Category: Health

At a press briefing earlier this month, Ashish Jha, the White House’s COVID czar, laid out some pretty lofty expectations for America’s immunity this fall. “Millions” of Americans, he said, would be flocking to pharmacies for the newest version of the COVID vaccine in September and October, at the same appointment where they’d get their yearly flu shot. “It’s actually a good idea,” he told the press. “I really believe this is why God gave us two arms.”

That’s how I got immunized last week at my local CVS: COVID shot on the left, flu shot on the right. I spent the next day or so nursing not one but two achy upper arms. Reaching high shelves was hard; putting on deodorant was worse. And it did make me wonder what would have happened if I’d ignored Jha’s teleological advice and gotten both jabs in the same arm. Maybe my annoyance would have been lessened. Or perhaps the same-side shots would have made the soreness in my left arm way worse. When I posed this puzzle to immunologists, vaccinologists, and pharmacists, I got back a lot of hems and haws. For the millions of Americans who will be getting two-shot appointments by fall’s end, they told me, the choice really does come down to personal preference in the absence of clear data: You’ve just gotta pick a side. Or, you know, two.

On the one hand (sorry), there are the vaccine double-downers. Sallie Permar, a pediatrician at Cornell University, and Stephanie Langel, an immunologist at Duke University, both said they’d probably get both shots in the same shoulder; so would Rishi Goel, an immunologist at the University of Pennsylvania. “Personally, I’d rather have one arm that’s slightly uncomfortable than both,” Goel told me.

On the other hand, we’ve got Team Divide-and-Conquer. Several experts said they’d follow the White House protocol of splitting shots left and right. Ali Ellebedy, an immunologist at Washington University in St. Louis, told me he’d prefer to have two slightly sore arms to one totally dead one. Jacinda Abdul-Mutakabbir, a pharmacist at Loma Linda University, says she generally recommends that her patients get the vaccines on separate sides “for comfort.” Last year, she opted to get the flu shot and a COVID booster within a few inches of each other, and “I wanted to chop my arm off,” she told me. “Never again.”

Read: America’s fall booster plan has a fatal paradox

The deciding logic here should be pretty intuitive, Permar told me. Two shots on one side might be expected to double how sore that arm will get, though the experience of each vaccine recipient will depend on a bevy of factors, including the ingredients in the shots and that person’s infection and vaccination history, as well as their immune-system health. Also, for people like my husband—who’s prone to very heavy vaccine side effects—the choice may not matter at all. He was so knocked out by the fever and chills that came with his COVID-flu-shot combo, he couldn’t have cared less which arms got the shots.

I dug around for studies examining the consequences of the one-versus-two-arm choice and found only one: a Canadian trial from 2003, which vaccinated a few hundred sixth-graders at two dozen middle schools against group C meningitis and hepatitis B at the same time. Roughly half the kids got both shots in the same arm; the others received one on each side. (Some kids in the latter group requested that their shots be administered by a pair of nurses who could plunge both syringes at the same time.) Among students in the same-arm group, 18 percent ended up with tenderness at the injection site that they rated “moderate or severe.” But those kids fared better than the ones in the two-arm group, 28 percent of whom experienced moderate or severe tenderness in at least one arm, and 8 percent of whom had it in both arms at the same time.

But those results apply only to that group of kids in that setting, with those two specific vaccines; there’s no telling whether the same trends would be seen with flu shots and COVID shots when given to children or adults. Michela Locci, an immunologist at the University of Pennsylvania, told me she suspects that combining flu and COVID inoculations in the same arm could actually drive extra side effects: “The overall inflammation might be higher,” she said.

Many pediatricians, who often have to administer four or five shots to a baby at once, are habitual splitters. “If there’s more than one vaccine syringe to give to a baby, generally, two legs are used,” Permar told me. (Kids usually upgrade to arm shots sometime in toddlerhood—it’s all about finding a muscle that’s big enough for the needle to hit its mark.) Doctors also have a nerdy reason to split shots between arms or legs. “If there’s a local reaction to the vaccine,” Permar said, “you can identify which vaccine it was if you separate them by space.” (For the record, I had a more painful reaction in my left arm, where I got the COVID shot. Others I’ve spoken with have reported the same disparity.)

