Good morning. We have news about Covid, monkeypox, and malaria today, but also the "wild west" of weight-loss drugs online.

Covid’s pattern looks damaging, persistent — and unlikely to change

So where are we now with Covid? Its early horrors have retreated, but more than 300 people are still dying every day in the U.S., and cases continue to mount as more transmissible variants rule. No one’s suggesting we’re out of the woods, but some experts told STAT’s Andrew Joseph that Covid looks more and more like other respiratory infections — mild in many people, but sometimes severe in certain high-risk populations.

And yet, some forecasts project 100,000 annual Covid deaths, if not more, for the next several years. That’s some 275 deaths a day. Many experts see SARS-CoV-2 retreating to something closer to the other human coronaviruses as we keep building up additional layers of immunity, from vaccination, boosters, and infections. But how long that process takes — three years? five years? 10 years? — remains an open question. Read more.

What about long Covid?

So where are we now with long Covid? While it certainly appears the coronavirus will be with us for the foreseeable future, answers about long Covid also continue to be elusive, from exactly what it is to how many people infected with Covid later have symptoms that persist for months or years. Yesterday, the federal government released two promised reports, one on services and supports and the other on research. Neither will allay concerns about the slow pace of scientific progress, but my colleague Rachel Cohrs spotted three new things:

HHS Assistant Secretary for Health Rachel Levine is the new long Covid coordinator (read her viewpoint in JAMA here).
NIH’s RECOVER initiative is working with the NIH All of Us research program.
Therapeutics clinical trials — of antivirals, anti-inflammatory, immune modulators, and “other or existing new treatments” — are expected to start by year’s end.

Monkeypox: Fractional vaccine dosing to be tested and potential blood donors to be examined

As monkeypox spreads around the globe — with more than 26,000 cases in the current outbreak — we have two new developments to tell you about:

Because the global need for monkeypox vaccine is outstripping the supply, NIH scientists are getting ready to explore a possible work-around, designing a clinical trial to assess two methods of stretching available doses of Jynneos, the only vaccine in the U.S. approved for vaccination against monkeypox. They plan to test whether using one-fifth of the regular amount of vaccine per person would provide as much protection as the current regimen of two full doses given 28 days apart. They will also test whether using a single dose might be enough. STAT’s Helen Branswell has more.
The American Red Cross is adding arm examinations of prospective donors (on top of standard fever checks) to look for the distinctive lesions that are a hallmark of the disease, STAT's Megan Molteni reports. And beginning in October, the Red Cross will require people who have been diagnosed with monkeypox or exposed to someone with a monkeypox infection to wait at least 21 days before giving blood.

Closer look: People looking for new weight-loss drugs find a ‘wild west’ of online prescribers

(Alex Hogan/STAT)

As Scott Kahan, director of a weight management clinic in Washington, D.C., told STAT’s Katie Palmer, the world of obesity and weight loss treatments and products has always been a wild west. That’s still true, even with GLP-1 receptor agonists, the first new FDA-approved chronic weight management drug since 2014. Dozens of telehealth companies are ready to prescribe it, which isn’t necessarily a bad thing, but experts worry that the rise in direct-to-consumer platforms could harm patients.

Even well-intentioned companies that pair prescriptions with weight loss coaching aren’t designed to provide long-term support. More troubling, experts say, are the platforms that have seemingly cropped up just to churn out prescriptions for a profit. “While there’s a legitimate core of the field, far more that surrounds it is bogus and nonsense and predatory,” Kahan said. Read more.

Monoclonal antibody treatment for malaria looks promising in early trial

It’s a small trial, but it’s big on hope. An experimental antibody treatment prevented malaria in most participants in an early-phase study published yesterday in NEJM. Only two of 17 participants in the Phase 1 clinical trial contracted malaria after being given the monoclonal antibody treatment, known as L9LS.

The participants at NIH’s Vaccine Research Center were introduced to malaria from two to six weeks after receiving L9LS. The highest two intravenous doses completely prevented infection; all six participants in the control group and two participants who received L9LS — one who got a lower IV dose and one who got a lower dose subcutaneously — contracted malaria. The WHO recommended the first-ever malaria vaccine, called RTS,S, last October but experts hope that a monoclonal antibody could further drive down malaria infection rates. STAT's Elissa Welle has more.

Civica Rx is selling its first outpatient generic drug

Four years ago, seven of the country’s largest hospital systems banded together to reverse rising prices and persistent shortages of generic drugs by launching their own not-for-profit manufacturer. Since then, it has supplied about 60 sterile injectable medicines to 55 health systems representing about 1,500 hospitals. Now, the venture called Civica Rx is working with a generic manufacturer to sell a cheaper generic version of an expensive prostate cancer medicine.

Under terms of the deal, Hikma Pharmaceuticals will supply pharmacies with a month’s supply of abiraterone for $160. And the nonprofit is asking pharmacies sell the medicine to consumers for $171, considerably less than what most consumers pay for brand-name Zytiga. Medicare Part D beneficiaries pay about $3,200 a month, although prices do vary. That’s not the only reason it’s complicated. STAT’s Ed Silverman explains the challenges, including hurdles in the system for reimbursing and providing incentives to pharmacies.

What to read around the web today

A ‘reversible’ form of death? Scientists revive cells in dead pigs’ organs, New York Times
Biden signs executive order to protect travel for abortion, Associated Press
70 deaths, many wasted organs are blamed on transplant system errors, Washington Post
Alnylam therapy for increasingly common heart disease succeeds in closely watched trial, STAT
‘How can you not be excited?’: AI experts share enthusiasm about its future in health care, STAT