Coronavirus Files: Virus continues to evolve, while hospitals on edge as extra dollars disappear

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Amber Dance | Courtesy Photo

THE CORONAVIRUS FILES

By Amber Dance

Loss of pandemic funding endangers care for poor, uninsured

Safety-net hospitals, which provide care regardless of patient’s ability to pay, received a sorely needed financial boost during the pandemic thanks to billions in emergency federal funds. As that funding comes to an end, hospitals are struggling to provide care for people who’ve come flooding in with health problems after delaying treatment during the pandemic, writes Noah Weiland at The New York Times.

Even before COVID, such hospitals operated on slim margins, said Beth Feldpush of the trade group America’s Essential Hospitals.

As a result of 2020’s CARES Act, the government distributed $178 billion to hospitals and other health care providers to cover expenses and lost revenue.

The federal COVID-19 Uninsured Program handed out more than $20 billion to cover testing, vaccination and treatments for people without health insurance, but the program is now out of funds.

And the federal public health emergency declaration boosted coverage for Medicare and Medicaid patients, but that’s currently set to expire in July.

These temporary measures helped safety-net hospitals, but only to a certain extent. Michele Johnson, director of the aid group the Tennessee Justice Center, likened the pandemic aid to “some rouge on the corpse.”

More CARES Act money flowed to rich hospitals and large academic centers than to small clinics in rural areas, according to research by the nonprofit RAND Corporation.

Still, for hospitals that barely scrape by, every bit of aid is a boost. Now, while COVID hospitalizations remain low, people who put off care are returning to a severely strained system. Weiland describes everything from advanced cancers because people skipped screening, to broken bones left to fester for months, to an excess of bunions. At the same time, costs for medicines and staff have skyrocketed, creating a situation that’s overwhelming safety-net hospitals.

There’s no additional help in sight: The latest $10 million pandemic aid bill, which would cover more free treatments and vaccines for all Americans, remains stalled in Congress.

New variants keep coming

The coronavirus continues to develop new mutations and combinations of mutations at a rate too fast for scientists to keep up. The latest variants to watch — but not panic over — are new flavors of omicron known as BA.4, BA.5, and BA2.12.1.

Currently, the BA.2 variant, which is about 30% more transmissible than BA.1 that came before it, makes up more than half of U.S. cases.

And the virus is still spreading effectively. For example, despite stringent requirements for vaccination and day-of COVID testing, several attendees of the April 30 White House Correspondents Dinner have since tested positive for the virus.

BA.2.12.1 is now coming on strong, at just over one-third of U.S. cases and rising. This one is 25% more transmissible than BA.2

Scientists are also watching the BA.4 and BA.5 variants, now surging in South Africa.

“It just seems like the latest chapter of a never-ending saga,” Dr. Peter Chin-Hong of UC San Francisco told the Los Angeles Times.

All three variants seem to be better at evading the immune response than what’s come before. They each have mutations that likely help them bind more tightly to target cells and avoid antibodies that try to get in the way, reports Brenda Goodman at CNN.

It’s not yet known if these variants cause milder or more severe disease.

“The data all point to the possibility of more reinfections from newer omicron subvariants,” writes Beth Mole at Ars Technica. “This could drive yet more waves of infection in the U.S. and around the world — though experts don’t expect another towering wave like the BA.1 surge in January.”

The continued evolution of the omicron variant could undermine the efficacy of vaccines based on the BA.1 version that are now under development, Mole writes.

It could also be a sign that the coronavirus is moving towards more flu-like behavior, writes Megan Molteni at STAT. With influenza, variants tend to drift from one similar version to another, in contrast to the arrival of markedly different variants as happened with the coronaviruses beta, delta, omicron and the like.

“This could be good news, because more stable, predictable evolution would make it easier to develop meaningful COVID-19 vaccines and boosters,” writes Molteni.

