THE CORONAVIRUS FILES
By Amber Dance
Black and Hispanic COVID patients went untreated due to skin color
Patients with darker-color skin experienced delayed COVID care in Baltimore hospitals during 2020 and 2021, according to a new study in JAMA Internal Medicine.
A blood oxygen level of 94% or less is the cutoff for treatments such as remdesivir, but finger-clip pulse oximeters overestimated oxygen levels by more than 1% in nonwhite patients, the study authors found when they compared those readings to more accurate arterial blood oxygen tests.
The result was that more than one-quarter of the more than 7,000 patients whose records were included in the study should have received treatment that they didn’t get right away, due to the inaccurate readings.
Black patients were 29% less likely to qualify for needed treatment based on pulse oximeter readings than white patients.
For Hispanic patients, the chances of recognizing their eligibility for advanced treatment was 23% lower than for whites.
In some cases, the delay was merely an hour; other patients probably never got the treatment they needed.
“These are likely patients who were seen in emergency rooms and sent home,” study author Tianshi David Wu told Usha Lee McFarling at STAT.
The authors are still trying to figure out if the problem led to unnecessary deaths.
For Asians, the data are muddier. This study found that the pulse oximeters overestimated their oxygen levels, but an earlier report suggested the readers have similar accuracy between white and Asian people.
There weren’t very many Asian patients in the Baltimore-based research, so it’s difficult to say whether they experienced unnecessary delays, McFarling writes.
It’s not technically difficult to create pulse oximeters that work with a wider range of skin tones, and some devices already exist. The challenge is in testing the devices and obtaining FDA approval, and then replacing all the monitors hospitals already own.
That means the only solution right now is for darker-skinned, sick patients is to question pulse oximeter results or demand a painful arterial blood draw — “really just trading one bias for another,” Dr. Thomas Valley of the University of Michigan told STAT.
Different omicron variants threaten summer season
These variants are gaining traction in South Africa, where the situation has often presaged what happens in the States.
The most recent U.S. estimates suggest these two variants together make up 6% to 7% of U.S. infections — up from just 0.02% a month ago.
They seem to have a transmissibility advantage, as well as mutations that help them evade prior immunity from infections or vaccinations, reports Brenda Goodman at CNN.
Already, people are reporting their second case of omicron, writes Melody Schreiber at The New Republic: “People who recover from COVID-19 can now be reinfected in a matter of months.”
Some evidence suggests that second infections and post-vaccination cases are less severe, hinting that third and fourth cases might be milder still, writes Katherine J. Wu in The Atlantic.
The situation adds up to a potential summer of breakthrough and recurrent infections, but not necessarily more severe disease, Columbia University microbiologist Dr. David Ho told Goodman.
The rise of new versions of omicron also hints that the coronavirus might be entering a period of more predictable evolution, writes Ewen Callaway at Nature.
While in previous years of the pandemic, novel variants arose seemingly out of nowhere, earning new Greek-letter designations, more predictable viruses like influenza tend to follow the same genetic lineage from year-to-year. COVID could be settling into a similar pattern, with the dominant strain transitioning from one omicron variant to the next.
Then again, there could still be room for more diverse and dangerous variants, or a comeback of the delta strain.
“I think we should be cautious in extrapolating general rules from a fairly short observation time frame,” said viral evolution expert Jesse Bloom of the Fred Hutchinson Cancer Center in Seattle.
Senior deaths rose with omicron wave
The demographics of COVID deaths in 2022 look a lot like they did in 2020, before vaccines, report Benjamin Mueller and Eleanor Lutz at The New York Times. Seniors are again bearing the brunt of the disease.
In 2021, older Americans were largely protected by recent vaccinations, but now immunity among seniors has waned, leaving them vulnerable once again.
“Despite widespread vaccination among seniors, virus death rates among older Americans surged to near-record levels during the first omicron wave,” writes Arielle Mitropoulos at ABC News.
In January 2022, people older than 75 were 136 times more likely to die from COVID than those between 18 and 29.
Death rates have been particularly high among older Hispanic Americans, reports Mitropoulos.
Meanwhile, COVID precautions are diminished or nonexistent in many places, and the omicron variant is better at avoiding the immunity that people do have.
An estimated 30% of seniors aren’t up to date on their shots — either not fully vaccinated or not boosted.
People 50 and older are now eligible for a second booster, but seniors and physicians told the Times that the booster effort is “listless and disorganized.”
Antiviral pills such as Paxlovid are still hard to come by, despite the government’s latest efforts.
“This is not simply a pandemic of the unvaccinated,” said global health expert Andrew Stokes of Boston University. “There’s still exceptionally high risk among older adults, even those with primary vaccine series.”
China’s lockdown is causing a medical dye shortage
The pandemic, especially the severe restrictions happening in China, continue to disrupt the global supply chain.
One result is that hospitals are running low on dyes they use in medical CT scans, forcing them to ration the scans and making it more difficult to diagnose many patients, writes Reed Abelson in The New York Times.
The dyes have a variety of uses, such as mapping heart blood vessels and blood clots, diagnosing cancer, and identifying infections.
The GE Healthcare plant in Shanghai that makes the dyes was closed for several weeks.
FDA commissioner Dr. Robert Califf told a Senate committee the shortage is “just unbelievable.”
The Shanghai plant has reopened, at limited capacity, and shortages are expected to continue into the summer.
The shortage echoes oxygen shortages earlier in the pandemic, and may further compound the delays in care many people have experienced since the pandemic began.
“It’s definitely causing more stress for patients,” said Chicago oncologist Dr. Shikha Jain.
Mark your calendars: June FDA meeting preview
That June 15 meeting is just one of four days’ worth of big meetings for the FDA’s advisory committee on vaccines.
First, on June 7 the committee is slated to discuss emergency authorization for Novavax’s protein-based COVID-19 vaccine in adults. Efficacy against infection was 90.4% in a study conducted before delta and omicron. The FDA said Friday it’s concerned about a risk of heart inflammation after the vaccine.
On June 14, the committee will review Moderna’s request for children ages 6 through 17. Full doses for adolescents, and half-doses for children under 12, yielded antibody responses on par with those the vaccines created in adults.
Then on June 15, after months of delays, the committee will consider authorization of mRNA vaccines for the youngest children. Both Moderna and Pfizer say their vaccines create an antibody response comparable to that of already-authorized vaccines in adults. Moderna has requested emergency authorization for two quarter-doses in children from 6 months to 5 years old. Pfizer, after failing to meet antibody target levels with two doses at one-tenth the adult strength, is now asking for authorization of three doses; preliminary data indicate this provided 80.3% efficacy against symptomatic disease in a trial amid omicron.
Finally, on June 28, the committee will discuss updating the vaccines for the variants most likely to be circulating in fall, when it’s expected there will be another round of boosters on offer. Both Moderna and Pfizer are testing new formulas specific for omicron, which might be combined with the original vaccines.
“But the omicron version that’s around in a few months may be significantly different than the strain the vaccine was designed to target,” warns Caitlin Owens at Axios. “The jury is still out as to whether an omicron-specific vaccine has significant benefits compared to the original version.”
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