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Weighing when the pandemic’s over, community baby showers as prenatal care, & doctors trying ketamine to ease entry into addiction treatment

May 8, 2023
Reporter, Morning Rounds Writer
"Color Code" is back. For season 2 of the podcast,"Color Code," STAT's Nicholas St. Fleur zooms in on the birthplace of American suburbs and the place where he grew up. Listen to "​​Welcome to Long Island: segregation and suburban health."

coronavirus

When will we know the pandemic is over?

Add another unknown to the list of Covid uncertainties. Yes, the WHO has ended the global health emergency it declared over Covid, but the pandemic is still taking lives every day while transmission of the virus continues. About as close as we'll get to closure is a transition from something that causes widespread illness and unexpected levels of death to something more predictable and less dangerous, experts told STAT's Helen Branswell. How the virus evolves and how our immune systems cope with it will determine when we get there.

Unlike flu pandemics, we have no coronavirus guideposts to look to, the scientists said. And then there's public perception. "There are two totally separate issues at hand here," Michael Osterholm of the University of Minnesota said. "One is what the virus is doing, and the second one is what people are thinking. And they may not always be fully in sync." Read more.


public health

As public health emergencies end, so will CDC leader's tenure

Two other public health milestones were passed on Friday after the WHO declared an end to the Covid-19 global health emergency. One was widely expected and the other was surprising for its timing:

  • With the U.S. public health emergency expiring this week, the CDC said Friday it would no longer attempt to track all Covid infections, an effort long since made futile by ubiquitous rapid tests done at home, STAT's Branswell notes.
  • On the same day, CDC Director Rochelle Walensky announced she'd leave the agency June 30. "I took on this role with the goal of leaving behind the dark days of the pandemic and moving CDC — and public health — forward into a much better and more trusted place," Walensky said in an email to her staff. A source told STAT that the decision to leave was hers, and that the White House would have preferred that she remain in the job. Helen has more.

addiction

Tiny ketamine doses may help people starting addiction treatment, doctors say

As fentanyl has taken over the U.S. illicit drug supply, its potency has also overwhelmed addiction treatments to help people stop using it. When transitioning to buprenorphine, people suffer what's known as "precipitated withdrawal." Its effects are so harsh people give up on buprenorphine, one of only two drugs approved for addiction. The other approved drug, methadone, is available only at specialized clinics.

Enter ketamine, an anesthetic used both medicinally and recreationally that has hallucinogenic effects at high doses. Tiny doses at the beginning of buprenorphine treatment ease the pain of withdrawal symptoms and opioid cravings, according to three doctors who presented their research last month at the American Society of Addiction Medicine's annual conference. Caveats: The doctors' findings are largely observational, no randomized trial has been conducted, and there is little existing medical literature on the practice. STAT's Lev Facher has more on this and other approaches.



Closer Look

Community baby showers can be prenatal care — and save lives

20230203_CommunityBS_07895Monique Jaques for STAT

Community baby showers bring together families, health care providers, city officials, and others. Growing more popular in New York City and across the country, they offer a valuable connection to public resources such as WIC, which provides formula for children, and SNAP, the food stamp program, that are available during pregnancy and after childbirth. At some showers in the city, patients can talk to their health care providers about birth plans and childbirth classes.

That's critical in New York, where the maternal mortality rate for Black people is eight times the rate of non-Hispanic white people. As of 2018, nearly 40% of pregnant people in the Bronx were getting inadequate prenatal care — a higher share than the city overall. And then there are the daily needs: Nearly 1 in 3 people in the Bronx live in poverty, making baby essentials difficult to obtain. STAT contributor Monique Jaques has photos and reporting here.


vaccines

Study offers clues to a rare heart condition in young men after Covid vaccination

It's a very rare side effect, but a troubling one. Some people, especially teen boys, develop the heart inflammation known as myocarditis after receiving an mRNA vaccine. A new study in Science Immunology rules out three causes — an allergic response to the vaccine, antibodies induced by the vaccine, and an autoimmune response in which the body attacks its own healthy cells. Instead, looking at blood samples from 23 patients, the researchers discerned evidence of inflammatory proteins driving an overactive immune system."We were a little relieved that what we found was the inflammation-induced myocarditis" because it's easier to treat than an autoimmune condition, Yale virologist and study co-author Akiko Iwasaki told STAT's Elaine Chen. Most of these myocarditis cases, which tend to resolve quickly, occur after a second vaccine dose, suggesting a longer delay between doses might help. Read more.


covid-19

People with brain fog during an infection more likely to have long Covid, study finds

Among myriad unanswered questions surrounding long Covid, one of the most vexing is why some people but not others recover from their infections only to have long-lasting symptoms harming their mental and physical health. A small new study in JAMA Network Open found that people who said they had trouble thinking clearly, remembering, or concentrating in the first four weeks of their illness and a history of depression and anxiety were more likely to say they had brain fog up to three months later. 

Michael Zandi, a neurologist at University College London, takes a cautious view. "Correlation is not causation, and while psychological factors are important to address where present in patients after Covid, we cannot assume that cognitive symptoms are caused by these factors alone," he said. "There is an urgent need to understand the biology underlying these symptoms to allow selection of patients for treatments in drug trials in parallel with appropriate rehabilitation."


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What we're reading

  • The Planned Parenthood problem, The New Yorker

  • Cracking an intriguing secret of centenarians: Why so few are ravaged by Alzheimer's disease, Boston Globe
  • Geisinger board member: Local consolidation influenced Kaiser-Geisinger deal, STAT
  • Opinion: Why Americans feel more pain, New York Times
  • Opinion: The amoxicillin shortage continues to force pediatricians and families to scramble, STAT

Thanks for reading! More tomorrow,


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