|THIS WEEK IN HEALTHCARE
What happened in healthcare this week—and what we think about it.
Battling public health emergencies old and new
The widespread protests that swept the nation this week, coming in the midst of state-by-state reopening efforts, sparked fears of a resurgence of coronavirus cases in cities already hard hit by the virus. On Thursday, Centers for Disease Control and Prevention (CDC) director Robert Redfield told a House committee that protestors should “highly consider being evaluated and get[ting] tested” for the virus. The uneven restart of the economy has already led to a worrisome uptick in cases, as tracked by the (excellent) COVID Exit Strategy project, which showed 24 of 50 states with increasing 14-day case trends by the end of the week. Meanwhile, ICU capacity is becoming strained in several parts of the country, including, notably, Minneapolis, which has seen some of the most intense protests following the murder of George Floyd. In addition, researchers warned this week that the use by police of riot control agents like tear gas, common in several cities, could worsen the situation by amplifying the spread of virus-containing droplets, worsening infections, and undermining the ability to fight off disease.
The scenes of large numbers of protestors gathered closely together on the streets created a sharp contrast with the situation just a few weeks ago, when most Americans were sheltering indoors under stay-at-home orders. This has led some critics to highlight the conflicting advice coming from public health advocates. As the death of George Floyd once again illustrated, however, racism and police brutality are public health crises as well, and the intersection between the coronavirus pandemic and racial inequality is complicated. As reported by the COVID Racial Data Tracker—a collaboration between the well-regarded COVID Tracking Project and the Antiracist Research & Policy Center—black people account for at least 22,204 of US deaths from COVID-19, or 24 percent of deaths where the victim’s race was reported. To cite just one example, 77 percent of COVID-19 patients hospitalized in Louisiana’s largest health system were black, and 54 percent of COVID-19 fatalities statewide were black, even though blacks account for only 33 percent of the state’s population. Accuracy of data remains an issue, and this week the Trump administration ordered labs to start reporting race and ethnicity data on every person tested for the virus starting August 1st. But it is clear that black Americans and other racial and ethnic minority groups are suffering disproportionately from the pandemic, for reasons tightly bound to the broader health, income, and social inequalities faced by many. George Floyd survived COVID-19, but was not immune to the deadly impact of racism and inequality he had to navigate every day. Enough is enough. US coronavirus update: 1.91M cases, 110K+ confirmed deaths, 18.7M tests conducted.
Lancet, NEJM retract COVID treatment studies amid data questions
This week two major medical journals retracted observational studies evaluating the efficacy of drug treatments for COVID-19 patients, due to growing concerns about the integrity of the patient data undergirding both analyses. The Lancet retracted a paper published in May which reported that hydroxychloroquine increased mortality of coronavirus patients, likely due to an increase in heart arrhythmias, a well-known side effect of the drug. Just hours later, NEJM pulled a study concluding that two common classes of blood pressure medications were safe to use in COVID patients. Both studies relied on patient data aggregated by analytics firm Surgisphere Corp., which came under fire after serious questions about the dataset’s validity and accuracy surfaced; investigative work from The Guardian was crucial in bringing the flaws to light. Surgisphere has refused to provide raw data to study authors or independent auditors.
The situation has had cascading effects on ongoing research into coronavirus treatments. After the Lancet study was published, the World Health Organization (WHO) paused recruitment for an international study evaluating the efficacy of hydroxychloroquine out of safety concerns; WHO restarted recruitment again on Wednesday. The debacle highlights the challenge in balancing the desire for quick results with the need for scientific rigor amid the pressure of the pandemic. And while study retractions are nothing new, given the politicization of hydroxycholorquine in particular, the retractions could serve to undermine public trust in the validity of scientific research and provide fuel for those who wish to use it to advance their own objectives.
Physicians acquire Steward Health Care from Cerberus Capital
Private equity (PE) firm Cerberus Capital Management is selling control of Steward Health Care, a Dallas-based health system with 35 community hospitals across nine states, to a management group of Steward’s own physicians. Led by CEO Dr. Ralph de la Torre, Steward physicians will control 90 percent of the company and Medical Properties Trust will maintain its 10 percent stake. The transaction will make Steward one of the largest physician-owned and operated healthcare companies in the country, and end a decade of ownership by Cerberus, which bought Boston-based Caritas Christi Health Care system in 2010, converted it into a for-profit company renamed Steward, and pursed a path of national expansion. Steward’s financial position may have played a role in the timing of the deal—the system reported operating losses across the last three years amid a period of major expansion. We’ve long thought that PE firms are largely uninterested in being long-term owners of physician practices and other care assets, and will likely look to resell assets, pocketing the profits from aggregating smaller players and improving their performance. And we’ve heard doctors who have been unsatisfied with the outcome of other PE deals muse that they would love the chance to buy their practices back. The coronavirus pandemic is making PE firms more gun-shy about the financial outlook for care delivery businesses. If physicians can organize the necessary capital, we might see more “physician reacquisition” by doctors who sold their practices and now find themselves beset with seller’s remorse.