Omicron Variant BA.2.12.1 Spreading Quickly Across US; Related Cases Up Nearly 100% In Past 2 Weeks

 In February, the first few cases of two new, more infectious variants were identified in the Northeastern United States. Dubbed BA.2.12.1 and BA.2.12.2, these sublineages of the BA.2 variant made up only 1.5% of newly-sequenced positive tests before March 19.

But, warned New York State Public Health officials, the new variants are thought to have a 23%–27% growth advantage over BA.2, which itself had an estimated 30% growth advantage over the original Omicron. About 6 weeks later, the numbers support that theory.

For the week ending April 16, BA.2.12.1, which seems to be the more dominant of the two, made up 19% of all newly-sequenced positive Covid tests in the country. Centers For Disease Control data released today show that BA.2.12.1, now makes up 36.5% of all newly-sequenced positive Covid tests. That’s a jump of close to 100% in the past two weeks.

CDC

The share of cases related to BA.2.12.1 is even higher in some parts of the U.S.

In the Northeast region defined by New York, New Jersey and Connecticut, where the variant first took hold, it now accounts for 61% of all new cases. Nearby, in the region made up of Delaware, D.C., Maryland, Pennsylvania, Virginia and West Virginia, the share is 40%.

In the Southwest, which seems to be about 2-3 weeks behind the Northeast in the spread of many recent variants, numbers are much lower. CDC figures indicate that in California, Nevada and Arizona, BA.2.12.1 now accounts for 20% of new cases. Across Arkansas, Louisiana, New Mexico, Oklahoma and Texas it is 13.9%. The region defined by Alaska, Oregon, Washington and Idaho has identified the variant in only 12% of its most recent cases.

The share of BA.2.12.1 regionally the U.S. (in red) vs. BA.2 (in pink).CDC

See the map to the left for a graphical representation of the share of BA.2.12.1 vs. BA.2, which became dominant across the country only four weeks ago.

And the freight train hasn’t stopped with BA.2.12.1. Just last week, the first cases of two even newer variants, also thought to be more infectious than BA.2, were discovered in the U.S.

As the variants have spread, cases and hospitalizations have begun to rise, as well. The 7-day average number of cases in the country has risen from about 25,000 in late March to more than 56,000 today, a 100+% rise. The 7-day average number of patients hospitalized with Covid in the U.S., which generally trails a rise in cases by about two weeks, has risen from a recent low of about 25,000 on April 4 to over 56,000 cases in late April, also a more than 100% rise, despite the standard lag of two weeks between a rise in cases and hospitalizations.

https://deadline.com/2022/05/covid-omicron-variant-ba-2-12-1-spreading-quickly-united-states-1235015293/

Carnival Cruise Ship passengers say COVID overwhelmed ship

 Passengers on a Carnival Cruise Ship that docked Tuesday in Seattle say more than 100 people aboard the ship tested positive for COVID-19 and the ship was overwhelmed.

Multiple people say they’re in quarantine at Seattle-area hotels after testing positive or being exposed to someone with COVID-19. Carnival Cruise Line would not confirm how many people tested positive, but said there were a number of positive cases, KING5 reported.

Darren Sieferston, a passenger on the cruise from Miami to Seattle, is in quarantine after testing positive. He said the crew’s response was chaotic.

“They didn’t have enough staff to handle the emergency that was happening, period,” said Sieferston. “They were overwhelmed and they didn’t have a backup course in how to handle about 200 people affected with COVID. We all suffered.”

Passengers tell KING 5 they waited hours for meals, weren’t properly isolated and couldn’t get ahold of medical staff.

“We couldn’t call anybody...Basically, we sat in the room, you call and it would ring, ring, ring and ring all day long” said Sieferston.

