Listen Up

Friday, December 17, 2021

Even before COVID, Dr. Michael Greiwe, knew that telemedicine technology would help his orthopedic practice, OrthoCincy, grow as well as increase his patient’s satisfaction and engagement. So he developed the OrthoLive telemedicine platform because there was nothing that met his needs as an orthopedic provider.In this episode, hosts John Ellis and Jennifer Thompson chat with Dr. Greiwe, Founder of Ortholive, which provides convenient, secure access to care while increasing efficiency, revenue, and user satisfaction without a steep or unnecessary learning curve. Listen as we discuss how telemedicine has affected the healthcare industry, the challenges, and the opportunities and what it may look like a few years from now.



Post Covid demand for healthcare continues as the cycle continues to be a seasonal one.  The latest iteration of Covid 19 is now called "Omicron". It is even more easily transmitted and highly infections.  Current rates of growth are double daily.


Even in non related medical specialties physicians are finding it helpful if not necessary to use telehealth to improve patient access, decrease transportation and diminish exposure especially to elderly patients with chronic diseases, such as diabetes, heart disease, or immun-compromise. The key ingredient for prevention was and always will be vaccination.  The third jab is recommended for all those who are eligible.

 

Tune in to discover:

 

  • The process and the challenges of implementing telemedicine
  • The evolution and role of improved technology
  • What happens to telemedicine post-COVID?
  • Is there data that correlates to increased revenue for practices?
  • Is telemedicine a sustainable model where healthcare clinics use telemedicine to fill empty appointment slots?
  • The accessibility of telemedicine for rural communities and healthcare practices

Saturday, December 11, 2021

The COVID-19 pandemic caused by the novel coronavirus (SARS-CoV-2) continues to reshape the globe.

New York's COVID Surge Is Back and So Is Its Mask Mandate.

The resurgence of Covid 19 appears to have become regional, and appears in waves. The earliest cases in the United States were easily found to be near and around international airports originating from airline traffic from South Africa.  It did not take long for community outbreaks to occur.  Twenty-first Century travel and transportation makes case tracking very difficult, since public health resources are already strained.

Mask fatigue and vaccine resistance by the public add a troublesome component to the war on COVID. Facing a winter surge in COVID-19 infections, New York Gov. Kathy Hochul announced Friday that masks will be required in all indoor public places unless the businesses or venues implement a vaccine requirement.  Though supported by many, mask mandates also have become a hot-button issue. Republican elected officials reacting to Hochul's announcement called it an unnecessary burden on businesses.


"This newest mask mandate is government overreach at its worst," said Republican Assemblyman Mike Lawler of suburban Rockland County. "Across New York state, we are getting shots in arms and our vaccination rate is one of the highest in the nation."

COVID disinformation has also affected good judgment amongs caregivers. The Federated Board of State Medical Boards of Medical Examiners and the Tennessee Board of Medical Examiners have issued warnings and reprimands to those M.D. issuing false information about COVID vaccinations and treatments.

12 State Boards Have Disciplined Docs for COVID Misinformation


“Physicians who generate and spread COVID-19 vaccine misinformation or disinformation are risking disciplinary action by state medical boards, including the suspension or revocation of their medical license. Due to their specialized knowledge and training, licensed physicians possess a high degree of public trust and therefore have a powerful platform in society, whether they recognize it or not. They also have an ethical and professional responsibility to practice medicine in the best interests of their patients and must share information that is factual, scientifically grounded and consensus-driven for the betterment of public health. Spreading inaccurate COVID-19 vaccine information contradicts that responsibility, threatens to further erode public trust in the medical profession and puts all patients at risk.”

The organization said 15 state boards have now adopted similar statements.

Chaudhry said the FSMB was "encouraged by the number of boards that have already taken action to combat COVID-19 disinformation by disciplining physicians who engage in that behavior and by reminding all physicians that their words and actions matter, and they should think twice before spreading disinformation that may harm patients."

Only 12 state medical boards have taken action against physicians who have spread false or misleading information about COVID-19, according to a new survey from the Federation of State Medical Boards (FSMB).

The FSMB reports that in its 2021 annual survey two-thirds of its 71 member boards (which includes the United States, its territories, and Washington, DC) reported an increase in complaints about doctors spreading false or misleading information.

"The staggering number of state medical boards that have seen an increase in COVID-19 disinformation complaints is a sign of how widespread the issue has become," said Humayun J. Chaudhry, DO, MACP, president and CEO of the FSMB, in a statement.

Thursday, December 9, 2021

COVID-19 Infections Among Vaccinated More Common and Severe in Immunocompromised: Study


Breakthrough COVID-19 cases are more common and severe in people with weakened immune systems, according to a new study.

Breakthrough infections are those that occur in vaccinated people.

Immunocompromised vaccinated people were three times more likely to contract COVID-19, the disease caused by the CCP (Chinese Communist Party) virus, according to researchers, who published their findings in the Journal of Medical Economics.


