient data stripped of personally-identifiable information for zip codes and services dates. So far, more than 200 research projects have been approved that can access some tier of those data.

June 21, 2021

Delta variant could create “two Americas”

Given the wide regional variations in vaccination rates in the U.S. and the rise of the Delta variant, experts are warning that “two Americas” may emerge. In areas with high vaccination levels, people can expect to be protected against the variant. But in those with low vaccination rates, the Delta variant—which first emerged in India—may drive outbreaks this fall or winter. A recent study from Scotland published in The Lancet found that patients’ risk of being hospitalized when infected with the Delta variant was about twice that of the Alpha variant, which first emerged in the U.K. British data indicate that the Delta variant is also between 40% and 60% more transmissible than the U.K. variant

Could the vaccine rollout have been improved?

Close to 180 million Americans have had at least one dose of vaccine, but 100,000 Americans have died of covid since February when the vaccine rollout was underway. The New York Times asked experts what other vaccination strategies should have been pursued to cut that level of mortality. Experts offered five strategies: delayed second dosing, an approach taken in the U.K. and Canada, to stretch vaccine supplies among vulnerable patients; a younger rollout to include more people ages 50-64; a targeted rollout to get vaccine to the hardest-hit zip codes; faster congressional action, with money approved sooner for vaccine distribution; and a better public relations campaign to overcome vaccine hesitancy and provide more information about access.

June 18, 2021

Covid’s high toll among IMGs

A research letter points out that IMGs make up about 25% of the American physician workforce—but 45% of the doctors who’ve died from covid. With Abraham Verghese, MD, as its lead author, the letter looks at data on 132 physician deaths from covid as of late November 2020. The authors found that 60% of those deaths occurred among primary care physicians, even though primary care doctors make up only 37% of practicing physicians. (According to the letter, 40% of IMGs work in primary care.) As to why the IMG death toll was disproportionately high, the letter points out that close to 40% of physician deaths were in New York and New Jersey, which have high numbers of IMGs. Also, because those states were particularly hard hit during the early part of the pandemic, those doctors had higher rates of exposure. “The larger number of deaths among IMGs,” the authors write, “highlights their important contribution to patient care.”

Antibody cocktail cuts mortality in some hospitalized patients

Regeneron’s monoclonal antibody cocktail received an EUA in the U.S. to treat patients with mild to moderate covid. Results out of the U.K. this week, according to a press release, found that the therapy produced a mortality benefit among hospitalized patients whose own immune systems weren’t producing antibodies. Among such seronegative patients, use of the cocktail cut 28-day mortality rates by 20%, shortened length of stay and reduced the need for mechanical ventilation. (The therapy produced no benefits in hospitalized patients generating their own antibody response.) In the trial, close to 9,800 patients were randomized to either usual care plus the antibody combo or just usual care; among the usual care group, 30% were seronegative. One skeptic about the results quoted by Reuters noted the cocktail’s high price and said its efficacy would depend on being able to readily identify and treat the hospitalized patients who could benefit.

Got a startup?

New York’s Mount Sinai is launching an incubator program that’s looking for pre-seed and seed stage startups in health care and biotech. FierceHealthcare reports that the new incubator—called Elementa Labs—will offer accepted startups a 12-week virtual program as well as access to a champion and Mount Sinai’s network of experts. The new program is accepting applications through Sept. 30 from startups willing to trade some future equity. Mount Sinai has a robust commercialization arm that filed close to 400 patents last year. The incubator’s first participant is avoMD, which makes a mobile clinical decision support platform.

June 15, 2021

Vaccination disparities

Big vaccination milestones: An AMA survey finds that 96% of practicing physicians in the U.S. have been vaccinated, and Vermont is the first state to have 80% of its population age 12 and older at least partially vaccinated. But a report from Kaiser Family Foundation finds that vaccination rates in communities of color are still lagging, with only 63% of Hispanics and 51% of African-Americans expected to be vaccinated by July 4. As for when those communities will be 70% vaccinated, the report claims that will be the end of July for Hispanics and the beginning of September for Blacks. The report also notes that many states aren’t on track to achieve 70% vaccination rates with at least one shot by July 4.

June 14, 2021

Judge tosses anti-vaxx lawsuit brought by hospital workers

A federal judge this weekend threw out a lawsuit brought by more than 100 hospital workers who were suspended from Houston Methodist Hospital for refusing to be vaccinated against covid. The workers, who say they will appeal, claimed in their suit that they did not believe the vaccines were safe because they’d been issued only EUAs by the FDA, not full approvals. In his ruling, the judge rejected the argument that the hospital’s policy of mandatory covid vaccinations was forcing workers to take part in a “human trial”—and called “reprehensible” the plaintiffs’ complaint that the vaccine mandate was similar to medical experiments done during the Holocaust. USA Today reports that a growing number of hospitals around the country are beginning to require vaccination among their workers.

Link between second dose and heart inflammation in young people?

It’s rare but higher than expected, according to CDC and FDA officials. While the data are still preliminary, the agencies are investigating 573 cases of myocarditis and pericarditis reported in younger patients after receiving the second dose of either mRNA vaccine. (After the first dose, 216 cases have been reported.) The cases appear to be more common in men than in women, and most cases are mild. STAT reports that Israeli officials are also investigating “a possible link” between myocarditis and a second vaccine dose among men ages 16 to 30. According to agency officials, most of the patients for whom cases have been reported have fully recovered.

June 11, 2021

The push to vaccinate teens

Adults are more than 10 times more likely to be hospitalized for covid than patients under age 18. But a new report from the CDC points out that covid hospitalization rates among those ages 12 to 17 is twice that for seasonal flu, and that adolescents with chronic health issues are a big concern. Among teenagers hospitalized with covid from early January 2021 through April 2021, nearly one-third required ICU care and 5% needed to be on a ventilator, however none died. About 70% had underlying health issues, with obesity being the most common and chronic lung diseases, including asthma, and neurological conditions also occurring. As for vaccinations among teens, the Kaiser Family Foundation looked at state laws around needing parental consent. Most states—41 of them—require teens younger than 18 to get parental consent, while Nebraska mandates parental consent for those below age 19. But many states allow teens who are emancipated or homeless to self-consent, as do two cities: San Francisco and Philadelphia, where minors age 12 and older can themselves decide to be vaccinated.

Analysis argues for continued use of convalescent plasma

Hospitals’ use of convalescent plasma to treat covid dropped after several published studies found no apparent benefit. But new research from Johns Hopkins makes the case for clinicians taking another look. The authors compared data on both the number of plasma units distributed to hospitals and of covid hospital deaths, finding a strong negative correlation. According to the model that researchers devised, every 10% increase in the rate of plasma used in hospitals cut covid fatalities by 1.8%—while the decline in plasma use between November 2020 and February 2021 may have contributed to more than 29,000 excess covid deaths. As to why some studies found no therapeutic benefit, the authors note that in many of the negative trials, convalescent plasma was administered relatively late in the course of the illness when patients were too sick to benefit and their immune responses were driving their disease.

Urban-rural gap in death rates is getting worse

The good news is that mortality rates for both urban and rural Americans are falling. The bad news: A new JAMA research letter finds a widening gap in the rate of those declines. Looking at 1999-2019 data, the authors found that the mortality gap between those two areas grew by more than 170%. In 2019, the death rate was close to 665 deaths per 100,000 in urban America but 834 deaths per 100,000 in rural areas. While men had higher mortality rates than women, both men and women in rural areas died at higher rates than their urban counterparts. In related news, the CDC reports that U.S. death rates for nine conditions climbed last year during the pandemic. The AP reports that the common killers with spiking rates last year included diabetes, heart disease, Alzheimer’s, stroke and hypertension. Some experts chalk those increases up to patients delaying care for fear of becoming infected.

Did pandemic precautions kill off some flu strains?

Some possible positive fallout from all the masking and physical distancing: Certain flu strains may have become extinct that in turn could make it easier to develop a more effective flu shot. That’s according to a STAT article, which notes that certain strains of the flu haven’t been recorded in databases since March 2020. While flu shots typically are quadrivalent—targeting four separate flu viruses—trivalent ones may be OK going forward. But not all flu epidemiologists are convinced the strains are gone for good, and experts point out that very few cases actually undergo genetic sequencing. In a typical year, about 20,000 undergo such sequencing—but this year, only 200 were uploaded to a repository.

June 9, 2021

Hospitalizations jump in areas with low vaccination rates

The seven-day averages for both new covid cases and deaths have dropped, with most states seeing a 5% or greater decline in new cases. But vaccination rates have also fallen off dramatically, and the New York Times reports that covid hospitalizations are on the rise in areas with low vaccination rates. One Tennessee county where only 20% of the population is fully vaccinated, for instance, has seen a close to 700% increase in covid hospitalizations over the past two weeks. Part of the problem is the spread of variants, with the highly transmissible Delta strain from India now accounting for more than 6% of the cases sequenced in the U.S. Another part of the problem is highlighted in an article from The Center for Public Integrity: People who have established profitable businesses selling vaccine skepticism and conspiracies.

June 8, 2021

How does covid affect the brain?

That question still remains unanswered a year and a half into the pandemic. Autopsies of patients who’ve died of severe covid show acute damage in their brains, including clotting and “swarms of immune cells,” according to the Washington Post. And patients report a host of seeming neurological symptoms such as disturbances of vision and hearing, as well as vertigo. Experts quoted in the article, including UCSF’s S. Andrew Josephson, MD, editor in chief of JAMA Neurology, suspect the virus does attack the brain, but they’re not sure of the mechanism. Perhaps covid acts like herpes simplex, sometimes causing dangerous swelling of the brain that in turn triggers an autoimmune attack. Experts disagree on whether the virus invades the brain directly. The NYU Grossman School of Medicine has received federal funding for four years to develop a databank of neurological studies and a biobank of tissue samples.

Pandemic precautions may have killed off some flu strains

Some possible positive fallout from all the masking and physical distancing that’s taken place over the past 18 months: Certain flu strains may have become extinct, and that in turn could make it easier to develop a more effective flu shot. That’s according to a STAT article, which notes that certain strains of the flu haven’t been record in databases since March 2020. While flu shots typically are quadrivalent—targeting four separate flu viruses—trivalent ones may be OK going forward. However, not all flu epidemiologists are convinced the strains are gone for good, and experts point out that very few actually undergo genetic sequencing. In a typical year, about 20,000 undergo such sequencing—but this year, only 200 were uploaded to a repository.

June 4, 2021

Good riddance to the (in-person) med school interview

A new article in Slate highlights what may be positive fallout from the pandemic: the end of the expensive cycle of in-person interviews for those applying to medical schools. According to the article, candidates apply to an average of 17 medical schools; back in the day, applicants went in person to every interview they were able to get. That added up to a very expensive application process, discouraging those with lower incomes or those who couldn’t take time off work when applying. “It might be no surprise at all,” the article noted, “that 51 percent of medical students come from the wealthiest quintile of households, with 24 percent from the top 5 percent alone.” This year, however, the entire interview process went virtual, which some sources in the article believe may disadvantage newer and rural medical schools. However, the majority of candidates and admission officers quoted welcomed the change.

Study: Close to half of discharged patients suffer functional decline

A recent study from University of Michigan delivers this snapshot of what may be an underreported covid complication: Close to half—45%—of all covid patients discharged had significant functional decline. The study, published in PM&R, found that 20% of patients who experienced functional decline were no longer able to live independently after discharge and needed to either enter a post-acute facility or go live with a family member. Researchers looked at charts for close to 300 patients discharged between March and May 2020, the pandemic’s first wave. During that time, the study notes that clinicians were struggling to maintain hospital capacity and to minimize their own and colleagues’ exposure; as a result, 40% of the patients in the study didn’t receive a rehab evaluation while hospitalized. Among patients in the study who suffered functional decline, more than two-thirds (68%) needed to be discharged with some form of durable medical equipment.

June 2, 2021

Hospital employees push back against vaccine mandate

More than 100 unvaccinated staff members at Houston Methodist Hospital signed onto a lawsuit filed late last week, pushing back against that hospital’s vaccine mandate. The Washington Post reports that the suit likens mandatory covid vaccination to medical experimentation without consent. The lawsuit states that the hospital—through compulsory vaccination—”is forcing its employees to be human ‘guinea pigs’ as a condition for continued employment.” Experts quoted in the article point out that the “experimentation” charge is absurd, given that the vaccines now in use went through rigorous clinical trials. Among staff members at the hospital, 99% have been vaccinated. According to the EEOC, companies can mandate vaccinations for employees within a workspace. However, employers must also meet a host of legal considerations, including accommodating employees’ health concerns—which encompass having disabilities as well as religious reasons against being vaccinated—and keeping vaccination information confidential. While most employers aren’t mandating vaccinations, many are offering incentives to encourage employees to get them.

Covid variants get new names

Can’t remember which variant is the B.1.1.7 or the B.1.671.2? While members of the medical community may be able to recognize the various variant designations, the World Health Organization has announced a new naming system for important variants, going with the Greek alphabet instead of the current system that relies on numbers and periods. The variant first identified in Britain (B.1.1.7) will now be known as Alpha because it was the first major one to be identified; the Indian variant (B.1.671.2), which was the fourth strain to be identified, will now be known as Delta. Once the number of variants exceeds the 24 letters in the Greek alphabet, a new naming system will be called for. STAT reports that the new nomenclature is a bid to make it easier for the public to keep important variants straight. It’s also a move to encourage reporting of new variants because the names of countries of origin now won’t be associated with an emerging mutation.

June 1, 2021

The ongoing search for effective treatments

Coronavirus spurred an unprecedented wave of targeted research into possible treatments. But according to a Wired writer looking at covid trials, most of those studies “were crap.” Despite a few standout trials, including those that showed the efficacy of steroids, most covid studies were either not randomized or were so small as to reach no solid conclusions. Now, however, large randomized trials being conducted in both the U.S. and Europe are looking at therapies with real potential: infliximab, an immune-suppressant; the anti-inflammatory imatinib; and artesunate, an antimalarial. In the U.S., another series of trials is gearing up to look at repurposed drugs that may be effective against mild or early covid. The chaos in covid trials might yield another important future change: master protocols to allow trials to test more than one drug at a time. During covid, the U.S. government spent $18 billion researching vaccines and only $8 billion on therapeutics. The article points out that the federal government needs to step up and sponsor more trials on repurposed drugs because such drugs don’t represent enough profit for Big Pharma to fund.

Study: Close to half of discharged patients suffer functional decline

A recent study from University of Michigan delivers this snapshot of what may be an underreported covid complication: Close to half—45%—of all covid patients discharged had significant functional decline. The study, published in PM&R, found that 20% of patients who experienced functional decline were no longer able to live independently after discharge and needed to either enter a post-acute facility or go live with a family member. Researchers looked at charts for close to 300 patients discharged between March and May 2020, the pandemic’s first wave. During that time, the study notes that clinicians were struggling to maintain hospital capacity and to minimize their own and colleagues’ exposure; as a result, 40% of the patients in the study didn’t receive a rehab evaluation while hospitalized. Among patients in the study who suffered functional decline, more than two-thirds (68%) needed to be discharged with some form of durable medical equipment.

May 28, 2021

How much delayed care wasn’t needed?

Will care delayed during the pandemic help researchers shine a light on low-value health care? A Kaiser Health News article examines the growing body of evidence on outcomes for people who delayed care during the pandemic to determine if that care is unnecessary. One study, for example, found that VA patients who had elective surgeries canceled because of covid showed no increased use of the ED compared to patients who had undergone the same surgeries two years before. A HealthAffairs article suggests that researchers could study differences in pre-pandemic and current outcomes for screening colonoscopy (particularly among older patients), regular measurements of hemoglobin A1c for diabetics and knee arthroscopy for articular cartilage repair. In related news, a recent study found that while routine preop testing before low-risk surgery is common, it adds little value. A study in JAMA Internal Medicine found that of people undergoing preop testing for three low-risk surgeries, half had one or more preop tests while 29% had two or more tests. Older patients were the most likely to receive testing, and the most common tests were CBC counts and electrocardiograms.

“Burnout” doesn’t really cover it

Before the pandemic, many health care workers were already struggling with burnout. But to be able to communicate and work through what health care professionals have experienced in the past 18 months, “leaders and organizations need expanded vocabularies, strategies and resources.” That’s according to a Becker’s Hospital Review editorial, which delves into the many facets of clinicians’ experience since the pandemic began. Labeling all of those reactions—fear, moral injury, invalidation, isolation, exhaustion—as “burnout” prevents groups and organizations from addressing specific factors that drive those different feelings. Making matters worse: Some organizations try to meet the current mental and emotional challenges with the same menu of strategies they used pre-pandemic, as if those experiences could be managed through yoga classes or more workouts. Instead, the editorial argues, health care organizations need to offer new kinds of resources for mental health and emotional support. They also shouldn’t expect the difficult effects of working through the pandemic to subside when covid patients stop being hospitalized. “Naming distinct emotions or experiences helps diffuse their charge and gives us a say in what we do with them,” the editorial concludes.

Lotteries, other incentives, drive vaccination rates

A recent college grad in Ohio is $1 million richer this week, the first of five winners to be named in Ohio’s “Vax-a-Million” lottery. Also named: The first of what will be five teenagers awarded a full scholarship to Ohio public colleges, all part of that state’s drive to boost vaccination rates among those age 16 and older. In the week after it was rolled out, Ohio’s lottery drive increased vaccinations in that state by more than 30%. Colorado, Oregon, New York and California have followed suit, announcing big-cash lotteries, while Maryland will hold drawings for 40 days straight, giving vaccinated state residents 18 and older a chance to win portions of a total $2 million pot. The lotteries are part of an array of vaccination incentives, ranging from new cars and sporting goods to a chance to win a year of free domestic airline travel. (All vaccinated members of United’s MileagePlus program can enter that travel lottery by June 22.) In other vaccination efforts, states and cities are switching from having only mass vaccination sites to mobile campaigns. The New York Times reports, for instance, that Los Angeles will move to mobile vaccine vans and trailers by Aug. 1, using mobile units to target communities with the lowest vaccination rates. Similar mobile clinics have been set up in Washington state, Delaware and Minnesota.

With breakthrough infections, the CDC courts controversy

The CDC continues to provide state-level data on breakthrough infections, which occur in people who are fully vaccinated. But the agency is drawing fire for its decision to, starting this month, collect data and report on only those breakthrough cases severe enough to result in hospitalizations or deaths. As of the end of April, the CDC had received reports on more than 10,200 breakthrough infections (out of more than 100 million full vaccinations), with 63% occurring in women. Based on preliminary data, 27% of those cases were asymptomatic, while 10% were hospitalized and 2% died. As for the CDC’s decision to stop collecting data on all breakthrough infections, those who support the change say that only cases that tax the health care system are worth monitoring. But critics believe the CDC is losing the opportunity to learn whether breakthrough infections are associated with a specific vaccine and whether mild or even asymptomatic cases produce long-term complications.

May 24, 2021

Huge health care meeting says only vaccinated can attend

One of the biggest medical meetings to return after the pandemic has announced that all attendees will need to provide proof that they’re vaccinated. The Healthcare Information and Management Systems Society (HIMSS), whose meetings before covid routinely drew 40,000-plus attendees, will host its next meeting this August in Las Vegas. An article in Heathcare Innovation says the meeting will consider attendees fully vaccinated if two weeks have passed since their last shot of the Moderna or Pfizer/BioNTech vaccines or if two weeks have passed since their single dose of the J&J vaccine. HIMSS says it is currently evaluating how it will require attendees to prove their vaccination status, but it will likely use digital technology that protects the privacy of attendees. Meeting organizers say they plan to keep an appropriate amount of space on the exhibit hall floor between exhibitors and to use social-distancing strategies during educational sessions.