Read: Families are going rogue with rapid tests

The CDC advocates for separating vaccination shots by at least one inch of space. Per the agency, if a COVID shot is being given at the same time as a vaccine “that might be more likely to cause a local injection site reaction,” the shots should be dosed into “different limbs, if possible.” Two types of flu shots cleared for use in people 65 years and older—the high-dose vaccine and the adjuvanted one—fall into that category. But the different-limb advice doesn’t seem to apply to other flu shots, including those cleared for use in younger adults and kids.

However someone ends up taking simultaneous flu and COVID shots, the placement is unlikely to affect how much protection the vaccines provide. There could be an argument for letting “each side focus on its own thing,” says Gabriel Victora, an immunologist at Rockefeller University. “But it probably doesn’t make a whole lot of difference.” Children routinely get combo vaccines, such as DTaP and MMR, each of which combines multiple disease-fighting ingredients in a single syringe. The triple-threat formulas work just as well as injecting their individual parts. The immune system is used to multitasking: It spends all day being bombarded by microbes, so there’s good reason to believe that with vaccines, too, our body will see simultaneous shots “as independent events,” Goel told me.

Which arm gets picked for which shot, though, will affect where the jab’s contents end up. After a vaccine is injected, its immunity-inducing ingredients meander to the nearest lymph node, such as the ones in the armpits. There, hordes of immune cells fight over the vaccine’s bits, and the fittest and fiercest among them are selected to leave the lymph node and fight. Here, again, doubling up on one arm shouldn’t be an issue, Goel said: The immune-cell boot camps in these lymph nodes have “a good amount of real estate.”

It might even be a good idea to stick the same limb—and thereby, the same lymph node—every time you get another dose of a particular vaccine. After immune cells in a lymph node spot a particular bit of pathogen, some of them march off into battle, but others may hang around like reserve troops, mulling over what they’ve learned. A couple of recent studies, one of them in mice, hint that repeated delivery of the same ingredients to those veteran learners could give the body a slight edge—though the extent of that advantage “might be marginal,” Victora told me. Still, Langel, of Duke, told me jokingly that because she usually gets all of her vaccines in her “non-writing” arm, the lymph node beneath it could now be especially superpowered—a “nice bonus” for her defenses on the whole.

That said, no one should stress too much about getting a shot in the “wrong” arm. “It’s not like you’re immune on the left side and not on the right side,” Goel told me. Immune cells travel throughout the body; there is no midline DMZ. Permar even points out that getting the newly formulated COVID vaccine, which includes new ingredients tailored to fight Omicron subvariants, on the opposite side from the previous rounds could help its ingredients reach a fresher slate of cells. “I think you could convince yourself either way,” she told me. Which, honestly, leaves me totally at peace with my choice. Apart from arm achiness, I had no other side effects—and in a way, I preferred the symmetry of the one-on-each-side injections.

With all that said, it’s worth briefly acknowledging a third option: Splitting the flu and COVID vaccines into separate visits. I was, before my most recent COVID shot, some 10 months out from my previous dose. But it felt awfully early for my flu shot, which might be better timed for peak protection if taken later in the season. Still, the allure of getting it all over with was too tantalizing, especially because I happen to have a lot of travel up ahead. In the grand scheme of things, the bigger, more important choice was opting into the shots at all.

Has COVID-19 become no more dangerous than the flu for most people?

That’s a question that scientists are debating as the country heads into a third pandemic winter. Early in the pandemic, COVID was estimated to be 10 times more lethal than the flu, fueling many people’s fears.

“We have all been questioning, ‘When does COVID look like influenza?”’ says Dr. Monica Gandhi, an infectious disease specialist at the University of California, San Francisco. “And, I would say, ‘Yes, we are there.'”

Gandhi and other researchers argue that most people today have enough immunity — gained from vaccination, infection or both — to protect them against getting seriously ill from COVID. And this is especially so since the omicron variant doesn’t appear to make people as sick as earlier strains, Gandhi says.