The Epoch Times refers to the novel coronavirus, which causes the disease COVID-19, as the CCP virus because the Chinese Communist Party’s coverup and mismanagement allowed the virus to spread throughout China and create a global pandemic.

The study found that just 0.08 percent of fully vaccinated people had a breakthrough case, but that 0.18 percent of immunocompromised people had a breakthrough infection. While immunocompromised people represented 18 percent of those studied, they accounted for over 38 percent of infections, nearly six in 10 hospitalizations, and all the deaths.

Researchers analyzed nearly 1.2 million U.S. HealthVerity database records between Dec. 10, 2020, and July 8.

The study was conducted by Pfizer scientists and funded by the company, which makes one of the three COVID-19 vaccines available in the United States.


“The results supplement other real-world studies, and support the introduction of a third dose of a COVID-19 vaccine to increase protection among the immunocompromised individuals,” Manuela Di Fusco, the lead author and a part of Pfizer’s health economics and outcomes research team, said in a statement.

The cutoff date means researchers excluded records from the time period when other research indicates vaccine effectiveness against infection waned significantly, as many Americans were vaccinated in late 2020 or early 2021. Breakthrough infections, hospitalizations, and deaths have risen over time.

Booster doses, or third doses of the Pfizer or Moderna vaccines, were cleared by U.S. drug regulators in recent weeks because of the waning effectiveness.

The Centers for Disease Control and Prevention, which initially recommended the additional shots for those 50 and older, announced on Nov. 29 that its now advising all individuals 18 and older to get one.

The agency cited the emergence of the Omicron CCP virus variant, although many scientists say it’s too soon to tell if the variant evades immunity better than other strains.

The new study was published after researchers in the Netherlands reported that an examination of 378 breakthrough infections identified in the country between January and July signaled the emergence of the CCP virus Delta variant and “a strong increase in breakthrough infections,” with more seen in people vaccinated with the AstraZeneca or Johnson & Johnson jabs than people who got a Pfizer or Moderna shot.

Researchers said in the pre-print paper that they saw many severe breakthrough cases among the elderly, although symptomatic cases were recorded in a number of younger people.

“Altogether, these results indicate that the emergence of the Delta variant might have lowered the efficiency of particular vaccine types to prevent SARS-CoV-2 infections and that, although rare, the elderly are particularly at risk of becoming severely infected as the consequence of a breakthrough infection,” they said.










COVID-19 Infections Among Vaccinated More Common and Severe in Immunocompromised: Study

Friday, December 3, 2021

What went wrong in December 2019 ?

From the very beginning of the COVID-19 crisis, Dr. Jay Bhattacharya has been on the front lines of analyzing, studying, and even personally fighting the pandemic. In this wide-ranging interview, Dr. Bhattacharya takes us through how it started, how it spread throughout the world, the efficacy of lockdowns, the development and distribution of the vaccines, and the rise of the Delta variant. He delves into what we got right, what we got wrong, and what we got really wrong. Finally, Dr. Bhattacharya looks to the future and how we will learn to live with COVID rather than trying to extinguish it, and how we might be prepared to deal with another inevitable pandemic that we know will arrive at some point.



Omicron, where did it come from?

 

Wednesday, December 1, 2021

First Case of Omicron Virus Variant Detected in US: Officials


First Case of Omicron Virus Variant Detected in US: Officials



The first case of the CCP (Chinese Communist Party) virus Omicron variant was detected in California, officials said Wednesday.


Genomic sequencing conducted at the University of California, San Francisco, and confirmed by scientists with the Centers for Disease Control and Prevention confirmed the case was caused by the variant.

The patient traveled from South Africa on Nov. 22 and tested positive for COVID-19 a week later.

The person, who has not been publicly identified, is self-isolating, Dr. Anthony Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases, told reporters in Washington.

All of the person’s close contacts have been contacted and, thus far, all have tested negative for COVID-19, a disease caused by the CCP virus.

The person is fully vaccinated. He or she is experiencing mild symptoms that are improving.

“We knew that it was just a matter of time before the first case of Omicron would be detected in the United States,” Fauci said.

He urged people to get a COVID-19 vaccine if they have not and to get a booster if they already have.

Health authorities have not identified any additional potential cases at this point.

The United States restricted travel from South Africa and seven other African counties on Monday under an order from President Joe Biden. Passengers from other countries entering America will soon face stricter rules.

Officials around the world have imposed similar measures, citing the emergence of the variant in Africa.

The earliest known cases were identified in South Africa and Botswana in November, though testing of samples showed a patient with Omicron was in Nigeria in October, officials announced there earlier Wednesday.

Experts aren’t sure whether Omicron is more transmissible or whether it causes more severe disease. They have also expressed uncertainty on whether the variant evades immunity, including the protection bestowed by vaccines, better than other strains.

The omicron variant appears to be highly transmissible and less virulent.  There is still some doubt about the effectiveness of the original covid vaccines against Omicron Covid. 