Vaccines help vaccinated and unvaccinated nursing home residents

New data show that covid vaccines are slowing down spread of the virus in vaccinated and unvaccinated residents of nursing homes. A correspondence published in The New England Journal of Medicine found that in more than 13,000 nursing home residents vaccinated with the Moderna or Pfizer/BioNTech vaccine, cases of the virus dropped from 822 within two weeks of the first shot to 38 cases two weeks after the second shot. Among nearly 4,000 unvaccinated residents, cases of the virus dropped from 173 within 14 days of the vaccination clinic to 12 cases after the second vaccination clinic. There was more good news: 66% of cases were asymptomatic in the two weeks after the first vaccination clinic, and 83% were asymptomatic after the second vaccination clinic.

May 21, 2021

CDC details more cases of blood clots after J&J vaccine

Late last week, the CDC announced that it had found more cases of “potentially life-threatening” blood clots among people who received the J&J shot. A Medscape article says that the CDC has identified 28 cases of thrombosis with thrombocytopenia syndrome out of the nearly 3 million people who received the J&J vaccine. Three of those people died. The agency noted that the side effects resemble those found in a small number of Europeans who received the AstraZeneca vaccine. Both shots use adenovirus technology to deliver messages that instruct the body to make covid proteins to help the body fight the infection.

Fauci says vaccines offering “near-complete protection” against variants

During the keynote address before the American Thoracic Society meeting, Anthony Fauci, MD, said new data show the vaccines being used in the U.S. are offering “near-complete protection” against the U.K. and South African covid variants. According to a MedPage Today report, Dr. Fauci cited data from a research letter published in The New England Journal of Medicine. That letter found that that the Pfizer/BioNTech vaccine was 90% effective against the U.K. variant and 70% effective against the South Africa variant. The data come from a study of nearly 400,000 people in Qatar. Dr. Fauci added that preliminary data on the vaccines’ effectiveness against the Brazil and India variants are similarly promising, although he warned that the situation could change.

May 14, 2021

More data on vaccines’ effectiveness in protecting health care workers

If you have colleagues who are refusing to get a covid shot, you can point to a new study that shows the Pfizer/BioNTech vaccine will keep them safe. A JAMA study found that in a group of health care workers in Israel, only eight of 5,500 fully vaccinated workers got symptomatic covid, compared to 38 of nearly 760 unvaccinated workers. The study also found that asymptomatic infections occurred in 19 fully vaccinated health care workers and 17 unvaccinated workers. Because the group of vaccinated workers was so much larger than the number of unvaccinated workers, the data showed that unvaccinated workers were 14% more likely to have asymptomatic cases of covid. A research letter in the same issue of JAMA similarly found fewer symptomatic infections among vaccinated health care workers, but it also found more asymptomatic infections among the vaccinated.

CDC releases report on “stark differences” in vaccination rates

While nearly 80% of Americans 65 and over have received at least one dose of the covid vaccine, there are gaps in vaccine coverage that illustrate some of the geographic, racial and social disparities the country faces as it tries to reign in the pandemic. A CDC report says that vaccinated Americans are overwhelmingly white, although demographic data weren’t available for everyone in the study population. The report also found stark differences by geography. In Alabama, for example, fewer than 70% of seniors have received at least one dose of the vaccine, compared to nearly 100% of older adults in New Hampshire. Counties with lower vaccination rates tended to have higher numbers of older adults with “social vulnerabilities,” such as a lack of access to the Internet and living alone.

Most docs vaccinated, support mandatory vaccines for clinicians

A Medscape poll provides data on vaccination rates for physicians and what they think of mandatory vaccinations for health care workers. The survey of nearly 1,000 physicians found that 79% are partially vaccinated and that 75% are fully vaccinated. That leaves 16% who have no plans to get vaccinated and 5% who are planning on getting the shot. In the survey, 69% of physicians said they believe employers should require clinicians to get a shot. Seventy percent of those physicians said the shots should be required immediately; the other 30% advocated for waiting for full FDA approval before requiring vaccinations for health care workers. Seventy-five percent of female physicians supported the idea of mandatory vaccines for clinicians compared to 67% of male physicians, and support was highest among physicians 65 and older. Among nurses, 62% were already vaccinated, but only half supported the idea of mandatory vaccines for clinicians.

CDC’s messaging a mess, according to critics

While the CDC has made major announcements in the last week about the nature of how the covid virus spreads (via aerosolized particles) and the need—or lack thereof—for masks, critics are complaining that the agency’s messaging has been too conservative and is confusing the public. A STAT article outlines the issues the CDC has had with its messaging, pointing that its mask guidance a week or so ago was so conservative that it was lampooned on The Daily Show. A poll conducted by the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health found that only 52% of Americans said they have “a great deal of trust” in the CDC, and only 37% said the same thing about the NIH or FDA. An NPR article says those sentiments extend to state and local health agencies, which are trusted by just over 40% of Americans.

I hate myself on screens! The psychologic fallout of covid

One side effect of the pandemic appears to be a growing interest in cosmetic surgery. A MedPage Today article explains that as people have been staring at images of themselves on platforms like Zoom, many haven’t liked what they’ve seen. “Zoom dysmorphia” is a term dermatologists are using to describe the fallout, which one small study found was associated with a 57% increase in cosmetic consultations. In that study, 86% of patients cited video conferencing as the reason they were seeking a consult. The study found that the most common concerns cited by patients were wrinkles on their upper face, circles under the eyes, dark spots on the face, and sagging necks.

May 9, 2021

Can the J&J vaccine cause anxiety-related adverse events?

The pandemic has clearly challenged the mental health of many people, but can the stress of covid produce a physical response to a vaccine? Researchers claim that’s exactly what happened when dozens of Americans had post-vaccine symptoms this spring that included fainting or dizziness. According to a Modern Healthcare article, 64 people who received the J&J vaccine in five states experienced problems, but experts from the CDC say those issues were not caused directly by the vaccine. CDC researchers suspect that the people who experienced issues had specifically sought out the J&J’s one-dose shot because they were anxious about getting a vaccine. This anxiety, the researchers claim, likely made these people “more highly predisposed to anxiety-related events” when getting vaccinated. CDC researchers also discovered that about one-quarter of people who experienced problems after getting the covid shot said that they had experienced similar side effects after getting other vaccines. According to a MedPage Today article, data published this week in the MMWR found that there were 8.2 anxiety-related episodes for every 1,000 people who received the J&J vaccine, compared to 0.05 episodes per 1,000 people who received the flu vaccine. Concerns that people are anxious about the J&J vaccine are backed up by recent polling data, which found that about three in four Americans who haven’t yet been vaccinated said they won’t get the J&J vaccine. Those same Americans rated the J&J vaccine as less safe than the Moderna and Pfizer vaccines.

Report names hospitals performing the most unnecessary procedures

May 5, 2021

What do Leapfrog safety grades look like during a pandemic? (updated 5/7/2021)

New safety ratings from the Leapfrog Group gave 906 hospitals its top rating and more than 1,000 hospitals a “C” grade or worse. While the ratings have been around for 20 years, the group says that its current ratings serve as a proxy for safety during the pandemic. The report ranks states with top-performing and low-performing hospitals, noting that four states—Idaho, Maine, Massachusetts and Virginia—had more than half of their hospitals scoring an “A” grade. The organization has also posted testimonials from hospitals explaining what they have done during the pandemic to keep patients safe. Fierce Healthcare notes that the Leapfrog Group’s reporting methods have been challenged by hospitals and researchers.

30-days post-diagnosis, covid patients face “excess” health issues, increased death

A study in Nature found that more than 30 days after being diagnosed with covid, patients face an “excess burden” of a variety of problems, and that even patients with mild infections face an increased risk of death within six months of a diagnosis. A Healio article says that researchers found that 30 days after a diagnosis, covid patients who were not hospitalized had a nearly 60% increased risk of death, with 8.39 excess deaths per 1,000 people. Patients hospitalized after 30 days faced a 51% increased risk of death, with excess deaths in this group estimated about 29 per 1,000 people. The researchers also found that beyond 30 days, covid patients faced a “substantial burden of health loss” involving nearly every organ in the body. The most common issues were respiratory conditions, but researchers also saw nervous system issues, cardiovascular problems and GI issues.

April 30, 2021

Real-world data confirm efficacy of covid vaccines

Real-world data from a small trial show that the Pfizer-BioNTech and Moderna vaccines are 94% effective in reducing hospitalization among Americans 65 and older who got both shots. A report in MMWR notes that in people who received only one shot, the vaccine was 64% effective. The study represents the first real-world data. While another Israeli study had come up with similar results, it looked at only the Pfizer-BioNTech vaccine. The MMWR study looked at 417 adults hospitalized with COVID-19–like illness in 14 states between January and March 2021.

Creative strategies to get more Americans vaccinated

As vaccination rates in the U.S. begin to wane, a long list of organizations is coming up with creative strategies to vaccinate more Americans. A hospital in Jackson Hole, Wyo., for example, is giving its employees a $600 bonus if they’re fully vaccinated by May 31. A Houston health system is not only using a carrot to encourage vaccinations (by offering $500 payments), but it is also threatening to fire employees who can’t provide proof of vaccination by June 7. The giant insurer Cigna is offering U.S. employees $200 in their health savings accounts and paid time off to get vaccinated. And on the national level, President Biden has announced tax credits that businesses can take if they give employees paid time off to get vaccinated.

FDA “encourages” hospitals to return to one-and-done for N95s

In another sign that some signs of normalcy are on the horizon, the FDA is encouraging health care workers to return to the pre-pandemic policy of using N95 masks once and then discarding them. While hospitals are still legally allowed to sterilize and re-use N95s, the FDA is currently recommending a one-use policy and in the coming weeks is expected to begin requiring health care facilities to discard masks after one use. A Modern Healthcare article says that the announcement comes on the heels of word that U.S. manufacturers have surpluses of PPE for sale. Many hospitals say they have three to 12 months of PPE stockpiled.

Rules for buprenorphine relaxed as opioid use rises in long haulers

The Biden administration will make it easier for physicians to prescribe buprenorphine to treat opioid disorder. A Fierce Healthcare article says that the HHS has released new guidelines that exempt physicians and other clinicians from some certification requirements to prescribe the drug that were viewed as onerous. The Trump administration had announced the changes earlier this year, but the current administration put them on hold until now. The change is significant given the rise in overdose deaths during the pandemic. A Kaiser Health News article notes that a new study found “alarmingly high rates” of opioid use among covid long haulers at VA hospitals around the country. The study is raising alarms about a new epidemic of opioid addiction.

April 28, 2021

Good, bad news about your chances of getting covid

First, the good news: Health care providers rarely get covid on the job. In a study published this month in Clinical Infectious Diseases, researchers performed viral sequencing to determine the origins of covid in health care workers. They found no signs of healthcare-associated transmission in “the majority” of infections they evaluated. A Medscape article says that 11% of the infections studied in health care workers could be attributed to one of their coworkers and 4% could be attributed to one of their patients.

The not-so-good news is for health care professionals who work a lot of nights. A study in the journal Thorax found that people who worked some shifts outside of a traditional 9-5 schedule were more than twice as likely to get covid as people who work during the day. People who only worked nontraditional shifts were 2.5 times more likely to be diagnosed with covid. Researchers found these risks persisted even after controlling for known risk factors like BMI and smoking. They hypothesized that shift work’s effects on the circadian rhythm may alter the body’s response to the covid virus.

April 26, 2021

One unvaccinated nursing home worker; dozens of infections and three deaths

A covid outbreak in March in a nursing home in Kentucky is a stark reminder of the consequences of continuing to work with vulnerable patients while not being vaccinated. The New York Times reports that while 90% of the residents in that home had been vaccinated, that was the case for only half the staff. One unvaccinated worker who became infected caused 26 infections among residents (including 18 among those vaccinated) and 20 infections among other staff members. Three of the infected residents died, including one who’d had vaccine. A CDC write-up of the outbreak notes that the infections were “a newly introduced variant to the region.” The New York Times points out that resistance to being vaccinated has been high around the country among nursing home staff.

Even mild covid cases are linked to higher mortality risk

New VA data deliver this bad news: Being infected with covid—even without needing to be hospitalized—leads to a 59% greater risk of death within six months than among those who don’t become infected. Further, six-month mortality risk is also high among covid patients who are hospitalized, running 51% more than among patients with seasonal flu. Published in Nature, the study is based on data from more than 70,000 VA patients; fewer than 20% of those patients were women, and most were over age 60, according to Forbes. The study is one of the largest to look at “long covid,” those symptoms patients suffer long after their acute infection. And speaking of seasonal flu, here’s a New York Times headline from last week: “The Flu Vanished During Covid.” While recent flu seasons in the U.S. have each produced more than 200,000 recorded cases a year, the 2020-21 season saw only 2,000.

Bamlanivimab is out as a monotherapy

Earlier this month, the FDA revoked its EUA for bamlanivimab when administered alone, saying that the covid variants that are on the rise are resistant to being treated with the monoclonal antibody alone. As a result, Medicare will pay for bamlanivimab as a monotherapy only if administered between Nov. 10, 2020, and April 16, 2021. But there’s good news: The FDA also indicated that alternative therapies consisting of combined monoclonal antibodies are still appropriate. Those include casirivimab/imdevimab as well as bamlanivimab/etesevimab, and fact sheets about the use of those combinations can be found here and here. The FDA has issued EUAs for those combinations for the same indications that bamlanivimab alone used to have: for adult and certain pediatric patients with mild to moderate covid.

 April 23, 2021

More younger people are being hospitalized

A handful of states—many of them hard hit with covid a year ago—are once again the country’s hotspots, according to the Wall Street Journal (subscription required). About three-quarters of all new cases last week were reported in five states: Michigan, Florida, New York, Pennsylvania and New Jersey. CNN reports that, due to the U.K. variant being more contagious and more older patients being vaccinated, hospitalizations are on the rise among younger patients, who are suffering more severe complications than expected. Last month, for instance, New Jersey saw a 31% jump in covid hospitalizations among patients ages 20 to 29 and a 48% increase in covid hospitalizations among ages 40 to 49. An article in The Atlantic posits a future in which adults stop worrying about their elder parents becoming infected and start worrying about their children under age 12, who will be the last group vaccinated. Around the world, India is in crisis, setting global records for new daily cases (more than 300,000). The CDC is warning against traveling to India, saying that if a trip in unavoidable, only fully vaccinated people should travel there. The U.K. is now banning all travelers from India.

How soon will vaccine supply in the U.S. catch up to demand?

As of Monday, all adults in all states are eligible for vaccine and vaccine supplies have bumped up significantly from just a month ago. Kaiser Family Foundation now predicts that within the next two to four weeks, the U.S. will likely hit a tipping point where finding Americans who want to be vaccinated will become much harder. “Federal, state, and local officials, and the private sector,” the foundation writes in a policy statement, “will face the challenge of having to figure out how to increase willingness to get vaccinated among those still on the fence.” In addition to those hesitating to get vaccine, 20% of Americans polled claim they won’t be vaccinated or will only if required. The Cleveland Clinic is partnering with Mayo and more than 50 other hospitals and health systems on the “Get the Vaccine to Save Lives” campaign, producing public service announcements to convince those who haven’t yet been vaccinated to step up. And to entice employees to be vaccinated, one hospital in Wyoming—St. John’s Health in Jackson Hole—is giving each full-time vaccinated employee a $600 bonus—and offering the same to those who’ve held off, as long as they’re fully vaccinated by May 31. The goal is to have as many employees vaccinated as possible before summer tourists start to arrive. Meanwhile, while the FDA and CDC may decide later today whether to end the pause in using the J&J vaccine, phase 3 trial results for that vaccine have been published in the NEJM. The results: 75% efficacy at more than 28 days, and 85% against severe or critical disease.

April 22, 2021

Nursing vacancies grow, and burnout is widespread

Hospitals are reporting a spike in unfilled nursing positions, a dilemma that hospitals have increasingly tried to meet with growing numbers of (expensive) traveling nurses. In a survey of 100 hospital executives, 36% said they expect to have more than 25 nursing positions open this year, a rate more than twice what it was in 2020 (17%). Among respondents, 70% reported losing between 5% and 30% of their nursing staff as a result of covid. In other news, a Washington Post-Kaiser Family Foundation poll found that three out of every 10 health care workers are considering leaving the profession, due to burnout and stress. While 55% of all health care workers surveyed reported burnout, younger people had higher levels: 69% among those age 18 to 29 and 61% among those age 30 to 39. Mona Masood, DO, a Philadelphia psychiatrist, started the Physician Support Line (1-888-409-0141) a year ago, staffing it with hundreds of volunteer psychiatrists and fielding more than 2,500 calls. Dr. Masood told the Washington Post that she is most concerned about health care workers when the pandemic ends, likening them to soldiers returning from war.

April 19, 2021

New variant tracking system will target biological threats

The White House last week announced a $1.7 billion federal program to track covid mutations. As proposed, the program would establish the first permanent national infrastructure to tackle biological threats. AP reports that the network has three components: directing the CDC and state health departments to map genetic samples (to be funded with $1 billion); partnering with universities to create six research and development centers to identify emerging pathogens ($400 million); and creating a national data-sharing network ($300 million). According to the AP, the funds are part of the recently approved coronavirus relief package and are designed to “break what experts say is a feast-or-famine cycle in U.S. preparedness for disease threats.”

Why are vaccinated people getting infected?

Their numbers are tiny, which is reassuring. But a very few cases are being recorded of fully vaccinated patients coming down with what are being called “breakthrough infections” and testing positive for covid. In rare cases, some even have been hospitalized and a few deaths have occurred, according to ProPublica. Experts don’t know why; further, they are concerned that many cases of breakthrough infections aren’t being sampled and analyzed to find out which variants, if any, may be driving the very few reported cases. Another problem: Some states aren’t reporting the level of symptoms that patients with breakthrough infections are having. South Carolina’s health department has reported 155 cases of breakthrough infections out of 950,500 full vaccinated patients, an infection rate of 0.02%. MedPage Today coverage points out that the number of breakthrough cases are as expected.

April 16, 2021

Working nights alters your genetic “circadian rhythmicity”

We all know that working nights stinks, but new research yields data on how night work may increase your risk for cancer. An MDedge article says that researchers have found that a simulation of night work changed “the normal circadian rhythmicity of genes,” which can lead to hallmarks of cancer. The study, which appeared in the Journal of Pineal Research, concluded that night work reduces the ability of the body’s RNA to repair genes affected by working at night. During the simulation, some of the genes of participants lost their normal day-shift rhythmicity. The study also found that night work increases endogenous and exogenous DNA damage. The next step, researchers say, is to test real-world night-shift workers to see if the damage from unrepaired DNA builds up over time, increasing cancer risk.

Pandemic spurs rapid evolution of chief wellness officer role

A survey done last summer at University of Utah Health about the pandemic came to this conclusion: “a substantial number of employees and trainees experienced major stress and work disruptions.” In fact, one in five reported considering leaving the health care workforce because of covid-related challenges, particularly around child care, and 30% considered cutting their work hours. It’s results like these that underscore the importance of wellness efforts in health care, while a new NEJM article highlights the evolving role of chief wellness officers during the pandemic. The authors, who are chief wellness officers from health systems and academic centers around the country, say that support services in many of their institutions were underutilized even during the pandemic, due in part to the ongoing stigma over using mental health resources. Successful outreach deployed during the pandemic included in-person wellness rounds. Importantly, the authors note that the intensity of treating covid patients hasn’t allowed clinicians to process their experiences.

