Category: Morbidity

Northwestern Medicine shares new findings from the Comprehensive COVID-19 Center as significant demand remains for patient appointments

Mary Pat Campbell

Link: https://news.nm.org/northwestern-medicine-shares-new-findings-from-the-comprehensive-covid-19-center-as-significant-demand-remains-for-patient-appointments/

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Long COVID occurs in approximately a third of COVID survivors and is now the third leading neurologic disorder in the United States. In May 2020, during the height of the pandemic, Northwestern Medicine physicians noticed this growing trend and established one of the first Comprehensive COVID-19 Centers in the United States to treat patients suffering from lingering impacts of the virus such as brain fog, shortness of breath and chest pain. Three years later, a new study published in the American Journal of Medicine reports key findings from more than 1,800 patients who were evaluated during the first 21 months at the Northwestern Medicine Comprehensive COVID-19 Center (CCC) with neurology, pulmonology and cardiology being the most commonly accessed specialties and still in high-demand today.  

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The team evaluated 1,802 patients (350 post-hospitalization and 1,452 non-hospitalized) via telehealth or in-person at the CCC between May 2020 and February 2022. Patients were seen in 2,361 initial visits in 12 specialty clinics including neurology, pulmonology, cardiology, otolaryngology, gastroenterology, infectious diseases, endocrinology, nephrology, hematology, dermatology, psychiatry and rheumatology. Patients most commonly sought treatment from neurology (49%), pulmonology (25%) and cardiology (12%) specialists.

Among patients tested:

–        85% of patients reported decreased quality of life

–        51% had cognitive impairment

–        45% had altered lung function

–        83% had abnormal CT chest scans

–        12% had elevated heart rate on rhythm monitoring

–        Frequency of cognitive impairment and pulmonary dysfunction was associated with severity of acute COVID-19

–        Non-hospitalized patients with positive COVID-19 testing had similar findings than those with negative or no test results

DEMOGRAPHICS

–        65% of patients identified as female

–        Average age at first clinic visit was 47 years old

–        72% were White, 10% were Black, 4% were Asian and 13% were Hispanic

Publication Date: 13 Jul 2023

Publication Site: Northwestern Medical

$50 Billion in Opioid Settlement Cash Is on the Way. We’re Tracking How It’s Spent.

Mary Pat Campbell

Link: https://kffhealthnews.org/news/article/opioid-drugmakers-settlement-funds-50-billion-dollars-khn-investigation-payback/

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More than $50 billion in settlement funds is being delivered to thousands of state and local governments from companies accused of flooding their communities with opioid painkillers that have left millions addicted or dead.

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Most of the settlements stipulate that states must spend at least 85% of the money they will receive over the next 15 years on addiction treatment and prevention. But defining those concepts depends on stakeholders’ views — and state politics. To some, it might mean opening more treatment sites. To others, buying police cruisers.

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What’s more, many states are not being transparent about where the funds are going and who will benefit. An investigation by KHN and Christine Minhee, founder of OpioidSettlementTracker.com, concluded only 12 states have committed to detailed public reporting of all their spending.

The analysis involved scouring hundreds of legal documents, laws, and public statements to determine how each state is divvying up its settlement money among state agencies, city and county governments, and councils that oversee dedicated trusts. The next step was to determine the level and detail of public reporting required. The finding: Few states promise to report in ways that are accessible to the average person, and many are silent on the issue of transparency altogether.

More than $3 billion has gone out to state and local governments so far. KHN will be following how that cash — and the billions set to arrive in coming years — is used.

Author(s): Aneri Pattani

Publication Date: 30 March 2023

Publication Site: Kaiser Health News

Batch-dependent safety of the BNT162b2 mRNA COVID-19 vaccine

Mary Pat Campbell

Link: https://onlinelibrary.wiley.com/doi/full/10.1111/eci.13998

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Vaccination has been widely implemented for mitigation of coronavirus disease-2019 (Covid-19), and by 11 November 2022, 701 million doses of the BNT162b2 mRNA vaccine (Pfizer-BioNTech) had been administered and linked with 971,021 reports of suspected adverse effects (SAEs) in the European Union/European Economic Area (EU/EEA).1 Vaccine vials with individual doses are supplied in batches with stringent quality control to ensure batch and dose uniformity.2 Clinical data on individual vaccine batch levels have not been reported and batch-dependent variation in the clinical efficacy and safety of authorized vaccines would appear to be highly unlikely. However, not least in view of the emergency use market authorization and rapid implementation of large-scale vaccination programs, the possibility of batch-dependent variation appears worthy of investigation. We therefore examined rates of SAEs between different BNT162b2 vaccine batches administered in Denmark (population 5.8 million) from 27 December 2020 to 11 January 2022.