Serologic tests and sampling is being performed on current cases of   Omicron.  Laboratory analysis will take several weeks to yield data.

The revolution in manufacturing , using mRNA technique will allow rapid manufacturing of a new vaccine can be accomplished in about one month. Approval by the FDA, EC and WHO will take several additional months for clinical trials.  If safety margins are good an emergency usage authorization EUA could be granted by the FDA.









First Case of Omicron Virus Variant Detected in US: Officials

Monday, November 29, 2021

Black Friday and Cyber-Monday bring more surprises from COVID



The news this weekend about a new variant "Omicron" has fueled speculation about up coming events in the world of pandemics.  Truly, no one knows much about it yet.  It will require about two weeks to gather meaningful data about Covid Omicron.

Fortunately the WHO and the nations of the world are not taking any chances, based upon the original outbreak in December 2019.  Poor communications, delays in lockdowns and the unavailability of a vaccine contributed to the fiasco in early 2020. Viral immunologists are already making plans to develop a new vaccine based upon early samples from already infected patients.  The affected countries, U.K. South Africa, Botswana and other countrie have been quarantined until these issues are determined.



Much of the previous tests, and treatments probably will be unchanged

Current knowledge about Omicron 

Researchers in South Africa and around the world are conducting studies to better understand many aspects of Omicron and will continue to share the findings of these studies as they become available.  

Transmissibility: It is not yet clear whether Omicron is more transmissible (e.g., more easily spread from person to person) compared to other variants, including Delta. The number of people testing positive has risen in areas of South Africa affected by this variant, but epidemiologic studies are underway to understand if it is because of Omicron or other factors.  

Severity of disease: It is not yet clear whether infection with Omicron causes more severe disease compared to infections with other variants, including Delta.  Preliminary data suggests that there are increasing rates of hospitalization in South Africa, but this may be due to increasing overall numbers of people becoming infected, rather than a result of specific infection with Omicron.  There is currently no information to suggest that symptoms associated with Omicron are different from those from other variants.  Initial reported infections were among university students—younger individuals who tend to have more mild disease—but understanding the level of severity of the Omicron variant will take days to several weeks.  All variants of COVID-19, including the Delta variant that is dominant worldwide, can cause severe disease or death, in particular for the most vulnerable people, and thus prevention is always key. 

Effectiveness of prior SARS-CoV-2 infection 

Preliminary evidence suggests there may be an increased risk of reinfection with Omicron (ie, people who have previously had COVID-19 could become reinfected more easily with Omicron), as compared to other variants of concern, but information is limited. More information on this will become available in the coming days and weeks. 

Effectiveness of vaccines: WHO is working with technical partners to understand the potential impact of this variant on our existing countermeasures, including vaccines. Vaccines remain critical to reducing severe disease and death, including against the dominant circulating variant, Delta. Current vaccines remain effective against severe disease and death.   







Effectiveness of current tests: The widely used PCR tests continue to detect infection, including infection with Omicron, as we have seen with other variants as well. Studies are ongoing to determine whether there is any impact on other types of tests, including rapid antigen detection tests.  

Effectiveness of current treatments:   Corticosteroids and IL6 Receptor Blockers will still be effective for managing patients with severe COVID-19. Other treatments will be assessed to see if they are still as effective given the changes to parts of the virus in the Omicron variant.  




 China has not reported cases of the Omicron variant, nor have Brazil, or Russia.






























Expert Newsletters - MashupMD: A Tribute to Omicron

Wednesday, November 17, 2021

SARS-COVID 2 is not the same as Inluenza.

Lung autopsies of COVID-19 patients reveal treatment clues

SARS-CoV-2 prevents lung tissue repair, regeneration.

What

Lung autopsy and plasma samples from people who died of COVID-19 have provided a clearer picture of how the SARS-CoV-2 virus spreads and damages lung tissue. Scientists at the National Institutes of Health and their collaborators say the information, published in Science Translational Medicine, could help predict severe and prolonged COVID-19 cases, particularly among high-risk people, and inform effective treatments.

Although the study was small—lung samples from 18 cases and plasma samples from six of those cases—the scientists say their data revealed trends that could help develop new COVID-19 therapeutics and fine-tune when to use existing therapeutics at different stages of disease progression. The findings include details about how SARS-CoV-2, the virus that causes COVID-19, spreads in the lungs, manipulates the immune system, causes widespread thrombosis that does not resolve, and targets signaling pathways that promote lung failure, fibrosis and impair tissue repair. The researchers say the data are particularly relevant to caring for COVID-19 patients who are elderly, obese, or have diabetes—all considered high-risk populations for severe cases. Study samples were from patients who had at least one high-risk condition.

The study included patients who died between March and July 2020, with time of death ranging from three to 47 days after symptoms began. This varied timeframe allowed the scientists to compare short, intermediate, and long-term cases. Every case showed findings consistent with diffuse alveolar damage, which prevents proper oxygen flow to the blood and eventually makes lungs thickened and stiff.

