Louis-Armstrong

The Health 202: Coronavirus survival rates in the United States haven’t improved since the summer

“It’s been rock solid stable since July, around 1.7 percent,” said David Dowdy, an associate professor at the Johns Hopkins Bloomberg School of Public Health. “If anything, I think there is a concern it will go up again because we’re seeing hospitals reaching their capacity.”

Treatments have improved survival rates incrementally.

There’s no doubt health providers have discovered best practices for treating seriously ill covid-19 patients since the onset of the pandemic, along with some new therapeutics. In the past two weeks the Food and Drug Administration has given emergency approval to two monoclonal antibody treatments, one from Eli Lilly and another from Regeneron Pharmaceuticals. 

The treatments are designed to prevent infected people from developing severe illness by imitating the body’s natural defenses. They’re given to non-hospitalized patients, typically those who are at increased risk for severe illness due to either age or an underlying condition. President Trump received monoclonal antibodies when he was treated for the coronavirus in October.

“Monoclonal antibodies, which are concocted in laboratories, are proteins that mimic the immune system’s ability to attack the virus,” The Washington Post’s Laurie McGinley and Carolyn Y. Johnson explain. “In a clinical trial, the Regeneron drug reduced hospitalizations or emergency room visits when given to people at high risk of developing severe disease. It was also shown to reduce the amount of virus in people’s bodies.”

In a call with reporters yesterday, top Trump administration officials said they’ll be shipping out enough of Regeneron’s antibodies treatment for 30,000 patients — and plan to ship out enough for another 50,000 patients next week.

“If you have tested positive for covid-19 and are at high risk for severe disease, we may have treatment options that can help you,” Health and Human Services Secretary Alex Azar said.

But the impact of better treatments is marginal.

The U.S. case fatality rate — which is the number of people who die out of everyone diagnosed — was around 5 to 6 percent in the springtime. That’s partly because fewer people were being tested, so fewer cases overall were being detected. But health providers were also figuring out for the first time how to treat covid-19 patients in severe respiratory distress.

Over the summer, as testing expanded and hospitals tried different drugs and procedures on patients, the case fatality rate in the United States declined to between 1.5 and 2 percent. And that’s where it has remained over the past three months or so.

Trevor Bedform, a genomic epidemiologist at the Fred Hutchsinson Cancer Research Center, found there have been no improvements in the death rates since August. Since then, the death rate among those diagnosed with covid-19 has averaged 1.8 percent, he told The Atlantic.

“This rate is a major improvement, down more than tenfold from the earliest days of the pandemic, when deaths were high and the extreme limits on coronavirus testing held down the number of diagnosed cases,” The Atlantic’s Alexis C. Madrigal and Whet Moser write. “But in this new phase of the pandemic, when testing is more widely available and a much higher proportion of cases are diagnosed to begin with, it is also terrible, terrible news.”

The antibody treatments from Eli Lilly and Regeneron are the most promising treatments so far.

But they’re in short supply and difficult to administer, so they’re not going to be a magic bullet for saving the nation from a massive death toll this winter.

“They’re very expensive and difficult to ramp up and produce at scale,” Dowdy said. “Do I really think these will move the needle on case fatality on a national level? Probably not.”

Ahh, oof and ouch

AHH: The Trump administration has agreed to start the transition process, clearing the way for coordination on a pandemic response. 

The General Services Administration ascertained on Monday that President-elect Joe Biden is the “apparent winner” of the Nov. 3 presidential election, triggering the start of a transition process that had been delayed by Trump’s refusal to concede the election. The decision by Administrator Emily Murphy comes amid growing pressure from business leaders, national security experts and some Republican lawmakers for the administration to coordinate with Biden’s team amid a global pandemic.

Trump tweeted on Monday that while his challenge to the election results continues, he will cooperate with the transition process.

The delayed transition process has prevented the Biden team from consulting with federal health officials, including the head of the federal government’s vaccine program. The Biden team has also been unable to access real-time data on availability of hospital beds or the status of the Strategic National Stockpile.

Biden sounded the alarm about the impact of the transition delay in Wilmington, Del., last week, warning that it could impact the government’s plan to distribute a coronavirus vaccine. “More people may die if we don’t coordinate,” Biden said.

OOF: Biden plans to restore coronavirus briefings and bring sidelined CDC career officials back into the spotlight.

Biden advisers say plans include bringing sidelined officials from the Centers for Disease Control and Prevention, including Nancy Messonnier, the CDC’s respiratory disease chief, and Anne Schuchat, the CDC’s principal deputy director, back into the spotlight. Both scientists ran afoul of the Trump administration when their dire warnings conflicted with the president’s efforts to downplay the virus in the early months of the pandemic. Multiple people close the transition told Politico that the reemergence of Messonnier and Schuchat would also boost morale within the health agency.

“When he takes office in January, Biden will confront a nation deeply skeptical of both public health interventions and federal agencies like the CDC and Food and Drug Administration that have spent the majority of the pandemic grappling with intense political pressure,” Alice and Adam report.

The Biden team seems determined to avoid the type of conflicting messages on the virus that have come out of the Trump administration. Biden’s team has also elevated prominent public health officials and experienced public communicators to key roles in the coronavirus transition task force.

