CDC Identifies New COVID-19 Syndrome in Adults Similar to MIS-C in Kids
The Centers for Disease Control and Prevention (CDC) reported Friday that some adults may experience dangerous systems that are similar to a coronavirus-associated syndrome in children. The condition is being called multisystem inflammatory syndrome in adults (MIS-A), which researchers say is similar to multisystem inflammatory syndrome in children (MIS-C). Neither condition is obviously linked to coronavirus, and patients may not demonstrate any other symptoms that would suggest COVID-19 infection. According to CDC, MIS-A has taken the lives of three individuals and also disproportionately affects racial and ethnic minorities. In a new study, CDC researchers report the cases of 27 adults aged 21-50 years who had similar syndromes, most with extreme inflammation throughout their bodies and malfunction of organs, though not the lungs. Although hyperinflammation and extrapulmonary organ dysfunction have been described in hospitalized adults with severe COVID-19, these conditions are generally accompanied by respiratory failure," they report in CDC's Morbidity and Mortality Weekly Report. "In contrast, the patients described here had minimal respiratory symptoms, hypoxemia (low blood oxygen), or radiographic abnormalities in accordance with the working case definition, which was meant to distinguish MIS-A from severe COVID-19; only eight of 16 patients had any documented respiratory symptoms before onset of MIS-A." A third of the patients described in the report tested negative for active coronavirus infection but were positive for antibodies to the virus. In addition, all but one of the MIS-A patients in the report belonged to racial or ethnic minority groups, the researchers said. "Clinicians and health departments should consider MIS-A in adults with compatible signs and symptoms," the team advised. "These patients might not have positive SARS-CoV-2 PCR or antigen test results, and antibody testing might be needed to confirm previous SARS-CoV-2 infection."
MedPAC Eyes Deflation, Bundling as Solutions to High-End Testing Under Lab Fee Schedule
During a two-day meeting in September, the Medicare Payment Advisory Commission (MedPAC) examined the issue of costly, high-end tests impacting Medicare's clinical lab fee schedule (CLFS). MedPAC's Brian O'Donnell estimated that independent labs may be providing as much as 93 percent of these high-complexity tests. He also suggested that prior authorization could be a factor in utilization control. The overall rate of test utilization increased from 12.8 tests per beneficiary in 2017 to 12.9 tests in 2019, but spending increased from $7.1 billion to $7.5 billion over that two-year span, largely attributable to a 251 percent increase in spending on molecular pathology tests. The absolute figures constituting this increase are $530 million in 2017 and $1.4 billion in 2019. MedPAC member Brian DeBusk advocated bundling such tests with the overall episode of care. Bruce Pyenson, a consulting actuary, remarked that the commoditization of clinical chemistry in conventional tests might serve as a blueprint, and that a standard annual deflation rate might be set at either 5 percent or 10 percent. In response to the discussion, the American Clinical Laboratory (ACLA) noted that laboratory services are not widgets conducive to competitive bidding. ACLA President Julie Khani said clinicians and patients are still going through a learning curve as to the value of molecular tests. She said, "For this reason, ACLA believes it is unwise to rush and consider policies [that] would erect barriers to patient access," particularly when used for identifying possibly ineffective cancer treatments.
CDC Acknowledges COVID-19 Can Spread Via Tiny Air Particles
Wall Street Journal
The Centers for Disease Control and Prevention (CDC) has updated its guidelines on coronavirus transmission, confirming that tiny airborne particles can linger for hours and travel beyond the 6-foot threshold for social distancing. The agency first acknowledged the potential role of aerosol droplets in September, but backpedaled just days later. Now, it again says that particles can infect from more than six feet away, while emphasizing this is not the primary mode of transmission. "CDC continues to believe, based on current science, that people are more likely to become infected the longer and closer they are to a person with COVID-19," a news release from the agency reads. "Today's update acknowledges the existence of some published reports showing limited, uncommon circumstances where people with COVID-19 infected others who were more than 6 feet away or shortly after the COVID-19-positive person left an area." Reporting in the Journal of the American Medical Association, an MIT researcher calculates that respiratory droplets, previously thought to fall to the ground after traveling a few feet, can actually move as much as 26 feet after a sneeze and 20 feet after a cough. Common denominators for people who become infected under these circumstances, scientists say, are being unmasked in indoor environments with low ventilation for long periods of exposure.