So unless a more virulent variant emerges, COVID’s menace has diminished considerably for most people, which means that they can go about their daily lives, says Gandhi, “in a way that you used to live with endemic seasonal flu.”

But there’s still plenty of differing views on this topic. While the threat from COVID-19 may be approaching the peril the flu poses, skeptics doubt it’s hit that point yet.

“I’m sorry — I just disagree,” says Dr. Anthony Fauci, the White House’s medical adviser, and director of the National Institute of Allergy and Infectious Diseases. “The severity of one compared to the other is really quite stark. And the potential to kill of one versus the other is really quite stark.”

COVID is still killing hundreds of people every day, which means more than 125,000 additional COVID deaths could occur over the next 12 month if deaths continue at that pace, Fauci notes. COVID has already killed more than 1 million Americans and it was the third leading cause of death in 2021.

A bad flu season kills about 50,000 people.

“COVID is a much more serious public health issue than is influenza,” Fauci says, noting this is especially true for older people, the group at the highest risk dying from the disease.

Debating the way deaths are counted

The debate over COVID’s mortality rate hinges on what counts as a COVID death. Gandhi and other researchers argue that the daily death toll attributed to COVID is exaggerated because many deaths blamed on the disease are actually from other causes. Some of the people who died for other reasons happened to also test positive for the coronavirus.

“We are now seeing consistently that more than 70% of our COVID hospitalizations are in that category,” says Dr. Shira Doron, an infectious disease specialist and professor at Tufts University School of Medicine. “If you’re counting them all as hospitalizations, and then those people die and you count them all as COVID deaths, you are pretty dramatically overcounting.”

If deaths were classified more accurately, than the daily death toll would be closer to the toll the flu takes during a typical season, Doron says. If this is true, the odds of a person dying if they get a COVID infection — what’s called the case fatality rate — would be about the same as the flu now, which is estimated to be around 0.1%, or perhaps even lower.

In a new report from the Centers for Disease Control and Prevention published Thursday, researchers attempted to filter out other deaths to analyze mortality rates for people hospitalized “primarily for COVID-19.” They find the death rate has dropped significantly in the omicron era, compared to the delta period.

But Fauci argues that it’s difficult to distinguish between deaths that are caused “because of” COVID and those “with” COVID. The disease has been found to put stress on many systems of the body.

“What’s the difference with someone who has mild congestive heart failure, goes into the hospital and gets COVID, and then dies from profound congestive heart failure?” he asks. “Is that with COVID or because of COVID? COVID certainly contributed to it.”

A second reason many experts estimate that COVID’s mortality rate is probably lower than it appears is that many infections aren’t being reported now because of home testing.

The fatality rate is a ratio — the number of deaths over the number of confirmed cases — so if there are more actual cases, that means that the likelihood of an individual dying is lower.

“I believe that we have reached the point where, for an individual, COVID poses less of a risk of hospitalization and death than does influenza,” Doron says.

Dr. Ashish Jha, the White House COVID-19 response coordinator, agrees, especially because the vaccines and treatments for COVID are better than those for the flu.

“If you are up-to-date on your vaccines today, and you avail yourself of the treatments, your chances of dying COVID are vanishingly rare and certainly much lower than your risk of getting into trouble with the flu,” Jha told NPR.

Risk remains high for the elderly and frail

But Jha stresses that omicron is so contagious and is infecting so many people that it overall “on a population level poses a much greater threat to the American population than flu does,” and it can still cause a greater number of total deaths.

And, mortality rates for any disease vary by age and other demographic factors. Importantly, COVID remains much more lethal for older and medically frail people than younger people. Recent data from the CDC shows that compared to 18- to 29-year-olds, people aged 65 to 74 have 60 times the risk of dying; those aged 75 to 84 have 140 times the risk; and those 85 and older have 330 times greater risk.

The danger is especially high for those not vaccinated, boosted and treated properly. And with COVID still spreading widely, they remain vulnerable to exposure from social contact.

While younger, otherwise healthy people can sometimes get very sick and even die from COVID, that’s gotten rare.

