New work in @JAMA_current today - who has been getting those precious monoclonal antibody infusions for COVID-19 in the US?

It's not pretty ...

Work led by @CarolineLBehr with @kejoynt @ermeara Arnie Epstein and John Orav.

jamanetwork.com/journals/jama/… ImageImageImage
@JAMA_current @CarolineLBehr @kejoynt @ermeara We identified 1.9 million cases of COVID-19 in Medicare claims without hospitalization/death in the first week.

In nearly every case, those at higher risk of dying from COVID-19 were LESS likely to get monoclonal antibodies (mAbs).

jamanetwork.com/journals/jama/…
@JAMA_current @CarolineLBehr @kejoynt @ermeara Overall, 7.2% of Covid cases got mABs.

But the variation by demographic group is extreme.

0 chronic conditions: 23.2%
6+ chronic conditions: 4.7%

No Medicaid: 8.1%
Medicaid eligible: 4.6%

White: 7.4%
Black: 6.2%

No dementia: 7.8%
Dementia: 3.7%
@JAMA_current @CarolineLBehr @kejoynt @ermeara I was also shocked at how much mAb distribution varied across the country.

In the South, 10.6% got mABs while in the Western states, only 2.9%!

In Rhode Island and Louisiana 24.9% and 21.2% got mAb, but 1% or less in Alaska and Washington.

I think that's crazy ImageImage
@JAMA_current @CarolineLBehr @kejoynt @ermeara Bottom line: mAb therapy did NOT get to those who needed it most in many, many places in the US from Nov 2020-Aug 2021.

Why? Getting mAb is extremely complex and has to be done quickly.

@CarolineLBehr and I discuss more in a piece in @statnews today.

statnews.com/2022/02/04/hig…
@JAMA_current @CarolineLBehr @kejoynt @ermeara @statnews Read the whole paper at @JAMA_current here:
jamanetwork.com/journals/jama/…

And thanks to my wonderful co-authors and @NIHFunding from National Institute on Aging for supporting this work.

Keep an eye out for MS4 @CarolineLBehr in the future :)

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More from @ml_barnett

Dec 22, 2021
Here's my list of 12 papers in 2021 at the intersection of health care, medicine, economics and policy that surprised me, made me think, or were just damn clever.

I'm just going to focus on non-COVID-19 papers - we have enough of that other stuff in our feeds.

Off we go!

/1
Before we dive in - this is
A) definitely not comprehensive
B) definitely not in order of awesomeness

I’m also focusing on papers written by folks outside my direct circle of collaborators (w/ a couple of non-Harvard exceptions I can’t resist).

Sorry @AnupamBJena

/2
@AnupamBJena The first set of papers falls under the theme of "obviously broken systems that we could fix and improve health."

Paper 1:
"SNAP Participation and Health Care User in Older Adults" led by Seth Berkowitz @UNC_SOM and @SanjaybMDPhD in @AnnalsofIM

acpjournals.org/doi/10.7326/M2…
Read 30 tweets
Dec 9, 2021
New analysis in @NEJM today with coauthors @McGarryBE @ashdgandhi @DavidCGrabowski

Vaccine mandates continue to be controversial, including in nursing homes. What are the stakes exactly?

The results are sobering, to say the least ...

nejm.org/doi/full/10.10…
@NEJM @McGarryBE @ashdgandhi @DavidCGrabowski From June-Aug 2021, we compared resident and staff infection + mortality rates between 12,000 homes with the lowest staff vaccination rates (~30%) vs. highest (~80%).

In the least vaccinated homes:
+132% COVID cases in residents
+58% staff cases
+195% resident mortality

yikes
@NEJM @McGarryBE @ashdgandhi @DavidCGrabowski Over an 8 week period, if all nursing homes were magically raised to the highest staff vaccination levels nationally (~80%), we would have:

4,775 fewer resident cases
7,501 fewer staff cases
703 fewer resident deaths (nearly 50% of all deaths)
Read 4 tweets
Nov 8, 2021
Extremely provocative French study out in @JAMAInternalMed this morning on persistent COVID symptoms.

What is the association between persistent symptoms and COVID-19 serology vs. patient belief that they had COVID?

jamanetwork.com/journals/jamai…
@JAMAInternalMed The authors took a cross sectional cohort of >26,000 French survey respondents and compared their reports of persistent symptoms in early 2021 with:

1) COVID-19 serology collected May-Nov 2020
2) Self-reported belief about prior COVID-19 infection

2x2 table of pt chars below
@JAMAInternalMed Their findings:
1) Positive serology associated with 10/18 persistent symptoms

2) Positive belief association with 15/18 persistent symptoms

3) Controlling for serology, belief, other characteristics, all symptoms were associated with +belief, but not +serology (except anosmia)
Read 6 tweets
Mar 13, 2021
There was a totally overlooked trial in @NEJM this week with jaw-dropping results. The question: how should we diagnose diabetes in pregnancy?

23,792 pregnant women randomized to receive either 1-step or 2-step screening for gestational diabetes.

nejm.org/doi/full/10.10…

/1
@NEJM There's no consensus on how to diagnose diabetes in pregnancy, which is VERY common and, if treated, can reduce risk of infant + maternal complications.

So the authors compared the more sensitive, single visit "one step" approach to a "two step" approach that can take 2 visits.
@NEJM There was a HUGE difference in diabetes diagnosis between the two groups:

One-step: 16.5% of women diagnosed with diabetes

Two-step: 8.5% diagnosed

This diagnosis comes with a lot of emotional and clinical baggage!!

…pregnancychildbirth.biomedcentral.com/articles/10.11…
Read 9 tweets
Jan 13, 2021
Brief primary care rant.

It's 2021. We have developed an effective vaccine for a novel virus in months and we can land a probe on a comet.

There is major cognitive dissonance with our potential as a society vs. the every day struggle to provide basic care for common conditions
Let me give a few examples.

Take hypertension. 1 in 3 Americans has it. It causes millions of years of life lost.

What is the process to diagnose and treat it? I have to beg my patient to buy a $40 cuff at a pharmacy, measure their BP, then call or send the numbers to me.
Alternative is coming to the office to get their BP measured. What a waste of resources. There are no cheap BP cuffs that can upload measurements to our EHR. Insurance doesn't cover them.

Without data I can't just randomly prescribe and titrate a BP med and hope for the best.
Read 12 tweets
Dec 8, 2020
On Saturday, I went outside to clear the small hill of ice that snow plows helpfully deposit on our driveway when it snows.

I didn't see a slick patch of ice. My feet flew into the air and I went splat on my left shoulder.

I was in enormous pain and realized I needed help.
I went to a local ED with a shoulder dislocation. I had a totally normal experience - in fact, I think above average.

But this time, as a patient, I learned again how "totally normal" in our health system is frustrating, isolating and bewildering.
After I checked in and was sitting in the waiting room, the endorphins from my fall wore off and I realized that I was in terrible pain.

The triage nurse called me in. I told her I was in a lot of pain. She snapped at me: "Look, I'm doing my job and you have to wait your turn."
Read 19 tweets

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