OUCH: Thoughts of suicide have spiked among young adults during the pandemic.

“Since the coronavirus arrived, depression and anxiety in America have become rampant. Federal surveys show 40 percent of Americans are now grappling with at least one mental health or drug-related problem. But young adults have been hit harder than any other age group, with 75 percent struggling,” The Post’s William Wan reports. 

One in 4 young adults thought about killing themselves in the past 30 days, according to a CDC survey conducted this summer. While experts won’t have national data on suicides for at least two years, coroners and medical examiners in some counties have noted dramatic increases in suicides. Meanwhile, other countries, which do a better job tracking deaths by suicide in real-time, have already reported sharp upticks in suicides in recent months amid the pandemic.

The United States has already seen suicides rise 35 percent over the past two decades, even as they declined globally. The situation has been even worse for young adults and teens, with suicide rates in this group increasing by 56 percent between 2007 and 2018. Easier access to guns and record sales of firearms this year could fuel even more deaths. 

But politicians have done little to confront suicides amid the pandemic. Of $175 billion in emergency funding allocated to medical facilities during the pandemic, less than 1 percent has gone to mental health or substance abuse services. Meanwhile, crisis centers are facing severe cuts as the pandemic devastates state and local budgets, Wan reports.

The transition

Former U.S. drug czars are calling for a Cabinet-level position on drug policy.

Former directors of the Office of National Drug Control Policy, Barry McCaffrey, who served in the Clinton administration, and Bill Bennett, who held the position under George H. W. Bush, joined health care providers and anti-drug advocates in a letter calling Biden to restore the head of the ONDCP to a cabinet-level position. 

The Obama administration in 2009 elected to make the position a presidential appointment in the Executive Office rather than a Cabinet-level position, but, as the letter writers points out, Biden has previously advocated that the drug czar be on “equal footing” with other members of the cabinet.

Covid-19 will dominate the agenda of Biden’s foreign policy team.

Biden has said he intends to restore American leadership in the global response to the coronavirus pandemic, vowing to rescind Trump’s withdrawal from the World Health Organization on day one. On Monday, Biden named the likely appointees who will guide this effort, including Antony Blinken for secretary of state and Jake Sullivan as national security adviser. Both served in top foreign policy positions under the Obama administration and signal a return to global cooperation. 

Blinken, who has served as a key adviser to Biden on foreign policy issues, told the Wall Street Journal earlier this month he expected the pandemic to dominate administration’s early foreign policy efforts. Sullivan, for his part, advised Biden on domestic policies to confront the coronavirus pandemic during the campaign, playing a lead role in drafting Biden’s “Build Back Better” economic recovery plan.

Top among the issues confronting the president-elect’s foreign policy would-be team, which also includes veteran diplomat Linda Thomas-Greenfield as U.N. ambassador, will be defining the U.S. role in global vaccine distribution. The European Union, Canada, Japan and China have all joined Covax, an international agreement aimed at pooling resources to ensure equitable distribution of vaccines. Biden, however, has said little about how his administration will balance the imperative to ensure vaccines for Americans against the need for vaccines in developing countries.

Biden will also nominate Alejandro Mayorkas to serve as the secretary for the Department of Homeland Security. Mayorkas, who was the director of U.S. Citizenship and Immigration Services under Obama, has touted his experience leading the department’s response to Ebola and Zika outbreaks. He could also play a role in unraveling some of the more than 400 immigration policy changes put in place by the Trump administration, including a public charge rule that penalizes legal immigrants for using Medicaid and other public benefits.

More on the coronavirus

  • A negative coronavirus test before the holidays is not an all-clear. Testing is less accurate before symptoms begin, with one study from researchers at Johns Hopkins estimating a false negative rate near 100 percent on the first day someone is exposed to the coronavirus, with that rate dropping to 67 percent on the fourth day from exposure, Vox’s Brian Resnick reports.
     
  • Bodies of around 650 people who died in the spring covid-19 surge in New York are still in freezer trucks, which the city set up to cope with remains as hospital morgues ran out of room. “Many of the bodies are of people whose families can’t be located or can’t afford a proper burial, according to the city’s Office of Chief Medical Examiner,” the Wall Street Journal’s Paul Berger reports.
     
  • While it’s hard to compare varying study designs directly, AstraZeneca’s vaccine may offer slightly lower protection than vaccines from Pfizer and Moderna. But it’s also likely to be cheaper and easier to transport than competitors, making it a compelling option for much of the world. AstraZeneca’s vaccine candidate was 70 percent effective on average and 90 percent effective in a smaller study group that received a lower dose, The Post’s William Booth and Carolyn Y. Johnson report. The company has said it will begin submitting data to clinical regulators around the world, including the FDA.
     
  • New York Gov. Andrew Cuomo (D) faced a backlash after saying he planned to host a Thanksgiving dinner with his 89-year-old mother and two daughters. Cuomo, who later backtracked on his holiday plans, has urged New Yorkers to reconsider plans to gather for the holidays, the New York Times’s Jesse McKinley and Luis Ferré-Sadurní report.

Sugar rush

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