'We’ve been here before': Another Covid spike could be coming, experts warn

While U.S. Covid-19 cases, hospitalizations, and deaths are all down dramatically from their peaks just two months ago, some experts are growing increasingly nervous that the positive trends may be slowing down or even headed for reversal. The country needs to prepare for another spike in cases, they’re warning, even if it turns out to be a minor one. Europe has seen a surge of cases in recent weeks, which may again foreshadow what’s ahead in the U.S. And some U.S. wastewater surveillance sites are picking up increased viral levels. “The mortality rate is coming down, the case rate is coming down, hospitalizations are coming down,” Ezekiel Emanuel of University of Pennsylvania told reporters yesterday. "But let’s remember, we’ve been here before.” STAT’s Andrew Joseph outlines some factors influencing case rates and parses what could happen next.

Here's where Biogen's Aduhelm study ended up

When it comes to Biogen’s controversial Alzheimer’s drug Aduhelm, even publishing the data is steeped in drama. The key data that led to Aduhelm’s FDA approval were finally published yesterday, more than two years after they were first described in a press release. But the data appear not in a major journal but in the little-known Journal of the Prevention of Alzheimer’s Disease, worrying critics that Biogen found a low-stakes forum for a study that deserves scrutiny. “We are not going to comment on the details of our publication process,” a Biogen spokesperson said. (Axios previously reported that Biogen pulled the study from consideration by JAMA.) Journals are ranked by an “impact factor,” so NEJM’s is 91, JAMA’s is 56, and JPAD’s is 4.5. “I think it shows how many journals with impact factors that would blow it away couldn’t come to terms with what Biogen actually wanted published,” analyst Brian Skorney told STAT’s Matthew Herper.

Reported TB cases fell in 2020, but that decline may not turn out to be real

A 20% decline in tuberculosis cases recorded by the U.S. National Tuberculosis Surveillance System during the first year of the pandemic compared to the previous four years sounds hopeful, but a new CDC report says that may be too good to be true. The average number of TB cases has been trending downward, so a drop could be expected, but incidence has been decreasing a more modest 2% to 3% annually over the past 10 years. Based on pharmacy data on anti-TB medications, that 20% drop likely includes a real decline, possibly a side effect of pandemic mitigation measures as well as drops in immigration from countries where the disease is more widespread. But chances are also high that TB diagnoses are being missed or delayed. “Public health programs should be prepared for a possible rebound in TB cases after the pandemic,” the authors write.

Closer look: Replacing the brain's cleanup crew shows promise in mice for neurologic diseases

A section of a mouse brain showing replacement of microglia (green) after a bone marrow transplant. (YOHEI SHIBUYA, STANFORD UNIVERSITY SCHOOL OF MEDICINE)

From anemia to leukemia, unhealthy cells can make for unhealthy people, but replacing these cells can help patients. What if the same were true for neurological diseases? A study published yesterday in Science Translational Medicine raises the tantalizing possibility that researchers could one day replace microglia, immune cells that scour the brain for infection and damage. Scientists found microglia could be swapped out in mice with an infusion of stem cells as part of a bone marrow transplant, helping mice with a neurodegenerative disease live longer and move more normally. There’s no guarantee the finding holds up in people and the researchers want to tweak the procedure so that it’s less toxic. Still, the findings raise hopes that isolating a person’s blood stem cells, correcting their genetic errors, and reintroducing those cells could remedy microglia defects in brain diseases. STAT’s Jonathan Wosen has more.

Cost of cancer care often means medical debt

Cancer has many costs, not the least of which is financial. A survey from the American Cancer Society Cancer Action Network out today reports that half of cancer patients or survivors say they have incurred medical debt related to cancer, and 73% of them worry about affording current or future care. Other findings:

Women were more likely to report medical debt (57%) than men (36%).
African American individuals (62%) were more likely to incur debt than white people (52%).
Most respondents (62%) with medical debt delayed or avoided medical care for minor issues; nearly half (45%) delayed care for serious issues.
To afford care, respondents delayed major purchases (36%), went through most or all of their savings (28%), took on more credit card debt (28%), and borrowed from relatives and friends (20%).

Mental health visits to EDs vary with Covid peaks

Covid’s toll on mental health is a challenge that health care systems struggle to meet. A new JAMA Psychiatry study looks at visits to hospital emergency departments for mental health reasons before, during, and after the Delta surge. Based on electronic medical records from more than 3,600 facilities, adults’ mental health visits made up a larger proportion of ED visits after Covid cases peaked, compared with before that peak and before the pandemic. There were some differences: During Delta, visits among Asian people increased and after the case surge, they fell for adults aged 18 to 24 years old and for American Indians or Alaska Natives. Stress may worsen mental health or people may delay seeking the care they need when Covid cases soar, the authors say. Either way, they write, EDs need to be prepared.

What to read around the web today

Diabetes and Covid-19: Scientists explore potential connection. Associated Press
Brain-imaging studies hampered by small data sets, study finds. New York Times
Lawmakers and PhRMA trade accusations of ‘misleading’ information on drug price hikes. STAT+
Covid’s ‘silver lining’: Research breakthroughs for chronic disease, cancer, and the common Flu. Kaiser Health News
A compromise is reached on an intellectual property waiver for Covid-19 vaccines, but does it go far enough? STAT+