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Our Take: Update on the omicron variant, vaccines, and other COVID-19 treatments

Dec 13, 2021

So far, nearly all reported cases of COVID-19 resulting from infection with the omicron variant have been mild, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention (CDC), said during a news briefing on Friday.

She cautioned that data on the latest variant provides only a very early glimpse of omicron infections here in the U.S.

According to the CDC’s most recent Morbidity and Mortality Weekly Report, as of last Wednesday 43 people had confirmed cases of COVID-19 attributed to the omicron variant. One-third of them had traveled internationally during the two weeks before testing positive or exhibiting symptoms.

Among the group, 34 had been vaccinated and 14 had also received a booster shot, although five had been infected within the two weeks after receiving the booster, before the shots had time to take full effect. Six of the overall group had previously been infected with some version of the SARS-CoV-2 coronavirus. There was one hospitalization, which lasted two days. So far, no deaths have been reported.

Although the first confirmed case in the U.S. was reported in California on Dec. 1, the CDC report noted that the earliest onset of symptoms among the 43 cases started on Nov. 15, suggesting that the omicron variant was present in the U.S. earlier than health officials originally thought.

As of Friday, cases associated with the omicron strain had been reported in 25 states.

On Wednesday, Pfizer and BioNTech acknowledged that blood samples taken from people who had received the initial two-dose vaccination showed a 25-fold drop in neutralizing antibodies against the omicron variant. But they also reported that a booster shot appears to provide the same level of protection against the omicron strain as the two-dose series provided against the earliest strain of the virus. The blood samples were taken three weeks after the second dose of the vaccine or a month after the booster.

On Thursday, the FDA authorized boosters of Pfizer and BioNTech’s vaccine for 16- and 17-year-olds, giving the green light for those in this age group to receive a booster at least six months after receiving the initial series of vaccinations.

Dr. Ugur Sahin, CEO of BioNTech, said the companies continue to work on an adapted vaccine that could “help to induce a high level of protection against omicron-induced COVID-19 disease as well as a prolonged protection compared to the current vaccine.”

Public health officials still do not know yet whether omicron-specific vaccines will be needed. If the existing vaccines provide enough protection to prevent most people from being hospitalized or dying, then adapting the vaccines for omicron and future variants may not be necessary. Instead, new vaccines could be developed annually, as they are for new strains of influenza.

Last Tuesday, GlaxoSmithKline and Vir Biotechnology said preclinical data indicates that an investigational monoclonal antibody they are developing, sotrovimab, appears to be effective against all tested variants of the coronavirus — including omicron. The drug would be taken during the early stages of infection, with the goal of preventing progression to more serious disease.

Last Monday, the FDA authorized the first treatment to be used as a pre-exposure prophylaxis for COVID-19. The emergency use authorization was issued for AstraZeneca’s Evusheld (tixagevimab administered with cilgavimab). The long-acting, injectable treatment is only authorized for individuals who are at least 12 years old, who are not infected with the SARS-CoV-2 virus and have not been recently exposed to someone who is infected, and who either have a compromised immune system or a history of severe adverse reactions to a COVID-19 vaccine.

Meanwhile, the delta variant continues to drive reported COVID-19 cases up substantially. As of Friday, cases were up 23% compared with before Thanksgiving, based on data from Johns Hopkins University.

What else you need to know
City of Hope will acquire Cancer Treatment Centers of America (CTCA). Although the organizations did not provide financial details in their joint press statement, Reuters reported the value of the deal at $390 million. City of Hope is a National Cancer Institute-designated cancer research and treatment organization based in Duarte, Calif., near Los Angeles. It is also a founding member of the National Comprehensive Cancer Network. CTCA is based in Boca Raton, Fla., with hospitals and outpatient care centers in Arizona, Georgia, and Illinois. The acquisition is expected to close in early 2022, pending regulatory approval. Dr. Pat Basu will stay on as CEO of CTCA, reporting to Robert Stone, City of Hope’s CEO. After the deal has been completed, City of Hope plans to convert CTCA from a for-profit network to a non-profit organization.

Cigna is a co-investor in Bright Health Group’s latest round of financing. Through its capital ventures arm, Cigna Ventures, the insurer will contribute the lion’s share of the total $750 million investment. New Enterprise Associates, Bright Health’s largest investor to date, will contribute the remaining $200 million. Bright Health comprises Bright Healthcare, which offers commercial and Medicare health plans, and NeueHealth, which provides care through a network of 131 owned and affiliated clinics. Tom Richards, head of Cigna Ventures, said in a news release, “We look forward to exploring new ways that NeueHealth and Evernorth can potentially provide services to each other’s customers and clients.” Evernorth is the brand name of Cigna’s health services portfolio.

The use of telehealth by Medicare beneficiaries increased 63-fold year over year from 2019 through 2020, according to a new report by the Department of Health and Human Services. In 2019, approximately 840,000 Medicare Part B visits were conducted via telehealth, the report notes. With the onset of the pandemic, the number of telehealth visits increased in 2020 to about 52.7 million. Specialists in behavioral health experienced the largest increase; one-third of the visits to these specialists were conducted through telehealth. Despite the dramatic increase in telehealth usage during this time period, overall health care visits for Medicare beneficiaries dropped 11.4%.

Centene is exploring “strategic alternatives” for its international business, which generates revenue of more than $2 billion, according to an investor presentation. Two-thirds of that revenue comes from Circle Health Group, which operates a network of more than 50 hospitals, clinics, and specialist centers in the U.K. Centene already had a 40% stake in Circle Health before acquiring full ownership in July of this year. Ribera Salud, based in Valencia, Spain, generates the remainder. Centene owns 90% of Ribera, which operates 10 hospitals and 71 primary care and outpatient clinics. Centene said it is reviewing its non-core assets as part of the company’s ongoing portfolio optimization processes.

BD (Becton, Dickinson and Co.) has chosen a name for the new company that will take over BD’s diabetes care business: embecta. BD announced in May that it would spin off its diabetes business into an independent, publicly traded company. The Franklin Lakes, N.J.-based manufacturer of injection devices said in a press release that it anticipates finalizing the spinoff in the second quarter of 2022. Devdatt Kurdikar, who joined BD in February and is the worldwide president of BD Diabetes Care, will be embecta’s CEO.

What we’re reading
Diagnostic Excellence Through the Lens of Patient-Centeredness. JAMA Viewpoint,11.18.21
Audio Interview: Waning Immunity against SARS-CoV-2. NEJM, 12.7.21 
At-home primary care demo hasn’t saved Medicare money, study finds. Modern Healthcare, 12.6.21 (subscription required)

What else we’re reading
How We Got to Now: Six Innovations That Made the Modern World, by Steven Johnson.

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