They also found that SARS-CoV-2 directly infected basal epithelial cells within the lungs, impeding their essential function of repairing damaged airways and lungs and generating healthy tissue. The process is different from the way influenza viruses attack cells in the lungs. This provides scientists with additional information to use when evaluating or developing antiviral therapeutics.


Tuesday, November 9, 2021

Israeli Study Shows How COVID-19 Immunity Wanes over Time – NIH Director's Blog



The winter holidays are approaching, and among the many things to be grateful for this year is that nearly 200 million Americans are fully vaccinated for COVID-19. That will make it safer to spend time with friends and family, though everyone should remain vigilant just to be on the safe side. Though relatively uncommon, breakthrough infections are possible. That’s why the Centers for Disease Control and Prevention (CDC) recommends booster shots for several at-risk groups, including folks 65 years and older, those with underlying medical conditions, and people whose occupations place them at high risk of exposure.

One of the main studies providing the evidence for CDC’s recommendation was recently published in the New England Journal of Medicine [1]. It found that vaccine-induced immunity, while still quite protective against infection and severe illness from COVID-19, can wane after several months.

The study is yet another highly informative report from Israel, where public health officials launched a particularly vigorous national vaccination campaign in December 2020. More than half of adult Israelis received two doses of the Pfizer vaccine within the first three months of the campaign. By May 2021, Israel had extremely small numbers of confirmed COVID-19 cases—just a few dozen per day.

But the numbers crept back up in June 2021. The rise also included a substantial number of breakthrough infections in vaccinated individuals. The vast majority of those cases in June—98 percent—were caused by the emerging Delta variant.

Researchers led by Yair Goldberg, Technion-Israel Institute of Technology, Haifa, wondered whether this resurgence of COVID-19 could be fully explained by the rise of the more infectious Delta variant. Or, they wondered, did the waning of immunity over time also play a role?

To find out, the researchers looked to over 4.7 million fully vaccinated Israeli adults, more than 13,000 of whom had breakthrough infections from July 11 to 31, 2021 with SARS-CoV-2. The researchers looked for an association between the rate of confirmed infections and the time that had passed since vaccination. Without any significant waning of immunity, one shouldn’t see any difference in infection rates among people who were fully vaccinated at the earliest opportunity versus those vaccinated later.

The results were clear: the rate of confirmed COVID-19 infection revealed a slow but steady waning of immunity over time. Among individuals 60 years or older who were fully vaccinated last January, the number of confirmed breakthrough infections was 3.3 per 1,000 people during the three weeks of the study. Those who were vaccinated in February and March had lower infection rates of 2.2 per 1,000 and 1.7 per 1,000, respectively. The data revealed a similar pattern in those aged 40 to 59 and those aged 16 to 39.

An important question is whether these breakthrough infections were serious enough to require hospitalization. While such cases were much less common, more than 400 of those with confirmed COVID-19 breakthroughs went on to develop severe illness. And, again, the data show a similar pattern of waning immunity. The rate of severe COVID-19 among adults 60 years of age or older who were fully vaccinated in January was 0.34 cases per 1,000 persons. The rate of severe illness dropped to 0.26 cases per 1,000 among those vaccinated in February and 0.15 cases per 1,000 for those vaccinated in March. The researchers report that the number of severe COVID-19 cases among the younger fully vaccinated groups were too small to draw any conclusions.

While the Delta variant surely has played a role in the resurgence of COVID-19 in recent months, these findings suggest that waning immunity also is an important factor. Understanding these dynamics is essential for making critical policy decisions. In fact, these data were a key factor in the decision by the Israeli Ministry of Health in July 2021 to approve administration of COVID-19 booster shots for individuals who’d been vaccinated at least 5 months before.

Back in the U.S., if you were among those who got your vaccine on the early side—good for you. If it’s been more than six months since your original shots, and if you are in one of the risk groups, you should consider a COVID-19 booster shot to remain optimally protected in the months ahead. I’ll be getting my Moderna booster this week. While you’re at it, consider getting your annual flu shot taken care of, too. The CDC guidelines state that it’s perfectly OK to get your COVID-19 and flu shots at the same time.


What about it?  WAI

Steve White says:
November 9, 2021 at 11:04 am
I am not against the vaccines or boosters, but I think the numbers the Director is citing from this study indicate the media and CDC have given out very misleading information. Instead of saying “In Israel, 1 in 300 people who got vaccinated in January have gotten infected” – a number which I think CDC knows will not scare people enough – and indeed, their own experts believed was not scary enough (they may not have had all the data available now but they certainly knew breakthroughs were rare when they advised on boosters) – to really push boosters, we are given horror stories about significantly reduced protection.
Stories about breakthroughs, which probably get some people running for their boosters, and others saying :Heck with it, what is the point?” Or other rationalizations.