FDA, CDC recommend a pause on the J&J vaccine

U.S. agencies are recommending halting the use of Johnson & Johnson’s one-dose covid vaccine pending the results of an investigation into six cases of clotting among recipients. STAT reports that the recommendation stops short of pulling the vaccine off the market, even temporarily. The clotting incidents, which all occurred in women, are similar to those found with AstraZeneca’s vaccine. All six cases were rare cerebral venous sinus thromboses in combination with thrombocytopenia. The six women affected were between the ages of 18 and 48, and their symptoms occurred between six and 13 days after they received the vaccine. As of this week, more than 6.8 J&J doses have been administered in the U.S. Two studies in NEJM—one looking at 11 patients in Germany and Austria, the other on five patients in Norway—delved into the clotting problems with AstraZeneca’s vaccine. The authors of both studies implicate platelet-activating antibodies targeting platelet factor 4 (PF4)-heparin, and they speculate that the antibodies are triggered by free DNA in the vaccine.

Prophylactic monoclonal antibodies?

A monoclonal antibody combination developed by Regeneron is being touted as a prophylaxis for household members of infected covid patients. According to a company press release, phase 3 trial results indicate that giving household contacts the casirivimab-imdevimab cocktail cut their risk of developing symptoms 72% during the first week and 93% in subsequent weeks. By day 29, only 1.5% of those who received the monoclonal antibodies had developed symptomatic infection vs. 7.8% of those given placebo. In addition, among those receiving the cocktail who developed symptoms, those symptoms lasted only one week vs. three weeks among those on placebo who became symptomatic.

April 12, 2021

OK to ease up on conserving N95s?

The FDA last week issued guidance that says it is now OK for health care personnel and facilities to transition away from conservation strategies with N95s and other filtering respirators. Included in the recommendations: Facilities can move away from using a crisis capacity strategy of conservation, and they can limit their decontamination of disposable respirators. They can also increase their inventory of available NIOSH-approved respirators and PAPRs. According to a press release, both the FDA and the CDC believe U.S. hospitals now have an adequate respirator supply. At the same time, the FDA made it clear that the agency is not revoking its current authorization of decontamination and bioburden reduction systems.

Covid pneumonia: Researchers find good results with home oxygen

According to a recent study, researchers in southern California got good results—low all-cause mortality and 30-day readmission rates—by discharging patients with covid pneumonia home with supplemental oxygen. Writing in JAMA Network Open, the authors detail the retrospective results of a program launched by the Los Angeles health department that included more than 620 patients. All needed at least 3L per minute of supplemental oxygen, and all were stable without any other indication for inpatient care. (Nurses followed up with patients within 12 to 18 hours of discharge from either the hospital or ED, and that back-up continued if indicated.) Followed for close to 30 days, patients had a mortality rate of 1.3% and a readmission rate of 8.5%. The authors point out that the intervention helped preserve inpatient beds for sicker patients, had an adequate safety profile and “may help optimize outcomes.”

April 9, 2021

Video games to treat brain fog?

A Boston-based startup made news last summer as the first company to get FDA clearance to market a video game as a prescription therapeutic. While that indication was for children with ADHD, Fierce Healthcare reports that the same company is now working with several major academic centers to test whether that digital treatment can improve covid “brain fog,” cognitive and mental effects that linger in some covid patients months after respiratory symptoms resolve. The company, Akili Interactive, is working with Vanderbilt University Medical Center, NewYork-Presbyterian Hospital and Well Cornell Medicine to design randomized trials. Those trials will test the ability of the video game which is marketed as EndeavorRx—to improve cognitive functioning. “The software,” according to the coverage, “provides challenges and stimuli that target the brain’s neural systems linked to focus, cognitive function and multitasking.” The academic centers plan to begin enrolling patients in the studies next month. A study published this February in Neuropsychopharmacology found that among patients with severe covid and prolonged hospitalizations, 81% had cognitive impairment that ranged from mild to severe.

U.K. variant: spiking cases, vaccine strategies, hospital testing

The spring’s steady downtick of cases is long over, with close to 65,000 cases a day now being reported. Many are occurring in cities in Michigan and New York, and experts say that most are being caused by the U. K. variant, although a variant first identified in New York City is behind outbreaks in Connecticut, New Jersey and Pennsylvania. Hospitalizations in areas with spiking cases are also rising, particularly among middle aged patients under age 50—a group that’s not close to being vaccinated. Some public health officials are urging the administration to divert vaccine supplies to Michigan, a move the Biden administration so far has rebuffed. Other experts have renewed calls made earlier this year to switch for now to a one-dose vaccine strategy, delaying second doses of both the Pfizer-BioNTech and Moderna vaccines for 12 weeks to allow more people to receive at least one dose. In other variant news, MedPage Today reports that the FDA is cautioning about possible problems with a molecular test brand popular in hospitals. Three Cepheid PCR tests (Xpert Xpress, Xpert Xpress DoD and Xpert Omni) pinpoint the N2 and E targets within viral RNA, according to the coverage, but the U.K. variant may reduce test sensitivity for the N2 target. Microbiologists quoted in the article, however, say they’re not worried about the accuracy of test results because the tests have multiple targets.

More setbacks for AstraZeneca

Another week, more AstraZeneca drama: A European agency now says that blood clots should be listed among the very rare side effects of that company’s covid vaccine. According to the European Medicines Agency, its members investigated more than 80 cases of thrombosis (out of 25 million doses administered) among patients given the AstraZeneca vaccine, 18 of which were fatal. Most of those cases were in women under age 60, and they occurred within two weeks of being vaccinated. While the agency noted “a possible link,” it did not recommend limiting the use of that vaccine, which is the go-to in European vaccination efforts. The WHO, meanwhile, notes that no causal relationship between the vaccine and clotting has yet been confirmed, although such a relationship is plausible. CNN reports that U.K. officials now recommend that people under age 30 look for alternative vaccines. While the AstraZeneca vaccine isn’t approved for use in the U.S., experts worry that concerns here about side effects, even when very rare, could spur vaccine hesitancy.

April 7, 2021

Up to 43,000 children in the U.S. have lost a parent to covid

A new research letter delivers this heartbreaking statistic: Tens of thousands of American children had lost at least one parent to coronavirus as of February 2021. Depending on the estimation model used by the authors, the number of children in the U.S. who have lost a parent ranges between 37,300 and 43,000. About three-quarters of them are adolescents, while 20,600 were non-Hispanic White and 7,600 were Black. Black children represent 20% of those who have lost a parent although they make up only 14% of the pediatric population. Due to covid, the tally indicates a 17.5%-20.2% increase in expected parental deaths. The letter, which was published by JAMA Pediatrics, estimated the number of affected children based on demographic simulation of several mortality scenarios, and the authors point out that the estimates don’t account for nonparental primary caregivers. “Sweeping national reforms,” they write, “are needed to address the health, educational, and economic fallout affecting children.”

Excess deaths last year jumped more than 20%

Another grim tally of coronavirus in 2020: All-cause mortality rates in the U.S. last year jumped 23%, with close to three-quarters of those deaths chalked up to covid. The number of excess deaths from March 2020 through the beginning of January this year was 522,000, according to a JAMA research letter. The authors found that death rates for Alzheimer’s, diabetes and heart disease also rose over the course of last year, particularly during covid surges. They also pointed out the racial disparities they uncovered in their analysis: While Blacks make up only 12.5% of the U.S. population, they account for close to 17% of the excess deaths recorded. An accompanying editorial points out that covid—despite the advances over the past century in public health, medicine and science—will likely contribute to almost as many deaths in the U.S. as the 1918 influenza pandemic.

April 6, 2021

Pfizer vaccine effective against South Africa, New York variants

In the fight against the South Africa variant, data show that the Pfizer-BioNTech vaccine is effective. Pfizer-BioNTech released data last week showing that its vaccine appeared to be 100% effective in preventing the South Africa variant of covid from spreading in a trial of 800 people. In addition, a MedPage Today article notes that data from a larger study showed that the vaccine had 91.3% efficacy in preventing symptomatic illness after a second dose was administered. In other variant news, data also show that both the Pfizer-BioNTech and Moderna vaccines appear to be effective against a New York variant of covid. A Medscape article says that a team of New York researchers exposed replicas of the New York variant to blood from people who had been vaccinated (and also to the Regeneron antibody therapy used to treat infected patients) to determine whether the variant could be “neutralized.” The study, which has not been peer-reviewed, found that antibodies induced by the vaccines were effective in blocking the variant. Finally, an Axios article offers an excellent overview of covid variants and strategies to stop them.

Videos help educate minorities about the basics of covid

An Annals of Internal Medicine study has found that giving basic information about pandemic protocols via video “modestly improved” knowledge among Black and Latino patients regardless of the race of the clinicians presenting information in the videos. A JAMA Network article says that when 15,000 participants viewed three videos covering pandemic basics like social distancing, hygiene and face masks, the control group did better on a short questionnaire. While 80% of people in the intervention group answered all questions correctly, 73% of people in the control group got all answers right. Researchers also found that Black participants who spoke via video to a Black physician were more likely to request more information about covid.

April 5, 2021

Vaccines: Calls grow in the U.S. for a dose-sparing strategy

Using a one-dose strategy—and delaying a second dose of either the Moderna or Pfizer-BioNTech vaccine so more people would receive a single dose—is now getting a renewed push. While advocates for such an approach went public earlier this year, the Biden administration along with the FDA and Anthony Fauci, MD, decided to stay the course, ensuring second doses for those who’d already received one dose three or four weeks earlier. But new daily cases are up 18% over the last two weeks, with alarming outbreaks reminiscent of July 2020 and December 2020 taking place around the country, including in Michigan. STAT reports that the U.K. has had a great deal of success by delaying second doses of both the Pfizer-BioNTech and AstraZeneca vaccines, and 47% of that population has received at least one dose amid falling caseloads. (By contrast, only 31% of the U.S. population has received at least one dose.) Advocates for the one-dose strategy in the U.S. include former Biden advisory board members Atul Gawande, MD; Zeke Emanuel, MD. PhD; and Michael Osterholm, PhD, MPH.

CDC issues new travel guidance for the vaccinated

Good news for those who are desperate to get away: The CDC last week issued updated guidance, saying that fully vaccinated travelers inside the U.S. don’t need to get tested before or after their trip, unless such testing is required by their travel destination. (People are considered to be fully vaccinated two weeks after their last required dose.) Those with full vaccinations also don’t need to quarantine in the U.S. after they travel. As for international trips, fully vaccinated travelers don’t need to be tested before travel (unless required to do so by their destination). But they do need a negative test result within three to five days after returning to the U.S. They do not, however, need to quarantine upon their return. All travelers, including those who are fully vaccinated, should continue to mask, stay physically distanced and wash their hands frequently.

April 2, 2021

J1 visas: Make convoluted process more simple

In a new JAMA perspective, a urology fellow with a J-1 waiver points out that, as a resident, he worked in the trenches with his colleagues during last spring’s covid crisis in New York. But as that surge subsided and other residents could take time off to visit family, that wasn’t available to him. Instead, both colleagues and the ECGME warned J-1s to not travel outside the country because re-entry couldn’t be guaranteed, making homesickness a hallmark of his pandemic experience as well. Complicating matters: U.S. immigration and customs has proposed having doctors extend their visas either through that agency—a process that can take up to 19 months—or at a consulate in their home country. The author calls on health care workers and institutions to advocate with lawmakers to make the visa renewal process easier, not more difficult. He writes that the French government is fast-tracking citizenship applications from front-line health care workers to show its appreciation for care rendered during the pandemic. The author also calls on hospitals to reach out to their IMG physicians proactively to offer mental health and emotional support. The number of J-1 physicians working in the U.S. has grown 62% over the last decade.

What’s hot, what’s not in covid spending

A report from MarketWatch details how the pandemic has changed Americans’ shopping habits, with televisions flying off shelves and pet, plant and cleaning supplies in high demand. At the same time, movie theaters saw their revenue tank from $12.2 billion in January 2020 to just over $825 million this February, while spending on cold and flu medications fell so hard that chain pharmacies saw a drop in profits last year. Spending on beer is up as is that for specialty cheeses—and also for kidney beans, an indication that many households are strapped for cash. Spending on sunscreen and cosmetics declined over the past year, while sales of books and musical instruments have grown.

April 1, 2021

One in five Americans polled isn’t interested in vaccine

As the number of covid cases rose 10% this week, more states are rapidly expanding vaccine eligibility, with all 50 states announcing plans to offer vaccine to anyone eligible for vaccine under FDA authorizations. That comes as Kaiser Health News reports that vaccine hesitancy continues to shrink in the U.S., with the “I’ll wait and see group” falling from 39% of those polled in December 2020 to 17% in March 2021. But the “definitely not” group that doesn’t intend to be vaccinated at all was 13% in March, with another 7% saying they’ll get vaccine only if it’s required. Hesitancy levels were high among white evangelicals and rural populations. Between December and March, 32% of all those polled had received at least one dose. Experts say the vaccination gap is particularly troubling among Hispanic patients, who are running into barriers to vaccine access. Often, communications about vaccine availability and registration are in English only, and many older people in the Hispanic community don’t have access to computers.

In vaccine development, good news for parents: Pfizer-BioNTech reports that its vaccine has been found to be 100% effective in adolescents ages 12 through 15. The randomized trial the results were based on—which have not yet been peer-reviewed—included more than 2,200 adolescents. None in the vaccine arm developed symptomatic disease nor had side effects. The two companies have started testing its vaccine in children under 12. (Moderna is also testing its vaccine in children of all ages.) Pfizer-BioNTech expects to ask the FDA to amend their EUA to have the vaccine available to older children before school starts in September.

Covid and post-discharge dysfunction

A new JAMA article spells out the troubling long-term neuropsychiatric toll of covid, with long-term symptoms among patients “suggesting brain involvement persists,” the authors write. Symptoms range from loss of taste and smell and brain fog to psychosis, seizures and thoughts of suicide. While experts still aren’t sure if the virus invades the brain, the article discusses several possible mechanisms that could be at play including crossing the brain-blood barrier or having inflammation and clots combine to cause microstrokes and other damage. Another study, this one out of Britain and published in The BMJ, describes other types of longer-term multiorgan dysfunction after discharge. Among close to 48,000 patients in NHS hospitals followed for more than four months, close to one-third were readmitted while more than 10% died, much higher rates than among non-covid controls. Those who developed multiorgan dysfunction post-discharge weren’t limited to the elderly. Becker’s Hospital Review reports that at least 24 hospitals and health systems around the U.S. have launched covid recovery programs for covid patients who have been discharged but need longer-term treatment. Most of those programs involve an initial evaluation and specialist referral including to neurologists, pulmonologists and cardiologists.

March 31, 2021

What did the pandemic do to hospital finances?

A new report from HHS’ OIG paints a gloomy picture of hospitals struggling after their plague year, saying that hospitals now are in “survival mode.” HealthLeaders notes that the report is based on survey responses gathered in February from more than 300 hospital administrators across 45 states. According to many of those administrators, hospitals are suffering financial instability due to higher expenses as well as staffing shortages and exhaustion. Particularly trying for hospitals, the report says, is how to balance ongoing covid treatment with regular hospital care. At the same time, some hospital systems seem to be doing fine. In a new podcast, two Modern Healthcare finance reporters point out that some large health systems—both for-profit and not-for-profit—actually saw their margins grow in 2020. Factors driving that increased profit (other than government grants) include higher acuity patients translating into more revenue and effective cost-cutting. The speakers also believe one pandemic-driven trend may become permanent: less ED traffic. Patients afraid of coming to EDs sought care in other settings, including urgent care, a shift that may persist.

March 30, 2021

Can an extra hour of sleep help prevent covid?

A new study says that getting an extra hour of sleep a night could go a long way to helping health care workers fight off covid. A study published in BMJ Nutrition, Prevention & Health found that a one-hour longer duration of sleep among health care workers was associated with a 12% reduction in the odds of getting covid. In individuals who reported three kinds of issues with sleeping (difficulty sleeping at night, poor continuity of sleep, and frequent use of sleeping pills), there was a nearly twofold increased risk of getting covid when compared with people who had no sleep issues. And in some countries in which health workers were studied, researchers found that daytime napping was associated with a 6% increase in the chance of getting covid. A MedPage Today article notes that the study also found health care workers who reported feeling daily burnout at work had not only a higher risk of covid, but a longer duration of infection and greater severity.

March 29, 2021

New data: Vaccines prevent 90% of covid infections (updated 3/30/2020)

New data found that the vaccine was 90% effective in preventing covid infection in people who were fully vaccinated (they had received two shots at least 14 days before) and 80% effective in people who were partially vaccinated (they had received one of two shots at least 14 days before). A CDC study looked at nearly 4,000 health care workers who received either the Pfizer or Moderna vaccines who had not previously been infected with covid. Nearly two-thirds of the group received two shots. For every 1,000 subjects who were fully vaccinated, researchers found 0.04 infections, compared to 1.38 infections per 1,000 people who had not been vaccinated. Among subjects who had received only one vaccine, researchers found 0.19 infections per 1,000 people.

A Medscape article says that more data may soon be available looking at how well vaccines prevent the transmission of covid. A trial that began last week is examining transmission of the virus among 12,000 college students. Half will receive the Moderna vaccine immediately, while the other half will receive the vaccine in four months.

March 26, 2021

Deaths are down, but case numbers are on the rise

According to the New York Times, the number of covid deaths over the past two weeks has fallen 31% while hospitalizations have dropped 10%. At the same time, officials note that case numbers are on the rise for the first time since January. Reuters this week reports that cases are trending up in 30 out of 50 states, with health officials hoping the increase in vaccinations will prevent a corresponding rise in covid deaths. A growing number of states have lowered the age of vaccine eligibility, with Alaska the first to offer vaccine to every resident 16 and older.

Covid burden linked to mortality in hospitals

What effect does “covid burden”—the number of covid patients in a given hospital, divided by that hospital’s number of beds—have on patient mortality? Writing in the Journal of Hospital Medicine, UCSF researchers looked at data on more than 14,200 covid patients admitted last April across 117 U.S. hospitals. They found that individual hospitals’ covid burden increased the odds of patients dying of covid, suggesting “that patient surges may be an independent risk factor for in-hospital death among patients with COVID-19.” In coverage of the study, Fierce Healthcare notes that the research adds to literature linking heavy covid surges to poor outcomes. The study authors also point out that their results could underscore the impact of a strained health care workforce on patient outcomes.

Surgeon general deja vu

For the second time in his career, former hospitalist Vivek Murthy, MD, MBA, has been confirmed and sworn in as the nation’s top doctor. Dr. Murthy, who previously filled the post of surgeon general during the Obama administration, proved to be a more controversial nominee this time around. During his confirmation hearings, some senators disapproved of Dr. Murthy’s support for gun reform (as they did during his first confirmation hearings), while other critics—including some in the medical community—questioned how much he’d earned from corporations as a consultant during the pandemic. The son of immigrant physicians, Dr. Murthy noted in a Twitter post that he has lost members of his own family to the pandemic. Once a hospitalist at Boston’s Brigham and Women’s, Dr. Murthy dealt with the Zika pandemic in 2016 and the opioid crisis during his first stint as surgeon general.

