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Morning Rounds Shraddha Chakradhar

Covid-19 has streamlined addiction medicine. Will the changes stick?

Covid-19 has complicated access to several kinds of health care, but one area where the pandemic has brought about unexpected — and long-sought — change is addiction medicine. Sweeping changes introduced by Congress in response to the pandemic have made it easier for people to obtain medication-assisted treatment. When before they may have had to make several in-person visits for a drug test and meetings with a physician and a counselor, many are now finding the process much simpler, since those visits can be handled via text messaging and video calls. The new concern, however, is whether these changes will stick around even after the pandemic ends. “You can’t put the genie back in the bottle,” Stephen Loyd, a Tennessee addiction doctor, tells STAT's Lev Facher. Read more here

Here's what else is new with the pandemic: 

  • As nursing homes continue to be disproportionately affected by Covid-19, the White House is now recommending that all residents and staff at these facilities be tested for the coronavirus in the next two weeks. 
  • A new model from a group convened by the WHO and UNAIDS estimates that a six-month disruption of antiretroviral therapy for HIV patients due to Covid-19 could lead to an additional 500,000 deaths in sub-Saharan Africa in the next year from AIDS-related causes, including tuberculosis.
  • Twitter just announced that it would warn users when a tweet containing information about Covid-19 was disputable or otherwise misleading. Such tweets could contain a label directing users to public health agency websites or the label would completely cover up the original tweet and warn users about the post's potentially misleading content, the company shared
  • In a new STAT First Opinion, physician Lauren S. Grossman shares how her experience treating people who forgo flu vaccinations only to end up sick makes her believe that many will similarly want to opt out of a Covid-19 vaccine, despite what's happening with the pandemic. And so, "I believe that our nation should, for the first time ever, require all Americans — or at least schoolchildren and workers in direct-contact jobs — to be vaccinated against this coronavirus," she argues.  

Doctors are unsure which Covid-19 patients should get remdesivir

The federal government may have adopted a plan to distribute the Covid-19 drug remdesivir to states and have them dole it out to hospitals, but clinicians are still left with the question of which patients in their wards ought to get the medication. A bigger problem than the drug's short supply is the limited information on how best to give out the drug. Even though the drug was shown recently to help patients recover quicker from Covid-19 than those given a placebo, physicians still don't have data on which patients are most likely to benefit most. The only other information hospitals seem to have is that the earlier in the infection a person is treated, the better they seem to fare. Beyond that, however, “if you have 20 patients but only two vials, how do you decide which two patients get those vials?" Erin Fox, director of drug information and support services at the University of Utah Medical Center, tells STAT's Eric Boodman and Casey Ross. Read more here

Inside STAT: In a medical first, doctors treat Parkinson’s with a novel brain cell transplant


(MOLLY FERGUSON FOR STAT)

In an exclusive new story, one that she began reporting in the fall of 2018, STAT's Sharon Begley takes readers through the ups and downs of how a patient with Parkinson's disease was the first to receive an experimental therapy for the condition, a treatment that relied on using the patient's own stem cells. These cells were extracted from the patient and coaxed into becoming functional brain cells — and the therapy involved transplanting these cells into the patient's brain in the hopes of replacing there the cells rendered dysfunctional by the neurodegenerative disease. What was appealing about the story, Sharon tells me, is that this patient — a man in his late 60s named George Lopez — funded much of the preclinical work with a $2 million check. And against many odds, including transporting the cells from Boston to New York for the surgery, Lopez also became the first to be able to get the therapy that he helped get developed.

New research sheds light on sex imbalances in diseases like schizophrenia and lupus

The findings of a new study provide genetic evidence to support why some diseases appear more frequently in one sex over another. Females are nine times more likely to develop lupus, for instance, while schizophrenia is not only more common among males, but also manifests more severely. In the study, researchers found that a gene called C4 puts people at risk for schizophrenia, but is also very protective against lupus and another autoimmune condition known as Sjögren’s syndrome (which also appears more frequently among women). And C4's effects are particularly pronounced in men, which may explain the discrepancy in how schizophrenia and lupus appear in this population versus in women. The findings could provide a pathway for developing therapies for these conditions, scientists tell STAT's Meghana Keshavan. Read more here

PrEP uptake among adolescents subject to barriers

A new analysis of adolescent use of pre-exposure prophylaxis, or PrEP, for HIV reveals that though those aged 12-24 made up 1 in 5 new HIV diagnoses in 2018, they face significant barriers to getting PrEP. Scientists looked at 58 studies conducted between 2009-2019 and found that, in at least one of those studies, the majority of adolescents were unaware of PrEP and that 86% of those who were eligible for the treatment were never informed about this option by their health care providers. Another study found that only around 1.5% of eligible youth were on PrEP. Among the studies that examined provider attitudes, many physicians said that prescribing the medication was outside their purview. The review also found that the high cost of PrEP — up to $13,000 a year without insurance — could be another barrier for at-risk youth. The authors of the review also offer ways to increase PrEP uptake among youth, including incorporating it into school health programs. 

Watching Disney movies to cope with the effects of chemotherapy

Music and movies have been proven to be good distractors from the emotional toll of stress and daily anxieties that can negatively affect health. Now, a small, new study finds that cancer patients who watched Disney movies during rounds of chemotherapy reported fewer symptoms of fatigue and improved social functioning scores. The findings were based on a trial of 50 women undergoing treatment for a gynecologic cancers, half of whom were assigned to watch Disney movies during their six rounds of treatment. Compared to the women who weren't assigned to watch these movies, the women who watched Disney films reported feeling less tense and worried; fewer symptoms of frustration and helplessness; and fewer feelings of encroaching on their families' social lives. One caveat: The study didn't include a third group that watched non-Disney movies, so it's unclear how much of the positive effects can be attributed to Disney films specifically. 

What to read around the web today

  • Secretive Jasons to offer advice on how to reopen academic labs shut by pandemic. Science
  • Workplace worries mount as US tracks new COVID-19 cases. Associated Press
  • He was a science star. Then he promoted a questionable cure for Covid-19. The New York Times Magazine
  • African scientists sense a once-in-a-life opportunity to push for research funding. Quartz Africa
  • Superintendent bragged about VA review of short-staffed soldiers home. Two months later, 73 veterans are dead. ProPublica

Thanks for reading! More tomorrow,

Shraddha

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Tuesday, May 12, 2020

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