Maybe they should have said, “breakthrough are so rare, and so unlikely to be severe, that we do not think boosters are really needed for most healthy people” -or something similar to that. Oh, wait …

Or, how about “while there is extra protection from getting a booster, for those who were already infected, the rate of reinfection is very low in either case” ?

I am not even going into the extremely low rate of severe illness among children, and the strong possibility they are better off with natural immunity – remember, the human race, and for that matter, all our ancestor mammalian races, presumably, have dealt with viruses from other species for millions of years. Think about this deeply – maybe we’ve evolved so that children strongly tend to not get severely ill, and tend to get lifelong protection, when exposed to novel viruses. Old folks who are no longer breeding – anything can happen to them – just what we see with this thing so far – and maybe giving kids vaccines, which will protect against one variant (the one they were designed to stop) very well, closely related variants less effectively, and other variants maybe not at all, will set them up to be more vulnerable for the coming variants, than kids who caught the first, apparently least virulent, variant, and now have some immunity to every vulnerable part of it.



Israeli Study Shows How COVID-19 Immunity Wanes over Time – NIH Director's Blog

Tuesday, November 2, 2021

Novavax has been granted its first emergency use authorisation in Indonesia for COVID-19 vaccine NVX-CoV2373, and expects other regulators in India, the Philippines and other countries to follow suit in the coming weeks.

Third world nations have been short changed during the 4 months that the pandemic spread throughout the world.  Many nations have even donated millions of doses of vaccines produced in their own countries. Canada recently agreed to donate several million dollars to the United Nations fund for distributing covid vaccines to those less developed nations.


Indonesia has applied for an emergency authorization for it's vaccine, NVX-COV2373. Nations in their own regional market place, including India. and the Phillipines will also join their effort.  These three nations may pool their resources to produce vacccines for many millions of people.  Local sources for vacccine will eliminate the challenges of distribution,  such a refrigeration, spoilage, and transportation.

Indonesia falls into that category as it has a fragmented healthcare system, despite universal access,  which is amplified by the geographical hurdles associated with being an archipelago with 275 million people spread across 6,000 islands. Initial shipments into the country are expected to begin “imminently,” said Novavax.

The vaccine is the first based on recombinant protein to be approved anywhere in the world, and has the key advantage over many of the currently approved jabs as it can be stored at regular refrigeration temperatures. That makes it well suited to distribution in countries where healthcare delivery is more challenging.

Recombinant protein is produced by recombinant DNA using bacteria (E.Coli) as a manufacturing process. E.coli  is the manufacturing plant for recombinant DNA and in turn. recombinant proteins


Why is E. coli used for transformation?

Other cell types including mammalian cells,  yeast, insect cells, or other eukaryocytic cells could be used. E. coli is a preferred host for protein production due to its rapid growth and the ability to express proteins at very high levels. Bacterial conjugation can be used to transfer large DNA fragments from one bacterium to another.

The following references explain in further the use of recombinant DNA/Protein for the manufacture of other Covid 19 vaccines.

Rather than using messenger RNA (m-RNA) to produce a 'spike protein' from the corona virus, the Indian Covid vaccine is manufactured as an inactive viral particle.


Covax information


1. Center for Systems Science and Engineering, Johns Hopkins University. COVID-19 Dashboard. [Accessed 15 Nov 2020.]
2. World Health Organization. DRAFT landscape of COVID-19 candidate vaccines, 12 November, 2020. https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines.
3. World Health Organization. WHO Concept for fair access and equitable allocation of COVID-19 health products. Final working version 9 September 2020. Geneva, Switzerland: World Health Organization, 2020. https://www.who.int/publications/m/item/fair-allocation-mechanism-for-covid-19-vaccines-through-the-covax-facility.
4. Emanuel EJ, Persad G, Kern A, et al. An ethical framework for global vaccine allocation. Science 2020;369:1309-12. 10.1126/science.abe2803  [PubMed] [CrossRef] [Google Scholar]
6. Gavi, the Vaccine Alliance. COVAX, the ACT-Accelerator Vaccines Pillar: Insuring Accelerated Vaccine Development and Manufacture, 2020. https://www.gavi.org/sites/default/files/covid/COVAX-Pillar-background.pdf.
7. Gavi COVAX Facility. Over US$ 2 billion raised to support equitable access to COVID vaccines with additional US$ 5 billion needed in 2021. Press release, 13 November 2020. https://www.gavi.org/news/media-room/over-us-2-billion-raised-suppor















Novavax gets first authorisation for its COVID-19 jab -

Tuesday, October 12, 2021

Financial speculation surrounding coronavirus drug developed with taxpayer money - The Washington Post




A hedge fund manager profited greatly from the development of a U.S. funded research at Emory University.  Ridgeback Pharma bought a license for it's use and then sold it to Merck.  The husband and wife team,.


Ridgeback Biotherapeutics had no laboratories, no manufacturing facility of its own and a minimal track record when it struck a deal in March with Emory University to license an experimental coronavirus pill invented by university researchers with $16 million in grants from U.S. taxpayers.

