6 Covid mysteries scientists hope to unravel

(Natsumi Chikayasu for STAT)

How will the virus evolve next? And how, exactly, does the virus transmit from person to person? Oh, and how long before we understand long Covid? More than two years after SARS-CoV-2 appeared, as the country edges toward 1 million deaths from Covid-19, there are still plenty of mysteries about the virus and the pandemic. STAT reporters set out to examine some of the big, lingering questions, in hopes of understanding how we might deal with Covid going forward, and prepare for the next pandemic. “Many predictions have been made during the pandemic; many have turned out to be dead wrong,” STAT’s Helen Branswell writes. “We’d like to avoid adding to that list. But here are some things we feel we can say with some certainty.” Read the special report here.

Judge voids federal mask mandate on airplanes, other public transit

A federal judge yesterday voided the national mask mandate that has required travelers on airplanes and other public transit to wear face coverings, despite the CDC’s recent extension of the rule until May 3. Hours later, several major airlines announced they would drop their mask requirements. U.S. District Judge Kathryn Kimball Mizelle of Tampa, Fla., said in her ruling that the mandate exceeded the authority of U.S. health officials in the pandemic, and the CDC improperly failed to justify its decision and did not follow proper rulemaking, the Associated Press reported. The Justice Department and the CDC declined to comment if they planned to appeal. “This is obviously a disappointing decision,” White House press secretary Jen Psaki told reporters yesterday. “The CDC is recommending wearing a mask on public transit.”

Top U.S. cancer hospitals place hefty markups on drugs, study says

Some of the top cancer hospitals in the country are putting hefty markups on cancer drugs, a new JAMA Internal Medicine study shows. Researchers found that hospitals were making a bigger profit by charging commercial health insurers anywhere from double to seven times what it cost the hospitals to acquire the drugs. In the most extreme case, the prostate cancer drug leuprolide had a median markup of 634%, Bob Herman reports in STAT+. Fifteen other drugs had net price markups of at least 200%, according to the analysis, which included prices for two dozen cancer drugs, negotiated and paid by commercial insurers, at facilities with the highest designation from the National Cancer Institute. Only 27 of the 61 hospitals included in the study disclosed the negotiated price of at least one of those drugs, flouting federal price transparency laws.

Closer look: How a physician’s injury shaped his view of chronic pain

As medicine grapples with its role in the opioid crisis, another conversation has emerged: how knee-jerk efforts to cut back opioid use can also endanger chronic pain patients, who might turn to illicit drugs to manage their pain. “The risks of a patient either continuing to take opioids or stopping them make one thing clear: starting anyone on opioids is one of the most important decisions any clinician can make,” writes physician Haider Warraich in a STAT First Opinion. Warraich, who has suffered from chronic back pain for 14 years, said his initial injury “has gone on to indelibly shape how I view others in affliction.” He argues that clinicians “must adopt an approach rooted in empathy, with ample access to the myriad tools — including opioids if needed — that can safely help those in extremis.” Read more.

Updated acetaminophen labeling didn’t reduce hospitalizations for accidental overdoses

Despite two updates to labels on acetaminophen products, hospital admissions for accidental overdoses in Canada remained the same, a new paper reports. Overdosing on acetaminophen — a very common ingredient in dozens of over-the-counter drugs — can lead to acute liver failure. Accidental overdoses “represent a substantial and increasing proportion of these events. In Canada, the proportion of acetaminophen-related injuries from accidental overdose increased from 27% in 2006 to 45% in 2011,” researchers write in the journal CMAJ. Language on the drug labels was updated in 2009 and 2016 to better communicate risks of overdose and promote safer use. Still, hospital admissions for accidental acetaminophen overdose were essentially unchanged between 2004 and 2020, suggesting a need for additional safety measures.

Researchers study taking race out of UTI risk calculation

For years, doctors have used race as a variable in calculating children’s risk of developing a urinary tract infection — with Black patients being less likely to develop UTIs than non-Black ones, according to previous research. But a new meta-analysis of 16 studies, including almost 18,000 children, found that race could be replaced by other factors, such as a history of UTIs and duration of fever, and still produce an accurate prediction model. The updated risk calculator, dubbed UTICalc 3.0, attempts to acknowledge how race is often a proxy for other factors in medicine. “The association between race and UTIs observed in many previous studies still requires explanation as we shift clinical and translational science toward race-conscious medicine,” the researchers wrote in JAMA Pediatrics.

What to read around the web today

Cel-Sci’s CEO used private call to tip off select investors about cancer drug update. STAT+
She went to one doctor, then another and another. Washington Post
A rising tally of lonely deaths on the streets. New York Times
Animal rights group urges USDA to probe research facilities for failing to inspect monkey shipments. STAT+
Toxic shower water. Sewage pits. ‘Infuriating’ woes in California’s Coachella Valley mobile parks. Desert Sun