Your Potty Will Now Take Your Pulse
Volume 7, Issue 18 | May 10, 2023
In This Issue
Applying COVID Dx lessons to TB
The end of the COVID emergency (both WHO and US)
Data reporting impact after US PHE ends
Something very weird is happening at GISAID
New and Noteworthy
WHO: COVID is no longer an international emergency
COVID is no longer an international health emergency - but it remains a health threat, according to the World Health Organization. The announcement will have few direct repercussions, but it’s still an important milestone. In his statement, the WHO Director-General reminded us that globally, COVID has already killed almost 7 million people - and even today, someone dies from COVID every three minutes. But now that we have vaccines, treatments, and broad immunity, now is the appropriate time to transition to long-term management of COVID.
Once more, for the folks in the back: What’s changing with the end of the COVID Public Health Emergency
As you no doubt know, the main COVID public health emergency (PHE) in the US will end tomorrow, May 11, 2023. Politico published an excellent overview of what is changing and what is not.
From a testing perspective - we summarize one last time:
COVIDTests.gov will no longer provide free at-home COVID tests (although the federal government does have a stockpile of tests in case of unexpected surges or outbreaks in the future).
Private payers / insurance companies will no longer be required to reimburse members for the purchase of at-home tests. The Department of Labor has encouraged private payers to continue covering at-home tests, but it’s unclear how many will do so.
Medicare recipients will no longer be able to request free at-home tests every month. Medicare Advantage plans could cover at-home tests as a supplemental benefit at their discretion. As is the case for other tests, there will be no co-pay for physician-ordered COVID tests (likely mostly lab-based tests). But there could be a co-pay for the doctor’s visit needed to order the test.
With change, especially reduction of opportunity, scammers rush in and claim to have a “great deal just for you!” USA Today has a short course on how to recognize and avoid these scams.
Data reporting for COVID also changing
COVID data reporting has been steadily evaporating for the last year. With the end of the PHE, the CDC data systems will finally transition to a state that essentially treats COVID like other infectious diseases.
According to COVID-19 Data Dispatch, some of the most significant changes are:
PCR labs will no longer be required to report COVID results to the CDC (i.e., no more national case numbers)
Instead of numbers of cases, CDC will use hospital admissions, ER visits, and deaths as their primary metrics for tracking how and where COVID-19 is spreading, and how significant any surges are.
Two things that won’t change: variant surveillance (using both PCR samples and wastewater data) and monitoring vaccination levels and vaccine effectiveness and safety.
COVID was fourth leading cause of death in 2022
COVID deaths dropped significantly in 2022, down 47% on an age-adjusted basis from 2021 - from 115.6 to 61.3 per 100,000 people - but remained in the top five most common causes of death, coming in at #4. On the question of deaths “from COVID” versus “with COVID,” 76% of death certificates list the virus as the primary cause, and 24% listed it as a contributing cause. While COVID accounted for 6% of deaths and shrank year over year, cancer, heart disease and unintentional injuries (including drug overdose) deaths rose over the same period. Many believe that the increase in these other areas are due, in part, to missed health screenings as well as the additional stress that the pandemic caused.
Commentary: While these decreases in COVID mortality are welcome, they don’t yet feel like cause for celebration. There will always be debates as to what could have / should have / would have been done better, but one thing is clear: COVID has permanently changed humanity’s disease landscape.
What on Earth is going on at GISAID?
GISAID, originally founded as a user-friendly place for influenza variant tracking, became the most-used open-access repository for COVID sequences beginning with the very first sequence that Chinese researchers deposited in the database in early January 2020. Since then it has become the most important repository for sequences of evolving COVID variants worldwide - information that is essential for designing and modifying diagnostic tests, vaccines and therapies. Today GISAID contains 15.5 million COVID sequences (far more than any other database) and has expanded to several other viral pathogens.
This open-source data platform has always been a bit different from others. It is only available to users who register on the site, and users must agree to get permission before republishing sequences found there. In addition, as Nature described it, “Those who wish to publish analyses of data housed in GISAID must offer to collaborate with the scientists who produced the sequences.” So far, so fabulous.
Unfortunately, a series of revelations over the past few months has shaken worldwide confidence in GISAID. According to a recent investigation and review by Science, GSAID leadership (a murky and difficult-to-identify group) has a history of inconsistent adherence to its own access guidelines. They’ve silenced critics, and their initial promises to share the data with other open-access databases (such as GenBank in the US) have not been fulfilled.
We will not rehash all the details here, but seriously, the story reads like a Netflix thriller and would be entertaining if it was not so threatening to global research. The kicker: GSAID’s founder, Peter Bogner, apparently had an alternative persona named Steven Meyers, who was GSAID’s front man and “bad cop.”
Commentary: We commend the reporting that brought more to light about GSAID and its founder. But the global health issue / challenge that needs to be addressed is far bigger. We need to ensure that researchers around the world have a stable, reliable, and trustworthy place to share data, especially viral genomes. We wholeheartedly agree with Edward Holmes, virologist at University of Sydney, who said, “The key lesson from the COVID-19 pandemic is that data sharing is the single most important thing we can do to help prevent and control pandemics.” But we would emphasize that the importance of sharing is not just about viral genomes but the key learnings about testing, vaccination, and treatment. More information on the GSAID Crisis in Nature.
A porcelain throne that takes your pulse
Your doc has told you to monitor your heart rate and oxygen levels at home, but you keep forgetting to do it. Well, there’s one thing you can’t possibly forget to do: Use the toilet. Guess what? The FDA just approved a toilet seat that can do the monitoring for you.
For now, heart rate and O2 saturation are the only things the seat can measure, but the company that makes it is planning to submit later this year for approval to add blood pressure to the list. The seat should be available for purchase by the end of the year (now you know what to get Uncle Bob for Christmas).
Food for Thought
Can we apply what we learned from diagnosing COVID to tuberculosis?
A Nature Microbiology commentary this week indicts diagnostic practices as the weak link in tuberculosis care. Every year 1.6 million people die from TB, mostly in lower-income countries. The therapies exist, but promptly matching the right therapies to the right patients requires a diagnostic paradigm shift, in large part by applying what we learned during the COVID pandemic. The extract below from the paper makes this clear: We need increased diagnostic funding to perform more and better tests, closer to the patient, at lower costs.
Commentary: We know how to do this. Let’s just get it done.
Source: Nature Microbiology, 01 May 2023
Quick Hits
Last week, Pennsylvania became the first state in the nation to require that insurance companies cover all breast cancer screening - including ultrasound, MRI, and genetic testing - without a copay.
Mpox case rates in Chicago have surged, reaching “the highest weekly new case rate in any US region so far this year,” according to Howard Brown Health, which serves the Chicago LGBTQ+ community.
San Francisco International Airport has become the first US airport to routinely screen airplane wastewater for COVID and monitor for variants.