Why the Omicron Offshoot BA.5 is a Big Deal

CNN | By Brenda Goodman

Once again, Covid-19 seems to be everywhere. If you feel caught off-guard, you aren't alone.

After the Omicron tidal wave washed over the United States in January and the smaller rise in cases in the spring caused by the BA.2 subvariant, it might have seemed like the coronavirus could be ignored for a while. After all, the US Centers for Disease Control and Prevention estimated in December that nearly all Americans had been vaccinated or have antibodies from a past infection. Surely all that immunity bought some breathing room.

But suddenly, many people who had recovered from Covid-19 as recently as March or April found themselves exhausted, coughing and staring at two red lines on a rapid test. How could this be happening again -- and so soon?

The culprit this time is yet another Omicron offshoot, BA.5. It has three key mutations in its spike protein that make it both better at infecting our cells and more adept at slipping past our immune defenses.

In just over two months, BA.5 outcompeted its predecessors to become the dominant cause of Covid-19 in the United States. Last week, this subvariant caused almost 2 out of every 3 new Covid-19 infections in this country, according to the latest data from the CDC.

Lab studies of antibodies from the blood of people who've been vaccinated or recovered from recent Covid-19 infections have looked at how well they stand up to BA.5, and this subvariant can outmaneuver them. So people who've had Covid as recently as winter or even spring may again be vulnerable to the virus.

"We do not know about the clinical severity of BA.4 and BA.5 in comparison to our other Omicron subvariants," CDC Director Dr. Rochelle Walensky said at a White House Covid-19 Response Team briefing Tuesday. "But we do know it to be more transmissible and more immune-evading. People with prior infection, even with BA.1 and BA.2, are likely still at risk for BA.4 or BA.5."

A 'full-on' wave

The result is that we're getting sick in droves. As Americans have switched to more rapid at-home tests, official case counts -- currently hovering around 110,000 new infections a day -- reflect just a fraction of the true disease burden

"We estimate that for every reported case there are 7 unreported," Ali Mokdad, professor of health metrics sciences at the University of Washington's Institute for Health Metrics and Evaluation, wrote in an email.

Other experts think the wave could be as much as 10 times higher than what's being reported now.

"We're looking at probably close to a million new cases a day," Dr. Peter Hotez said Monday on CNN. "This is a full-on BA.5 wave that we're experiencing this summer. It's actually looking worse in the Southern states, just like 2020, just like 2021," said Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine in Houston.

That puts us in the range of cases reported during the first Omicron wave, in January. Remember when it seemed like everyone everywhere got sick at the same time? That's the situation in the United States again.

It may not seem like a very big deal, because vaccines and better treatments have dramatically cut the risk of death from Covid-19. Still, about 300 to 350 people are dying on average each day from Covid-19, enough to fill a large passenger jet…

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Our Mental Health Crisis is Getting Worse. New 988 Suicide Hotline Can be our Fresh Start.

USA Today | Dr. Jerome Adams

This column contains discussion of suicide. If you or someone you know might be struggling with suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-8255.

Before COVID-19, nearly 40 million people in the United States were identified in 2019 as having mental illness. Worse, fewer than half (45%) received treatment. The stress of the pandemic has exacerbated this crisis, with isolation, stress and worsening access to treatment. 

Across the country, mental illness and suicide rates are high and rising. Approximately 20% of adults reported in 2020 that they suffered from mental illness, and the share of adults reporting anxiety or depression disorders spiked to over 41% last year.

Deaths attributed to suicide

About 47,500 deaths were attributed to suicide in 2019, compared with more than 38,000 in 2010, according to the Centers for Disease Control and Prevention.

Mental illness and suicide are particularly pronounced among young people and those in rural areas. In rural America, higher suicide rates are further compounded by even greater challenges in accessing care.

Let's go nationwide: Our clinics meet mental health needs and lighten the load on law enforcement

July's launch of 988, a new mental health crisis response number, marks a historic opportunity to ensure that the growing number of people in crisis can get appropriate and more equitable access to mental health services – and that our broader emergency response infrastructure (which includes 911, emergency medical services and law enforcement) can guide people to the right places, at the right times.

By July 16, all telecommunications carriers must provide access to 988, which will direct calls to the National Suicide Prevention Lifeline, a switchboard that provides free crisis counseling and emotional support to more than 2 million callers a year and connects them to one of more than 180 crisis centers nationwide.

The new, easy-to-remember 988 will provide an alternate access point into care and help keep people in crisis from needlessly cycling through hospital emergency rooms and the criminal justice system. It will also provide minority communities that are often fearful of calling 911 for a loved one in mental health crisis, an option less biased toward a response based solely in law enforcement…

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Approaches to Improving Medicare’s Home Health Benefit: Lessons from Medicaid

The Commonwealth Fund

Medicare’s home health benefit is crucial to the welfare of beneficiaries, but its application in providing personal care leaves much room for improvement in terms of service availability and equity.

Drawing on insights from Medicaid programs’ experiences in providing personal care services, we found that: 1) a systematic approach to the referral and provision of personal care services is necessary to support equitable access; 2) separating the assessment and care plan development from the service provider helps to eliminate conflict in payment incentives; and 3) a fairly compensated direct-care workforce is required. While Medicaid programs help to fill gaps in Medicare’s coverage, restrictive and varying eligibility requirements limit its role.

Introduction

The Medicare home health benefit is designed to enable beneficiaries to receive care in their homes after hospitalizations or other acute events or for ongoing needs. It covers skilled services such as nursing and physical therapy, as well as home health aide services, including help with personal care activities like bathing, dressing, grooming, feeding, and getting around.

In practice, however, the home health benefit is falling short of its potential. Many beneficiaries are not aware of the benefit at all, many providers do not order these services for their patients, and home health agencies often do not provide the full range of services. Medicare home health visits have declined steeply over the past 20 years, and payment incentives affect who is served and how (Exhibit 1). Moreover, racial and ethnic disparities in access to these services have been documented for patients with postacute needs. When Medicare does not cover home health services, the burden of finding and paying for them is borne by individuals and their family members — often to the detriment of their health and finances.

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Geographic Variation in Medicare Home Health Expenditures

Am J Manag Care. 2022;28(7):In Press

ABSTRACT

Objectives: To quantify geographic variation in home health expenditures per Medicare home health beneficiary and investigate factors associated with this variation.

Study Design: Retrospective study design analyzing US counties in which at least 1 home health agency served 11 or more beneficiaries in 2016. Several sources of 2016 national public data were used.

Methods: The key variable is county-level Medicare home health expenditures per home health beneficiary. Counties were grouped into quintiles based on per-beneficiary expenditures. Analyses included calculation of coefficients of variation, computation of the ratio of 90th percentile to 10th percentile in expenditures, and linear regression predicting expenditure. The control variables included characteristics of patients, agencies, and communities.

Results: Significant variation in home health expenditures was identified across county quintiles, with a 90th-to-10th-percentile expenditure ratio of 2.5. The percentage of for-profit agencies in the lowest quintile was 15.7 compared with 81.7 in the highest quintile of spending. Unadjusted spending differed by $3864 (95% CI, $3793-$3936), compared with $3611 (95% CI, $3514-$3708) in the adjusted model, between counties in spending quintiles 1 and 5. Although state fixed effects explained nearly 20% of the variation in home health expenditures, 42% of the variation remained unexplained.

Conclusions: Home health care exhibits considerable unwarranted variation in per-patient expenditures across counties, signifying inefficiency and waste. Given the expected growth in home health demand, strategies to reduce unwarranted geographic variation are needed.

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