Carnival said there were no serious health issues. The company’s website says guest are required to be fully vaccinated and tested before a trip. Some exemptions are accommodated with proper testing.

https://apnews.com/article/covid-health-seattle-9fc10d7f393fc4581a8fe256a2f527cd

Medicare For All would mean worse care for all

 Senate Budget Committee Chairman Bernie Sanders (I-Vt.) has announced that as early as next week, his committee will hold a hearing “on the need to pass a Medicare for All single-payer program.”  

Sanders gets an “A” for passion, but an “F” in compassion.  

The non-partisan Congressional Budget Office has cautioned that Sanders’ Medicare for All bill would create “a shortage of providers, longer wait times, and changes in the quality of care.” 

Indeed, the non-partisan Medicare Payment Advisory Commission has warned since at least 2003 that Medicare’s approach to health care quality “is largely neutral or negative.” Enrolling 330 million people in the program would only make the problem worse.  

Thankfully, there is a (potentially bipartisan) way to reverse Medicare’s negative impact on quality: Apply “public option” principles not to the private health insurance market but to Medicare, where this traditionally Democratic idea would dramatically increase choice and competition. 

Since 1965, Medicare has paid providers more for low-quality care than for high-quality care. For example, in 1995, Utah’s Intermountain Health Care reduced mortality by improving how it treated pneumonia. Medicare rewarded those quality improvements by paying Intermountain less.  

In 1999, Duke University developed a better way to treat congestive heart failure. Medication adherence increased. Hospitalizations fell. Resource use fell by half. Again, Medicare (and private insurers with similar payment rules) responded by reducing payments. Duke eventually had to shutter the program for lack of funds.

In 2002, Whatcom County, Washington improved glucose management for diabetics and stabilized congestive heart failure patients, saving $3,000 per patient. The county ended up shuttering the program for the same reason Duke did. 

Need more evidence?  

In 2009, Medicare reduced payments to Texas’ Baylor Medical Center after the system cut heart-failure readmissions in half with no increase in mortality. Hospitals can nearly double net revenues if a Medicare patient develops post-operative complications. Medicare pays hospitals nearly $3,000 more per patient when low-quality care leads to more post-acute care and readmissions. Medicare paid a large urban hospital system more when it allowed urinary-tract or bloodstream infections than when it prevented them. 

It doesn’t have to be this way.  

In the mid-1990s, Group Health Cooperative of Puget Sound improved diabetes care with an “average cost savings [] of $685-$950 per patient per year.” Group Health’s different payment rules—which markets developed a century before Congress enacted Medicare—allowed it to profit from those quality improvements.

What Sen. Sanders doesn’t get is that medicine is so complex, no single payment system can promote all aspects of health care quality. Locking in any single set of payment rules—as a single-payer system by definition must—will always reward low-quality care and penalize progress.  

Competition drives providers to improve all dimensions of quality—even those their own payment rules discourage. Improving care across the board requires letting all varieties of payment rules compete on a level playing field. 

Public-option principles demand exactly that: a level playing field where consumers are the ultimate arbiters of quality and efficiency. Public-option supporters want a new government program to be one of the competitors.

But there’s no need for a new program. Traditional Medicare is a government-run plan that already competes against private insurers. Economist Mark Pauly explains that Medicare “is essentially a risk-adjusted voucher program” that lets enrollees choose between a public option and private Medicare Advantage plans.

That playing field, however, is anything but level. Congress bars certain plans, encourages excessive coverage, and penalizes high-quality coverage. It further violates public-option principles by offering larger subsidies to healthy enrollees if they choose Medicare Advantage, and to sicker enrollees if they choose traditional Medicare.  

Public-option principles demand eliminating all such distortions. Most important, they require that each enrollee’s subsidy neither rise nor fall depending on which health plan, or how much coverage, he or she chooses. Only one type of subsidy can do that: cash.  

Public-option principles require that Medicare mirror Social Security, which gives enrollees cash and trusts them to spend it. In 2022, Medicare will spend enough to give each enrollee an average cash subsidy of $12,100. Income- and risk-adjustment would give poorer and sicker enrollees thousands more to ensure they could afford coverage. 

