Antiviral pills on the way; death rates climb in rural areas

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Amber Dance | Courtesy Photo

Delta pounds rural communities

COVID-19 is moving to the country. While cases were highest in urban areas as the pandemic began, the pattern flipped as summer drew to a close, according to a new report from the Rural Policy Research Institute. Now rural case rates outnumber those in cities, and rural dwellers are at more than twice the risk of death as urbanites.

Experts predict the gap will widen, reports Lauren Weber at Kaiser Health News. “We’ve turned many rural communities into kill boxes,” said the head of the National Rural Health Association, Alan Morgan. “And there’s no movement towards addressing what we’re seeing in many of these communities, either among the public or among governing officials.”

Lower vaccination rates are a key contributor, with a variety of underlying causes. Researchers from Syracuse University point to more Trump voters and fewer people achieving academic degrees. At Healthline, Moira McCarthy cites a “perfect storm of personal freedom beliefs, mistrust of the government, a culture that tends toward taking care of things on their own, highly shared misinformation, and, yes, faith.” Dr. Scott J. Anzalone of Logan, Ohio, told her that since rural COVID-19 rates were low early in the pandemic, it created a “false sense of security” among many residents. People in rural areas are particularly vulnerable to misinformation due to the twin decline of rural health care systems and local news outlets, leaving them no obvious source for accurate health advice, opines Kerry Thomson, executive director of the Center for Rural Engagement at Indiana University, at NBC News.

Lack of access to health care or emergency treatment is also a factor. Writes KHN’s Weber, “The pressures of the pandemic have compounded the problem by deepening staffing shortages at hospitals, creating a cycle of worsening access to care.” When the virus infiltrates rural regions, telehealth can come to the rescue, writes Katie Palmer at STAT. “When we think about diversity, equity, and inclusion, for me it’s not only necessarily race and ethnicity, but it’s geography as well,” Roxie Wells, president of Hoke Hospital in Raeford, North Carolina, tells Palmer. “I truly believe that people who live in rural communities should expect outstanding high-quality care in their communities, and now that telehealth is such a huge part of what we do, I think that it is highly plausible.” But the telehealth revolution has yet to reach many rural areas, reports Erin Brodwin, also at STAT.

A COVID pill so good, they stopped the trial early

The phrase “game changer” appeared in many news stories last week trumpeting the announcement that pharmaceutical maker Merck’s experimental medication halved risk of hospitalization or death in people with mild or moderate COVID. Dr. Anthony Fauci, speaking on CNN’s “State of the Union,” called the company’s results “really quite impressive.” So impressive, in fact, that an independent review board recommended the company cut its trial short to seek emergency authorization as soon as possible. The twice-a-day, easy-to-swallow pill could be a big deal, writes Umair Irfan at Vox, because the COVID-specific treatments already available are “expensive, difficult to administer, not widely available, or only marginally effective.” Antibody treatments and remdesivir, the only antiviral drug with FDA approval, require infusion into the bloodstream by medical providers. In contrast, a pill would require only a prescription and a glass of water.

However, Reuters reports that a pair of Indian drug makers trialing Merck’s formula are seeking to halt their studies in moderate cases for the opposite reason, because the results were lackluster. “It was not immediately clear whether the Indian drug makers and Merck used identical criteria to define moderate COVID-19 cases,” Reuters notes.

Antivirals have been slow in coming compared to antibodies or vaccines; in part that’s because they’re trickier to make. Viruses live inside our own cells and use many of our proteins, so scientists must design molecules that can prevent the viruses from functioning without hurting us, too. (I delved deeper into the difficulties of antiviral research here.) Merck’s drug, molnupiravir (named after Thor’s hammer) works by mimicking a building block for the virus’s genome. When the virus goes to copy its genes, the decoy is incorporated and gums up the works. In addition to Merck’s drug, there are two other main contenders in the race for oral antivirals, as Ed Cara lays out at Gizmodo: Pfizer recently announced progress with a drug that interferes with one of the virus’s enzymes, so it can’t mature and copy itself. And Atea Pharmaceuticals and Roche are jointly developing another decoy drug, like molnupiravir.