March 23, 2021

Good news for AstraZeneca? Not so fast

Yesterday’s announcement from AstraZeneca—that interim trial results of its vaccine indicate 79% efficacy against symptomatic covid, 100% efficacy against severe covid and hospitalization—was welcomed news. But in what news coverage claims is an unprecedented step, an NIH panel has weighed in with a “not so fast.” The problem, according to a NIH letter released late yesterday, is that those interim results may be based on “outdated and potentially misleading” data. But according to the Washington Post, the NIH panel has been working with AstraZeneca and has found the vaccine to be between 69% and 74% effective. Anthony Fauci, MD, is quoted as saying that the problem is probably not with the vaccine—”very likely a very good vaccine”—but with the rollout of trial data.

Almost half of all health care workers have not been vaccinated

While health care workers have been at the front of the line to receive vaccine, a new poll indicates that more than four out of 10 health care workers have not been vaccinated. The poll, which was put out by both the Kaiser Family Foundation and the Washington Post, finds that just a bare majority (52%) of health care workers across the country have received at least one dose of covid vaccine. While an additional 19% were either scheduled to be vaccinated or planned to, 18% did not plan on being vaccinated while another 12% remained undecided. More than one in three surveyed health care workers reported not being confident that the vaccines were safe and effective. The survey, which was held mid-February to early-March, gathered responses from more than 1,300 health care workers. In related news, Kaiser Health News reports that new covid cases among nursing home staff members have plummeted by more than 80%. That’s despite the vaccine hesitancy felt by many staff members, with some nursing homes reporting that only half their staff have been vaccinated so far.

Yes, there are covid stamps

None of them, unfortunately, have yet been issued in the U.S. But a piece in JAMA written by French researchers points out that 21 countries as well as the U.N. have issued dozens of different stamps commemorating the pandemic. Iran was the first to do so last March. Many of the stamps depict clinicians, scientists or first responders, while a few contain public health messages about hand-washing and social distancing. Some also show patients being ventilated and attended to by health care workers. One in a series of covid-related stamps issued by the Isle of Man has an illustration of a clinician in scrubs and a red cape.

March 22, 2021

A drive-in Match?

It was once again a remote Match Day last Friday for more than 33,000 medical students and the more than 2,600 candidates around the world looking for residency slots. It was also an historic one that offered the most positions in Match history, with the number of slots up 3% from last year. MedPage Today reports that the need to hold a virtual Match Day led many medical schools to become creative, with at least one school holding a drive-in Match ceremony while another sent bottles of champagne or cookies to students’ homes. As for remote matching, students noted that not being able to travel to in-person interviews allowed them to apply to more programs. Internal medicine drew one-quarter of all applicants, with the number of internal medicine positions up 25% over five years ago. Over that same time frame, the number of family medicine positions increased 44%.

Study: Good news for the AstraZeneca vaccine (updated above)

After a tough week last week, the AstraZeneca vaccine has garnered some good news, showing 79% efficacy against symptomatic covid and 100% efficacy against severe covid and hospitalization. The vaccine’s manufacturer delivered the interim results of its phase 3 trial in a press release, saying the data were based on results from more than 32,000 participants. The two-dose vaccine was found to be just as efficacious in patients over age 65. STAT reports that the study also uncovered no safety problems, including any with blood clots; concerns about clotting led the AstraZeneca vaccine rollout being suspended in several European countries. Based on the results, the vaccine manufacturer intends to ask the FDA for emergency use authorization in the U.S.

March 19, 2021

Getting covid helps prevent reinfection for about six months

Research published in The Lancet found that most people who get covid have some protection from the virus for at least six months, although older people saw less immunity from becoming re-infected. The study found that being infected with covid reduced subjects’ chances of being infected again by 80%, but that figure fell to 50% for people over 65. A New York Times article says that the study is unique because it has been difficult to study reinfection rates, which require access to testing and genetic sequencing to confirm reinfections. The study was also conducted on a small population, and because researchers weren’t able to talk to the study’s subjects, it’s possible that people who became infected were asymptomatic and didn’t feel any ill effects of covid. The study also doesn’t take into account the possibility that people who have had covid and have some immunity can get reinfected in less than six months if they’re exposed to a different variant of the virus. A Newsweek article notes that Anthony Fauci, MD, warned of this scenario this week during congressional testimony.

Patients prefer clear (not cloth) masks when talking to docs

A study published in JAMA Open Network found that surgeons who talked to their patients wearing clear masks, not standard cloth masks, saw better patient ratings. Researchers studied 200 patients from 15 surgery clinics in seven different subspecialties. When it came to providing clear explanations, surgeons with clear masks received a score of 95% compared to 78% for surgeons wearing cloth masks. Patients rated surgeons wearing clear masks higher on empathy (99% vs. 85%) and on building trust (94% vs. 72%). While patients said they preferred clear masks, 53% of surgeons said they were unlikely to replace their traditional masks with clear masks.

March 17, 2021

It’s been a tough week for the AstraZeneca vaccine (updated)

AstraZeneca’s covid vaccine took a beating this week on multiple fronts. The week began with European countries banning AstraZeneca’s vaccine because of concerns about blood clots, claims that an article in Science examines. Europe’s equivalent of the FDA offered its support for the vaccine later in the week, but much of the damage had already been done. Things got worse when a study concluded that the vaccine doesn’t do very well in preventing infection from the South African (B.1.351) variant of corona. Data published in the New England Journal of Medicine found that more than 90% of the cases in the study were caused by the variant, and that the vaccine’s efficacy against that variant was only about 10%. The study found that the AstraZeneca vaccine had an overall efficacy of 22% for all cases (not just cases caused by the variant) of mild to moderate covid. Finally, the U.S. announced yesterday that it is planning to send millions of doses of the AstraZeneca vaccine to Mexico and Canada. Federal officials have been sitting on a stockpile of the shots while awaiting FDA approval of the vaccine.

March 16, 2021

Are we giving the best PPE to the wrong people?

New data show that we may be giving the best PPE to the wrong health care workers. An article from Kaiser Health News notes that while “aerosol-generating procedures” (think intubating patients) have been viewed as the most dangerous in terms of spreading covid, recent data say that a basic cough produces 20 times as many particles as an intubation. As a result, health care workers wearing a surgical mask (as recommended by the CDC) have a higher risk of infection by being in the same room as a covid patient than being near a patient during an intubation. While the thinking on covid risk is slowly shifting, a group of health care experts has stuck to the position that it’s safe for front-line workers to be around covid patients wearing only a surgical mask, while N95s be reserved for covid ICUs. One source in the Kaiser article said that the thinking about PPE during covid has been “upside down.”

Nurses exhausted and stressed, but staying in health care

A new survey of 22,000 nurses has found that younger workers seem to be bearing the emotional brunt of the pandemic. The survey found that among early-career nurses (those under 34), 81% reported exhaustion, 71% reported feeling overwhelmed, 65% were anxious or unable to react, and 47% felt sad. Among older nurses (those over 55), by comparison, about half (47%) reported exhaustion and 37% reported feeling overwhelmed. A Health Leaders article notes the survey also found that nearly 20% of nurses indicated they are financially worse off since the beginning of the pandemic, but most said they don’t plan to leave their current job or the profession. About 30% of surveyed nurses haven’t received a vaccine, and about 25% say they are undecided about getting vaccinated. Finally, only 73% say they have adequate PPE.

March 13, 2021

 Are you giving covid patients too many antibiotics?

New data show that while more than half of covid patients last spring received antibiotics, only a “fraction” of them had bacterial infections. A MedPage Today article said that data show that most antibiotics were given within 48 hours of admission, before most physicians know their patients’ infection status. The data from a Pew Charitable Trusts project found that 36% of covid patients received more than one antibiotic and that only 20% of admissions had suspected or confirmed bacterial pneumonia. The MedPage Today article notes that a study found that VA hospitals used more antibiotics in the first five months of 2020 than in any year since 2016.

March 11, 2021

Study: Working at the hospital doesn’t increase your covid risk

New data claim that hospital workers don’t have a higher risk of getting covid at work,
proof that infection prevention practices are working. The study, which was published by JAMA Network Open, found that even nurses, who have the most direct contact with patients, don’t face a greater risk of getting the virus at work as shown by the presence of covid antibodies.

Among the 25,000 hospital workers studied, the overall positivity rate for covid antibodies was 4%. Physicians had a positivity rate of 3.7%, nurses had a positivity rate of 4.8%, and NPs/PAs had a positivity rate of 3.5%. Nonclinical staff had a positivity rate of 3.9%, but the highest rates were found among environmental service workers (7.4%). The study came out at about the same time as the release of a database of more than 3,500 U.S. health care workers who have died of covid. The list, compiled by a partnership between the Guardian and Kaiser Health News, analyzes the deaths by demographics including occupation, state and race/ethnicity.

March 10, 2021

Colchicine lacks mortality benefit

A trial looking at covid treatments has dropped an arm testing the drug colchicine, which is widely used to treat gout and other inflammatory conditions, because of a lack of a mortality benefit. The RECOVERY trial, which is evaluating potential covid treatments at hospitals in the UK, Indonesia and Nepal, found colchicine produced no 28-day mortality benefit when compared to usual care. An article on MDedge notes that the RECOVERY trial has already identified two anti-inflammatory drugs, dexamethasone and tocilizumab, that can help the survival rates of covid patients. A statement is online.

March 8, 2021

A look at whether vaccines can help long haulers

With the U.S. now giving 2 million vaccines a day, limited evidence suggests that the vaccines may be offering covid long haulers relief from their symptoms. A MedPage Today article cites anecdotal evidence of the recently vaccinated getting some relief from long-term effects of covid, but it also points out that the data are preliminary. A survey of nearly 500 covid long haulers found that 27% of respondents reported feeling “slightly better,” while 16% said their symptoms were “much better” and 5% said they were back to normal. Several experts interviewed for the article endorsed the idea of further studying the impact that the vaccine may be having on long haulers, noting that there are multiple reasons that a vaccine would provide those patients with relief. One recent study on long haulers found that up to one-third of covid patients with severe infections may suffer from post-traumatic stress disorder.

Is delaying second dose of vaccine a good idea?

Health experts are batting down the idea of delaying a second covid vaccine in order to get at least one vaccine into a bigger group of people. The CDC’s Advisory Committee on Immunization Practices recently ruled that there’s not enough evidence to delay a second vaccine or to give only one dose to people who have already had covid. A MedPage Today article says that members of that committee worried that estimates of the effectiveness of the protection offered by one dose are imprecise, and also that one dose may not sufficiently protect people from emerging variants. Last week, Anthony Fauci, MD, warned that delaying a second dose puts Americans at risk and urged health officials to continue with a two-dose schedule. A Medscape article says that while Dr. Fauci has spoken to health officials from the U.K. about their strategy of delaying second doses of the vaccine, he said he didn’t believe the strategy was a good choice for the U.S.

March 4, 2021

Asthma doesn’t increase hospitalizations, serious illness in covid

Data from patients tested for covid in California earlier this year found that asthma is not an independent risk factor for developing a severe case of the infection or increased risk hospitalization. Researchers at Stanford University found that out of nearly 170,000 people who received a covid test between March and September of 2000, there were no differences in hospitalization rates based on whether people had asthma. An article in MDedge said that 28% of patients with asthma had asymptomatic covid compared to 36% of people without asthma. While 53% of people with asthma had severe or critical cases of covid, so did 51% of people without asthma. The data were released as part of a poster presentation at the American Academy of Allergy, Asthma and Immunology’s virtual meeting this year.

Do lockdowns lead to more alcohol withdrawals?

Covid lockdowns seem to be leading to more cases of alcohol withdrawal. Data from a single-center study of hospitalized patients found that between March and September of 2020, rates of alcohol withdrawal jumped by 34% when compared to 2019. A MedPage Today article says that while rates of withdrawal were higher in all of 2020, they were higher immediately after lockdown periods. Researchers accounted for seasonal fluctuations in rates of alcohol withdrawal by comparing data from the same biweekly periods in 2019 and 2020. The data come from a sample size of 340 patients and were published in JAMA Network Open.

March 3, 2021

A look at pandemic-related violence against health care workers

Out of more than 1,000 reported attacks on health care workers in 2020, more than 400 were directly related to the covid pandemic. Incidents included arson at testing facilities, health care workers targeted on their way home after work because of fears that they would spread the virus, and violent responses to workers trying to enforce mask requirements. Individual health care workers were also arrested and assaulted after going public with concerns about the safety of PPE or criticizing government policies about the pandemic. The report, published by Data from Safeguarding Health in Conflict, found that health care workers “frequently” reported being attacked on their way to and from work. The report notes that hotspots for violence included India and Mexico, but violence against health care workers was reported in 79 countries.

WHO issues “strong recommendation” against hydroxychloroquine

The World Health Organization has made a strong recommendation against using hydroxychloroquine to prevent covid. An article in New England Journal says that the recommendation, which was published in the BMJ, is based on a meta-analysis of six clinical trials. The analysis found that hydroxychloroquine had “little to no effect” on covid patients’ mortality or admission rates. Researchers also found that hydroxychloroquine didn’t reduce rates of covid as confirmed by lab results.

March 2, 2021

The five diseases that are associated with covid hospitalizations

A new study found that about one-third of covid hospitalizations were attributable to obesity. Researchers examining a little more than 900,000 U.S. covid hospitalizations found that 30.2% were attributable to obesity/severe obesity, followed by hypertension (26.2%), diabetes (20.5%), chronic kidney disease (12.9%), and heart failure (11.7%). Researchers also looked at the impact that combinations of disease had on covid hospitalizations and found that 40.7% of admissions were attributable to diabetes/hypertension, followed by diabetes/obesity (44.%), diabetes/hypertension/obesity (58.7%), and diabetes/hypertension/obesity/heart failure (63.5%). The study was published by the Journal of the American Heart Association.

Can vaccines in older people prevent the need for ventilators?

New data from Israel have found that older people given a covid vaccine were less likely to require mechanical ventilation to treat the virus than younger people who haven’t been vaccinated. Data from Israel found that Israelis 70 and older who had received the Pfizer vaccine were 67% less likely to need a ventilator than Israelis under 50. The study, which was published in MMWR, compared ventilation rates from February 2021 with rates from October-December of 2020. A Medscape article says that researchers found 80% of older Israelis had received the vaccine compared to only about 10% of people under 50.

April 30, 2021

Real-world data confirm efficacy of covid vaccines

Real-world data from a small trial show that the Pfizer-BioNTech and Moderna vaccines are 94% effective in reducing hospitalization among Americans 65 and older who got both shots. A report in MMWR notes that in people who received only one shot, the vaccine was 64% effective. The study represents the first real-world data. While another Israeli study had come up with similar results, it looked at only the Pfizer-BioNTech vaccine. The MMWR study looked at 417 adults hospitalized with COVID-19–like illness in 14 states between January and March 2021.

Creative strategies to get more Americans vaccinated

As vaccination rates in the U.S. begin to wane, a long list of organizations is coming up with creative strategies to vaccinate more Americans. A hospital in Jackson Hole, Wyo., for example, is giving its employees a $600 bonus if they’re fully vaccinated by May 31. A Houston health system is not only using a carrot to encourage vaccinations (by offering $500 payments), but it is also threatening to fire employees who can’t provide proof of vaccination by June 7. The giant insurer Cigna is offering U.S. employees $200 in their health savings accounts and paid time off to get vaccinated. And on the national level, President Biden has announced tax credits that businesses can take if they give employees paid time off to get vaccinated.

FDA “encourages” hospitals to return to one-and-done for N95s

In another sign that some signs of normalcy are on the horizon, the FDA is encouraging health care workers to return to the pre-pandemic policy of using N95 masks once and then discarding them. While hospitals are still legally allowed to sterilize and re-use N95s, the FDA is currently recommending a one-use policy and in the coming weeks is expected to begin requiring health care facilities to discard masks after one use. A Modern Healthcare article says that the announcement comes on the heels of word that U.S. manufacturers have surpluses of PPE for sale. Many hospitals say they have three to 12 months of PPE stockpiled.

Rules for buprenorphine relaxed as opioid use rises in long haulers

The Biden administration will make it easier for physicians to prescribe buprenorphine to treat opioid disorder. A Fierce Healthcare article says that the HHS has released new guidelines that exempt physicians and other clinicians from some certification requirements to prescribe the drug that were viewed as onerous. The Trump administration had announced the changes earlier this year, but the current administration put them on hold until now. The change is significant given the rise in overdose deaths during the pandemic. A Kaiser Health News article notes that a new study found “alarmingly high rates” of opioid use among covid long haulers at VA hospitals around the country. The study is raising alarms about a new epidemic of opioid addiction.

April 28, 2021

Good, bad news about your chances of getting covid

First, the good news: Health care providers rarely get covid on the job. In a study published this month in Clinical Infectious Diseases, researchers performed viral sequencing to determine the origins of covid in health care workers. They found no signs of healthcare-associated transmission in “the majority” of infections they evaluated. A Medscape article says that 11% of the infections studied in health care workers could be attributed to one of their coworkers and 4% could be attributed to one of their patients.

The not-so-good news is for health care professionals who work a lot of nights. A study in the journal Thorax found that people who worked some shifts outside of a traditional 9-5 schedule were more than twice as likely to get covid as people who work during the day. People who only worked nontraditional shifts were 2.5 times more likely to be diagnosed with covid. Researchers found these risks persisted even after controlling for known risk factors like BMI and smoking. They hypothesized that shift work’s effects on the circadian rhythm may alter the body’s response to the covid virus.

April 26, 2021

One unvaccinated nursing home worker; dozens of infections and three deaths

A covid outbreak in March in a nursing home in Kentucky is a stark reminder of the consequences of continuing to work with vulnerable patients while not being vaccinated. The New York Times reports that while 90% of the residents in that home had been vaccinated, that was the case for only half the staff. One unvaccinated worker who became infected caused 26 infections among residents (including 18 among those vaccinated) and 20 infections among other staff members. Three of the infected residents died, including one who’d had vaccine. A CDC write-up of the outbreak notes that the infections were “a newly introduced variant to the region.” The New York Times points out that resistance to being vaccinated has been high around the country among nursing home staff.

Even mild covid cases are linked to higher mortality risk

New VA data deliver this bad news: Being infected with covid—even without needing to be hospitalized—leads to a 59% greater risk of death within six months than among those who don’t become infected. Further, six-month mortality risk is also high among covid patients who are hospitalized, running 51% more than among patients with seasonal flu. Published in Nature, the study is based on data from more than 70,000 VA patients; fewer than 20% of those patients were women, and most were over age 60, according to Forbes. The study is one of the largest to look at “long covid,” those symptoms patients suffer long after their acute infection. And speaking of seasonal flu, here’s a New York Times headline from last week: “The Flu Vanished During Covid.” While recent flu seasons in the U.S. have each produced more than 200,000 recorded cases a year, the 2020-21 season saw only 2,000.

Bamlanivimab is out as a monotherapy

Earlier this month, the FDA revoked its EUA for bamlanivimab when administered alone, saying that the covid variants that are on the rise are resistant to being treated with the monoclonal antibody alone. As a result, Medicare will pay for bamlanivimab as a monotherapy only if administered between Nov. 10, 2020, and April 16, 2021. But there’s good news: The FDA also indicated that alternative therapies consisting of combined monoclonal antibodies are still appropriate. Those include casirivimab/imdevimab as well as bamlanivimab/etesevimab, and fact sheets about the use of those combinations can be found here and here. The FDA has issued EUAs for those combinations for the same indications that bamlanivimab alone used to have: for adult and certain pediatric patients with mild to moderate covid.