Enrollees would spend that money better than government bureaucrats do. Evidence shows that cost-conscious patients force providers to reduce prices and that when seniors control their health decisions, even those with cognitive limitations make good choices. 

While Medicare for All would condemn generations to low-quality care, applying public-option principles to Medicare would improve health care through choice and competition. It’s a Democratic idea even Republicans can love. 

Michael F. Cannon is director of health policy studies at the Cato Institute and coauthor of “Would ‘Medicare for All’ Mean Quality For All?” (with Jacqueline Pohida, AGPCNP-BC, Quinnipiac Health Law Journal, 2022). 

https://thehill.com/blogs/congress-blog/3477455-medicare-for-all-would-mean-worse-care-for-all/

Even as COVID Cases Rise, Mask Mandates Stay Shelved

 An increase in COVID-19 infections around the U.S. has sent more cities into new high-risk categories that are supposed to trigger indoor mask wearing, but much of the country is stopping short of bringing back restrictions amid deep pandemic fatigue.

For weeks, much of upstate New York has been in the high-alert orange zone, a Centers for Disease Control and Prevention designation that reflects serious community spread. The CDC urges people to mask up in indoor public places, including schools, regardless of vaccination status. But few, if any, local jurisdictions in the region brought back a mask requirement despite rising case counts.

In New York City, cases are again rising and this week crossed the city's threshold for "medium risk," indicating the widening spread of the subvariant knowns as BA.2 that has swept the state's northern reaches. But there appears to be little appetite from Mayor Eric Adams to do an about face just a few months after allowing residents to shed masks and put away vaccination cards that were once required to enter restaurants and concert halls. Adams has said the city could pivot and reimpose mandates but has stressed that he wants to keep the city open.

"I don't anticipate many places, if any, going back to mask mandates unless we see overflowing hospitals — that's what would drive mask mandates," said Professor David Larsen, a public health expert at Syracuse University in upstate New York, whose own county is currently an orange zone.

"People are still dying, but not in the same numbers," he said.

Nationally, hospitalizations are up slightly but still as low as any point in the pandemic. Deaths have steadily decreased in the last three months to nearly the lowest numbers.

The muted response reflects the exhaustion of the country after two years of restrictions and the new challenges that health leaders are facing at this phase of the pandemic.

An abundance of at-home virus test kits has led to a steep undercount of COVID-19 cases that were once an important benchmark. Researchers estimate that more than 60% of the country was infected with the virus during the omicron surge, bringing high levels of protection on top of the tens of millions of vaccinations. Hospitalizations have increased but only slightly.

"If a mask mandate were reinstated right this minute, I don't think it'd be very successful," said Jim Kearns, a videographer at the State University of New York in Oswego, another upstate New York community in the CDC's orange zone.

"I think a lot of people are just over it," he said. "If I saw death rates and hospitalizations going up in crazy numbers, and if I felt that there was a danger to me and my family, I would put it on in a heartbeat. But it has been a long two years."

In Boston, even as COVID-19 cases began to tick up again, there's been little drive to reimpose the indoor mask mandate city officials largely lifted two months ago. Boston still requires masks in schools and on school buses. A statewide mask mandate was lifted for schools at the end of February.

The city is now focused on what Boston Mayor Michelle Wu has described as recovery efforts, including attracting workers and visitors back to the city's downtown. Health officials continue to urge caution. During April's running of the Boston Marathon, which drew tens of thousands of competitors, race organizers and city officials recommended runners take steps to stop the spread of the virus by getting vaccinated, tested for COVID-19 and not accepting water from spectators.

In Maine, there have been few efforts to reinstate COVID-19 precautions, even after Democratic Gov. Janet Mills tested positive for COVID-19 at the end of April. The 74-year-old, who had received a second booster, said she believes that's "one of the reasons why I am still feeling well" and encouraged others to get vaccinated.

One of the most jarring reactions came in Philadelphia, which last month abandoned its indoor mask mandate just days after becoming the first U.S. metropolis to reimpose compulsory masking in response to an increase in COVID-19 cases and hospitalizations.

