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Myoung Cha

Jan 18 • 11 tweets • 2 min read

My ten “surprises” in healthcare for 2022 — events that the average person would only assign a one out of three chance of taking place but which I believe have a better than 50% likelihood of happening. Styled after Byron Wien’s annual predictions. 🧵

blackstone.com/news/press/byr…

#1: There is at least one new variant that emerges in 2022 that drives another omicron-sized surge of cases and hospitalizations, putting renewed stress on the healthcare system.

#2: Employers capitulate in mandating in-person return-to-work (with a few notable exceptions) for 2022. A widely distributed workforce enhances the value proposition of national, scaled healthcare players and virtual solutions.

#3: The cumulative impact of COVID on election districts with higher unvaccinated rates makes a difference in several very close mid-term races in the fall.

#4: 25+ million people in the US report dealing with long COVID symptoms by the end of 2022 — more than the total number of asthma patients and shy of the type 2 diabetes patient population.

#5: Governments around the world put massive pressure on Pfizer, Moderna, and Merck to scale global vaccine and therapeutic capacity — either through a grand deal or IP waiver/knowledge transfer.

#6: Labor shortages and wage inflation drive an unvirtuous cycle of price increases in concentrated healthcare markets. Rate increases ripple through the system in 2023 and beyond.

#7: The dawn of virtual-first primary care products matches the moment of a post-COVID world with 2-3x the engagement of traditional telemedicine-based urgent care. Every major health plan is actively selling a virtual primary care plan for the 2023 season.

#8: Meta launches its first wrist wearable, primarily as a controller for its metaverse platform but with a few interesting health features at launch.

#9: MLRs skyrocket with sustained COVID-related costs (including home test reimbursements), catch-up procedures long deferred, and the impact of delayed preventative care and screenings coming home to roost.

#10: Oracle-Cerner, Athenahealth, and Microsoft-Nuance mark the kickoff of large deal making in health tech in 2022.

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Myoung Cha

@cha_myoung

Jan 16

@CarbonHealth

1/ How “mild” is omicron?

When compared against Delta hospitalization and death rates, the numbers look better.

When you look at how sick people are when they seek care, the data tells a different story.

Some data from @CarbonHealth since early December 2022 thru present🧵

2/ Symptomatic COVID+ patients are showing up to our clinics with more symptoms than COVID- patients presenting with flu-like symptoms:

3 or more symptoms: 58% (+) versus 43% (-)
4 or more symptoms: 38% (+) versus 25% (-)

3/ Most common COVID+ symptoms are cough (65%), sore throat (51%), headache (45%), and runny nose (45%).

COVID+ symptoms are 1.5-2.0x overweight cough and fever compared to COVID- patients

Read 6 tweets

Myoung Cha

@cha_myoung

Jan 13

1/ Even with the Supreme Court invalidating the Biden vaccine mandate, large companies are likely to take matters into their own hands with “sticks” (versus “carrots”). Even with a “mild” variant, economic consequences are significant enough to impact corporate behavior 🧵

2/ With hospitalizations surging (with fewer deaths) among the unvaccinated, the bill will come due at some point — to the tune of $20,000+ per hospitalization.

healthsystemtracker.org/brief/unvaccin…

3/ Beyond hospitalization costs, the higher case rates of unvaccinated people have implications for productivity loss due to absence along with short-term disability costs. Chart below shows the trend for NYC.

Read 11 tweets

Myoung Cha

@cha_myoung

Jan 10

1/ With the omicron wave putting untold pressure on staffing across a wide variety of industries, it is not inconceivable for these staffing shortages to become more “endemic” with behaviors that have likely changed forever. 🧵

2/ An estimated 5 million people are isolating at home due to omicron, which could “deal a significant hit to the economy over the next month or two.”

wsj.com/articles/omicr…

3/ In historical flu seasons, the current omicron-driven work absentee rate would be ~2x the average peak of workplace absence due to all illnesses in the US (largely flu).

Read 14 tweets

Myoung Cha

@cha_myoung

Jan 6

1/ One of the biggest policy failures over the last 2 years is the lack of COVID testing, particularly evident now with omicron — both the supply and the quality of what we have available at scale. Where is our Operation Warp Speed for diagnostics? 🧵

2/ Based on the sheer scale of testing volume, it’s clear many are concerned with exposure to omicron and are not yet “done with COVID”. Labs are reporting >1.5 million PCR tests per day right now. But this is a massive underestimate of the total volume w/antigen tests in the mix

@AbbottNews

3/ Based on recent disclosures, the leading antigen test kit mfg. production volumes right now are estimated to be ~120 M tests/month

@AbbottNews: 50 M/month
@QuidelDX: 70 M/month

This is ~4x the reported daily PCR volume with a clear hunger for even more from consumers.

Read 16 tweets

Myoung Cha

@cha_myoung

Jan 1

1/ There are a lot of takes that this omicron wave will bring us closer to “normal” in 2022 when COVID will become endemic and be “just like the flu.” A comparison with historical flu seasons shows just how far away this really is and how much longer we may need to go. 🧵

2/ The key societal question is what level of mortality & morbidity do we accept from COVID in the long run. If influenza is the right analogue, then this chart shows that COVID has broken well beyond the baseline and “epidemic” threshold of mortality of prior flu seasons.

3/ “Just like the flu,” you say?

Let’s drill into some US data:
* 11,707 weekly PIC (pneumo, influenza, COVID) deaths since Labor Day
* At the peak of Delta, ~18,000 weekly PIC deaths

This is 3-5x our pre-COVID flu baseline (~3,500 weekly deaths).

cdc.gov/flu/weekly/wee…

Read 18 tweets

Myoung Cha

@cha_myoung

Dec 29, 2021

@pfizer

1/ The great hope right now is that the orals from @pfizer and @Merck are the “silver bullet” that will bring an “end” to omicron and the pandemic. These are amazing new Rx’s, but deploying them properly will be way harder than people think. 🧵

2/ We now have another weapon in the toolkit with oral pills that do not have the same burdensome requirements of mAbs. ~90% risk reduction from Pfizer’s Paxlovid in high-risk patients is indeed excellent. pfizer.com/news/press-rel…

3/ The FDA EUA for Paxlovid specifies that the treatment must be administered within 5 days of symptoms. The name of the game here is speed: the longer the treatment start is from symptom onset, the less impact these orals will likely have.

Read 18 tweets

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