“I think it’s really important people have an accurate sense of the reality in order to go about their lives,” says Dr. Jake Scott, an infectious disease specialist at Stanford University. “If their risk assessments are being driven by or influenced by these overestimated hospitalization and death rates, I think that’s problematic.”

Waiting to see if the pattern in confirmed

Other researchers still argue that COVID remains far riskier than the flu.

“However you slice it, there was never an instance where COVID-19 was milder than the flu,” says Dr. Ziyad Al-Aly of Washington University in St. Louis, who has done research comparing COVID to the flu.

“We’ve never, ever in the history of the pandemic, in all our studies from the beginning until now, have found that COVID-19 is equally risky to the flu,” Al-Aly says. “It’s always carried a higher risk.”

Some experts are waiting for more data showing a clear trend in reduced mortality rates.

“I’ll probably feel more comfortable saying something like, ‘Oh COVID is similar to the flu’ when we actually see a pattern that resembles that,” says Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital in Boston in the division of health policy and public health. “We’re sort of just starting to see that, and I haven’t really seen that in a sustained way.”

Many also point out that COVID can increase the risk of experiencing long-term health problems, such as long COVID.

“Even people with mild to moderate symptoms from COVID can end up with long COVID,” Fauci says. “That doesn’t happen with influenza. It’s a totally different ball game.”

But Gandhi also questions that. Much of the estimated risk for long COVID comes from people who got seriously ill at the start of the pandemic, she says. And if you account for that, the risk of long-term health problems may not be greater from COVID than from other viral infections like the flu, she says.

“It was really severe COVID that led to long COVID. And as the disease has become milder, we’re seeing lower rates of long COVID,” Gandhi says.

In fact, some experts even fear that this year’s flu season could be more severe than this winter’s COVID surge. After very mild or even non-existent flu seasons during the pandemic, the flu hit Australia hard this year. And what happens in the Southern hemisphere often predicts what happens in North America.

“If we have a serious influenza season, and if the omicron variants continue to cause principally mild disease, this coming winter could be a much worse flu season than COVID,” says Dr. William Schaffner, an infectious disease researcher at Vanderbilt University.

ex-Propeller Health CEO to advise Aevice Health’s board

Singapore-based medtech company Aevice Health has appointed David Van Sickle, former CEO of mobile respiratory health firm Propeller Health, as its strategic board advisor.

According to a media release, Van Sickle, who has over 15 years of experience in digital health, will assist Aevice Health’s team in developing a US commercialisation strategy. He will also support the company’s efforts in building clinical evidence for its remote monitoring solutions.

“David’s experience and expertise will be instrumental in helping Aevice Health excel in the US market and beyond. He brought Propeller Health to the global stage and revolutionised the way asthma and COPD are managed. I look forward to his guidance and believe he will serve as a similar catalyst to the growth of Aevice Health,” said CEO Adrian Ang.

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Surgical robot maker Brain Navi to enter Middle East, Egypt markets

Taiwanese surgical robot maker Brain Navi is set to enter the GCC region and Egypt through its latest distribution partnership with Medtreq Medical Equipment.

The deal involves the distribution of its NaoTrac surgical navigation robot, which combines machine vision and a proprietary algorithm to perform robot-assisted surgery, streamlining surgical procedures with real-time imaging and minimal invasive outcomes.

Aside from the Middle East and Egypt, the companies will also market the NaoTrac robots in Jordan, as well as in Southeast Asia, including the Philippines, Indonesia, Malaysia, and Singapore, through Medtreq’s Philippine branch.

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Olympus introduces third-gen Visera Elite surgical visualisation platform

Olympus Corp., a Japanese optical and digital precision technology manufacturer, has unveiled its latest surgical visualisation platform for endoscopic procedures across multiple medical disciplines.

The Visera Elite III offers multiple observation modes, integrating 3D and infrared imaging functions from its predecessor Visera Elite II and a 4K imaging function from VISERA 4K UHD system.

It comes with a focus adjust mode during 4K surgical observation and an EDOF (Extended Depth of Field) function that allows precise endoscopic observations through continuous broad focus and seamless magnification. It also provides C-AF (Continuous Auto Focus) capability that automatically adjusts the focus in accordance with the movement of the camera head and endoscope. It also supports fluorescence-guided surgery and Narrow Band Imaging, a unique observation mode developed by Olympus for examining features such as small blood vessels in the mucosa and surface patterns. 