That said, there’s no guarantee there aren’t more wild-card, Greek-letter variants in the future. Scripps Research physician Dr. Eric Topol writes on his blog that preparing for novel variants will require vaccines that create broad protection and more antiviral medications.

Delta is also still lurking in the wings, meaning it could re-emerge with new variants, writes Judy Siegel-Itzkovich at The Jerusalem Post.

Topol notes that there’s no reason to believe the next variant will cause milder disease than the ones that came before. Future variant severity is unpredictable, as is the ceiling on coronavirus transmissibility, so things could get worse before they get better.

Paxlovid fails to prevent infection

Recent data dashed hopes that the antiviral Paxlovid could be used as a post-exposure prophylactic to prevent infection in people who share a home with COVID patients.

While disappointing, these results are not wholly unanticipated, reports Matthew Herper at STAT. Dr. Daniel Barouch of the Beth Israel Deaconess Medical Center told him, “The biology of treating infection is different from the biology of preventing infection.”

It’s not clear exactly why the treatment didn’t help; it could be that the drug needed to be provided sooner after exposure to stop the virus in its tracks.

Reports have also surfaced recently that some people who take Paxlovid, after they’re infected, become sick again after they’ve finished treatment.

“Little is yet known about the rebound cases, such as whether the highly transmissible omicron variant plays a role,” reports Bloomberg. “While there’s no proof it’s caused by the drug, doctors say they need more information about what action to take when the virus surges in someone who’s just been treated.”

Pfizer says that in its studies, people who took placebo pills had the same rate of rebound as those on the real drug, suggesting the treatment isn’t causing the renewed symptoms.

Both the NIH and the FDA are looking into the problem, as are other research groups. There are a number of questions to answer, notes Dr. Paul E. Sax at the New England Journal of Medicine’s Journal Watch blog. For example, should the standard treatment course be longer, or should people who relapse take a second course of the drug?

Despite these issues, relapses seem to be rare, and experts told STAT’s Herper they remain confident in Paxlovid’s ability to thwart the virus.

Barouch said, “These new data would not make me less enthusiastic in prescribing Paxlovid for therapeutic purposes.”

FDA imposes limits on J&J vaccine

Johnson & Johnson’s coronavirus vaccine will now be accessible only for people who can’t take one of the other vaccines — due to allergy to an ingredient, for example, or because the others are unavailable — as well as those who flat-out refuse vaccines made with the messenger RNA technology used by Pfizer and Moderna.

The Johnson & Johnson shot uses a different formula: a virus that delivers the coronavirus spike DNA.

The FDA made this announcement last Thursday, citing 60 cases of blood clotting problems linked to the vaccine.

There have been nine deaths from the condition.

The agency and the CDC had temporarily paused the vaccine’s use back in April of 2021 when it had knowledge of just six cases of the clotting disorder.

The Johnson & Johnson vaccine initially showed promise because it was meant to be a one-shot, easily transported and stored inoculation, compared to the mRNA vaccines that each started with a two-dose series and required very cold storage.

But it never took off; 18.7 million J&J shots have been administered, compared to more than 558 million of the two mRNA vaccines combined.

Pfizer hopes for little-kid booster data within weeks

Pfizer, which is testing a three-dose regimen of its COVID-19 vaccine in children younger than five, now says it should have the results ready for regulators by late May or early June, AP News reports.

That would put it in line behind Moderna, which has already filed for authorization of its two-dose protocol for the youngest children, but still in time for anticipated meetings of the FDA’s outside advisory committee on vaccines.

While the vaccine can’t come soon enough for some parents, others aren’t in a rush. The latest poll from the Kaiser Family Foundation finds that 18% of parents with kids in this age group will hurry to the pharmacy, while 38% plan on a wait-and-see approach.

More than half of the parents surveyed said they didn’t have enough information to evaluate the vaccines’ safety and efficacy for their young children — a fair point, as the full data have not yet been made publicly available.

The poll also found that 27% of parents “definitely” would not vaccinate their kids under 5, and a further 11% would do so only if it were required.

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