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A total of 7,835,280 doses were administered to 3,748,215 persons with the use of 52 different BNT162b2 vaccine batches (2340–814,320 doses per batch) and 43,496 SAEs were registered in 13,635 persons, equaling 3.19 ± 0.03 (mean ± SEM) SAEs per person. In each person, individual SAEs were associated with vaccine doses from 1.531 ± 0.004 batches resulting in a total of 66,587 SAEs distributed between the 52 batches. Batch labels were incompletely registered or missing for 7.11% of SAEs, leaving 61,847 batch-identifiable SAEs for further analysis of which 14,509 (23.5%) were classified as severe SAEs and 579 (0.9%) were SAE-related deaths. Unexpectedly, rates of SAEs per 1000 doses varied considerably between vaccine batches with 2.32 (0.09–3.59) (median [interquartile range]) SAEs per 1000 doses, and significant heterogeneity (p < .0001) was observed in the relationship between numbers of SAEs per 1000 doses and numbers of doses in the individual batches. Three predominant trendlines were discerned, with noticeable lower SAE rates in larger vaccine batches and additional batch-dependent heterogeneity in the distribution of SAE seriousness between the batches representing the three trendlines (Figure 1). Compared to the rates of all SAEs, serious SAEs and SAE-related deaths per 1.000 doses were much less frequent and numbers of these SAEs per 1000 doses displayed considerably greater variability between batches, with lesser separation between the three trendlines (not shown).

Author(s): Max Schmeling, Vibeke Manniche, Peter Riis Hansen

Publication Date: 30 Mar 2023

Publication Site: European Journal of Clinical Investigation

GUN VIOLENCE ARCHIVE

Mary Pat Campbell

Link: https://www.gunviolencearchive.org/

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PUBLISHED DATE: April 20, 2023

Gun violence  and crime incidents are collected/validated from 7,500 sources daily – Incident Reports and their source data are found at the gunviolencearchive.org website.

Footnotes

  1. Number of source verified deaths and injuries
  2. Number of INCIDENTS reported and verified
  3. Calculation based on CDC Suicide Data
  4. Actual total of all non-suicide deaths plus daily calculated suicide deaths

All numbers are subject to change or incidents recategorized as new evidence is established and verified.

METHODOLOGY & DEFINITIONS AVAILABLE AT:
https://www.gunviolencearchive.org/methodology

www.gunviolencearchive.org
www.facebook.com/gunviolencearchive
On Twitter @gundeaths

Publication Date: accessed 20 April 2023

Publication Site: Gun Violence Archive

Obesity in Asia

Mary Pat Campbell

Link: https://www.genre.com/knowledge/publications/2023/april/ri23-1-en

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Figure 2 shows the incidence of cardiovascular disease and stroke in the male population.

This was derived from Gen Re’s Dread Disease experience study covering the period 2012–2015 and 2015–2019 for Hong Kong, Singapore and Malaysia. As per the analysis from the leading insurance companies of the respective market, 43% of men in Singapore, 40% of men in Malaysia and 26% of men in Hong Kong had critical illness claims due to cardiovascular disease and stroke between 2015 and 2019. When compared with the 2012–2015 analysis, it was noted that there is an increase in claims by 3% in Singapore, 10% in Malaysia and 1% points in Hong Kong, which may be associated with overweight and obesity or simply an older portfolio.

Due to increases in body weight and medical complications, insurance companies may be confronted with increasing claims which will impact their profitability. To mitigate this cost, insurance companies may have to increase the premium so as to commensurate with this rising claim cost. This increase in price will impact on the healthy population.

Health insurance premium has doubled in the past 10 years, but it is unclear how much of this premium is sufficient to cover the financial burden of the obesity pandemic. The evaluation of existing and developing new health coverages related to obesity-related conditions is an important consideration for the profitability of the health insurance providers.14

Author(s): Bharath UP

Publication Date: 12 April 2023

Publication Site: Gen Re

Covid National Emergency Ends

Mary Pat Campbell

Link: https://kelleyk.substack.com/p/covid-national-emergency-ends

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Biden signed H.J.Res. 7, which ended the national emergency for Covid. Both the text of the bill, and the corresponding press release from the White House are short and sweet. The White House recently said Biden “strongly opposes HJ Res 7,” but that he would sign the bill if it passed. It passed with bipartisan support in both the House.