The U.S. government has promised to purchase 1.7 million treatment courses of Merck’s drug if it’s authorized, and the meds could be available within months, reports JoNel Aleccia at Kaiser Health News. But many experts hurried to point out that pills are no substitute for vaccines; much better, Fauci said, to avoid the disease altogether.

Workplace vaccine mandates work on many, but not all

“We all respond to deadlines,” New York City Mayor Bill de Blasio told CNN recently. “We all respond to rules.” That certainly seems to be the case for the majority of the Big Apple’s health care workers and educators — well over 90% are now vaccinated, after state and city mandates went into effect on Oct. 4. A similar pattern is playing out in health systems across the country, writes Adeel Hassan at The New York Times. United Airlines recently reported that 96% of employees had gotten a vaccine as required; there were only 232 holdouts left out of 67,000 employees as of October 5. “Relatively few employees flat out resist vaccination,” writes Philip Bump at The Washington Post. Bump suggests that many people who once told pollsters they’d never take the vaccine changed their tune once their job was on the line. However, the mandates have not been without consequences, notes CNN’s Eric Levenson. Some health care systems have had to suspend many noncompliant employees; one in Buffalo, New York had to delay certain elective surgeries and close its doors to new ICU patients as a result.

More at-home tests to come

At-home COVID tests can tell you if you’ve contracted the virus for the cost of $7 to $50, in half an hour or less. That is, if you can find a test to buy — no easy task in the U.S., as The New York Times’ David Leonhardt discovered recently. The FDA has been slow to authorize the tests, leading to a shortage here while citizens of other countries have easy access to plenty of tests, often provided for free. “Knowing your COVID status in real time, on a frequent basis, is more important than ever,” write Dr. Michael J. Mina, an epidemiologist at Harvard, and Dr. Steven Phillips, vice president of science and strategy at the expert advocacy COVID Collaborative, in a recent The New York Times op-ed. “To end the coronavirus’ grip on American society, the United States must embrace rapid testing in a more substantial way.” Two recent moves by the government are poised to help: The FDA authorized a new test that is expected to double availability; and the White House is spending $1 billion on at-home rapid tests in hopes of quadrupling the supply by December.

This holiday season’s hottest item: a window fan?

While it’s tempting to see delta’s demise in ebbing national case rates, hospitalizations and deaths, we are still in the throes of a nasty pandemic. More than 700,000 people have died in the United States alone, and many regions remain in serious trouble. A majority of Alaska hospitals are rationing care. Even well-vaccinated New England is facing a surge that’s filling ICUs. And the California National Guard has been activated to help hospitals in the central and northern parts of the state. “This isn’t the first time a shift in numbers has lulled leaders into a false sense of safety,” writes Sophie Putka at Medpage Today. “It’s impossible to predict what will happen in the coming months — particularly with the potential for new variants, lackluster vaccination rates, and colder weather on the way.”

Nonetheless, as the seasons turn many Americans are looking ahead to the holiday season. So is the CDC, which recently released preliminary guidelines for 2021 holiday festivities — “sort of an epidemiologist’s take on Martha Stewart’s ‘Home for the Holidays’,” quips Bill Chappell at NPR. Key recommendations include holding celebrations out of doors, or if the party must move indoors, keeping doors and windows open with a fan pulling air out through one window so fresh air comes in through the others. For those considering air travel, Dr. Ashish Jha, dean of the Brown University School of Public Health, recently took a cross-country redeye with a barely masked seatmate that led him to conclude it’s time for vaccine mandates for domestic air travel. California Sen. Dianne Feinstein is thinking along similar lines, proposing a bill to require proof of vaccination — or a negative COVID test — before boarding.

Amber Dance | Columnist

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