But what the tiny Miami company did have was a growing team with experience in pharmaceutical development and research and a willingness from its wealthy owners — chief executive Wendy Holman and her husband, hedge fund manager Wayne Holman — to place a bet on the treatment in the midst of the coronavirus pandemic. That wager paid off with extraordinary speed in May when, just two months after acquiring the antiviral therapy called EIDD-2801 from Emory, Ridgeback sold exclusive worldwide rights to drug giant Merck.


The rapid turnaround of rights to a publicly financed drug highlights the frenzy of financial speculation that has accompanied the spread of the coronavirus around the world. Congress and the Trump administration have authorized more than $7 billion for research and industry subsidies in a desperate hunt for therapies and vaccines.

The perception that companies are profiteering during a global medical crisis — especially in cases where inventions were funded by taxpayers — poses political dangers to the pharmaceutical industry.

Demands are increasing in Congress and around the world that drug companies set affordable prices on coronavirus treatments and vaccines and distribute them equitably. Yet the role of middlemen like Ridgeback puts pressure on companies to increase prices, by adding extra costs. It also raises questions about who is financially benefiting by securing monopoly licensing rights to publicly financed inventions.
 



Ridgeback, which has one other drug in development for Ebola, was a relatively obscure entity when it snapped up EIDD-2801 from Emory in a deal signed March 19. The university, without disclosing terms, said in a news release that Ridgeback “will be responsible for conducting the necessary trials to bring EIDD-2801 to licensure.”


Within days of securing Emory’s licensing deal, the company mounted a campaign to win hundreds of millions in government funding to develop the drug, according to a whistleblower complaint by Rick Bright, former director of the Biomedical Advanced Research and Development Authority, as well as emails obtained by The Washington Post. After failing to secure the government contracts, Ridgeback launched a human safety trial of the drug in the United Kingdom and transferred rights to Merck in late May.

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In addition to an upfront payment of undisclosed size from Merck, Ridgeback will receive unspecified “milestone” payments and a share of net proceeds if the drug is approved, the companies said. Merck will conduct future clinical trials, apply for regulatory approvals and manufacture the drug, which has been shown in lab and animal studies to cripple the virus by interfering with viral RNA. Ridgeback said it will remain involved in developing the drug.

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Specialists in drug development called Ridgeback’s turnaround unusually rapid.

“I would think that universities … would not normally transfer products to basically a house-flipper,” said Aaron S. Kesselheim, a physician at Brigham and Women’s Hospital in Boston and professor at Harvard Medical School. “I wouldn’t think they would have to engage with speculators, like it appears that Ridgeback Biotherapeutics is.”

Ridgeback tests COVID-19 antiviral for patients in hospital—and at home

Wayne Holman, who holds a medical degree from New York University, is a hedge-fund manager with a long track record of investing in pharmaceutical stocks. He founded his fund Ridgeback Capital Management in 2006. Wendy Holman, chief executive of Ridgeback Biotherapeutics, is a former investment manager who was named to President Trump’s advisory council on HIV/AIDS in 2019.

The Holmans live on Miami’s exclusive Star Island, where they bought two mansions for a combined $47 million in 2014 and tore one of them down. Ridgeback Capital’s headquarters is in a small office building not far away in Coconut Grove, near a private school where Wendy Holman serves on the board of trustees. Ridgeback has one other drug in development that has been supported with $25 million in government contracts, a potential Ebola treatment invented by a division of the National Institutes of Health. 

EIDD-2801 is among hundreds of projects underway around the world to develop treatments and vaccines to combat the coronavirus amid signs that covid-19, the disease the virus causes, will become a stubborn, endemic illness that lingers in human populations for many years. If it works and is found to be safe, it likely would become a strong rival to Gilead’s remdesivir, the first antiviral to treat the coronavirus, which must be given intravenously.

“EIDD-2801 has several attributes including oral availability broad antiviral activity versus multiple coronavirus strains, notably SARS-CoV-2, as shown in preclinical studies, and early clinical results showing that it is well-tolerated from a study conducted by Ridgeback,” Merck said in an email.

But the path to Merck’s portfolio of early-stage drugs has grabbed attention.

Flip this property

“Molecule-flipping is a good characterization of what it is,” said James Love, director of Knowledge Ecology International, a nonprofit watchdog group that tracks public investments and intellectual property.

Hunting through scientific papers and forging alliances with academic laboratories is often done by small firms backed by venture capitalists. Start-ups looking to profit by securing rights to new molecules and nurturing their early-stage development are an ingrained part of the ecosystem of drug development. The goal typically is to push a drug far enough through the approval pipeline — a process that often takes years — until a larger company buys the rights and completes commercialization.

With the coronavirus creating huge demand, that activity is accelerating, say specialists in drug licensing and intellectual property.