 April 23, 2021

More younger people are being hospitalized

A handful of states—many of them hard hit with covid a year ago—are once again the country’s hotspots, according to the Wall Street Journal (subscription required). About three-quarters of all new cases last week were reported in five states: Michigan, Florida, New York, Pennsylvania and New Jersey. CNN reports that, due to the U.K. variant being more contagious and more older patients being vaccinated, hospitalizations are on the rise among younger patients, who are suffering more severe complications than expected. Last month, for instance, New Jersey saw a 31% jump in covid hospitalizations among patients ages 20 to 29 and a 48% increase in covid hospitalizations among ages 40 to 49. An article in The Atlantic posits a future in which adults stop worrying about their elder parents becoming infected and start worrying about their children under age 12, who will be the last group vaccinated. Around the world, India is in crisis, setting global records for new daily cases (more than 300,000). The CDC is warning against traveling to India, saying that if a trip in unavoidable, only fully vaccinated people should travel there. The U.K. is now banning all travelers from India.

How soon will vaccine supply in the U.S. catch up to demand?

As of Monday, all adults in all states are eligible for vaccine and vaccine supplies have bumped up significantly from just a month ago. Kaiser Family Foundation now predicts that within the next two to four weeks, the U.S. will likely hit a tipping point where finding Americans who want to be vaccinated will become much harder. “Federal, state, and local officials, and the private sector,” the foundation writes in a policy statement, “will face the challenge of having to figure out how to increase willingness to get vaccinated among those still on the fence.” In addition to those hesitating to get vaccine, 20% of Americans polled claim they won’t be vaccinated or will only if required. The Cleveland Clinic is partnering with Mayo and more than 50 other hospitals and health systems on the “Get the Vaccine to Save Lives” campaign, producing public service announcements to convince those who haven’t yet been vaccinated to step up. And to entice employees to be vaccinated, one hospital in Wyoming—St. John’s Health in Jackson Hole—is giving each full-time vaccinated employee a $600 bonus—and offering the same to those who’ve held off, as long as they’re fully vaccinated by May 31. The goal is to have as many employees vaccinated as possible before summer tourists start to arrive. Meanwhile, while the FDA and CDC may decide later today whether to end the pause in using the J&J vaccine, phase 3 trial results for that vaccine have been published in the NEJM. The results: 75% efficacy at more than 28 days, and 85% against severe or critical disease.

April 22, 2021

Nursing vacancies grow, and burnout is widespread

Hospitals are reporting a spike in unfilled nursing positions, a dilemma that hospitals have increasingly tried to meet with growing numbers of (expensive) traveling nurses. In a survey of 100 hospital executives, 36% said they expect to have more than 25 nursing positions open this year, a rate more than twice what it was in 2020 (17%). Among respondents, 70% reported losing between 5% and 30% of their nursing staff as a result of covid. In other news, a Washington Post-Kaiser Family Foundation poll found that three out of every 10 health care workers are considering leaving the profession, due to burnout and stress. While 55% of all health care workers surveyed reported burnout, younger people had higher levels: 69% among those age 18 to 29 and 61% among those age 30 to 39. Mona Masood, DO, a Philadelphia psychiatrist, started the Physician Support Line (1-888-409-0141) a year ago, staffing it with hundreds of volunteer psychiatrists and fielding more than 2,500 calls. Dr. Masood told the Washington Post that she is most concerned about health care workers when the pandemic ends, likening them to soldiers returning from war.

April 19, 2021

New variant tracking system will target biological threats

The White House last week announced a $1.7 billion federal program to track covid mutations. As proposed, the program would establish the first permanent national infrastructure to tackle biological threats. AP reports that the network has three components: directing the CDC and state health departments to map genetic samples (to be funded with $1 billion); partnering with universities to create six research and development centers to identify emerging pathogens ($400 million); and creating a national data-sharing network ($300 million). According to the AP, the funds are part of the recently approved coronavirus relief package and are designed to “break what experts say is a feast-or-famine cycle in U.S. preparedness for disease threats.”

Why are vaccinated people getting infected?

Their numbers are tiny, which is reassuring. But a very few cases are being recorded of fully vaccinated patients coming down with what are being called “breakthrough infections” and testing positive for covid. In rare cases, some even have been hospitalized and a few deaths have occurred, according to ProPublica. Experts don’t know why; further, they are concerned that many cases of breakthrough infections aren’t being sampled and analyzed to find out which variants, if any, may be driving the very few reported cases. Another problem: Some states aren’t reporting the level of symptoms that patients with breakthrough infections are having. South Carolina’s health department has reported 155 cases of breakthrough infections out of 950,500 full vaccinated patients, an infection rate of 0.02%. MedPage Today coverage points out that the number of breakthrough cases are as expected.

April 16, 2021

Working nights alters your genetic “circadian rhythmicity”

We all know that working nights stinks, but new research yields data on how night work may increase your risk for cancer. An MDedge article says that researchers have found that a simulation of night work changed “the normal circadian rhythmicity of genes,” which can lead to hallmarks of cancer. The study, which appeared in the Journal of Pineal Research, concluded that night work reduces the ability of the body’s RNA to repair genes affected by working at night. During the simulation, some of the genes of participants lost their normal day-shift rhythmicity. The study also found that night work increases endogenous and exogenous DNA damage. The next step, researchers say, is to test real-world night-shift workers to see if the damage from unrepaired DNA builds up over time, increasing cancer risk.

Pandemic spurs rapid evolution of chief wellness officer role

A survey done last summer at University of Utah Health about the pandemic came to this conclusion: “a substantial number of employees and trainees experienced major stress and work disruptions.” In fact, one in five reported considering leaving the health care workforce because of covid-related challenges, particularly around child care, and 30% considered cutting their work hours. It’s results like these that underscore the importance of wellness efforts in health care, while a new NEJM article highlights the evolving role of chief wellness officers during the pandemic. The authors, who are chief wellness officers from health systems and academic centers around the country, say that support services in many of their institutions were underutilized even during the pandemic, due in part to the ongoing stigma over using mental health resources. Successful outreach deployed during the pandemic included in-person wellness rounds. Importantly, the authors note that the intensity of treating covid patients hasn’t allowed clinicians to process their experiences.

FDA, CDC recommend a pause on the J&J vaccine

U.S. agencies are recommending halting the use of Johnson & Johnson’s one-dose covid vaccine pending the results of an investigation into six cases of clotting among recipients. STAT reports that the recommendation stops short of pulling the vaccine off the market, even temporarily. The clotting incidents, which all occurred in women, are similar to those found with AstraZeneca’s vaccine. All six cases were rare cerebral venous sinus thromboses in combination with thrombocytopenia. The six women affected were between the ages of 18 and 48, and their symptoms occurred between six and 13 days after they received the vaccine. As of this week, more than 6.8 J&J doses have been administered in the U.S. Two studies in NEJM—one looking at 11 patients in Germany and Austria, the other on five patients in Norway—delved into the clotting problems with AstraZeneca’s vaccine. The authors of both studies implicate platelet-activating antibodies targeting platelet factor 4 (PF4)-heparin, and they speculate that the antibodies are triggered by free DNA in the vaccine.

Prophylactic monoclonal antibodies?

A monoclonal antibody combination developed by Regeneron is being touted as a prophylaxis for household members of infected covid patients. According to a company press release, phase 3 trial results indicate that giving household contacts the casirivimab-imdevimab cocktail cut their risk of developing symptoms 72% during the first week and 93% in subsequent weeks. By day 29, only 1.5% of those who received the monoclonal antibodies had developed symptomatic infection vs. 7.8% of those given placebo. In addition, among those receiving the cocktail who developed symptoms, those symptoms lasted only one week vs. three weeks among those on placebo who became symptomatic.

April 12, 2021

OK to ease up on conserving N95s?

The FDA last week issued guidance that says it is now OK for health care personnel and facilities to transition away from conservation strategies with N95s and other filtering respirators. Included in the recommendations: Facilities can move away from using a crisis capacity strategy of conservation, and they can limit their decontamination of disposable respirators. They can also increase their inventory of available NIOSH-approved respirators and PAPRs. According to a press release, both the FDA and the CDC believe U.S. hospitals now have an adequate respirator supply. At the same time, the FDA made it clear that the agency is not revoking its current authorization of decontamination and bioburden reduction systems.

Covid pneumonia: Researchers find good results with home oxygen

According to a recent study, researchers in southern California got good results—low all-cause mortality and 30-day readmission rates—by discharging patients with covid pneumonia home with supplemental oxygen. Writing in JAMA Network Open, the authors detail the retrospective results of a program launched by the Los Angeles health department that included more than 620 patients. All needed at least 3L per minute of supplemental oxygen, and all were stable without any other indication for inpatient care. (Nurses followed up with patients within 12 to 18 hours of discharge from either the hospital or ED, and that back-up continued if indicated.) Followed for close to 30 days, patients had a mortality rate of 1.3% and a readmission rate of 8.5%. The authors point out that the intervention helped preserve inpatient beds for sicker patients, had an adequate safety profile and “may help optimize outcomes.”

April 9, 2021

Video games to treat brain fog?

A Boston-based startup made news last summer as the first company to get FDA clearance to market a video game as a prescription therapeutic. While that indication was for children with ADHD, Fierce Healthcare reports that the same company is now working with several major academic centers to test whether that digital treatment can improve covid “brain fog,” cognitive and mental effects that linger in some covid patients months after respiratory symptoms resolve. The company, Akili Interactive, is working with Vanderbilt University Medical Center, NewYork-Presbyterian Hospital and Well Cornell Medicine to design randomized trials. Those trials will test the ability of the video game which is marketed as EndeavorRx—to improve cognitive functioning. “The software,” according to the coverage, “provides challenges and stimuli that target the brain’s neural systems linked to focus, cognitive function and multitasking.” The academic centers plan to begin enrolling patients in the studies next month. A study published this February in Neuropsychopharmacology found that among patients with severe covid and prolonged hospitalizations, 81% had cognitive impairment that ranged from mild to severe.

U.K. variant: spiking cases, vaccine strategies, hospital testing

The spring’s steady downtick of cases is long over, with close to 65,000 cases a day now being reported. Many are occurring in cities in Michigan and New York, and experts say that most are being caused by the U. K. variant, although a variant first identified in New York City is behind outbreaks in Connecticut, New Jersey and Pennsylvania. Hospitalizations in areas with spiking cases are also rising, particularly among middle aged patients under age 50—a group that’s not close to being vaccinated. Some public health officials are urging the administration to divert vaccine supplies to Michigan, a move the Biden administration so far has rebuffed. Other experts have renewed calls made earlier this year to switch for now to a one-dose vaccine strategy, delaying second doses of both the Pfizer-BioNTech and Moderna vaccines for 12 weeks to allow more people to receive at least one dose. In other variant news, MedPage Today reports that the FDA is cautioning about possible problems with a molecular test brand popular in hospitals. Three Cepheid PCR tests (Xpert Xpress, Xpert Xpress DoD and Xpert Omni) pinpoint the N2 and E targets within viral RNA, according to the coverage, but the U.K. variant may reduce test sensitivity for the N2 target. Microbiologists quoted in the article, however, say they’re not worried about the accuracy of test results because the tests have multiple targets.

More setbacks for AstraZeneca

Another week, more AstraZeneca drama: A European agency now says that blood clots should be listed among the very rare side effects of that company’s covid vaccine. According to the European Medicines Agency, its members investigated more than 80 cases of thrombosis (out of 25 million doses administered) among patients given the AstraZeneca vaccine, 18 of which were fatal. Most of those cases were in women under age 60, and they occurred within two weeks of being vaccinated. While the agency noted “a possible link,” it did not recommend limiting the use of that vaccine, which is the go-to in European vaccination efforts. The WHO, meanwhile, notes that no causal relationship between the vaccine and clotting has yet been confirmed, although such a relationship is plausible. CNN reports that U.K. officials now recommend that people under age 30 look for alternative vaccines. While the AstraZeneca vaccine isn’t approved for use in the U.S., experts worry that concerns here about side effects, even when very rare, could spur vaccine hesitancy.

April 7, 2021

Up to 43,000 children in the U.S. have lost a parent to covid

A new research letter delivers this heartbreaking statistic: Tens of thousands of American children had lost at least one parent to coronavirus as of February 2021. Depending on the estimation model used by the authors, the number of children in the U.S. who have lost a parent ranges between 37,300 and 43,000. About three-quarters of them are adolescents, while 20,600 were non-Hispanic White and 7,600 were Black. Black children represent 20% of those who have lost a parent although they make up only 14% of the pediatric population. Due to covid, the tally indicates a 17.5%-20.2% increase in expected parental deaths. The letter, which was published by JAMA Pediatrics, estimated the number of affected children based on demographic simulation of several mortality scenarios, and the authors point out that the estimates don’t account for nonparental primary caregivers. “Sweeping national reforms,” they write, “are needed to address the health, educational, and economic fallout affecting children.”

Excess deaths last year jumped more than 20%

Another grim tally of coronavirus in 2020: All-cause mortality rates in the U.S. last year jumped 23%, with close to three-quarters of those deaths chalked up to covid. The number of excess deaths from March 2020 through the beginning of January this year was 522,000, according to a JAMA research letter. The authors found that death rates for Alzheimer’s, diabetes and heart disease also rose over the course of last year, particularly during covid surges. They also pointed out the racial disparities they uncovered in their analysis: While Blacks make up only 12.5% of the U.S. population, they account for close to 17% of the excess deaths recorded. An accompanying editorial points out that covid—despite the advances over the past century in public health, medicine and science—will likely contribute to almost as many deaths in the U.S. as the 1918 influenza pandemic.

April 6, 2021

Pfizer vaccine effective against South Africa, New York variants

In the fight against the South Africa variant, data show that the Pfizer-BioNTech vaccine is effective. Pfizer-BioNTech released data last week showing that its vaccine appeared to be 100% effective in preventing the South Africa variant of covid from spreading in a trial of 800 people. In addition, a MedPage Today article notes that data from a larger study showed that the vaccine had 91.3% efficacy in preventing symptomatic illness after a second dose was administered. In other variant news, data also show that both the Pfizer-BioNTech and Moderna vaccines appear to be effective against a New York variant of covid. A Medscape article says that a team of New York researchers exposed replicas of the New York variant to blood from people who had been vaccinated (and also to the Regeneron antibody therapy used to treat infected patients) to determine whether the variant could be “neutralized.” The study, which has not been peer-reviewed, found that antibodies induced by the vaccines were effective in blocking the variant. Finally, an Axios article offers an excellent overview of covid variants and strategies to stop them.

Videos help educate minorities about the basics of covid

An Annals of Internal Medicine study has found that giving basic information about pandemic protocols via video “modestly improved” knowledge among Black and Latino patients regardless of the race of the clinicians presenting information in the videos. A JAMA Network article says that when 15,000 participants viewed three videos covering pandemic basics like social distancing, hygiene and face masks, the control group did better on a short questionnaire. While 80% of people in the intervention group answered all questions correctly, 73% of people in the control group got all answers right. Researchers also found that Black participants who spoke via video to a Black physician were more likely to request more information about covid.

April 5, 2021

Vaccines: Calls grow in the U.S. for a dose-sparing strategy

Using a one-dose strategy—and delaying a second dose of either the Moderna or Pfizer-BioNTech vaccine so more people would receive a single dose—is now getting a renewed push. While advocates for such an approach went public earlier this year, the Biden administration along with the FDA and Anthony Fauci, MD, decided to stay the course, ensuring second doses for those who’d already received one dose three or four weeks earlier. But new daily cases are up 18% over the last two weeks, with alarming outbreaks reminiscent of July 2020 and December 2020 taking place around the country, including in Michigan. STAT reports that the U.K. has had a great deal of success by delaying second doses of both the Pfizer-BioNTech and AstraZeneca vaccines, and 47% of that population has received at least one dose amid falling caseloads. (By contrast, only 31% of the U.S. population has received at least one dose.) Advocates for the one-dose strategy in the U.S. include former Biden advisory board members Atul Gawande, MD; Zeke Emanuel, MD. PhD; and Michael Osterholm, PhD, MPH.

CDC issues new travel guidance for the vaccinated

Good news for those who are desperate to get away: The CDC last week issued updated guidance, saying that fully vaccinated travelers inside the U.S. don’t need to get tested before or after their trip, unless such testing is required by their travel destination. (People are considered to be fully vaccinated two weeks after their last required dose.) Those with full vaccinations also don’t need to quarantine in the U.S. after they travel. As for international trips, fully vaccinated travelers don’t need to be tested before travel (unless required to do so by their destination). But they do need a negative test result within three to five days after returning to the U.S. They do not, however, need to quarantine upon their return. All travelers, including those who are fully vaccinated, should continue to mask, stay physically distanced and wash their hands frequently.

April 2, 2021

J1 visas: Make convoluted process more simple

In a new JAMA perspective, a urology fellow with a J-1 waiver points out that, as a resident, he worked in the trenches with his colleagues during last spring’s covid crisis in New York. But as that surge subsided and other residents could take time off to visit family, that wasn’t available to him. Instead, both colleagues and the ECGME warned J-1s to not travel outside the country because re-entry couldn’t be guaranteed, making homesickness a hallmark of his pandemic experience as well. Complicating matters: U.S. immigration and customs has proposed having doctors extend their visas either through that agency—a process that can take up to 19 months—or at a consulate in their home country. The author calls on health care workers and institutions to advocate with lawmakers to make the visa renewal process easier, not more difficult. He writes that the French government is fast-tracking citizenship applications from front-line health care workers to show its appreciation for care rendered during the pandemic. The author also calls on hospitals to reach out to their IMG physicians proactively to offer mental health and emotional support. The number of J-1 physicians working in the U.S. has grown 62% over the last decade.

What’s hot, what’s not in covid spending

A report from MarketWatch details how the pandemic has changed Americans’ shopping habits, with televisions flying off shelves and pet, plant and cleaning supplies in high demand. At the same time, movie theaters saw their revenue tank from $12.2 billion in January 2020 to just over $825 million this February, while spending on cold and flu medications fell so hard that chain pharmacies saw a drop in profits last year. Spending on beer is up as is that for specialty cheeses—and also for kidney beans, an indication that many households are strapped for cash. Spending on sunscreen and cosmetics declined over the past year, while sales of books and musical instruments have grown.

April 1, 2021

One in five Americans polled isn’t interested in vaccine

As the number of covid cases rose 10% this week, more states are rapidly expanding vaccine eligibility, with all 50 states announcing plans to offer vaccine to anyone eligible for vaccine under FDA authorizations. That comes as Kaiser Health News reports that vaccine hesitancy continues to shrink in the U.S., with the “I’ll wait and see group” falling from 39% of those polled in December 2020 to 17% in March 2021. But the “definitely not” group that doesn’t intend to be vaccinated at all was 13% in March, with another 7% saying they’ll get vaccine only if it’s required. Hesitancy levels were high among white evangelicals and rural populations. Between December and March, 32% of all those polled had received at least one dose. Experts say the vaccination gap is particularly troubling among Hispanic patients, who are running into barriers to vaccine access. Often, communications about vaccine availability and registration are in English only, and many older people in the Hispanic community don’t have access to computers.

In vaccine development, good news for parents: Pfizer-BioNTech reports that its vaccine has been found to be 100% effective in adolescents ages 12 through 15. The randomized trial the results were based on—which have not yet been peer-reviewed—included more than 2,200 adolescents. None in the vaccine arm developed symptomatic disease nor had side effects. The two companies have started testing its vaccine in children under 12. (Moderna is also testing its vaccine in children of all ages.) Pfizer-BioNTech expects to ask the FDA to amend their EUA to have the vaccine available to older children before school starts in September.

