DCMedical News: Friday, October 22, 2021
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
THE BIG STORY Friday, October 22, 2021
Randomized Controlled Trial Shows Pfizer-BioNTech Booster Shot 95%+ effective
Today’s Financial Times (here) reports the results of the first randomized controlled trial of vaccination booster shots against the COVID-19 virus. The report says, “A booster shot of the BioNTech/Pfizer vaccine is 95.6 per cent effective against COVID-19 compared with a placebo, the companies said yesterday, citing preliminary results from the first randomized, controlled trial on boosters.” The trial included 10,000 participants, all of whom had completed the two-shot Pfizer regiment. Half were randomized to receive a further equal-strength dose of the shot, half a placebo; five cases of COVID-19 took place in patients receiving the booster, 109 with trial participants who took the placebo. Results were consistent across differences in age, gender, race, ethnicity and underlying health conditions among the participants.
CDC Follows FDA In Approval of COVID-19 Vaccine Booster Shots
CQ reports (here) that “Centers for Disease Control and Prevention vaccine advisers unanimously voted, 15-0, to recommend COVID-19 booster doses for all individuals who received the Johnson & Johnson vaccine, and half of a dose for some individuals who received the Moderna vaccine.”
The CDC last month recommended booster shots for Pfizer vaccine recipients. “Advisers recommended the half-dose [50 micrograms] of the Moderna COVID-19 vaccine six months after the second dose for adults ages 65 and up and adults 18 to 64 years old who are at high risk because of underlying medical conditions or their work environments. The advisers also recommended a COVID-19 booster of the Johnson & Johnson vaccine two months after receiving the initial Johnson & Johnson vaccine.”
The report noted that “An estimated total of 99.1 million Americans will qualify for a COVID-19 booster, including more than 39 million eligible Moderna recipients and 13 million Johnson & Johnson recipients.”
Antibody Testing for Immunity, Vaccine Passports? Not a Good Idea
A review in JAMA Network (here) reports that “Early in the COVID-19 pandemic, developers designed SARS-CoV-2 antibody tests to detect whether people had been infected. Some experts thought the blood tests eventually would help to ease lockdowns. One idea was that those with antibodies likely would be immune to reinfection at least temporarily, allowing them to reenter society without putting themselves or others at risk.”
But, says the report, “The concept of an immunity passport based on having antibodies didn’t pan out. The early consumer tests’ accuracy was unproven, making the results somewhat dubious. More fundamentally, the so-called correlates of protection were unknown. Which specific antibodies guarded against SARS-CoV-2 reinfection? How high did their levels need to be? And how long would they provide a reliable defense?”
Now, “the arrival of COVID-19 vaccines revived [their] interest in serology. Could a simple blood test reveal whether the vaccine was working or, later, if it was time for a booster shot?” The FDA (May communication here) “discouraged antibody testing as a do-it-yourself immunity check in a communication to the public and clinicians this past spring.”
However, according to the JAMA report, “A recent New York Times article (here) described concierge clinicians who regularly test their clients for SARS-CoV-2 antibodies. And Florida-based Epitome Risk Solutions promises that the direct-to-consumer SARS-CoV-2 serology assay it sells for $170 ‘correctly identifies the number of neutralizing antibodies you have with 100% specificity’ so that in ‘24-48 hours you’ll know if your immune system is still protecting you from COVID’ after vaccination or infection.”
WHO Reports on Deaths and Vaccination Rates Among Health Workers
The World Health Organization reported (STAT, here) Thursday that “115,000 health care workers died from Covid-19 from January 2020 to May of this year, according to a new World Health Organization estimate, as the agency pushed once again for efforts to address vaccine inequity. Globally, 2 in 5 health care workers are fully vaccinated . . . In most high-income countries, more than 80% of health care workers are fully vaccinated, Tedros said. But in Africa, the rate is less than 1 in 10.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Cost Effectiveness of Lung Cancer Screening
A study in JAMA Oncology (here) examines the US Preventive Services Task Force (USPSTF) 2021 recommendation on lung cancer screening, “which lowered the starting age for screening from 55 to 50 years and the minimum cumulative smoking exposure from 30 to 20 pack-years . . . Although costs are expected to increase because of the expanded screening eligibility criteria, it is unknown whether the new guidelines for lung cancer screening are cost-effective.” The modeling study found the criteria cost-effective, but suggested that “expanding screening eligibility to include former smokers who have not smoked for more than 15 years might further improve the cost-effectiveness of the screening program.”
Financial Toxicity in Cancer Care Merits Coordinated Policy Approach
Also in JAMA Oncology, a “Viewpoint” (here) from researchers at the University of Colorado, American Cancer Society and MD Anderson contends that “Financial toxicity associated with cancer care is well known. The efforts of health care professionals are poorly supported and have limited effectiveness without wrap-around policies that address access to care, exorbitant health care costs, high out-of-pocket costs, the absence of paid medical leave, and other important gaps in our social safety net. We expect such policies to result in fewer medical bankruptcies and fewer people forgoing care altogether or continuing to work while jeopardizing their health.”
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Nimbly Meeting Changing Needs
Modern Healthcare (here) reports that “Amita Health, the largest health system in the Chicago area, is splitting up . . the organization was formed in 2015 as a joint venture of national chains Ascension and AdventHealth. Now the organizations are divvying up the chain’s 19 hospitals.” A statement from Amita said “Leaders of both sponsoring organizations have determined that going forward separately is in their collective best interest in order to more nimbly meet the changing needs and expectations of consumers in the rapidly evolving healthcare environment.”
Tenet Turns to Profit, Attributes Improvement to Acuity of Surgical Cases
For its third quarter, Tenet (earnings call transcript from Seeking Alpha here, Tenet slide presentation here, Modern Healthcare report here) reported $450 million in net income, compared to a loss of $200 million in the same period a year before. The company logged a 10% increase in net revenue per case which it attributed to higher per case acuity. The company sold five hospitals in the Miami area to Steward in the quarter, and now plans to buy ownership and management interests in nine ambulatory surgery centers from Compass Surgical Partners with 125 surgeons who perform “lots” of spine surgeries and total joints. Tenet reported that its ambulatory surgery segment, called United Surgical Partners, has added 1,700 new physicians year-to-date.
READINGS AND REFERENCES
Testimony by Sara Collins of The Commonwealth Fund before the Senate Finance Committee (here), “The Current Status of Employer Health Insurance Coverage in the United States.”
Select Coronavirus Public Health Resources and References may be found here.
2021 CQ Congressional Calendar here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
October 25, 26, 27, 28
November 1, 2, 3, 4, 5, 15, 16, 17, 18, 30
December 1, 2, 3, 6, 7, 8, 9, 10
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org