Norovirus: “I’m back! Did you miss me?”
Volume 7, Issue 7 | February 15, 2023
In This Issue
The next batch of end-of-PHE info
Lessons Learned: Can “free society” and “pandemic security” coexist in America?
Diagnostics industry down to new-normal size
China whitewashes its pandemic
New and Noteworthy
Another virus to stomach - but no need for panic
If you have ever taken a cruise, you are familiar with the GI bug called norovirus (hopefully only by name, not by experience). The good news is that a bout with norovirus is a relatively short-lived event - one to three mighty unpleasant days. The bad news is that it is far more easy to catch than COVID: Surfaces, food touched by an infected person, and feces-contaminated water can all remain infectious for days. (You might want to avoid the hot tub for a bit.) Alcohol-based hand sanitizer does not kill this thing - only thorough hand-washing with soap and water works, as does a 5-8% bleach solution for surfaces.
Is there a test? Yes, a lab-based one - though most people are diagnosed based only on their symptoms. However, some people do get tested, and right now more than 15% of those tests are coming back positive, according to the CDC.
This winter, small outbreaks have been declared in community after community - 225 of them this year, according to the CDC - in some cases closing schools, to the consternation of several media outlets. However, if you look at norovirus levels over the past decade, the current situation is just par for the course - things were actually much worse in February of last year.
Commentary: This is yet another case of viruses returning to pre-pandemic levels as COVID precautions are winding down. It’s great to see the media taking infectious disease seriously, especially pandemic-potential viruses, but we’d prefer it if they would save the apocalyptic tone for actual apocalypses (zombie or other). You can only cry wolf so many times before people stop paying attention.
More end-of-PHE clarifications arrive - and more still to come
More information about the implications of the end of the Public Health Emergency (PHE) came out last week in a fact sheet issued to state governors by HHS. Our highlights:
Testing. Private insurers will no longer be required to cover tests or testing costs. Medicare Part B members will have coverage without cost sharing only for lab-based tests ordered by their provider. State Medicaid must provide free testing until September 30, 2024; after that, each state can choose its coverage level.
Testing Data and Reporting. Mandatory reporting of data from labs will end. Hospital data reporting will continue through April 30, 2024, but frequency may be reduced from the current daily reporting.
Supply Chains and Reporting. Reporting of supply interruptions or discontinuation of products will no longer be required. However, the FDA is seeking congressional authorization to continue this practice.
Cost-sharing with patients will be a central theme moving forward, essentially making COVID’s status the same as other diseases. Medicaid is an exception: It “will continue to cover COVID-19 treatments without cost sharing through September 30, 2024. After that, coverage and cost sharing may vary by state.”
Telehealth. Medicare telehealth capabilities will remain in place until December 2024.
PREP Act Coverage. Liability protections for entities involved with COVID countermeasures may be impacted. Stay tuned for nuances in coverage and possible extensions.
More pandemic lessons: We know what we need to do. It’s not as clear that we’re capable of doing it.
Another “lessons learned from the pandemic” report has landed, this one from the CSIS Global Health Policy Center, Brown University Pandemic Center, and COVID Collaborative. Its set of next steps:
Get together at the local level, in groups that include people from all backgrounds, out of our political, socioeconomic, and racial bubbles, and talk (not yell, talk) about how to “overcome pandemic divides across red, blue, and purple states.”
Build new tools for pandemic response - ones that are more flexible, and that empower folks at the local level.
Find the folks who can lead pandemic response at a local level - both the health and medicine bits and the everyday-life stuff - and help them be ready to do that if/when necessary.
Get people more engaged with public health data. If we do it right, people should want to check it the way they check the weather reports.
Train public health officials in crisis response.
At the federal level, figure out who’s in charge of what, and make sure everyone knows what their jobs are.
Commentary: More than any other report we’ve read, this one is candid about the damage that political divisions have caused to public health in this country, and about what is needed to heal it: “A new, pragmatic consensus is needed that bridges deep divides and is fueled by candor, self-criticism, humility, a determined optimism, and civility.” And yet, the report itself includes the caveat that “it does not necessarily represent unanimous consensus by the meeting participants.” It’s gonna be a long road.
Diagnostics industry adjusting to the new normal
Diagnostics and medtech company announcements in the last few weeks have reflected the change in demand for COVID testing compared to a year ago. With demand substantially down, companies are now restructuring or reducing their staff. While the volume of COVID tests and testing is likely to be lower, it’s also expected to be more steady than the boom-and-bust cycles we’ve seen over the past three years.
Food for Thought
China’s whitewashed pandemic puts us all at risk.
Commentary: We may never know how many people have died of COVID in China. There is no doubt that the country’s strict Zero-COVID regulations saved lives while they were in place. However, its equally strict rules about which deaths can be attributed to the virus resulted in a significant sustained undercount (deaths must occur in a hospital and must involve respiratory failure, or they can’t be attributed to COVID) - the numbers coming out of China made no sense. Through the end of 2022, the US suffered 1.1 million deaths while China recorded just 5,250 - with a 4.3x larger population.
Detailed academic studies during 2022 estimated that COVID deaths in China have likely been undercounted by ~4x. Yesterday, The New York Times estimated a total mortality of up to 1.5 million - an undercount of ~15x. Since then, China officially reported 82,000 deaths while some observers estimated 95% of the population were infected.
More Commentary: Timely and accurate reporting of the pandemic is essential to invoke effective local, national and global countermeasures (testing, masking, isolation, vaccines, therapies, etc.). Nearly one quarter of the world’s population lives in China. If the rest of the world doesn’t know what’s happening to the health of people there, how can we possibly know what we need to do to prepare?
Quick Hits
Another COVID data mainstay is shutting down - the Johns Hopkins Coronavirus Resource Center (CRC), whose dashboard tracking cases and deaths will cease collecting new data on March 10, 2023. Hopkins will continue to offer free access to the CRC archive and other dashboards on COVID health security, treatments, vaccines and public health.
Last week, the CDC added COVID-19 vaccines to its list of recommended standard immunizations for children and adults. In addition, the agency updated guidelines for influenza; pneumococcal; measles, mumps, and rubella; and hepatitis B vaccines.