City officials, who had said they wanted to head off a new wave of infections, abruptly backtracked after what they said was an unexpected drop in the number of people in the hospital and a leveling-off of new infections. The turnabout came amid rising opposition to the reinstatement, but city officials said the decision was about data, not politics.

Inaction by cities comes after a federal judge in Florida last month struck down a national mask mandate for travelers on planes, trains and buses. The CDC still urges people to wear face coverings but the Transportation Security Administration said it would stop enforcing mask mandates at airports and on flights, even as the White House said it would appeal the ruling.

In March, Vermont's largest city, Burlington, ended its indoor mask mandate following a drop in COVID-19 cases. Burlington was one of more than two dozen Vermont communities that required masking after the Legislature in November gave towns and cities the authority to do that. Even as the masks came off, COVID made a return in the state.

Half of Vermont's 14 counties have now been rated as having high community levels of COVID-19, according to the CDC. The rankings are based on a handful of factors, including new hospital admissions for the virus.

Chicago's infection rate is also rising, even though like in most places hospitalizations and deaths remain low.

But the increasing number of infections caused enough concern that the school district sent a letter to parents alerting them to the possibility that with the rise, Cook County, which includes Chicago, "may be moving from 'low risk' to a 'moderate risk' category in the coming days."

The letter did not say if the school district could again require students and staffers to wear masks or return to remote learning.

https://www.medscape.com/viewarticle/973415

Worst TB Outbreak in 20 Years Reported in Washington State

 Tuberculosis cases are increasing in Washington, which has put public health officials on "heightened alert," according to a recent announcement from the Washington State Department of Health.

Widespread disruptions in health care and missed tuberculosis diagnoses during the COVID-19 pandemic have likely added to the increase – both locally and globally.

"It's been 20 years since we saw a cluster of TB cases like this," Tao Sheng Kwan-Gett, MD, the state's chief science officer, said in the announcement.

"The pandemic has likely contributed to the rise in cases and the outbreak in at least one correctional facility," he said. "Increased access to TB testing and treatment in the community is going to be key to getting TB under control."

Case numbers appeared to fall in Washington during the first year of the pandemic, possibly due to less reporting and missed diagnoses. But in 2021, cases rose quickly. The state reported 199 cases, marking a 22% increase from 2020.

So far this year, 70 cases have been reported, including 17 new cases that all have connections with each other and several state prisons.

The state's Department of Corrections, Department of Health, and the CDC are working together on testing and decreasing spread, MaryAnn Curl, MD, the chief medical officer for the Corrections Department, said in the statement.

Tuberculosis cases are increasing worldwide. For the first time in more than a decade, TB deaths increased to about 1.5 million, according to the World Health Organization's 2021 Global Tuberculosis Report.

Across the U.S., the number of reported TB cases significantly declined at the beginning of the pandemic in 2020 but increased again in 2021, according to a recent CDC study.

The Kansas Department of Health also reported an outbreak of TB cases in March, according to USA Today .

At the beginning of the pandemic, some people with TB may have been diagnosed with COVID-19 because both are infectious diseases that attack the lungs and have similar symptoms, the Washington Health Department said.

Like COVID-19, tuberculosis can spread through the air when an infected person coughs or sneezes. But unlike COVID-19, TB typically requires that you have prolonged exposure to become infected.

Symptoms of tuberculosis can include chest pain and coughing, with or without blood, as well as fever, night sweats, weight loss, and fatigue.

Tuberculosis is preventable, treatable, and curable, the Washington Health Department said. Those who travel to countries where TB is more common face higher risks for exposure, as well as those who live or work in settings where TB may spread, such as homeless shelters, prisons, jails, and nursing homes.

People can develop inactive TB, also called latent TB, which doesn't have any symptoms and isn't contagious. If people with inactive TB don't get quick diagnosis or treatment, the infection can become active TB and cause symptoms. State health officials estimated that about 200,000 people in Washington have inactive TB.

