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Revenge of the COVID Contrarians
On Christmas Eve of 2020, my father was admitted to the hospital with sudden weakness. My mother was not allowed to join him. She pleaded with the staff — my dad needed help making medical decisions, she said — but there were no exceptions at that grisly stage of the coronavirus pandemic.
I contemplated making the trip from Maryland to New Jersey to see whether I, as a doctor, could garner special treatment until I realized that state and employer travel rules would mean waiting for a COVID-19 test result and possibly facing quarantine on my return. In the end, my father spent his time in the hospital alone, suffering the double harm of illness and isolation.
These events still frustrate me years later; I have a hard time believing that restrictions on hospital visitation and interstate travel helped more people than they hurt. Many Americans remain angry about the pandemic for other reasons too: angry about losing a job, getting bullied into vaccination, or watching children fall behind in a virtual classroom. That legacy of bitterness and distrust is now a major political force.
Canada Confirms First Imported Clade 1b Mpox Case
The Public Health Agency of Canada (PHAC) on Nov. 22 announced the country’s first imported clade 1b mpox infection, marking the seventh country outside of Africa to report an illness involving the novel clade.
The patient from Manitoba sought care in Canada shortly after returning from travel. PHAC said the case is associated with an ongoing outbreak of clade 1 mpox in central and eastern Africa. It added that the patient is isolating and that a public health investigation, including contact tracing, is under way.
“The risk to the general population in Canada remains low at this time. PHAC continues to actively monitor the situation and will provide updated information as it becomes available,” the agency said.
Flu Vaccine Estimated to Be 21% Effective Against Flu Spread to Household Members
A study of 700 people who tested positive for influenza suggests that their risk of infecting household contacts was 18.8% and that the estimated effectiveness of flu vaccines against secondary infections is 21.0%.
Vanderbilt University–led researchers tested nasal swabs for evidence of influenza and analyzed symptom diaries for up to 7 days from 699 participants and their 1,581 household members during the 2017-18, 2018-19 and 2019-20 respiratory virus seasons. Case-patients had sought care at clinics in Tennessee and Wisconsin after experiencing flu-like symptoms.
“The degree to which vaccines reduce secondary infections after exposure to influenza, especially in high transmission settings, like households, may be especially informative to individuals at increased risk for severe influenza complications,” the study authors wrote.
The findings were published last week in JAMA Network Open.
Biden Proposes Weight Loss Drug Coverage for People on Medicare and Medicaid
The Biden administration plans to require Medicare and Medicaid to offer coverage of weight loss medications for people seeking obesity treatment.
The new rule, which was proposed by the administration Tuesday, would dramatically expand access to anti-obesity medications such as Ozempic and Wegovy, from Novo Nordisk, and Mounjaro and Zepbound, from Eli Lilly.
Medicare has been barred from paying for weight loss drugs, unless they’re used to treat conditions like diabetes or to manage an increased risk of heart disease. States can decide whether to cover obesity drugs under Medicaid, but the majority don’t.
The Biden administration is proposing to reinterpret the law barring coverage by classifying obesity drugs as treatment for a “chronic disease,” rather than as weight loss medications.
Review and Meta-Analysis Links Preconception Antibiotic Use to Reproductive Risks
A systematic review and meta-analysis suggests that preconception exposure to certain antibiotic classes increases the risk of infertility, miscarriage, and congenital anomalies, researchers reported last week in eClinicalMedicine.
While the risks of antibiotic use during pregnancy have been well documented, less attention has been paid to the potential of antibiotic use during preconception — the months before pregnancy when women can take steps to improve their health and the health of their future child.
To summarize the existing evidence, researchers with the Chinese University of Hong Kong identified 15 articles on preconception antibiotic exposure that were published from 1975 to 2023 and involved more than 1.2 million women. The primary outcomes of interest included infertility, pregnancy rate, fecundability rate, miscarriage, and congenital malformation, which were measured by odds ratios, relative risks and fecundability ratios.
RSV Prevention Tools Somewhat Cost-Effective, Studies Show
University of Michigan and Centers for Disease Control and Prevention (CDC) investigators determined that both maternal respiratory syncytial virus (RSV) vaccination and the monoclonal antibody nirsevimab are likely cost effective in certain situations for RSV.
These findings, both published today in Pediatrics, were presented to the CDC’s Advisory Committee on Immunization Practices and were instrumental in the recommendation of these products.
Both studies assessed the cost-effectiveness of these products for infants in their first RSV season; the maternal vaccine is administered during weeks 32 to 36 of pregnancy, with maternal antibodies passed through the placenta.
The monoclonal antibody is given as a one-time injection to infants under 8 months before their first RSV season if they did not benefit from maternal vaccination. Older babies at risk for severe RSV can also get nirsevimab during their second RSV season.