Covid and post-discharge dysfunction

A new JAMA article spells out the troubling long-term neuropsychiatric toll of covid, with long-term symptoms among patients “suggesting brain involvement persists,” the authors write. Symptoms range from loss of taste and smell and brain fog to psychosis, seizures and thoughts of suicide. While experts still aren’t sure if the virus invades the brain, the article discusses several possible mechanisms that could be at play including crossing the brain-blood barrier or having inflammation and clots combine to cause microstrokes and other damage. Another study, this one out of Britain and published in The BMJ, describes other types of longer-term multiorgan dysfunction after discharge. Among close to 48,000 patients in NHS hospitals followed for more than four months, close to one-third were readmitted while more than 10% died, much higher rates than among non-covid controls. Those who developed multiorgan dysfunction post-discharge weren’t limited to the elderly. Becker’s Hospital Review reports that at least 24 hospitals and health systems around the U.S. have launched covid recovery programs for covid patients who have been discharged but need longer-term treatment. Most of those programs involve an initial evaluation and specialist referral including to neurologists, pulmonologists and cardiologists.

March 31, 2021

What did the pandemic do to hospital finances?

A new report from HHS’ OIG paints a gloomy picture of hospitals struggling after their plague year, saying that hospitals now are in “survival mode.” HealthLeaders notes that the report is based on survey responses gathered in February from more than 300 hospital administrators across 45 states. According to many of those administrators, hospitals are suffering financial instability due to higher expenses as well as staffing shortages and exhaustion. Particularly trying for hospitals, the report says, is how to balance ongoing covid treatment with regular hospital care. At the same time, some hospital systems seem to be doing fine. In a new podcast, two Modern Healthcare finance reporters point out that some large health systems—both for-profit and not-for-profit—actually saw their margins grow in 2020. Factors driving that increased profit (other than government grants) include higher acuity patients translating into more revenue and effective cost-cutting. The speakers also believe one pandemic-driven trend may become permanent: less ED traffic. Patients afraid of coming to EDs sought care in other settings, including urgent care, a shift that may persist.

March 30, 2021

Can an extra hour of sleep help prevent covid?

A new study says that getting an extra hour of sleep a night could go a long way to helping health care workers fight off covid. A study published in BMJ Nutrition, Prevention & Health found that a one-hour longer duration of sleep among health care workers was associated with a 12% reduction in the odds of getting covid. In individuals who reported three kinds of issues with sleeping (difficulty sleeping at night, poor continuity of sleep, and frequent use of sleeping pills), there was a nearly twofold increased risk of getting covid when compared with people who had no sleep issues. And in some countries in which health workers were studied, researchers found that daytime napping was associated with a 6% increase in the chance of getting covid. A MedPage Today article notes that the study also found health care workers who reported feeling daily burnout at work had not only a higher risk of covid, but a longer duration of infection and greater severity.

March 29, 2021

New data: Vaccines prevent 90% of covid infections (updated 3/30/2020)

New data found that the vaccine was 90% effective in preventing covid infection in people who were fully vaccinated (they had received two shots at least 14 days before) and 80% effective in people who were partially vaccinated (they had received one of two shots at least 14 days before). A CDC study looked at nearly 4,000 health care workers who received either the Pfizer or Moderna vaccines who had not previously been infected with covid. Nearly two-thirds of the group received two shots. For every 1,000 subjects who were fully vaccinated, researchers found 0.04 infections, compared to 1.38 infections per 1,000 people who had not been vaccinated. Among subjects who had received only one vaccine, researchers found 0.19 infections per 1,000 people.

A Medscape article says that more data may soon be available looking at how well vaccines prevent the transmission of covid. A trial that began last week is examining transmission of the virus among 12,000 college students. Half will receive the Moderna vaccine immediately, while the other half will receive the vaccine in four months.

March 26, 2021

Deaths are down, but case numbers are on the rise

According to the New York Times, the number of covid deaths over the past two weeks has fallen 31% while hospitalizations have dropped 10%. At the same time, officials note that case numbers are on the rise for the first time since January. Reuters this week reports that cases are trending up in 30 out of 50 states, with health officials hoping the increase in vaccinations will prevent a corresponding rise in covid deaths. A growing number of states have lowered the age of vaccine eligibility, with Alaska the first to offer vaccine to every resident 16 and older.

Covid burden linked to mortality in hospitals

What effect does “covid burden”—the number of covid patients in a given hospital, divided by that hospital’s number of beds—have on patient mortality? Writing in the Journal of Hospital Medicine, UCSF researchers looked at data on more than 14,200 covid patients admitted last April across 117 U.S. hospitals. They found that individual hospitals’ covid burden increased the odds of patients dying of covid, suggesting “that patient surges may be an independent risk factor for in-hospital death among patients with COVID-19.” In coverage of the study, Fierce Healthcare notes that the research adds to literature linking heavy covid surges to poor outcomes. The study authors also point out that their results could underscore the impact of a strained health care workforce on patient outcomes.

Surgeon general deja vu

For the second time in his career, former hospitalist Vivek Murthy, MD, MBA, has been confirmed and sworn in as the nation’s top doctor. Dr. Murthy, who previously filled the post of surgeon general during the Obama administration, proved to be a more controversial nominee this time around. During his confirmation hearings, some senators disapproved of Dr. Murthy’s support for gun reform (as they did during his first confirmation hearings), while other critics—including some in the medical community—questioned how much he’d earned from corporations as a consultant during the pandemic. The son of immigrant physicians, Dr. Murthy noted in a Twitter post that he has lost members of his own family to the pandemic. Once a hospitalist at Boston’s Brigham and Women’s, Dr. Murthy dealt with the Zika pandemic in 2016 and the opioid crisis during his first stint as surgeon general.

March 23, 2021

Good news for AstraZeneca? Not so fast

Yesterday’s announcement from AstraZeneca—that interim trial results of its vaccine indicate 79% efficacy against symptomatic covid, 100% efficacy against severe covid and hospitalization—was welcomed news. But in what news coverage claims is an unprecedented step, an NIH panel has weighed in with a “not so fast.” The problem, according to a NIH letter released late yesterday, is that those interim results may be based on “outdated and potentially misleading” data. But according to the Washington Post, the NIH panel has been working with AstraZeneca and has found the vaccine to be between 69% and 74% effective. Anthony Fauci, MD, is quoted as saying that the problem is probably not with the vaccine—”very likely a very good vaccine”—but with the rollout of trial data.

Almost half of all health care workers have not been vaccinated

While health care workers have been at the front of the line to receive vaccine, a new poll indicates that more than four out of 10 health care workers have not been vaccinated. The poll, which was put out by both the Kaiser Family Foundation and the Washington Post, finds that just a bare majority (52%) of health care workers across the country have received at least one dose of covid vaccine. While an additional 19% were either scheduled to be vaccinated or planned to, 18% did not plan on being vaccinated while another 12% remained undecided. More than one in three surveyed health care workers reported not being confident that the vaccines were safe and effective. The survey, which was held mid-February to early-March, gathered responses from more than 1,300 health care workers. In related news, Kaiser Health News reports that new covid cases among nursing home staff members have plummeted by more than 80%. That’s despite the vaccine hesitancy felt by many staff members, with some nursing homes reporting that only half their staff have been vaccinated so far.

Yes, there are covid stamps

None of them, unfortunately, have yet been issued in the U.S. But a piece in JAMA written by French researchers points out that 21 countries as well as the U.N. have issued dozens of different stamps commemorating the pandemic. Iran was the first to do so last March. Many of the stamps depict clinicians, scientists or first responders, while a few contain public health messages about hand-washing and social distancing. Some also show patients being ventilated and attended to by health care workers. One in a series of covid-related stamps issued by the Isle of Man has an illustration of a clinician in scrubs and a red cape.

March 22, 2021

A drive-in Match?

It was once again a remote Match Day last Friday for more than 33,000 medical students and the more than 2,600 candidates around the world looking for residency slots. It was also an historic one that offered the most positions in Match history, with the number of slots up 3% from last year. MedPage Today reports that the need to hold a virtual Match Day led many medical schools to become creative, with at least one school holding a drive-in Match ceremony while another sent bottles of champagne or cookies to students’ homes. As for remote matching, students noted that not being able to travel to in-person interviews allowed them to apply to more programs. Internal medicine drew one-quarter of all applicants, with the number of internal medicine positions up 25% over five years ago. Over that same time frame, the number of family medicine positions increased 44%.

Study: Good news for the AstraZeneca vaccine (updated above)

After a tough week last week, the AstraZeneca vaccine has garnered some good news, showing 79% efficacy against symptomatic covid and 100% efficacy against severe covid and hospitalization. The vaccine’s manufacturer delivered the interim results of its phase 3 trial in a press release, saying the data were based on results from more than 32,000 participants. The two-dose vaccine was found to be just as efficacious in patients over age 65. STAT reports that the study also uncovered no safety problems, including any with blood clots; concerns about clotting led the AstraZeneca vaccine rollout being suspended in several European countries. Based on the results, the vaccine manufacturer intends to ask the FDA for emergency use authorization in the U.S.

March 19, 2021

Getting covid helps prevent reinfection for about six months

Research published in The Lancet found that most people who get covid have some protection from the virus for at least six months, although older people saw less immunity from becoming re-infected. The study found that being infected with covid reduced subjects’ chances of being infected again by 80%, but that figure fell to 50% for people over 65. A New York Times article says that the study is unique because it has been difficult to study reinfection rates, which require access to testing and genetic sequencing to confirm reinfections. The study was also conducted on a small population, and because researchers weren’t able to talk to the study’s subjects, it’s possible that people who became infected were asymptomatic and didn’t feel any ill effects of covid. The study also doesn’t take into account the possibility that people who have had covid and have some immunity can get reinfected in less than six months if they’re exposed to a different variant of the virus. A Newsweek article notes that Anthony Fauci, MD, warned of this scenario this week during congressional testimony.

Patients prefer clear (not cloth) masks when talking to docs

A study published in JAMA Open Network found that surgeons who talked to their patients wearing clear masks, not standard cloth masks, saw better patient ratings. Researchers studied 200 patients from 15 surgery clinics in seven different subspecialties. When it came to providing clear explanations, surgeons with clear masks received a score of 95% compared to 78% for surgeons wearing cloth masks. Patients rated surgeons wearing clear masks higher on empathy (99% vs. 85%) and on building trust (94% vs. 72%). While patients said they preferred clear masks, 53% of surgeons said they were unlikely to replace their traditional masks with clear masks.

March 17, 2021

It’s been a tough week for the AstraZeneca vaccine (updated)

AstraZeneca’s covid vaccine took a beating this week on multiple fronts. The week began with European countries banning AstraZeneca’s vaccine because of concerns about blood clots, claims that an article in Science examines. Europe’s equivalent of the FDA offered its support for the vaccine later in the week, but much of the damage had already been done. Things got worse when a study concluded that the vaccine doesn’t do very well in preventing infection from the South African (B.1.351) variant of corona. Data published in the New England Journal of Medicine found that more than 90% of the cases in the study were caused by the variant, and that the vaccine’s efficacy against that variant was only about 10%. The study found that the AstraZeneca vaccine had an overall efficacy of 22% for all cases (not just cases caused by the variant) of mild to moderate covid. Finally, the U.S. announced yesterday that it is planning to send millions of doses of the AstraZeneca vaccine to Mexico and Canada. Federal officials have been sitting on a stockpile of the shots while awaiting FDA approval of the vaccine.

March 16, 2021

Are we giving the best PPE to the wrong people?

New data show that we may be giving the best PPE to the wrong health care workers. An article from Kaiser Health News notes that while “aerosol-generating procedures” (think intubating patients) have been viewed as the most dangerous in terms of spreading covid, recent data say that a basic cough produces 20 times as many particles as an intubation. As a result, health care workers wearing a surgical mask (as recommended by the CDC) have a higher risk of infection by being in the same room as a covid patient than being near a patient during an intubation. While the thinking on covid risk is slowly shifting, a group of health care experts has stuck to the position that it’s safe for front-line workers to be around covid patients wearing only a surgical mask, while N95s be reserved for covid ICUs. One source in the Kaiser article said that the thinking about PPE during covid has been “upside down.”

Nurses exhausted and stressed, but staying in health care

A new survey of 22,000 nurses has found that younger workers seem to be bearing the emotional brunt of the pandemic. The survey found that among early-career nurses (those under 34), 81% reported exhaustion, 71% reported feeling overwhelmed, 65% were anxious or unable to react, and 47% felt sad. Among older nurses (those over 55), by comparison, about half (47%) reported exhaustion and 37% reported feeling overwhelmed. A Health Leaders article notes the survey also found that nearly 20% of nurses indicated they are financially worse off since the beginning of the pandemic, but most said they don’t plan to leave their current job or the profession. About 30% of surveyed nurses haven’t received a vaccine, and about 25% say they are undecided about getting vaccinated. Finally, only 73% say they have adequate PPE.

March 13, 2021

 Are you giving covid patients too many antibiotics?

New data show that while more than half of covid patients last spring received antibiotics, only a “fraction” of them had bacterial infections. A MedPage Today article said that data show that most antibiotics were given within 48 hours of admission, before most physicians know their patients’ infection status. The data from a Pew Charitable Trusts project found that 36% of covid patients received more than one antibiotic and that only 20% of admissions had suspected or confirmed bacterial pneumonia. The MedPage Today article notes that a study found that VA hospitals used more antibiotics in the first five months of 2020 than in any year since 2016.

March 11, 2021

Study: Working at the hospital doesn’t increase your covid risk

New data claim that hospital workers don’t have a higher risk of getting covid at work,
proof that infection prevention practices are working. The study, which was published by JAMA Network Open, found that even nurses, who have the most direct contact with patients, don’t face a greater risk of getting the virus at work as shown by the presence of covid antibodies.

Among the 25,000 hospital workers studied, the overall positivity rate for covid antibodies was 4%. Physicians had a positivity rate of 3.7%, nurses had a positivity rate of 4.8%, and NPs/PAs had a positivity rate of 3.5%. Nonclinical staff had a positivity rate of 3.9%, but the highest rates were found among environmental service workers (7.4%). The study came out at about the same time as the release of a database of more than 3,500 U.S. health care workers who have died of covid. The list, compiled by a partnership between the Guardian and Kaiser Health News, analyzes the deaths by demographics including occupation, state and race/ethnicity.

March 10, 2021

Colchicine lacks mortality benefit

A trial looking at covid treatments has dropped an arm testing the drug colchicine, which is widely used to treat gout and other inflammatory conditions, because of a lack of a mortality benefit. The RECOVERY trial, which is evaluating potential covid treatments at hospitals in the UK, Indonesia and Nepal, found colchicine produced no 28-day mortality benefit when compared to usual care. An article on MDedge notes that the RECOVERY trial has already identified two anti-inflammatory drugs, dexamethasone and tocilizumab, that can help the survival rates of covid patients. A statement is online.

March 8, 2021

A look at whether vaccines can help long haulers

With the U.S. now giving 2 million vaccines a day, limited evidence suggests that the vaccines may be offering covid long haulers relief from their symptoms. A MedPage Today article cites anecdotal evidence of the recently vaccinated getting some relief from long-term effects of covid, but it also points out that the data are preliminary. A survey of nearly 500 covid long haulers found that 27% of respondents reported feeling “slightly better,” while 16% said their symptoms were “much better” and 5% said they were back to normal. Several experts interviewed for the article endorsed the idea of further studying the impact that the vaccine may be having on long haulers, noting that there are multiple reasons that a vaccine would provide those patients with relief. One recent study on long haulers found that up to one-third of covid patients with severe infections may suffer from post-traumatic stress disorder.

Is delaying second dose of vaccine a good idea?

Health experts are batting down the idea of delaying a second covid vaccine in order to get at least one vaccine into a bigger group of people. The CDC’s Advisory Committee on Immunization Practices recently ruled that there’s not enough evidence to delay a second vaccine or to give only one dose to people who have already had covid. A MedPage Today article says that members of that committee worried that estimates of the effectiveness of the protection offered by one dose are imprecise, and also that one dose may not sufficiently protect people from emerging variants. Last week, Anthony Fauci, MD, warned that delaying a second dose puts Americans at risk and urged health officials to continue with a two-dose schedule. A Medscape article says that while Dr. Fauci has spoken to health officials from the U.K. about their strategy of delaying second doses of the vaccine, he said he didn’t believe the strategy was a good choice for the U.S.

March 4, 2021

Asthma doesn’t increase hospitalizations, serious illness in covid

Data from patients tested for covid in California earlier this year found that asthma is not an independent risk factor for developing a severe case of the infection or increased risk hospitalization. Researchers at Stanford University found that out of nearly 170,000 people who received a covid test between March and September of 2000, there were no differences in hospitalization rates based on whether people had asthma. An article in MDedge said that 28% of patients with asthma had asymptomatic covid compared to 36% of people without asthma. While 53% of people with asthma had severe or critical cases of covid, so did 51% of people without asthma. The data were released as part of a poster presentation at the American Academy of Allergy, Asthma and Immunology’s virtual meeting this year.

Do lockdowns lead to more alcohol withdrawals?

Covid lockdowns seem to be leading to more cases of alcohol withdrawal. Data from a single-center study of hospitalized patients found that between March and September of 2020, rates of alcohol withdrawal jumped by 34% when compared to 2019. A MedPage Today article says that while rates of withdrawal were higher in all of 2020, they were higher immediately after lockdown periods. Researchers accounted for seasonal fluctuations in rates of alcohol withdrawal by comparing data from the same biweekly periods in 2019 and 2020. The data come from a sample size of 340 patients and were published in JAMA Network Open.

March 3, 2021

A look at pandemic-related violence against health care workers

Out of more than 1,000 reported attacks on health care workers in 2020, more than 400 were directly related to the covid pandemic. Incidents included arson at testing facilities, health care workers targeted on their way home after work because of fears that they would spread the virus, and violent responses to workers trying to enforce mask requirements. Individual health care workers were also arrested and assaulted after going public with concerns about the safety of PPE or criticizing government policies about the pandemic. The report, published by Data from Safeguarding Health in Conflict, found that health care workers “frequently” reported being attacked on their way to and from work. The report notes that hotspots for violence included India and Mexico, but violence against health care workers was reported in 79 countries.

WHO issues “strong recommendation” against hydroxychloroquine

The World Health Organization has made a strong recommendation against using hydroxychloroquine to prevent covid. An article in New England Journal says that the recommendation, which was published in the BMJ, is based on a meta-analysis of six clinical trials. The analysis found that hydroxychloroquine had “little to no effect” on covid patients’ mortality or admission rates. Researchers also found that hydroxychloroquine didn’t reduce rates of covid as confirmed by lab results.

March 2, 2021

The five diseases that are associated with covid hospitalizations

A new study found that about one-third of covid hospitalizations were attributable to obesity. Researchers examining a little more than 900,000 U.S. covid hospitalizations found that 30.2% were attributable to obesity/severe obesity, followed by hypertension (26.2%), diabetes (20.5%), chronic kidney disease (12.9%), and heart failure (11.7%). Researchers also looked at the impact that combinations of disease had on covid hospitalizations and found that 40.7% of admissions were attributable to diabetes/hypertension, followed by diabetes/obesity (44.%), diabetes/hypertension/obesity (58.7%), and diabetes/hypertension/obesity/heart failure (63.5%). The study was published by the Journal of the American Heart Association.

Can vaccines in older people prevent the need for ventilators?

New data from Israel have found that older people given a covid vaccine were less likely to require mechanical ventilation to treat the virus than younger people who haven’t been vaccinated. Data from Israel found that Israelis 70 and older who had received the Pfizer vaccine were 67% less likely to need a ventilator than Israelis under 50. The study, which was published in MMWR, compared ventilation rates from February 2021 with rates from October-December of 2020. A Medscape article says that researchers found 80% of older Israelis had received the vaccine compared to only about 10% of people under 50.