Moreover, this latest system allows users to set up customised departmental profiles for different medical disciplines.

Olympus now allows software upgrades to Visera Elite III to add new surgical imaging functions, making it no longer necessary to replace an entire surgical visualisation system to access the latest technology. 

Visera Elite III will become available across Europe, EMEA, parts of Asia, Oceania, and Japan from September this year.

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Andhra Pradesh’s NATCO Cancer Center adopts Dozee’s RPM solution

The NATCO Cancer Center, the flagship cancer hospital of the state of Andhra Pradesh in India, has started installing a contactless remote patient monitoring solution from Dozee.

The connected bed platform uses AI to track vital parameters such as heart rate, respiration rate, blood pressure, oxygen saturation, ECG, and temperature. It also has an early warning system that helps staff identify signs of patient deterioration. 

In adopting the solution, Dr Durgaprasad, professor and head of Radiation Oncology at NATCO Guntur, said: “Cancer patients need constant vital monitoring, timely critical care, and at the same time are highly prone to associated infections. By adopting Dozee’s contactless patient monitoring [solution], nurses and doctors can prioritise critical patients as a result of the timely alerts.”

The remote patient monitoring solution is being provided through Dozee’s MillionICU initiative, which seeks to convert one million hospital ward beds into smart connected beds.

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During the first two years of the pandemic, the number of people working from home in the United States tripled, home values grew and the percentage of people who spent more than a third of their income on rent went up, according to survey results released Thursday by the U.S. Census Bureau.

Providing the most detailed data to date on how life changed in the U.S. under COVID-19, the bureau’s American Community Survey 1-year estimates for 2021 showed that the share of unmarried couples living together rose, Americans became more wired and the percentage of people who identify as multiracial grew significantly. And in changes that seemed to directly reflect how the pandemic upended people’s choices, fewer people moved, preschool enrollment dropped and commuters using public transportation was cut in half.

The data release offers the first reliable glimpse of life in the U.S. during the COVID-19 era, as the 1-year estimates from the 2020 survey were deemed unusable because of problems getting people to answer during the early months of the pandemic. That left a one-year data gap during a time when the pandemic forced major changes in the way people live their lives.

The survey typically relies on responses from 3.5 million households to provide 11 billion estimates each year about commuting times, internet access, family life, income, education levels, disabilities, military service and employment. The estimates help inform how to distribute hundreds of billions of dollars in federal spending.

Response rates significantly improved from 2020 to 2021, “so we are confident about the data for this year,” said Mark Asiala, the survey’s chief of statistical design.

While the percentage of married-couple households stayed stable over the two years at around 47%, the percent of households with unwed couples cohabiting rose to 7.2% in 2021 from 6.6% in 2019. Contrary to pop culture images of multigenerational family members moving in together during the pandemic, the average household size actually contracted from 2.6 to 2.5 people.

People also stayed put. More than 87% of those surveyed were living in their same house a year ago in 2021, compared to 86% in 2019. America became more wired as people became more reliant on remote learning and working from home. Households with a computer rose, from 92.9% in 2019 to 95% in 2021, and internet subscription services grew from 86% to 90% of households.

The jump in people who identify as multiracial—from 3.4% in 2019 to 12.6% in 2021—and a decline in people identifying as white alone—from 72% to 61.2%—coincided with Census Bureau changes in coding race and Hispanic origin responses. Those adjustments were intended to capture more detailed write-in answers from participants. The period between surveys also overlapped with social justice protests following the killing of George Floyd, who was Black, by a white Minneapolis police officer in 2020 as well as attacks against Asian Americans. Experts say this likely lead some multiracial people who previously might have identified as a single race to instead embrace all of their background.

“The pattern is strong evidence of shifting self-identity. This is not new,” said Paul Ong, a professor emeritus of urban planning and Asian American Studies at UCLA. “Other research has shown that racial or ethnic identity can change even over a short time period. For many, it is contextual and situational. This is particularly true for individuals with multiracial background.”