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“Merck is much better positioned and funded to move the drug through development,” said Joseph A. DiMasi, director of economic analysis and research at the Tufts Center for the Study of Drug Development, which receives drug industry funding. “It is the speed with which this has happened that is extraordinary. That speed in the context of a pandemic is a good thing.”

Stock markets show hunger for a coronavirus treatment. But don’t expect a magic bullet.

The flood of government money is spurring attention to diseases that have been neglected by large drug companies. Vaccines and therapies for viruses do not hold the promise of large, lucrative drug sales because they are not taken as regular treatments for chronic conditions. Many virus outbreaks disappear on their own, making it risky for companies to spend on research. To plug the gap, U.S. government agencies support academic research, or invent and develop drugs directly in government labs.

“When it was limited to things like Ebola and SARS, you didn’t see as much as engagement by the private sectors. These were normally backwater areas in neglected disease,” said Love. “People now are rushing in and scaling up.”

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Emory had secured pledges of $30 million in government contracts from science and defense agencies in the past five years to develop EIDD-2801 but tapped just more than half of the available funds, an Emory spokeswoman said. The university did not respond to questions about how it picked Ridgeback.

“Emory is proud that we invented EIDD-2801, and we appreciate the partnerships and government support that makes it possible to provide therapies that will benefit society,” Nancy Seideman, Emory’s vice president for academic communications, said in an email. “Any royalties that we receive — if anything — are channeled directly back to serving our educational and scientific mission.”

In instances where taxpayer-financed drugs make it to market via exclusive licensing deals — which typically have undisclosed terms — debates have sprouted around monopoly pricing.

Liberal members of Congress and consumer advocates have demanded that taxpayers’ investments be factored into government contracts for development of coronavirus treatments and vaccines, and that terms of licensing deals be disclosed to the public. But Democratic proposals to place constraints on prices for covid-19 therapies did not make it into the $3 billion in emergency subsidies for the drug industry that lawmakers approved in March.

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Some companies with experimental medicines backed by public investment have been the subject of intense financial speculation. Investors have gambled that Gilead’s drug remdesivir, which has been proven to modestly improve outcomes, will produce a windfall for the company. The company’s stock has been subject to volatile swings in the past three months.

Remdesivir was developed with at least $70 million in public investment, according to advocates, and a debate has begun about costs and access before Gilead has even set a price.

Even finding a covid-19 vaccine won’t be enough to end the pandemic

Moderna is developing a leading vaccine candidate that is co-owned by the NIH. Government interest in the vaccine has not stopped a boost in the company’s stock of nearly 200 percent since the end of February.

EIDD-2801, which was invented as an influenza drug and has demonstrated effectiveness against multiple viruses in lab dishes, works similarly to Gilead’s remdesivir by interfering with viral RNA. But it has the advantage of being a pill, which means it could be taken by people in their homes, soon after symptoms appear. If the drug proves to be safe and effective, it could prevent countless hospitalizations and deaths and reduce the spread of infection.

Drugs in its class have been known to cause genetic mutations that lead to birth defects, but Merck said when it licensed the drug last week that it was “well-tolerated.” Wayne Holman has said the drug can safely be used for a short course of treatment to fight a viral infection.

As for potential pricing, “Merck and Ridgeback are committed to ensuring that any medicines we develop for SARS-CoV-2 will be accessible to patients globally,” Merck said in an email. It would not discuss specifics.

The deal between Emory and Ridgeback was inked by the university’s Drug Innovation Ventures at Emory (DRIVE), a nonprofit tech-transfer corporation led by Emory scientist George Painter, who holds patents related to the drug. Highly accomplished in both laboratories and boardrooms, Painter is the former chief executive of Chimerix, a North Carolina drug company, and a high-ranking official in antiviral research at the former Glaxo Wellcome. Painter did not respond to interview requests.

On March 20, the day after the Ridgeback licensing contract was completed, Painter and other scientists at the University of North Carolina, Vanderbilt University and Emory posted a preliminary scientific paper on the preprint website bioRxiv.org showing EIDD-2801 thwarted SARS-CoV-2 in human cells and in mice infected with other types of coronaviruses. The peer-reviewed journal Science Translational Medicine published the paper on April 6.

At Vanda Pharmaceuticals, a biotechnology firm headquartered in Washington, D.C., founder and chief executive Mihael Polymeropoulos saw the scientific results in the journal and had his company contact Emory about a potential licensing opportunity. It was too late.

“They came back and they said they had already done a deal with this company, Ridgeback,” Polymeropoulos said. “This deal must have happened in record speed.”

The chief operating officer at Emory’s DRIVE told the Daily Report, an Atlanta trade publication, that the licensing contract, which normally would take four to six months to complete, was negotiated and signed in two weeks after a “mad scramble” by university and Ridgeback lawyers rushing to respond to the coronavirus.

Ridgeback’s involvement burst into the broader public sphere in early May, when Bright, the ousted head of BARDA, filed his explosive whistleblower complaint. Bright alleged that he clashed with Robert Kadlec, the Health and Human Services assistant secretary for preparedness and response, over demands that he award BARDA contracts to well-connected companies. HHS has said it “strongly disagrees” with Bright’s allegations.

