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Morning Rounds Shraddha Chakradhar

Gilead ups its donation of the Covid-19 drug remdesivir for U.S. hospitals

Gilead Sciences is increasing the number of doses of remdesivir that it is donating to the government by more than 300,000, STAT's Eric Boodman has learned. Remdesivir was recently shown to offer some benefit to Covid-19 patients by speeding up time to recovery by about four days. The company had previously planned on donating 607,000 doses but has now upped it to 940,000 doses, figures that were mentioned in an HHS letter sent to state governors yesterday and which could help an extra 55,000 patients. Although the letter didn't explain the reason for the increase, the move comes as the federal government works to try and ensure more equitable distribution of its limited supply of the drug. Read more here

Here's what else is new with the pandemic: 

  • President Trump revealed yesterday that he has been taking the antimalaria drug hydroxychloroquine and a zinc supplement "for about a week and a half now" to lessen Covid-19 symptoms should he get infected. Hydroxychloroquine is unproven for Covid-19, though Trump has touted it for weeks as a potential treatment. The FDA has also warned against using hydroxychloroquine outside a hospital or clinical trial setting after reviewing "reports of serious heart rhythm problems” in Covid-19 patients treated with the drug.
  • HHS Secretary Alex Azar leveled heavy criticism against the WHO yesterday, saying that the global health agency didn't adequately warn the world about Covid-19. “There was a failure by this organization to obtain the information that the world needed, and that failure cost many lives,” Azar said in prepared remarks to the World Health Assembly, the WHO's governing body. 
  • Early results from a Phase 1 trial of Moderna's Covid-19 candidate vaccine suggest that people who received the injection generated a similar immune response to those who have recovered from Covid-19 infection. The trial only included eight people, but the data are likely to be seen as encouraging even as the company pursues more trials with the vaccine. 
  • Even as other states work on reopening some businesses and parts of routine life, nursing home and other long-term facilities — whose residents have accounted for a third of all U.S. Covid-19 deaths — are still in limbo and unsure of what comes next. Read more here

Long-acting injectable shows promise in preventing HIV infection

Preliminary findings of a new study show for the first time that a long-acting injectable can prevent HIV in certain populations. The drug, cabotegravir, was being tested since December 2016 in a global trial of more than 4,500 men who have sex with men as well as transgender women who have sex with men. Participants were assigned to receive either cabotegravir every two months, daily oral preventive pills known as Truvada, placebo injections, or placebo pills. As of last month, only 12 people in the cabotegravir group were diagnosed with HIV, compared with 38 people in the Truvada group. Having to take daily pills poses a challenge for many people, and the hope is that an injectable that's only needed once every eight weeks might increase adherence. Based on the results thus far, the study investigators will offer cabotegravir to all participants, including those who were assigned to take Truvada.  

Researchers warn of long-term mental health impact of novel coronavirus infections

Short-term mental health symptoms stemming from a coronavirus infection may continue for a long time after hospitalization, according to a new analysis. Researchers found that around 30% of patients hospitalized for SARS and MERS, and almost 70% of the most serious Covid-19 patients experienced symptoms of delirium — general mental disturbance and sometimes hallucinations. Although there isn't yet data on the long-term mental impacts of Covid-19, studies that looked at data from SARS and MERS patients showed that many of the most severely ill patients experienced depression, anxiety, fatigue, and PTSD for months or even years following their hospitalization. One caveat: The authors warn that the studies assessing long-term mental health in SARS and MERS patients didn't have high-quality data — including the lack of a control group in some cases. 

Inside STAT: 9 ways Covid-19 may forever upend the U.S. health care industry


(Mike Reddy for STAT)

A part of the "new normal" that Covid-19 has brought on is a reckoning of the health care infrastructure in the U.S., one that has shattered age-old assumptions about the role of medicine, health care providers, insurers, and drug makers in the lives of Americans. STAT asked health policy experts about ways in which the pandemic is likely to change — and in many ways has already altered — how the U.S. views health care. Among their nine predictions is how Covid-19 is likely to return drug manufacturing to the U.S. as a result of shuttered factories in China. The pandemic's economic effects are also likely to put pressure on employers to reduce health insurance costs and be more flexible with the kinds of plans they offer, signaling perhaps another step away from the established model of employer-provided health insurance.  STAT's Lev Facher has more here

Q&A: NIH workshop on addressing maternal mortality in the U.S.

Today and tomorrow, the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the NIH's Office of Research on Women's Health are hosting a workshop where clinicians and researchers will share work on conditions that increase the risk of mortality among pregnant women and new mothers. The workshop will also touch on what's currently known about Covid-19 in this population as well as how women of color are particularly at risk of dying during pregnancy. I spoke to Diana Bianchi, director of NICHD, to learn more. 

What is the purpose of the workshop? 
Maternal deaths are a relatively rare event — and each death is extremely important. The important thing is that 60% of the deaths are preventable. The goal of this workshop is to understand the predisposing factors that women have going into pregnancy that push them into a much higher risk situation. Pregnancy is [also] a stress test for later health: Even if you didn’t have hypertension going in, for instance, but get it during pregnancy, it’s a sign that you’re more likely to develop it later in life. 

What comes next?
The short-term goal is to determine specific priorities that can be fed into funding initiatives. We're also planning an initiative to be announced more formally in the fall that will focus on reducing specific maternal morbidity issues — such as hemorrhage or infection. This workshop will also give us foundational information to finalize that initiative.    

As health costs balloon, primary care doesn't see similar boost in spending


Although U.S. spending on health care nearly doubled between 2002 -2016, new research finds that spending on primary care stayed relatively stable during that period. The national health expenditure ballooned from $810 billion in 2002 to more than $1.6 trillion in 2016. Inpatient visits, prescriptions, and specialty care were the biggest drivers behind the increase in health expenses, while primary care only made up 4% of the cost increase. At the same time, the overall spending on primary care decreased slightly over the study period, from making up 6.5% of all health costs in 2002 to 5.4% of costs 14 years later. Given the benefits of primary care — including making health care easier to access for many people — the authors of the study write that the U.S. needs to further invest in primary care.

What to read around the web today

  • COVID-19 data sharing with law enforcement sparks concern. Associated Press
  • How smart city planning could slow future pandemics. Wired
  • Google develops AI to identify patients at high risk of blindness. STAT Plus
  • The Black American amputation epidemic. ProPublica
  • Opinion: Ventilators are important for Covid-19 care. So is proper staffing. STAT

Thanks for reading! More tomorrow,

Shraddha

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Tuesday, May 19, 2020

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