One thing that is tied to the national emergency is an extension of COBRA deadlines for people who are out of work. These deadlines are extended during the “outbreak period” which ends 60 days after the end of the national emergency.

The DHS rules for vaccine mandates for foreign travelers at land border crossings from Canada and Mexico rely on the national emergency as their legal basis, so theoretically they will end with the national emergency. But there has been no official actions to lift those rules, and I suspect the White House expects this vaccine mandate to continue for at least another month. (See section on travel vaccine mandates further down for more details.)

Author(s): Kelly K

Publication Date: 11 April 2023

Publication Site: Check Your Work

I Gave Myself Severe Diarrhea for Science. Don’t Tax Me for It.

Mary Pat Campbell

Link: https://reason.com/2023/04/05/i-gave-myself-severe-diarrhea-for-science-dont-tax-me-for-it/

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I drank the bespoke pathogenic cocktail as part of what’s known as a “human challenge study” run by the Center for Vaccine Development at the University of Maryland, Baltimore. In a human challenge study, adult volunteers are exposed to a pathogen. The study I was involved in was intended to test an experimental vaccine. The process may sound somewhat medieval, but these studies are critical scientific tools that prioritize participant safety. From 1980 to 2021, over 15,000 volunteers have been exposed to one of dozens of diseases in such studies, and not one has died. 

Dysentery can be fatal. While Shigella is treatable with antibiotics, resistance is evolving at a worrying pace, and tens of thousands of children still succumb to it every year in the developing world. Those it does not kill are often left with stunted growth.

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For my assistance in the development of a potentially lifesaving vaccine, I was paid $7,350. My motivations were altruistic to a degree: I wanted to pay my privilege forward. As I told Business Insider, however, I am not a complete saint and would not have done it for free.

As far as the Internal Revenue Service (IRS) is concerned, the compensation for my bout of dysentery has zero charitable component; it’s just regular old income, indistinguishable from, say, freelance writing or mowing lawns. If, God forbid, I am ever audited, I hope the IRS agent believes me when I say that’s just my diarrhea money.

I maintain, though, that I should not be taxed on that $7,350 at all: Treating clinical trial compensation as taxable income is just bad policy. 

Author(s): JAke Eberts

Publication Date: 5 April 2023

Publication Site: Reason

Flesh-rotting drug ‘Tranq’ linked to dozens of NY deaths: Schumer

Mary Pat Campbell

Link: https://nypost.com/2023/03/26/new-york-seeing-tranq-drug-related-deaths-schumer/

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Tranq – the deadly “zombie” drug formally known as xylazine – is circulating across New York and has been tied to dozens of deaths in the state, Senate Majority Leader Chuck Schumer warned Sunday.

Use of the flesh-rotting substance is “spreading” in Syracuse, Albany, Rochester and the Greater New York City area, Schumer said, as he called on increased federal funding for the state to help fight the disturbing trend.

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Tranq, a veterinary drug, is Narcan-resistant, meaning its effects cannot be reversed in the event of an overdose.

It is said to cause skin and bone to deteriorate or rot over time. 

The US Drug Enforcement Administration recently issued a public safety alert, announcing that the agency had seized mixtures of xylazine and fentanyl in 48 of the 50 states. 

Author(s):Haley Brown and Stephanie Pagones

Publication Date: 26 Mar 2023

Publication Site: NY Post

ChatGPT: A conversation about underwriting and life insurance

Mary Pat Campbell

Link: https://www.dig-in.com/opinion/chatgpt-a-conversation-about-underwriting-life-insurance

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RGA decided to put ChatGPT to the test by posing three questions related to underwriting and the future of life insurance. The answers from ChatGPT that follow are entirely AI-generated. Following those responses is a brief FAQ that further explores this emerging topic.

How will COVID-19 affect U.S. long-term mortality?

It is difficult to predict the long-term effects of COVID-19 on mortality in the United States. The pandemic has already had a significant impact on mortality, with over 1.1 million COVID-attributed deaths reported in the country. However, it is possible that the mortality rate from COVID-19 could decline over time as more people become immune to the virus and as effective vaccines are developed and distributed.

