Will telemedicine transform test-to-treat?
Volume 7, Issue 2 | January 11, 2023
IN THIS ISSUE
Revised XBB.1.5 numbers
ASU Testing Commons Year in Review
USDA projects aim to improve SARS-CoV-2 surveillance in animals
Monitoring international airplane wastewater
COVID continues to teach us about the human immune system
New and Noteworthy
Test to Treat gets another T: Telemedicine
A month ago, we noted that while the test-to-treat (TTT) model was basically a good one - allowing people to get diagnosed with COVID and treated with Paxlovid during the same pharmacy visit - it didn’t adequately take into account the fact that a lot of people can’t easily get to a pharmacy. Two different groups have since jumped in to start solving that issue with the same tactic: Telemedicine.
One of the efforts is private and test-specific (from Lucira and Sesame), while the other is public and test-agnostic (from NIH’s RADx program and eMed; Liz is involved with that project). Both provide access to a free telehealth consult with a provider who can prescribe antivirals, and both offer the option to either pick up meds at a pharmacy or to have them delivered to the patient’s home. Lucira’s program requires you to buy their test; NIH’s requires you to live in certain places and to sign up for a study - which is looking at whether the telehealth model actually gives more people access to TTT, and whether people will bother to use it.
Commentary: These are baby steps, but a good start. Here’s hoping that this new model works well, and that more companies and communities start using it.
Fast, but not quite so fast, XBB.1.5
CDC cut its forecast estimate of the XBB family (mostly XBB.1.5) this week by nearly half. The year-end 2022 count is now set at 23.6% of all COVID sequences, down by a big 20 points from last week’s estimate of 44.1% (here is an explanation of why). Nevertheless, XBB.1.5 has made up half this gap in the past week, so it’s still the fastest-growing variant yet seen at any point in this three-plus-year pandemic, crowding out the briefly dominant BQ family.
We still have all the tools we need to combat this variant, and they’re simple. (This Nature article is a good reminder of the relatively successful tactics Japan has used, known as “the three Cs.”) Fortunately there is no sign (yet) of any increasing morbidity and mortality due to this most transmissible of all Omicron variants so far. See our revised chart here.
2022 Year in Review
The ASU Testing Commons 2022 Year in Review has been published. Click on the link to dig into the details, but here’s the TL;DR version:
EUAs continue to be issued in 2022, but at much lower numbers than previous years
FDA focused on less-invasive (nasal swab and saliva) and self (over-the counter / home) tests
Two new categories of tests created: breath and genotyping.
USDA is keeping an eye on the critters
The USDA is working on five research projects aimed at developing “tests and tools” to identify and monitor the SARS-CoV-2 virus in animals. Two of the projects intend to develop quick and easy tests for the virus in wild and domestic critters. Two more will look at our old friends the deer (and their elk cousins) to see how long the virus can persist in those species and whether they can serve as a potentially variant-producing intermediate host. The remaining project will develop a cell line to help researchers “better predict which animal species might act as . . . reservoirs for the virus.”
CDC tentatively dips toe into international airplane wastewater
Holy cow, people listened to us AGAIN! (Okay, maybe not really.) But last week we reported on the US’s new requirement that travelers coming from China present a negative COVID test taken within 48 hours of boarding a plane to the US. (Commentary: This may be “hygiene theater” that won’t do much to deter the virus’s transpacific spread.)
This week, the CDC announced that it had done some “very preliminary” work towards testing wastewater from planes that travel to the US from other countries. While it’s not clear that this tactic will prevent infected people from entering the US either, it would at least provide more information - and the option to sequence relevant samples.
Food for Thought
One (positive) legacy of COVID – a growing treasure trove of immune-system knowledge
A fascinating new paper in Science Immunology demonstrates just how much COVID is teaching us about the subtlety of the human immune system. According to the study, frequent exposure to SARS-CoV-2 through mRNA vaccination results in incrementally declining antibody effectiveness. Specifically, while each subsequent encounter increases the number of neutralizing antibodies, the type of antibody induced by the vaccine changes - to one that can’t alert a parallel inflammatory response as effectively.
Commentary: The success of antibiotics in the second half of the 20th century led to a decline in infectious-disease research in the developed world, primarily because - prior to HIV’s arrival - the great scourges of humankind throughout history were primarily bacterial in nature (though fungi and parasites did their share of damage, too). If any good is to come from the COVID pandemic, we must institutionalize the lessons we have learned at great cost: we must prioritize vaccination, testing, therapy, and public health. The antibody response we’re seeing in this study likely evolved to protect us against overreaction to frequently encountered pathogens, but in the case of SARS-CoV-2 reduces the long-term effectiveness of immune memory. It does not, however, provide a justification for not getting vaccinated or boosted - instead it points to the importance of spacing out boosters as recommended - every five to six months.
Quick Hits
The SARS-CoV-2 virus was found in 28 of 29 airplane wastewater samples taken between June and December 2022, according to the national public health laboratory in Malaysia. (The 29th sample hasn’t been analyzed yet.)
Scattered schools across the nation required masks or testing after the end-of-year holidays. But as of the end of 2022, more than 98% of schools no longer required students to mask, despite increasing COVID-19 transmission levels.