February 27, 2021

“Vaccinated Volunteers” bring comfort, aid to isolated patients

With hospitalized covid patients around the country languishing alone in ICUs and medical units, a hospital program in the South Shore of Massachusetts has come up with a solution that it hopes catches on nationwide: using vaccinated health care workers who volunteer to visit with the infected. As reported by the Boston Globe, the “Vaccinated Volunteers” program at Beth Israel Deaconess Hospital-Plymouth is the brainchild of an anesthesiologist who, once he was fully vaccinated, began spending his spare minutes in the hospital visiting with covid patients. Since he sent out a hospital-wide e-mail asking for more volunteers, dozens have come forward, talking to patients and acting as liaisons for family members who can’t come into the hospital. The program has a few simple rules: Volunteers must be at least 10 days past their second vaccine dose, they have to wear full PPE at all times with covid patients, and volunteers work with the same patient and family throughout a hospital stay.

Will covid change how glucose is monitored in hospitals?

One positive development coming out of the pandemic: Last spring, the FDA began allowing hospitals to monitor glucose levels among diabetic patients, particularly those with covid, with continuous glucose monitors—even though those devices are approved for only home use. Using receivers to collect data from the monitors has made it possible for nurses to not have to continuously take blood draws and, if needed, administer insulin remotely. According to STAT, hospitals so far have done only small studies on the monitors’ in-hospital use, but results reported indicate reduced glucose levels and better times in range. Several hospitals using the monitors—including Ohio State University’s Wexner Medical Center and Mount Sinai—are pooling their data on outcomes, while one device manufacturer is also maintaining a registry. The hope: Those data will eventually be submitted to the FDA for permanent approval in hospitals.

February 26, 2021

Study: Children with covid can have different presentations

Children and young people hospitalized with covid present with two major and different sets of symptoms, according to a new study. The research, which appeared this week in JAMA, reported on more than 1,100 patients younger than age 21 across 31 states. Just under half were diagnosed with MIS-C  (multisystem inflammatory syndrome in children), while the rest had acute covid, the same predominately lung-affecting illness found in adults. Those diagnosed with MIS-C tended to be between the ages of 6 and 12, but more than 80% of those with acute covid were younger than 6 or older than 12. The study also underscored marked racial disparities, which likely reflect socioeconomic factors: More than two-thirds of those hospitalized with either condition were Black or Hispanic. While Hispanic children and adolescents seemed to run an equal risk of either condition, Black children were found to face a higher risk of the inflammatory condition than the acute syndrome. Many patients in both groups needed ICU care, although that was more common among those with MIS-C.

February 24, 2021

U.S. covid deaths pass 500,000

This week, the number of deaths due to covid in the U.S. surpassed 500,000—making covid what one California ED physician called “our generation’s D-Day.” It’s notable, however, that more Americans have died of covid in one year than the number of service members in World War II. To memorialize the mortality milestone, The Nocturnists—a California-based collaborative of health care storytellers—issued “No Words” a three-minute illustrated video made to honor those lost. The video also honors the health care workers who cared for those patients and acknowledges, as a panel in the video states, “the pain for bearing witness.”

“Vaccinated Volunteers” bring comfort, aid to isolated patients

With hospitalized covid patients around the country languishing alone in ICUs and medical units, a hospital program in the South Shore of Massachusetts has come up with a solution that it hopes catches on nationwide: using vaccinated health care workers who volunteer to visit with the infected. As reported by the Boston Globe, the “Vaccinated Volunteers” program at Beth Israel Deaconess Hospital-Plymouth is the brainchild of an anesthesiologist who, once he was fully vaccinated, began spending his spare minutes in the hospital visiting with covid patients. Since he sent out a hospital-wide e-mail asking for more volunteers, dozens have come forward, talking to patients and acting as liaisons for family members who can’t come into the hospital. The program has a few simple rules: Volunteers must be at least 10 days past their second vaccine dose, they have to wear full PPE at all times with covid patients, and volunteers get to work with the same patient and family throughout a hospital stay

February 23, 2021

Who in health care is getting—and avoiding—the vaccine

When it comes to health care workers getting the covid vaccine, men are more likely toget vaccinated, in part because they are less hesitant—and opposed to—the idea of a covid vaccine. Preprint survey data from The Covid States Project found that 18% of surveyed male health care workers were vaccinated, compared to 9% of women. The survey found that those preferences translated into some trends about who in health care is and isn’t getting vaccinated. The data show that a 50-year-old white male doctor in the Northeast had a 45% chance of being vaccinated, while a 45-year-old Black female nursing assistant in the south had only a 6% chance. Finally, the survey found that among surveyed health care workers, 37% were hesitant about getting vaccinated and 21% were resistant. Survey data were collected between Dec. 16 last year and Jan. 11 this year.

Covid hospitalizations reach a low not seen since early November

New data show that U.S. covid hospitalizations have dropped to levels not seen since early November. A WebMD report says that since peaking on Jan. 6 at 132,000, covid hospitalizations have fallen for 40 days in a row. As of this week, about 56,000 Americans are hospitalized with covid. Hospitalizations from the virus haven’t been below 60,000 since Nov. 9. The data were published by the Covid Tracking Project.

A report from analyst firm Kaufman Hall notes that while that trend is good news from a public health perspective, it is further hurting hospitals’ finances. Operating margins for U.S. hospitals fell 4.6% from January 2020 to January 2021, in large part because patient volumes are still lagging. The report found that discharges last month were down 12.7% from the previous year, and ED visits plummeted by 25% during the same period. At the same time, hospitals’ total expenses increased 4.5% and labor costs jumped by 6%.

February 19, 2021

Is your health system (inadvertently) promoting misinformation?

They are some of the most respected names in American medicine: Northwell Health, Emory, Stanford, Mayo Clinic. Yet a new report from an online information watchdog has found that ads for these brands—as well as for Pfizer, the CDC and a host of consumer products—regularly appear on Web sites that peddle covid misinformation. NewsGuard, which monitors the content of Web news sites, reports that such health systems are inadvertently funding sites that claim that masks are dangerous and vaccines contain tracking microchips, due to their ads being placed by platforms like Google to reach target audiences. More than 4,000 brands, the report says, have run more than 42,000 ads on Web sites flagged by NewsGuard for covid misinformation. In related news, doctors and nurses are forming online networks to champion vaccines and drown out anti-vaxxers. Politico reports that public health groups are mobilizing vaccine advocates to respond when they are attacked online. An anesthesiologist who helped develop #ThisIsOurShot claims that batting down the anti-vaccine activists, who swarm advocacy sites with comments, is turning into something akin to “a military campaign.”

Round-up: anticoagulants, remdesivir, famotidine

Studies this week weighed in on several treatments, finding benefit to some but giving a thumbs-down to at least one. Some good news: A BMJ study of blood thinners in covid patients found that prophylactic anticoagulants within 24 hours of being admitted reduced 30-mortality from 19% to 14%. Researchers looked at data on more than 4,000 VA patients treated for covid between March and July last year. The group receiving the anticoagulants didn’t see an increased risk of serious bleeds, defined as an event requiring transfusion. As for remdesivir, a systematic review in Annals found that the drug “probably” improves recovery by 7%-10% and may reduce mortality by 1% or less. The review of four trials also found that remdesivir has little to no effect on length of stay, although it probably reduces serious adverse events by a “moderate amount.” And newly published data don’t paint a very positive picture on treating covid patients with the drug famotidine. A study in The American Journal of Gastroenterology compared patients given famotidine during their covid hospitalization to three groups: patients who didn’t take famotidine before or during hospitalization; patients who used PPIs; and patients who used hydroxychloroquine. Researchers found no mortality reduction in patients on famotidine and no difference in their use of “intensive services.”

Booster shots may be in order for Pfizer, Moderna vaccines

Correspondence from both Pfizer and Moderna this week suggest their vaccines, while highly effective against the U.K. variant, may not be as protective against the one from South Africa. Writing in NEJM, Moderna and NIH researchers say that the “protection … ” conferred by Moderna’s vaccine against the South African variant “remains to be determined,” although they did observe decreased neutralizing antibody titers. The results of a lab study done by Pfizer, also published in NEJM, likewise suggest the South African variant may reduce antibody protection from the vaccine. The vaccines’ limited availability is informing the debate over whether to delay second doses, allowing more people to at least receive one dose and some protection. In a case vignette in NEJM, hospital medicine’s own Robert Wachter, MD, argues for delaying second doses. In other covid news, the CDC finds that the life expectancy of Americans dropped a full year in 2020. The news was even worse for minorities and people of color: Life expectancy for Latinos last year fell almost two years (1.9), while the drop was almost three years (2.7) for Black Americans.

One-third of nurses, allied health providers leery of vaccine

A large survey of health care personnel found a lot of variation in what health care workers think about the covid vaccine—and whether they plan to get it—based on their roles. Perhaps most surprising, direct-care providers appear to be less likely to get the vaccine than workers who don’t provide direct care. An MDedge report says that while 62% of personnel not providing direct care would get the vaccine, only 54% direct care providers said they would get the shot. And among providers who had already cared for covid patients, only 52% said they would get the vaccine. While 80% of physicians and scientists said they would be vaccinated, one-third of RNs and allied health professionals were unsure. The data were published in Clinical Infectious Diseases.

February 17, 2021

Millions of fake N95 masks circulating through U.S. hospitals

A wave of fake N95 masks circulating throughout the U.S. has doctors and nurses worried about how much protection their PPE is offering. A Medscape report says that nearly 2 million of the fakes have been sent to hospitals in Washington state alone, and PPE manufacturer 3M says that nearly 10 million of the knockoffs have been confiscated in at least six states. The masks have also been confirmed in hospitals in Ohio, New Jersey and Minnesota. Some of the masks have been described as “odd-smelling” and “misshapen.” Some of the masks offer relatively high levels of filtration, but make breathing difficult. The fakes echo concerns about Chinese-made KN95 masks, which have sometimes turned out to be less effective than they claimed to be.

February 16, 2021

Good news, bad news about covid variants

First the bad news: Early data show that covid’s U.K. variant may be significantly deadlier than thought and puts more people in the hospital than non-variant forms of the infection. According to a MedPage Today article, the British government published data on the Web last week, claiming that U.K.-variant cases are between 30%-70% deadlier than non-variant cases. One study cited by the report found a relative death hazard of 1.58 within 28 days. Other studies cited found that the risk of hospitalization and admission to an ICU was higher for patients with the U.K. variant.

On a more positive note, British researchers have concluded in a preprint that two shots of the Pfizer vaccine may provide significant protection against both the U.K. and South African variants. Researchers found, according to a report from The Guardian, that while the vaccine’s protection was limited, it may still be strong enough to keep most people from becoming infected once they have received both doses. One study—one of the first to test a vaccine’s ability to fight off covid variants—used engineered viruses, not actual viruses from patients. Researchers also found that antibody responses received a significant boost in 90% of those who received a second dose.

Study: Famotidine shows no benefit in treating covid

Newly published data don’t paint a very positive picture on giving covid patients the drug famotidine. A study in The American Journal of Gastroenterology compared patients given famotidine during their covid hospitalization to three groups: patients who didn’t take famotidine before or during hospitalization; patients who used PPIs; and patients who used hydroxychloroquine. Researchers found no mortality reduction in patients given famotidine and no difference in their use of “intensive services.” A Healio report notes that data for the observational study came from electronic health records on covid patients.

February 15, 2021

New data: Prophylactic anticoagulants reduce covid mortality

A new study of using blood thinners in covid patients found that giving prophylactic anticoagulants within 24 hours reduced 30-mortality from 19% to 14%. Researchers looked at the electronic health records of more than 4,000 VA patients treated for covid between March and July. The study, which was published in the BMJ, found that the group that received the anticoagulants faced a 27% reduced risk of 30-day mortality and didn’t see an increased risk of serious bleeding events, which researchers defined as an event that required transfusion. The authors said the data shows a need for more randomized clinical trials.

Tocilizumab offers small but significant mortality benefit in covid

The drug tocilizumab, which is approved to treat rheumatoid arthritis, offers a small but statistically significant mortality benefit in treating covid. Data from the RECOVERY trial showed that 29% of covid patients treated with tocilizumab died within 28 days compared to 33% of patients treated with usual care. While the difference is small, researchers pointed out that the data show that for every 25 patients treated with the drug, one life will be saved. A MedPage Today article said that use of the drug also improved the probability of discharging patients alive after 28 days from 47% to 54%. That statistic applies to a large group, from covid patients who needed supplemental oxygen to those requiring intubation. Previous trials of tocilizumab have shown less clear results in treating covid.

February 13, 2021

Once vaccinated, should you quarantine after exposure?

So you’ve been vaccinated; do you still need to quarantine if you’re exposed? Not according to new guidance from the CDC, as long as you meet the following criteria: at least two weeks have passed since your second dose but not three months or more, and you’ve remained asymptomatic since the exposure. If you don’t meet those conditions, you’ll need to follow standard guidance and quarantine for two weeks, as long as you haven’t had covid within the previous three months. In other news, data hint that covid immunity—at least for those who’ve been infected—likely lasts six months. A new study from the U.K. found that 99% of patients who tested positive for covid retained antibodies for three months after being infected, while 88% remained seropositive for six months. Researchers think those data show that infected people retain some immunity. The researchers note that they weren’t able to assess antibody levels over time in patients who have been vaccinated rather than infected, but they call the data on immunity “encouraging” for those who’ve received vaccine.

Pulse oximeters may be missing hypoxemia in Black patients

While pulse oximeters are used everywhere to assess patients’ oxygen levels, they may not be accurately measuring those levels in Black patients and others of color. In NEJM in December, University of Michigan researchers detail their findings among ICU patients receiving supplemental oxygen. Those patients’ oxygen levels were measured both by pulse oximetry and by arterial oxygen saturation in arterial blood gas. Among Black patients, close to 12% of those with pulse oximetry readings between 92% and 96% were found to have arterial oxygen saturations of less than 88%, a percentage that fell to less than 4% among Whites. In a multicenter trial, those figures were 17% among Blacks and 6% among Whites. STAT reports that several senators have called on the FDA to review the devices, while “our findings highlight,” the authors wrote in NEJM, “an ongoing need to understand and correct racial bias in pulse oximetry and other forms of medical technology.”

February 10, 2021

How lethal is the U.K. variant?

Among countries moving swiftly with mass vaccinations, Britain may be the most successful, with experts saying the country may be able to vaccinate its entire population—at least with one dose—by the start of this summer. That’s good news for Britain because a new preprint based on an analysis of community test results and covid deaths in England suggests a 35% increase in death hazard with the U.K. variant over non-variant covid infections. Those data, the authors say, suggest the new variant is not only more transmissible but “may cause more severe disease.” Another preprint estimates that the number of covid cases caused by the U.K. variant in the U.S. is doubling every 10 days, due to a 35%-45% projected transmission rate increase.

Editorial: time to revisit no-visitation policies (updated)

A doctor at Mass General has penned an editorial saying that it’s time for hospitals to end their no-visitor policies. Trisha Pasricha, MD, writes that such policies were justifiable in the early days of the pandemic when hospitals were struggling with widespread shortages of PPE and testing supplies. But now, she argues, such policies only increase the trauma of patients and their families, and she cites her own experience: Last year, her grandmother was admitted to a hospital and died from covid, while all of her relatives (including Dr. Pasricha) were barred from visiting. In her hospital where she works, she writes, she sees her own loss “repeat itself in devastating variations” as visitors are either severely restricted or outlawed altogether.

“Of every mistake we’ve made in the pandemic, there is perhaps none I regret more than having inflicted this pain on families in their darkest hours.” She notes that most covid outbreaks in hospitals are being traced to health care workers not wearing masks; one commenter did point out that perhaps that is because no-visitation policies have been in force. Still, the author believes that universal masking, rapid test results and protective clothing for visitors would reduce transmission risks.

February 9, 2021

FDA revises authorization of convalescent plasma (updated) 

The FDA has revised its emergency authorization for using convalescent plasma to treat covid. The agency now states that only high-titer convalescent plasma can be used to treat covid patients in the early stages of infection. The FDA also says the therapy can be used for inpatients who have impaired humoral immunity and can’t produce an antibody response. As MD Edge reports, the revised authorization is based on data from a new clinical trial. The FDA originally issued an emergency authorization for convalescent plasma last August, but a revised fact sheet from the agency now notes that giving convalescent plasma late in covid infections hasn’t produced any significant clinical benefit. In other news, the NIH recently updated its recommendations on tocilizumab. Previously, the agency had recommended against its use (and that of other anti-interleukin-6 receptor monoclonal antibodies) outside clinical trials. But with new evidence, the NIH now says it can’t recommend either for or against its use in patients admitted to an ICU within 24 hours who need either a ventilator or high-flow oxygen. Some members of the NIH guideline panel say they would give patients who meet those criteria and are rapidly progressing to respiratory failure a dose of tocilizumab plus dexamethasone. Panel members continue to not recommend using the drug outside the ICU.

Booster shots for variants will undergo faster approval process (updated)

If booster shots are needed to help covid vaccines fight variant strains, the FDA will not require the same lengthy process that was needed to approve the original vaccines. The agency said it will unveil the review process for approving booster shots in the next few weeks. Reuters reports that acting commissioner of the FDA Janet Woodcock says that the Pfizer and Moderna vaccines still provide protection against existing covid variants, but both manufacturers have said they are bracing for the possibility that variants may require a booster shot. This week, South Africa announced that it will no longer use the Astra Zeneca vaccine because it is not effective enough in stopping the covid variant prevalent in that country. Meanwhile, a preprint estimates that the number of covid cases caused by the U.K. variant in the U.S. is doubling every 10 days, due to a 35%-45% projected transmission rate increase. Another preprint, which is based on an analysis of community test results and covid deaths in England, suggests a 35% increase in death hazard with the U.K. variant over non-variant covid infections. Those data, authors say, suggest the new variant is not only more transmissible but “may cause more severe disease.” Also in response to the spread of new variants in the U.S.: The CDC this week recommended wearing two masks or knotting the loops and tucking in the sides of surgical masks so they fit more tightly.

February 8, 2021

Most physician getting the vaccine for themselves, but not for patients

A new survey finds that 81% of physicians have received at least one dose of the covid vaccine and that 44% have received both doses. According to a survey by Medical Economics, only 5% of responding physicians decided to not get vaccinated, and 14% said they were still waiting. The survey also asked outpatient physicians about their experience administering the covid vaccine to patients, and the results weren’t particularly impressive. Only 11% said their practices have received vaccines to give to patients, and only 26% said that their patients have accurate knowledge about the vaccine.

Data hint that covid immunity likely lasts for six months

A new study from the UK found that 99% of patients who tested positive for covid retained antibodies for three months after being infected and that 88% remained seropositive for six months. Researchers think their data show that covid produces antibodies that give people who have been infected some immunity to the virus. The data found that seroprevalence varied by age, with 13.5% of people under 30 retaining antibodies vs. 6.7% of people over 70. A Medscape article notes that the results match up with data released last month, which found that patients who had recovered from covid had significant immunity to the disease.

February 5, 2021

Lull before the storm?

CDC director Rochelle Walensky, MD, MPH, announced this week that new covid cases and hospitalizations had fallen off since their peak in early January, with the number of daily infections dropping more than 13%. Further, while the number of deaths continues to rise, the pace of that increase has become less steep. But infectious diseases expert Michael Osterholm, PhD, MPH, of the University of Minnesota, is warning of a “Category 5” hurricane of new cases that could develop over the next several weeks and months due to covid variants. Among those, the U.K. variant is expected to become the dominant strain in the U.S., with the CDC’s variant-case tracker this morning reporting 611 cases across 33 states. As the pandemic enters its second year, CDC researchers writing in JAMA find that ED visits for mental health, suicide attempts, overdoses and violence rose last year between March and October compared to the same period the previous year. And the New York Times reports on a “parallel pandemic” of exhaustion and trauma among front-line clinicians.