There are also other factors that could affect the long-term mortality rate from COVID-19. For example, the effectiveness of public health measures, such as mask-wearing and social distancing, in controlling the spread of the virus could have a significant impact on the number of deaths. In addition, the availability of effective treatments for COVID-19 could also play a role in reducing the mortality rate from the virus.

It is important to continue monitoring the situation and taking steps to control the spread of the virus to minimize the impact on mortality.

Author(s): ChatGPT, Jeff Heaton, Dave Rengachary

Publication Date: 14 Feb 2023

Publication Site: Digital Insurance

Association of Cardiovascular Health With Life Expectancy Free of Cardiovascular Disease, Diabetes, Cancer, and Dementia in UK Adults

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2801750?guestAccessKey=9c49772f-a1bb-4a29-9a46-445f585b3781&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamainternalmedicine&utm_content=olf&utm_term=022723

Cite: JAMA Intern Med. Published online February 27, 2023. doi:10.1001/jamainternmed.2023.0015

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Question  What is the association of cardiovascular health (CVH) levels, estimated by the American Heart Association’s Life’s Essential 8 score, with life expectancy free of major chronic diseases?

Findings  In this cohort study of 135 199 adults from the UK Biobank study, high CVH level was associated with substantially longer life expectancy free of 4 major chronic diseases (cardiovascular disease, diabetes, cancer, and dementia) in both men and women. Furthermore, the disease-free life expectancy was similar between low and other socioeconomic groups among participants with high CVH.

Meaning  These findings support improvement in population health by promoting a high CVH level, which may also narrow health disparities associated with socioeconomic status.

Author(s): Xuan Wang, MD, PhD1; Hao Ma, MD, PhD1; Xiang Li, MD, PhD1; et al

Publication Date: 27 Feb 2023

Publication Site: JAMA Internal Medicine

One-Year Adverse Outcomes Among US Adults With Post–COVID-19 Condition vs Those Without COVID-19 in a Large Commercial Insurance Database

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jama-health-forum/fullarticle/2802095

JAMA Health Forum. 2023;4(3):e230010. doi:10.1001/jamahealthforum.2023.0010

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Key Points

Question  Do postacute sequelae of SARS-CoV-2 increase risks of 1-year adverse outcomes?

Findings  In this case-control study of 13 435 US adults with post–COVID-19 condition (PCC) and 26 870 matched adults without COVID-19, the adults with PCC experienced increased risks for a number of cardiovascular outcomes, such as ischemic stroke. During the 12-month follow-up period, 2.8% of the individuals with PCC vs 1.2% of the individuals without COVID-19 died, implying an excess death rate of 16.4 per 1000 individuals.

Meaning  Individuals with PCC may be at increased risk for adverse outcomes in the year following initial infection.

Author(s): Andrea DeVries, PhD1; Sonali Shambhu, BDS, MPH1; Sue Sloop, PhD1; et al

Publication Date:

Publication Site: JAMA Health Forum

Long COVID Correlates With High Mortality: Health Insurer

Mary Pat Campbell

Link: https://www.thinkadvisor.com/2023/03/03/long-covid-correlates-with-high-mortality-health-insurer/

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A giant health insurer says health plan enrollees who suffered from long COVID-19 symptoms were more than twice as likely as other enrollees to die during a 12-month follow-up period.

Andrea DeVries, a researcher at Elevance Health, and three colleagues found that, during the year studied, 2.8% of the 13,435 enrollees classified as having “post-COVID-19 condition” died, according to a study published in the JAMA Health Forum, which is affiliated with the Journal of the American Medical Association.

That compares with a death rate of just 1.2% for similar enrollees without COVID-19 during the same period.

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Elevance Health is the company formerly known as Anthem. The company provides or administers major medical coverage for about 48 million people.

The DeVries looked at claim records for 249,013 Elevance plan enrollees ages and older who were diagnosed with COVID-19 from April 1, 2020, through July 31, 2020 — before regulators had adopted a long COVID diagnosis code.

The team began by identifying enrollees with COVID-19 who had been enrolled in an Elevance plan for at least five months before being diagnosed with COVID-19 and who had survived for at least two months after the diagnosis date.

Because of the lack of a long COVID-19 diagnosis code, the team used claims for other conditions, such as loss of the sense of smell, brain fog, anxiety and heart rate problems, to come up with a list of enrollees with long COVID.

Author(s): Allison Bell

Publication Date: 3 March 2023

Publication Site: Think Advisor