Morning Rounds Shraddha Chakradhar

Covid-19: Trump outlines 'phases' to reopen states once coronavirus cases decline

President Trump yesterday told state governors that they could begin to ease restrictions in their states and start to reopen businesses that were shut to curb the spread of the virus. However, the guidelines would only apply to those states where health care providers have the capacity to treat all infected patients, and where Covid-19 cases have been on a downward trajectory for at least two weeks, said Deborah Birx, who has helped to coordinate the administration’s coronavirus response. STAT's Lev Facher has more on the federal government's three "phases" to reopen the economy here

Here's what else is happening: 

  • An early look at the Gilead Sciences trial testing remdesivir for Covid-19 has revealed that the drug seems to be helping severely ill patients rapidly recover from fever and respiratory symptoms, and nearly all patients who were given the drug at a Chicago hospital had been discharged from the hospital in less than a week. Read more here
  • Based on studies conducted by scientists at UnitedHealth Group, the FDA announced that it was allowing a broader range of swabs — including polyester ones — to be used for Covid-19 testing as well as expanding where in the nose people could be tested. 
  • The 13-minute test for Covid-19 that was developed by Abbott Laboratories and that has been used hundreds of times to test patients for the disease can sometimes give false positive results, according to lab experts and clinicians. 
  • N95 masks are highly coveted pieces of protection now, but in a new STAT First Opinion, Joseph Allen and David Christiani write that just using these masks isn't enough — people also ought to be trained on using them properly. 
  • The American Hospital Association, American Medical Association, and American Nurses Association sent a letter to the Trump administration expressing their concern over the racial disparities that are widening as a result of Covid-19. African American and Hispanic patients are being disproportionately affected by the virus, and the letter urges the administration to take several steps, including creating PSAs targeted to minority communities and the risks they face. 

Influential Covid-19 model shouldn't guide U.S. policies, critics say

The widely followed models from the Institute for Health Metrics and Evaluation at the University of Washington have oscillated between showing really dire outcomes for U.S. Covid-19 deaths, and, more recently, a more optimistic outlook. But epidemiologists are increasingly questioning the validity of the model. The Trump administration used the IHME's initial predictions of up to 240,000 U.S. deaths to formulate its pandemic response, but there is concern that the IHME's revised prediction of fewer than 70,000 deaths "will be used to suggest that the government response prevented an even greater catastrophe, when in fact the predictions were shaky in the first place,” epidemiologist Ruth Etzioni tells STAT's Sharon Begley. Experts are worried that the model's more optimistic forecast will result in measures being lifted prematurely or officials becoming complacent. Read more here

Sales of Juul's tobacco, mint flavors spiked after fruity ones went off the market

New research finds that sales of tobacco and mint flavors from e-cigarette maker Juul rose after the company announced that it was pulling its fruit flavors from the market. In November 2018, following pressure from the FDA, Juul voluntarily removed fruity and some sweet flavors — but not tobacco, mint, or menthol — from retail stores. By April 2019, the sales of fruit flavors declined, but Juul's share of sales from mint/menthol flavors nearly doubled and its share of tobacco flavor sales rose from 16% to 22%. Overall, Juul captured 91% of the market growth in tobacco flavor sales and all the growth in mint/menthol flavor sales. But another competitor, Njoy, saw a $37 million increase in monthly fruit flavor sales between September 2018-September 2019. Voluntary removal of products may not be sufficient to curb sales, the authors conclude, suggesting government regulation may also be necessary.  

Inside STAT: Experimental drug may offer new approach to treat schizophrenia 

Astrocytes from a brain affected by schizophrenia (right) have fewer fibers and occupy less volume. (WINDREM ET AL/CELL STEM CELL)

Decades after the last schizophrenia treatment was approved, a new type of drug for the condition is showing promise in a Phase 2 clinical trial, whose results were published this week. Developed by Sunovion Pharmaceuticals and called SEP-363856, the drug works via a different mechanism than previous drugs for schizophrenia and is believed to be safe and have milder side effects than currently available drugs. In a 245-person trial, the drug seemed to ease common symptoms of schizophrenia. At the same time, some experts are concerned that because the drug affects the same pathway as other drugs, albeit in a different way, its effects might not be as unique and that patients may not end up seeing much of an improvement in their symptoms. STAT Plus subscribers can read more from STAT's Meghana Keshavan here

Certain oral and pharynx cancers, especially those associated with HPV, are on the rise

Between 2007-2016, the rates of oral cancers and cancers of the pharynx increased, according to new CDC data. Here's more from the report: 

  • Overall findings: The number of all oral and pharynx cancer cases increased from around 35,000 cases in 2007 to nearly 45,000 cases in 2016, for an annual increase rate of around 1%. 
  • Site-specific changes: Rates of tonsil, oropharynx, and gum cancers increased by 2% or more per year during the 10-year study duration. At the same time, there was a similar decrease in cancers of the lip, hypopharynx, and soft palate. 
  • Implications: When grouped together, the rate of those cancers known to be caused by HPV — such as tonsil and oropharynx cancers — increased by more than 2% per year, whereas non-HPV-associated cancer rates decreased by around 0.4% per year. The report authors reinforce the need for widespread HPV vaccination to help combat this trend. 

Smartphone-based monitoring works as well as in-person visits to help patients control their BP

As physicians explore incorporating health technology into their practice, a new study finds that patients working on maintaining their blood pressure after a heart attack had equal rates of success whether they had in-person visits with a clinician or followed a protocol via smartphone. In the small study of 200 heart attack patients, half were tasked with maintaining their BP via tools paired with their smartphone — including a scale, a BP monitor, a step counter, and a heart rhythm monitor — while the other half went to clinicians for routine follow-ups. The results were similar in both groups: 79% of those in the smartphone group had controlled their BP after a year's follow-up, compared to 76% in the control group, a difference that was not statistically significant. Around 2% in both groups died at follow-up. Follow-up studies ought to look at the specific qualities that make patients suitable for smartphone-based BP monitoring, the authors write. 

What to read around the web today

  • A tiny hospital in Texas might help solve the mask shortage. Elemental
  • The plight of a hospital chaplain during the coronavirus pandemic. The New Yorker
  • Carnival executives knew they had a virus problem, But kept the party going. Bloomberg Businessweek
  • California resists push to lift limits on nurse practitioners during Covid-19 pandemic. California Healthline
  • The people who risked death for immunity. The Atlantic

Thanks for reading! More next week, 


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Friday, April 17, 2020


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