In The News

Misdirected antibodies linked to severe COVID-19

National Institutes of Health (NIH) / By Sharon Reynolds

The severity of COVID-19 can differ drastically between individuals. Some people never know they’ve been infected, while others may end up needing intensive care or dying from the disease.

Several factors have been associated with severe COVID-19, including preexisting health conditions like obesity, diabetes, and high blood pressure. Men are more likely to die of the disease than women. And the risk of dying from COVID-19 increases with age.

Researchers around the world have been looking for other risk factors for severe or fatal infection with SARS-CoV-2, the virus that causes COVID-19. An international project called the COVID Human Genetic Effort has been searching for genetic and molecular differences that may increase the risk of severe COVID-19. The project is co-directed by Dr. Helen Su from NIH’s National Institute of Allergy and Infectious Diseases (NIAID) and Dr. Jean-Laurent Casanova from Rockefeller University.

Two recent studies from the project, led by Casanova, found that some severe cases of COVID-19 could be linked to problems with immune-system proteins called type I interferons (IFNs). These IFNs are needed to fight off viral infections. In rare cases, genetic conditions blocked the production of these proteins. But more commonly, antibodies that mistakenly targeted the IFNs were found in the blood of people with severe or fatal COVID-19.

To better understand how common these autoantibodies are, Casanova and his colleagues screened for them in blood samples taken from more than 3,500 people with severe or fatal COVID-19 and more than 34,000 uninfected volunteers from 38 different countries. The new study was funded in part by several NIH components, primarily NIAID. Results were published on August 19, 2021, in Science Immunology.

The team found that 20% of people hospitalized with severe COVID-19 had high or intermediate levels of autoantibodies to type I IFNs. Autoantibodies were also found in at least 18% of people who died from the disease. In contrast, people with no or mild symptoms had very low levels of these autoantibodies. The researchers estimate that the autoantibodies may account for about 20% of total fatal COVID-19 cases.

The risk of having such autoantibodies increased with age. For example, while fewer than 10% of people under the age of 40 with severe COVID-19 had active levels of these autoantibodies, more than 21% of those over the age of 80 had them.

The researchers also found evidence of autoantibody production in uninfected volunteers. They were found in less than 1% of people between 18 and 69 years; in 2.3% of those between 70 and 79 years; and in 6.3% of those 80 years and older. This suggests that type I IFN autoantibodies existed before infection and become more common past age 70.

In a related paper published in the same issue of Science Immunology, the researchers identified another rare genetic defect that occurs only in men and results in disruption of IFN production. They estimated that this genetic risk factor accounts for at least 1% of cases of life-threatening COVID-19 in men under the age of 60.

“We can neatly explain much of severe COVID-19 as a net defect in type I IFN,” Casanova says. “To an extent never seen for any other acute infectious disease, these… studies collectively provide a molecular and immunological explanation for about 20% of critical cases.”

Autoantibodies against IFNs—at even very low levels—can be screened for in the clinic. Testing for these autoantibodies could help identify uninfected people who need aggressive preventive measures or infected people who need early aggressive treatment.

 

Process Revisions for Changes of Information for Medicare Certified Providers (From NAHC)

The Centers for Medicare & Medicaid Services (CMS) recently released revised instructions (Transmittal 10975/Change Request (CR) 12386) for processing of Medicare-certified provider information,  transitioning certain functions from the  Survey & Operations Group (SOG) Locations (formerly known as Regional Offices) to the Medicare Administrative Contractors (MACs) and the Provider Enrollment & Oversight Group (PEOG), which is part of the Center for Program Integrity. 

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Public Opinion Supports the Choose Home Care Act

The Partnership for Quality Home Healthcare (PQHH) recently released the results of a new poll conducted by Morning Consult, which underscores the popularity of home health and the importance of passing the Choose Home Care Act of 2021.  

86% of adults, including 94% of Medicare beneficiaries, expressed support for the Choose Home Care Act. The poll also demonstrated wide bipartisan support, with 83% of Republicans and 92% of Democrats showing support for the legislation. 

The results of the poll are highly in favor of increasing patient choice for post-hospital care. Here are several resources regarding the poll for your use:

 

New Poll: Seniors Want to Age at Home with Caregiver Support

McKnight’s Senior Living / By Diane Eastabrook 

new AARP poll finds voters over age 50 overwhelmingly want to age in their own homes with caregiver support. The poll comes as Congress prepares to vote on the Biden administration’s $3.5 trillion budget that includes billions of dollars for home- and community-based services.

In the survey of 1,400 older voters, AARP found 87% wanted to age in place with caregiver support; the same percentage wanted to choose how long-term care services would be provided.

Respondents also overwhelmingly supported a $5,000 tax credit for family caregivers, as proposed in the bipartisan Credit for Caring Act. And a majority of respondents supported increased resources for in-home care and for Medicaid to guarantee home care services as a choice for seniors in need of long-term care.

The survey found the broad support for in-home services was evenly divided between Democrats and Republicans. 

The administration’s plan, known as Build Back Better, would expand home care for older adults, while improving job training, wages and benefits for caregivers. The plan would also bolster affordable housing for seniors.

Several bills under discussion, such as the Caring for Credit Act, may wind up in the reconciliation package. Among them are the Choose Home Act, which would allow seniors who qualify for nursing home services to get skilled nursing care in their homes.

 

HCBS Funding Is Now in the Congressional Crosshairs

Home Health Care News / By Robert Holly
 
The $400 billion that the Biden administration wanted for strengthening the nation’s home- and community-based services (HCBS) infrastructure is likely in the crosshairs of Congress.
 
Currently, President Joe Biden and senior Democrats are working to figure out what’s included in the large spending legislation they hope to pass through the budget reconciliation process. Early estimates had a $3.5 trillion package touching on health care, education and climate change.
 
In order to pass the domestic investment plan via reconciliation, Democrats need the support of their entire party in the Senate. Yet some Senators, including Joe Manchin of West Virginia, have expressed a desire to get the spending legislation closer to $1 trillion to $1.5 trillion.
 
“Instead of rushing to spend trillions on new government programs and additional stimulus funding, Congress should hit a strategic pause on the budget-reconciliation legislation,” Manchin wrote in a recent Wall Street Journal op-ed. “A pause is warranted because it will provide more clarity on the trajectory of the pandemic, and it will allow us to determine whether inflation is transitory or not.”
 
In addition to the package’s overall price tag, Machin has expressed specific concerns about the plan to spend hundreds of billions of dollars on in-home care, according to a Tuesday report from Axios.
 
Other members of Congress have pushed back against investments in “soft” infrastructure as well.
 
Due to the lack of full-party support at the moment, funding for HCBS, which would likely be carved into the spending legislation through the recently introduced Better Care Better Jobs Act, may end up closer to $150 billion. Sens. Bob Casey of Pennsylvania and Ron Wyden of Oregon are among the key backers of the Better Care Better Jobs Act, along with Rep. Debbie Dingell of Michigan in the House.
 
Another Axios report from Friday [September 10th] said the House Ways and Means Committee was looking to invest $190 billion into HCBS.
 
Even if $400 billion is ultimately reduced to $190 billion, that would be a historic increase for HCBS providers, which for years have struggled with lackluster Medicaid rates and dire labor shortages.
 
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