The estimates show the pandemic-related impact of closed theaters, shuttered theme parks and restaurants with limited seating on workers in arts, entertainment and accommodation businesses. Their numbers declined from 9.7% to 8.2% of the workforce, while other industries stayed comparatively stable. Those who were self-employed inched up to 6.1% from 5.8%.

Housing demand grew over the two years, as the percent of vacant homes dropped from 12.1% to 10.3%. The median value of homes rose from $240,500 to $281,400. The percent of people whose gross rent exceeded more than 30% of their income went from 48.5% to 51%. Historically, renters are considered rent-burdened if they pay more than that.

“Lack of housing that folks can afford relative to the wages they are paid is a continually growing crisis,” said Allison Plyer, chief demographer at The Data Center in New Orleans.

Commutes to work dropped from 27.6 minutes to 25.6 minutes, as the percent of people working from home during a period of return-to-office starts and stops went from 5.7% in 2019 to almost 18% in 2021. Almost half of workers in the District of Columbia worked from home, the highest rate in the nation, while Mississippi had the lowest rate at 6.3% Over the two years, the percent of workers nationwide using public transportation to get to work went from 5% to 2.5%, as fears rose of catching the virus on buses and subways.

“Work and commuting are central to American life, so the widespread adoption of working from home is a defining feature of the COVID-19 pandemic,” said Michael Burrows, a Census Bureau statistician. “With the number of people who primarily work from home tripling over just a two-year period, the pandemic has very strongly impacted the commuting landscape in the United States.”

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Evernorth, the health services arm of insurer Cigna, announced it has added five new programs to its digital health formulary, including offerings from Big Health and Quit Genius.

The new additions to the formulary are Big Health’s Sleepio digital therapeutic for insomnia and its Daylight tool for anxiety, Quit Genius’ alcohol use disorder and opioid use disorder programs, and HealthBeacon’s injectable medication adherence tool for inflammatory conditions.

Evernorth also announced four pilot programs, which will evaluate the chosen tools for clinical impact and user experience. Those pilots are Jasper Health for cancer care, Zerigo Health for psoriasis and eczema, Hinge Health’s new women’s pelvic health program and Lid Sync’s medication adherence tool. 

The subsidiary said the tools included in its formulary have been reviewed by physicians, pharmacists and user experience experts, and meet Evernorth’s standards for clinical effectiveness, security and privacy, value and usability. Health plan sponsors can choose to offer these digital health tools as part of their benefits.

“Evernorth continues to expand our Digital Health Formulary to address unmet health care needs of patients with chronic and complex medical conditions,” Dr. Glen Stettin, chief innovation officer at Evernorth, said in a statement. “The latest additions give patients access to new and affordable options to improve and maintain their health while making it easier and cost effective for our clients to include these solutions in their benefit plans. The Digital Health Formulary is one of the ways we can connect employers, insurers and patients with innovative, affordable and evidence-based care that meet their broader healthcare needs.”

THE LARGER TREND

Express Scripts, a pharmacy benefit manager that is now under the Evernorth portfolio, first announced plans to launch a digital health formulary several years ago. It also added new tools to the program in late 2020, including Wildflower Health’s app-based women’s health offering, Quit Genius’ program for smoking and vaping cessation, and muscle and joint pain programs from Hinge Health.

Evernorth has recently added other offerings in the digital health and health tech space, including a partnership with Bicycle Health for virtual opioid use disorder treatment and an expansion of its continuous glucose monitor coverage. It acquired telehealth provider MDLive last year as well. 

A recent survey of 1,300 physicians by the American Medical Association found more doctors saw digital health tools as an advantage for patient care this year compared with 2016. However, there are still concerns about quality and efficacy. A study published in JMIR earlier this year found many digital health startups weren’t clinically robust, lacking clinical trials or regulatory filings. 

Meanwhile, Big Health announced a $75 million Series C funding round early this year, while Quit Genius closed a $64 million Series B in 2021. Irish firm HealthBeacon went public late last year on Euronext’s growth market in Dublin.