Happy Friday! We have news today on Covid, cancer, and mental illness, to be sure. But also kisses, licks, and drool.

Lessons from Covid wastewater surveillance — for the next time

The Omicron variant was already showing up in wastewater samples taken in November in California, New York, and Texas before the first case was identified in the U.S., a CDC report out yesterday says, including one sample predating alarms sounded in southern Africa that Covid-19 had taken a new turn. The wastewater study highlights how such surveillance can serve as an early warning system, but it also brings to mind the futility of travel bans to limit spread of a variant from Africa that had already arrived on U.S. shores. In a similar vein, in this STAT First Opinion, NYU’s Céline Gounder, Rockefeller’s Rick Bright, and Penn’s Ezekiel Emanuel call for a strategy — and list steps — to anticipate more and react less. “Leaders must look beyond the latest crisis and proactively prepare for an unknowable future, instituting policies and building programs that will guard against all respiratory viruses.”

Combination cancer drugs work best. Or do they?

Some drugs are thought to be more powerful together. In cancer, scientists have long thought synergistic drugs, where one agent paves the way for another to target a tumor more aggressively, are the epitome of combination therapy. But a growing line of research is beginning to shatter the idea that synergy should be a high priority in cancer treatment. The latest study, published yesterday in Clinical Cancer Research, examined 13 combinations with cancer immunotherapy drugs and found that the benefits of all the pairings seem to come from each drug independently, not how they work together. The finding points to a concession in cancer research: For all the advances made in cancer biology and combination therapy, scientists are still largely in the dark about tumors and the drugs that target them. STAT’s Angus Chen has more.

Kisses, licks, and drool: ‘Saliva sharing’ shapes how babies’ understand relationships

Raising a young child can be a bit … messy. There’s the drool to be wiped, the slobbery feeding and sharing of utensils — and plenty of kisses. But it turns out that all that exposure to family members’ spit (known in academic parlanceas “saliva sharing”) plays a crucial role in how we make sense of the world around us, a new study in Science shows. It helps shape our discernment of social relationships, starting from our first months of life. The study — with infants, toddlers, and young children as participants — found that we use saliva sharing as a cue to help distinguish “thick” relationships, connections in which people have strong attachments and feel a sense of obligation for the other. STAT’s Andrew Joseph explains why there’s something specific about spit.

Inside STAT: What if doctors were paid for answering patient emails?

(adobe)

It’s not uncommon for primary care doctor Maria Byron to spend multiple hours a week at the University of California, San Francisco, sifting through emails from patients seeking her medical advice. These messages might contain medication questions or completely new concerns. And while UCSF has seen volumes surge from a few hundred thousand such emails a year in 2016 to about 2 million in 2021, clinicians like Byron typically haven’t been paid for answering them. “It’s become sort of this extra thing that physicians are spending multiple hours a day doing,” Byron said. “That starts to weigh on people.” That’s why she’s leading a new effort at UCSF to let clinicians bill insurers for certain medical correspondence. It’s partly to assuage burnout, but also to give clinicians an incentive for spending chunks of their workday on email. STAT’s Mohana Ravindranath explores who pays and how it’s working.

U.S. older adults face more mental health challenges, including paying for care

Percentage of adults age 65 and older with a mental health need who reported any cost-related access problem. (Commonwealth Fund)

Most U.S. adults over 65 have some mental health coverage through Medicare, but a Commonwealth Fund report out today shows where that insurance falls short and how that compares to 12 other high-income countries. A survey conducted after the Covid-19 pandemic emerged found that 21% of older adults in the U.S. have a diagnosed mental health condition and 26% of those people have trouble paying for the care they need. The next highest rate of depression, anxiety, or other illness was 13% in New Zealand and the lowest was 5% in Germany. Fewer than 10% of adults in the U.K., France, Sweden, and Germany struggled to pay for care. There also were disparities in the U.S.: 32% of Hispanic people on Medicare reported a mental health diagnosis, compared to 21% of white and 12% of Black beneficiaries.

Younger may be better for oral immunotherapy to treat peanut allergy

For children with peanut allergy, the goal of oral immunotherapy is to slowly increase the threshold of peanuts they can tolerate. A small new study published yesterday in The Lancet suggests starting this daily therapy in kids 1 to 3 years old was more successful than at a later age. The trial in five U.S. academic medical centers gave 146 peanut-allergic children either increasing amounts of peanut protein powder — up to the equivalent of six peanuts after two and a half years — or the same rising amounts of an oat flour placebo. Among the kids who got peanut protein, 71% were desensitized, meaning they could eat 16 peanuts, compared to 2% of the kids who got placebo. And 21% were in remission at the trial’s end, meaning they still had no reaction to 16 peanuts 26 weeks later, compared to 2% on placebo. The younger the child, the more common remission was.

What to read around the web today

It’s a terrible idea to deny medical care to unvaccinated people. The Atlantic
U.S. moves to drop case against MIT scientist accused of hiding China links. New York Times
The Pharmalot View: If the Biogen CEO were truly ‘courageous,’ he would live with the Medicare decision. STAT+
Tufts Medical Center will close its pediatric hospital after more than a century of treating sick kids. Boston Globe
Listen: Biotech’s red tape, the latest billionaire science project, & a (possible) Omicron reprieve. STAT