Unprecedented jump seen in medical, nursing school applications

Applications to medical and nursing schools are seeing double-digit increases, with the AAMC noting that the number of applications to U.S. medical schools has jumped as much as 35%. Newsday reports that application numbers at some medical schools in New York state are almost 30% higher than usual, while the number of those applying to state nursing schools is likewise at an all-time high. As to why so many people want to start training, experts point to several factors, including the need for job security as well as wanting to serve patients during the pandemic. Also on the rise: applications for second nursing degrees as well as those in public health, pharmaceutics and respiratory care.

February 3, 2021

Link between covid and diabetes?

Physicians and researchers don’t have clear answers yet, but some inpatient physicians are reporting a sharp uptick in the number of covid patients with new-onset type 1 or
type 2 diabetes. As reported in the Washington Post, some patients’ blood sugar levels return to normal at discharge, while others are being discharged with diabetes. An international analysis, published last November, found that 14.4% of covid patients are newly diagnosed with diabetes. Meanwhile, it’s unclear whether covid patients developing diabetes have predisposing conditions, such as obesity, or if blood sugars are elevated due to steroids—or if covid is triggering a new type of diabetes. Some diabetes diagnoses are being reported in patients with mild or asymptomatic covid.

More big tech firms sign on to help with vaccines

News on the vaccine front: First, big tech is lending some of its considerable muscle to vaccine allocation, distribution, screening and management. FierceHealthcare
reports that Google Cloud is only the latest among the tech giants (others include
Microsoft and IBM) to bring its AI and machine-learning tools to bear on what’s been a bumpy rollout. Another recent article, this one in Kaiser Health News, describes how allocation can go wrong, as one small hospital in Michigan in December ended up with more than twice as many doses than it had requested. The extra doses helped vaccinate the administrators and faculty of a small nearby college and beauty school, while public health officials in that county received only 400 doses, not enough to vaccinate frontline health care workers. In other vaccine news, a CDC report outlines who received vaccine in the first month (Dec. 14-Jan. 14) of administration in the U.S. Nearly 13 million people that month—health care workers, as well as nursing-home residents and staff— were vaccinated. Among them, 63% were women while 55% were over age 50. The report notes, however, that race and ethnicity were reported for only half of those vaccinated. That breakdown: 60% were White, 12% were Latino, 6% were Asian, 5% were Black and 2% were Native American.

February 2, 2021

Health care workers’ risk factors, hospital outcomes

Data from Emory University on covid risk factors among its health care workforce find that demographic and community factors—including being Black and having contact with positive patients outside work—were more strongly linked to contracting covid than exposure on the job. In their study, which was published in Annals, researchers looked at serology tests and surveys completed by about one-third of Emory’s health care workers. Among them, 3.8% were found to be positive. Another study, this one in JAMA that focused on health care workers hospitalized with covid in North America, looked at those workers’ outcomes compared to hospitalized covid patients who don’t work in health care. The good news: Hospitalized health care workers had shorter lengths of stay vs. non-health care workers and were less likely to be admitted to the ICU. But no differences were found between those two groups in terms of mortality or need for mechanical ventilation or vasopressors.

Who got mitigation right? The NFL

A new CDC report details just how effective extensive surveillance and mitigation measures can be in stopping the spread of covid—as demonstrated by the NFL. Instead of capturing players in a bubble, the NFL launched its season last July, implementing strict mask requirements, closing off eating areas and quarantining high-risk contacts, with protocols modified over the course of the season. The league also implemented daily testing for more than 11,000 players and staff for a total of 623,000 PCR tests. And it used proximity tracking devices with expanded definitions of “contact” to include distance, time, mask use, and ventilation and air flow. That intensive contact tracing added to the literature on transmissions occurring during less than 15 minutes of cumulative interaction.

February 1, 2021

“Long covid” is difficult to define—and treat

While there’s a lot of attention being paid to “long covid,” physicians are stymied by its lack of identifying symptoms, which makes treating it more difficult. A MedPage Today article says that long covid adheres to no known pattern, and that many of its signs overlap with other complications of covid, from post-ICU syndrome to multisystem inflammatory disorder. Symptoms such as persistent, severe headache and “brain fog” are common, but they can be new or recurring symptoms and they can occur independent of the severity of the initial episode of covid. Data from China found that three-quarters of patients hospitalized with covid had one ongoing symptom, and 20% of patients who didn’t require supplemental oxygen during hospitalization reported decreased lung function six months later.

Two weeks after acute covid, 80% of patients have lingering symptoms

New data show that 80% of covid patients had “lingering” symptoms two weeks after an acute case of the infection. While more than 50 symptoms linked to covid were found post-infection, the most common were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%), dyspnea (24%), and anosmia (24%). The data were published as a non-peer-reviewed preprint on medRxiv. A MedPage Today article notes that a widely cited survey released last year found that 35% of covid patients had not returned to normal two to three weeks after testing positive, but those were mild infections treated in the outpatient setting.

January 28, 2021

New cases falling in half of states while vaccine acceptance grows

While most of the news surrounding covid has been nothing but bleak, there were two positive developments in covid news this week. HHS data show that a dozen states and more than 1,200 counties saw drops in new covid cases of 25% or more. Experts attribute the reduction not to the results of newly administered vaccines (it’s too soon), but to improved behavior by Americans. A HealthLeaders article says improvements include more social distancing and more mask-wearing. In the other piece of good news, the number of Americans on board with getting a covid vaccine is growing and reached 69% last week. The Harris Poll found the number of Americans interested in a vaccine was near the April peak of 73%. A FiercePharma article says that as recently as October, the number of Americans who said they would get a vaccine was at a low of 58%.

Read this Auschwitz survivor’s advice on dealing with covid grief

A 93-year-old Auschwitz survivor has a message for physicians who are suffering from PTSD as a result of treating covid patients for the better part of a year: Don’t blame yourself for surviving in the midst of so much death. Psychiatrist Edith Eger, PhD, watched Josef Mengele send her mother to the gas chambers while she and her sister were spared. A Newsweek article explains that Dr. Eger knows first-hand that survivor’s guilt can be a real part of PTSD. She tells clinicians to not say, “I’m fine but…” and to instead change it, “I’m fine and.” She says that clinicians can’t blame themselves for surviving when so many of their patients have died.

Biden reverses course on expanding buprenorphine

The Trump administration’s plans to allow more physicians to prescribe buprenorphine were put on hold this week. A Washington Post report says that while the new administration vowed in a statement to work to increase the use of buprenorphine to reduce overdoses, it also said that the guidelines expanding the number of physicians who could prescribe it was “premature.” The Washington Post article says that the Trump administration’s plan was plagued by legal and operational problems, including a lack of approval from the White House budget office. Stay tuned for more information.

January 27, 2021

Questioning early anticoagulation in critically ill covid patients

New data indicate that the early empiric use of anticoagulation in critically ill adults with
covid does not improve survival in these patients. An observational study in Annals of Internal Medicine found VTE in 6.3% of critically ill covid patients and major bleeding in 2.8% of these patients. Patients who were and weren’t anticoagulated in the first two days after being admitted to the ICU had similar in-hospitality mortality rates. Researchers say the data suggest that not only are the rates of VTE in critically ill covid patients lower than previously estimated, but that early anticoagulation may not produce any survival benefit.

Teaching hospitalists, locums hospitalists reduce LOS for covid patients

Covid patients seen by academic internists and locums physicians had a shorter LOS than patients seen by non-teaching hospitalists. Teaching internists reduced LOS for covid patients by 0.6 days when compared to non-teaching hospitalists. Locum hospitalists reduced LOS for covid patients by a full day when compared to employed hospitalists. The study, which appeared in the Journal of General Internal Medicine, found that there was no increase in costs, readmission rates or mortality for patients with a shorter LOS.

January 25, 2021

One in four HF patients hospitalized with covid will die

New data show that nearly one in four heart failure patients hospitalized for covid will die in the hospital. The study found an in-hospital mortality rate of 2.6% for patients hospitalized for acute heart failure compared to an in-hospital mortality rate of 24.2% for HF patients hospitalized with covid. A report from Healio says that the study examined a group of more than 130,000 heart failure patients hospitalized between April and September. Of those patients, nearly 24,000 were hospitalized with acute heart failure, just more than 8,000 were hospitalized with covid, and just over 100,000 were hospitalized for other reasons. An editorial in the same issue points out that HF patients hospitalized with covid tended to be Black and/or Hispanic, which is consistent with previous data about the prevalence of covid among minority groups.

NIH on using ivermectin for covid: Figure it out yourself

The NIH is now taking a neutral stance on using the antiparasitic drug ivermectin to treat covid, neither weighing in for or against the drug. As a result, it is leaving the decision about whether to use the drug to physicians and their patients. An NIH statement says the agency needs more data before it can provide guidance. A Medscape report notes that while some physician groups have adamantly supported using the drug to treat covid, critics compare it to the discredited drug hydroxychloroquine, which was promoted early in the pandemic. A middle-of-the road view appeared in a recent issue of NEJM, which argued that while there’s more evidence for ivermectin than ever existed for hydroxychloroquine, more data are needed.

January 22, 2021

CA nurses cry foul as they’re asked to see more patients

Faced with a covid surge, hospitals in California are relaxing restrictions on nursing-patient ratios, creating what nurses say are extreme working conditions, and leading to protests. California, which is the only state that legally regulates nursing-patient ratios, relaxed some of those rules in early December. A Kaiser Health News report says that ICU nurses can now be required to care for three patients instead of two, ED nurses and telemetry nurses can be required to care for six patients instead of four, and med-surg nurses can care for seven patients instead of five. While the change has some nurses protesting in the street, hospitals insist they need the flexibility to handle what could be as much as 7,000 new patients a day because of covid. The report says that the state has exhausted the supply of travel nurses and is considering pulling nurses from other units to care for covid patients. Nurses are concerned that the rules will not be returned to pre-covid levels after the pandemic is over.

Federal rules for prescribing buprenorphine loosened

Under a ruling issued in the final week of the Trump administration, nearly all physicians will now be able to prescribe the addiction treatment buprenorphine. Under the previous rules, physicians needed to undergo eight hours of training and receive an “X waiver” to prescribe the drug. Addiction treatment advocates have long complained that the rules prevented the drug from being given to more patients who need it. Under the new rules, physicians with only a DEA prescriber license will be able to treat up to 30 patients in a state, although that cap does not apply to hospital-based physicians. NPs and PAs will still need to apply for a waiver to prescribe the drug.

January 21, 2021

ED docs don’t always take the proper covid precautions

Nearly one-third of ED physicians don’t always use the correct PPE at work, and more than half have knowingly taken personal safety risks when treating patients. A Medscape survey asked ED doctors how often they practiced without the appropriate PPE and found that 21% of respondents said sometimes, 7% said often and 1% said always. A MD Edge report notes that more than half (54%) said that they’ve knowingly risked their personal safety to treat a covid “emergency,” and 74% said that their burnout has become more intense since the pandemic began. The survey also found that 71% of respondents had their income drop between 11% and 50% since the pandemic began.

January 20, 2021

Mortality rates for covid higher when ICUs are packed

It may not come as a surprise, but new data show that the ICUs that are the most packed with covid patients tend to have the highest mortality rates for those patients. A study in JAMA Network Open that looked at VA medical centers with 10 or more covid patients between March and April of 2020 found that mortality rates were twice as high in April (25%) as in July (12.5%). In April, covid populations were at their highest in those ICUs. By July, one-seventh of covid patients were in those ICUs. Researchers concluded that mortality rates for critically ill covid patients may be associated with the number of other covid patients in the ICU at the same time.

What does life look like inside a covid field hospital?

A team of physicians working at a field in hospital in Baltimore offers a window into their experience in the latest issue of the Journal of Hospital Medicine. The Baltimore Convention Center Field Hospital opened in April of 2020 as a 252-bed facility located on a single exhibit hall floor of the convention center. The hospital cares for stable adults with covid from any hospital or ED in Maryland and has cared for more than 500 patients, with 80% successfully discharged to outpatient care. The article explains that the hospital has experienced no cardiac arrests or on-site deaths in large part due to its use of rapid response teams to manage decompensating covid patients. The authors talk about the importance of early identification of decompensation in covid patients, particularly with individuals in their third or fourth week of illness. (The article cites data from Wuhan, China, which indicate that decompensation occurs predictably at day nine of symptoms.) The article offers two case studies from the physicians’ experience.

January 18, 2021

How health care is reaching out to vaccine-resistant workers

While there’s been a lot of attention paid to patients who don’t want to get a covid vaccine, health systems are also busy confronting the problem of workers who refuse to get vaccinated. Instead of forcing them to get the vaccine, some are trying to break through with reasoning. And when that approach doesn’t work, some health care facilities are resorting to bribes. A New York Times article says that to reach medical workers wary of getting a covid vaccine, some hospitals and long-term care centers are offering cash, extra time off and even Waffle House gift cards. The report says that in multiple cities, up to 30% of health care workers are not getting vaccinated. Some are worried about the newness of the vaccine; others cite a general lack of trust in the government.

When it comes to working with a different group of vaccine resisters—patients—an ID physician from Yale New Haven Health says that physicians need to try a multipronged approach. A HealthLeaders article offers four tips to help overcome patients’ objections to the covid vaccine that include casting the covid vaccine as part of a broader infection-prevention strategy and trying to understand patients’ values and goals to make a stronger case for getting the vaccine.

January 15, 2021

Surging covid cases force U.S. institutions to consider rationing care

In areas hard hit by the pandemic, health care institutions are beginning to raise the specter of rationing the care they provide covid patients. A ModernHealthcare report says that Arizona, which is facing one of the worst infection rates in the U.S., is nearing the day when its hospitals will have “triage officers” decide who gets treatment when there’s a shortage of staff, beds or ventilators. The leadership of five of the state’s biggest hospitals held a news conference to beg residents to mask up, socially distance and avoid large gatherings. The state has no mask mandate. In nearby Las Vegas, one hospital declared a disaster over the weekend after a covid surge left its ICU overflowing with patients. And in Atlanta, Grady Health System released a simple statement this week: “Grady is full.” For two weeks, the system’s daily count of covid patients has topped its peak numbers from the summer.

Are hospitals distributing the vaccine fairly? Critics cry foul

The sometimes-troubled rollout of the covid vaccine has some critics complaining that hospitals, which have been given tremendous authority in dispensing the vaccines, aren’t always doling the shots out fairly. A Kaiser Health News article says that in some hospitals, administrators and other workers who have no contact with patients have received the vaccine while patients and front-line staff have not. Other reports talk about the pressure that wealthy donors are placing on health care systems to jump the line. While the CDC and states have issued guidance on who should be vaccinated first, the report says those guidelines aren’t always followed. A New York Times report gives examples of healthy 20-somethings working in IT and research labs getting vaccinated before front-line workers and at-risk Americans. And a MedPage Today editorial says that hospitals need to stop “playing vaccine games” and show leadership in the often-absent lack of clear guidelines from states. The editorial says that when faced with issues like a surplus of vaccines, health systems are reluctant to go beyond the recommendations of their state and do the right thing (like ship those extra doses to a pharmacy with experience with vaccinations).

Which covid tests do doctors trust the most?

A new survey of 100 physicians in the U.S. and Europe found that most physicians (82%) trust the molecular (PCR) test to confirm active covid infections. When it comes to \ serology testing, by comparison, only 56% of physicians said they were confident in its accuracy and/or utility in confirming PCR results or identifying patients suspected of having a prior infection. The survey, which was conducted by the diagnostics company Oxford Immunotec Global PLC, asked physicians whether, when and how frequently they used four types of covid tests. More than 60% of respondents said they could use alternatives to serology and new tests to assess immunity and vaccine responses. Full results of the survey are available online. (Click on the link “December 2020, 100 Physicians Find raw data” on the bottom right side of the page.)

Federal government wins award for worst profiteering of 2020

This year’s Shkreli Awards find the federal government and Jared Kushner, President Trump’s son-in-law, at the top of the list of the worst examples of profiteering and dysfunction in health care. The awards are named after Martin Shkreli, the so-called “Pharma Bro” who earned public scorn—and jail time—for raising the price of an antiparasitic drug from $13.50 to $750 per pill. According to a MedPage Today report, Project Airbridge airlifted PPE from overseas, but instead of delivering the supplies to the neediest states, the PPE was given to six private medical supply companies to sell to the highest bidder. The Shkreli awards claim that action set in motion a bidding war among the states and blames the federal government and Kushner, who led Project Airbridge. Not only did the federal government end up outbidding states for PPE, but it seized PPE that states had managed to purchase on their own, exacerbating the shortage. A full list of all 10 Shkreli Awards for 2020 is online.

January 14, 2021

More data on what covid looks like post-discharge

Several new studies provide data, giving a picture of what covid looks like after discharge. Chinese researchers have found that three-quarters of people hospitalized with covid are still reporting at least one symptom six months later. The study, which was published in The Lancet, found that the most common symptoms were fatigue or weakness (reported by 63% of patients). Sleep difficulties were reported by 26% of patients and anxiety or depression was reported by 23% of patients. Researchers examined nearly 2,500 patients discharged between January and May of 2020.

An Annals of Internal Medicine article published in November found that 40% of discharged covid patients had not returned to normal activity 60 days after discharge. Researchers found that out of 1,648 patients who were admitted to Michigan hospitals, 13% were treated in ICUs, 70% received supplemental oxygen and 24% died. After discharge, 7% died and 15% were readmitted. After 60 days after discharge, 20% had no follow-up, 33% had persistent symptoms, and 20% had new or worsening symptoms.

A preprint published by medRxiv found that six months after discharge, 37.4% of patients exhibited neurological abnormalities during a neurological exam. The most common were cognitive deficits (17.5%), hyposmia (15.7%) and postural tremor (13.8%). Overall, patients displayed “a wide array” of neurological symptoms including fatigue (34% of patients), memory/attention issues (31%) and sleep disorders (30%). Researchers said that patients who experienced these symptoms tended to have experienced more severe respiratory signs of covid while hospitalized.

Better news came from a study in Annals of American Thoracic Society. Researchers found that while there was fatigue and deconditioning in post-discharge covid patients, only a small number faced persistent lung problems in the months after leaving the hospital. A Medscape article says that in 4% of patients presenting for follow-up evaluations, repeated chest imaging found persistent infiltrate or atelectasis. Researchers concluded that clinically relevant fibrosis is an uncommon consequence of covid.

January 12, 2021

Will the U.S. have enough doses of the vaccine for a second shot?

As the country struggles to get covid vaccines into the arms of the most vulnerable Americans, the federal government will recommend that states give all doses of the vaccine they have immediately, and not worry about saving doses for a second shot. While 22 million doses of the vaccine have been shipped to the states, only about 9 million have been given to individuals to date, according to CDC data.

To speed up the delivery of the vaccine, the federal government will recommend that Americans over 65 and all Americans with pre-existing conditions should receive the vaccine as soon as possible. That changes the previous policy, which said that states should save a second dose for everyone who had received the first shot.

According to a New York Times report,  second doses will be provided as vaccine manufacturers restock the government’s supplies. The announcement comes on the heels of President-elect Biden announcing that he would release all doses of the vaccine immediately after taking office.

There are concerns about administering all vaccines in stock without holding back doses for a second shot. A Medscape