Tuberculosis treatment can take a minimum of 6 months, and if it's not followed carefully, symptoms can become more severe, the Health Department said. Incomplete treatment can also contribute to the spread of antibiotic-resistant strains of tuberculosis.

https://www.medscape.com/viewarticle/973417

COVID-19 May Worsen Childhood Asthma

A study out of Children's Health of Orange County, California, that looked at 62,000 children with asthma who were tested for COVID-19 in the first year of the pandemic found that children who had infections had significantly more asthma-related visits, hospitalizations, emergency inhaler use, and steroid treatments within six months of their illness. Of the 62,000 children studied, 7,700 tested positive. Dr. Christine Chou, M.D., of Children's Health, said children who tested negative for the virus "had improved asthma control for the next six months, meaning fewer emergency department visits and hospitalizations for asthma, and less asthma treatment."

https://www.biospace.com/article/covid-19-may-worsen-childhood-asthma-after-infection-and-more-coronavirus-news/

Phathom Wins Approvals Against Antibiotic Resistance in H. pylori

 Phathom Pharmaceuticals is having a good week as the U.S. Food and Drug Administration approved two of its products for bacterial illnesses in adults.

Voquezna Triple Pak and Voquezna Dual Pak were both given the green light to treat Helicobacter pylori (H. pylori). The products' New Drug Applications had been granted priority review and also designated as Qualified Infectious Diseases Products.

Voquezna Triple Pak is made up of vonoprazan tablets, amoxicillin capsules and clarithromycin tablets, while the Dual Pak consists of vonoprazan tablets and amoxicillin capsules. Both are designed to address the H. pylori bacterial pathogen, which can lead to serious complications like non-cardia gastric cancer and peptic ulcer if left untreated. There are around 115 million people affected by this pathogen in the U.S. and eradication rates are below 80%.

Vonoprazan, a potassium-competitive acid blocker, is the first innovative acid suppressant from a new drug classification in the U.S. over the last three decades.

The FDA's decision is based on stellar results from the Phase III PHALCON-HP trial, which covered 1,046 patients with H. pylori.

Both treatment regimens demonstrated non-inferiority to lansoprazole triple therapy with no clarithromycin or amoxicillin resistant strain of the bacterium at baseline. Triple Pak demonstrated an 84.7% eradication rate versus 78.8% in the lansoprazole group, while Dual Pak showed a 78.5% eradication rate compared to lansoprazole triple's 78.8%.

Among the same patients, including those with clarithromycin-resistant strains of H. pylori, Voquezna Triple Pak logged an 80.8% eradication rate compared to 68.5% in lansoprazole with amoxicillin and clarithromycin. Those who received a Dual Pak logged 77.2% versus 68.5%.

Some adverse events were observed but were not much different from the AEs seen in lansoprazole triple therapy arms, such as dysgeusia, diarrhea, hypertension, abdominal pain, vulvovaginal candidiasis and nasopharyngitis.

Phathom notes that both products are not recommended for patients with hypersensitivity to amoxicillin or vonoprazan, other beta-lactams and those receiving drugs that contain rilpivirine. The clarithromycin component also makes them contraindicated in those with allergies to the drug or other similar antibiotic, those with a history of hepatic dysfunction and others.

"H. pylori eradication rates continue to decline in part due to antibiotic resistance, inadequate acid suppression and complex treatment regimens, resulting in treatment failures and complications for patients. New therapies that have the potential to address the limitations of current treatments are needed and we look forward to bringing these innovative vonoprazan-based treatment options to the millions of H. pylori sufferers in the U.S.," Terri Curran, president and chief executive officer of Phathom, said in a statement.

Voquezna Triple Pak and Voquezna Dual Pak will be out in the U.S. market by the third quarter of 2022. Phathom will be marketing the products exclusively.

https://www.biospace.com/article/phathom-s-antibacterial-combos-get-green-light-from-fda/