Morning Rounds Shraddha Chakradhar

Good morning! Elizabeth Cooney here subbing for Shraddha today. Some news to start your Friday:

Asymptomatic spread of Covid-19 looking even more likely

From the dawn of the coronavirus pandemic, scientists have worried that people who have no symptoms of Covid-19 could pass the disease on to others. Evidence so far has been largely anecdotal, but a new study conducted in South Korea offers more definitive proof that people without symptoms carry just as much virus in their nose, throat, and lungs as those with symptoms, and for almost as long. “It does confirm what we’ve suspected for a long time — that asymptomatic cases can transmit infection,” epidemiologist Benjamin Cowling told the New York Times.
In other pandemic news:

  • Nursing homes face an impossible decision during hurricane season this year: Should they evacuate their residents during the Covid-19 pandemic, risking the health and well-being of their patients and staff in the process? STAT's Natalya Ortolano reports.
  • As pressure mounts to develop a successful Covid-19 vaccine, FDA Commissioner Stephen Hahn insists any agency approval would “adhere to standards” that ensure safety and effectiveness, STAT's Ed Silverman writes. But Hahn left the door open to an emergency use authorization, raising concerns about political pressure to approve a vaccine before the November election.
  • After pressure from advocates in recent weeks, Moderna will now allow individuals living with HIV to be part of a late-stage clinical trial of its Covid-19 vaccine candidate, Bloomberg says. The biotech company had previously said it would exclude people with HIV from the trial. HIV advocates are pressuring vaccine partners Pfizer and BioNTech to do the same.

Trump’s ‘Buy American’ could shake up the drug industry. But its impact is unclear

President Trump signed a “Buy American” executive order yesterday, directing the federal government to buy certain drugs and medical devices solely from American manufacturers. The order could represent a seismic shakeup for the drug industry, STAT's Nicholas Florko reports, but the future is foggy. No one knows how much of the American drug supply chain is produced abroad. The executive order does not specify what drugs it covers; that job falls to the FDA to decide. And certain drugs and devices can be carved out from the executive order if buying the product in America would raise costs by more than 25%. “Taxpayers and patients will pay more for drugs and medical supplies,” economists warned the White House earlier this year on its “Buy American” plan.

Making — and explaining — cancer care choices during a pandemic

Cancer care, like so much of medicine during the coronavirus pandemic, is facing new challenges. Three new papers offer prioritization strategies, how to discuss them with patients, and what happened before the pandemic when some treatment was put on hold.

  • Lessons learned in Rwanda and Tanzania could guide priority setting in the U.S. “For many, it is the first time that external circumstances demand that they ask, 'Is this [visit, procedure, intravenous drug administration, scan, laboratory test] truly essential? If so, can it wait, and for how long? How is essential defined in this new reality?'” the authors write.
  • How should a doctor answer a patient who asks, “Is it not important to treat cancer as soon as it is discovered?” This perspective calls for recognizing fear and showing context, consideration, caring, and commitment. Translation: “Cancer is scary and it is natural to feel like you need to do something right away. For some cancers, it can be OK to wait a little while to start treatment.”
  • When hospitals are overwhelmed with Covid-19 patients, surgical delays become common. A study analyzing pre-pandemic delays in treatment found that for patients diagnosed with the early-stage breast cancer known as ductal carcinoma in situ (they waited) or early-stage estrogen receptor-positive breast cancer (they took a hormone therapy), there was no impact on overall survival. 

Inside STAT: Headspace is a huge hit. But where’s the science behind it?

(Maria Fabrizio for STAT)

2020 has, by all accounts, been a banner year for Headspace. Demand for the mindfulness and meditation app has skyrocketed since the Covid-19 pandemic and its ripple effects began taking a toll on mental health. Downloads have jumped dramatically in recent months, and the company now boasts as many as 60 million users. Headspace has also been flooded with requests from companies looking to buoy their work-from-home staffs’ wellbeing. But as Covid-19 catapults Headspace into a new stratosphere of popularity, experts say its scientific grounding is shakier than its subscription numbers might suggest. “I think we've seen a lot of exciting pilot studies,” said John Torous, director of digital psychiatry at Beth Israel Deaconess Medical Center. “But I don't think we've seen rigorous, high quality, reproducible research.” STAT’s Juliet Isselbacher has more.

Prescribing antibiotics when they aren’t needed is still a problem

Most doctors think inappropriate antibiotic prescribing and the superbug resistance it causes are serious national problems, but not as many of them think their own practices contribute to it, according to a survey from Pew and the AMA that found 60% of respondents believe they prescribe antibiotics more appropriately than their peers. A majority of internal medicine doctors also ranked obesity, diabetes, smoking, and opioid misuse higher than antibiotic resistance as far as impact on patients and daily practice while pediatricians put it third, behind obesity and vaccine hesitancy. Almost three-quarters say stewardship programs are necessary to reduce antibiotic resistance, but almost half said they would need “a lot of help” to implement stewardship interventions in their own practice.

Wrist fractures may do just as well with a cast as with surgery

It’s enough to make you wince just to think about bending your wrist back so far that it breaks. It’s an injury common in young, active people after a fall or a push; some get surgery and some heal in a plaster cast. A British study has found that putting the wrist in a cast was as good as surgery at healing fractures of the scaphoid bone; surgery was offered at six weeks to those in casts if healing was not progressing. Among 439 patients seen in 31 hospitals over three years who were randomly assigned to surgery or a cast (including 17 who switched from cast to surgery), evaluations were similar a year later when they were asked about pain and missing days of work.

What to read around the web today

  • Scientists may be using the wrong cells to study Covid-19. Wired
  • US kids, parents perform DIY tests for coronavirus science. AP
  • Life and debt at a private equity hospital. Bloomberg
  • Mexico state bans the sale of sugary drinks and junk food to children. The Guardian
  • NSF grant changes raise alarm about commitment to basic research. Nature

Thanks for reading! More on Monday,

Have a news tip or comment?

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Friday, August 7, 2020


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