In his complaint, Bright cited attempts to secure money for EIDD-2801 — first by Painter in November 2019, and then by Wendy Holman in early April — among episodes of alleged political pressure.

Bright said he rejected requests to fund EIDD-2801 because Emory had already received pledges of $30 million from the National Institute of Allergy and Infectious Diseases and the Department of Defense to cover development of the drug, including human safety testing. Without first seeing safety results, Bright said, it did not make sense to back the drug with new infusions of federal cash.

Wendy Holman’s pleas for government money in early April — less than two weeks after Ridgeback secured rights to the drug from Emory — are contained in emails she wrote to government officials. The full emails, excerpts of which were cited in Bright’s whistleblower complaint, were previously disclosed by the journal Science and were obtained by The Post. Holman said in one email to BARDA that she had been in personal contact with Kadlec, who wanted the project to move forward.

“We need this approval to start the clinical trial for EIDD-2801 as soon as possible,” Wendy Holman wrote to a BARDA contracting official on April 7, just days before Ridgeback planned to launch its first human safety trials. “Lives are literally depending on it, Dr. Kadlec is pushing us to move fast, but we can’t without this authorization.”

“To avoid any delay in executing this clinical trial, Ridgeback must receive approval … as soon as possible” to incur expenses in anticipation of a contract, Holman wrote to a related agency within the Office of the Assistant Secretary for Preparedness and Response on April 3. “We desperately need guidance on this.”

Bright said in his complaint that Ridgeback had been seeking $100 million to further the drug’s development. In an April 13 email, a BARDA official said the proposal from Ridgeback could obligate the government to pay the company more than $300 million. The contract official objected to the outlay because Ridgeback had not followed proper application procedures.

Ridgeback went away empty-handed by the time Bright departed in late April. It started its safety trial on April 10, testing the EIDD-2801 drug against a placebo in 122 healthy volunteers in England, according to its disclosure on clinicaltrials.gov. It hired a contract research organization called Covance to conduct the study. The NIH said in an email that Ridgeback conducted the study at its own expense.

In an interview with The Post on April 15, before the controversy erupted, Wayne Holman talked up the drug and made it clear that Ridgeback would be seeking partnerships and investment from the private sector.

“Treating orally and early can change the course of this pandemic. Not only would it treat the person that is sick, but it should theoretically reduce the infectiousness of that person, and the time period they are infectious to others,” he said. “We have inbound interest from pharma companies.”

 Covid 19 vaccines and treatments are generating enormous revenue for some pharma companies. It will probably. surpass the gains of Purdue from it's profits from opioid manufacturing.

Imagine if some of these profits were taxed and used to fund health care for low income citizens.

Monday, September 27, 2021

Digital Health ID card for every Indian. 5 key points explained

Are you fed up going through your wallet each time you go to a provider for services to pony up your Medicare card, Private Insurance cared, Medicaid card, social security card and driver's license and more?



It turns out that India is way ahead of the U.S.A. Prime Minister Narendra Modi will launch Ayushman Bharat Digital Mission that looks to provide easier access to integrated healthcare for citizens. 




Digital Health ID card for every Indian. 5 key points explained

Included with the Health ID are the following:

Key Facilities of Ayushman Bharat Digital Mission

Health ID: Every citizen will be allotted a health ID that will be used as their health account. The personal health records of the citizen will be linked to their respective Health ID. These records can be viewed with the help of a mobile application.

Healthcare Professionals Registry (HPR): A repository of registered nurses, doctors, paramedical with their qualifications, experience, and other relevant details.

Healthcare Facilities Registry (HFR): A repository of all public and private healthcare facilities across both traditional and modern systems of medicine. This will ensure ease of doing business for doctors, hospitals, and other healthcare service providers.

Personal Health Record Application: A self-managed health record of an individual linked to the 

Aarogya Setu App.


Thursday, September 16, 2021

FTC says health apps must notify consumers about data breaches — or face fines | TechCrunch

Is your fitness wearable ie, Fitbit, apple watch, or another device (such as a monitored pacemaker, glucometer being hacked ? Many of these devices are monitored by third parties to ensure reliability or report to the provider about the usage of the device. Their intent may. be benevolent to endure you are compliant, however there are many hackers stealing your data to sell to other interested parties.  The concerning issues are pointed out in this bulleting from the Federal Trade Commission.  Check out your monitoring device to see if it is HIPAA compliant. In the near future all monitoring devices should carry a HIPAA compliant badge on it and/or the instruction sheet much like a CE or UL approval rating.

FTC says health apps must notify consumers about data breaches — or face fines | TechCrunch: Facebook today is announcing the launch of new products and features for business owners, following the threat to its ad targeting business driven by Apple’s new privacy features, which now allow mobile users to opt out of being tracked across their iOS apps. The social networking giant has r…