Automated texting system for at-home monitoring of COVID-19 patients shown to save lives

1. Automated texting system for at-home monitoring of COVID-19 patients shown to save lives

Patients enrolled in COVID Watch were 68 percent less likely to die from COVID-19

Abstract: https://www.acpjournals.org/doi/10.7326/M21-2019             

URL goes live when the embargo lifts

A retrospective cohort analysis found that an algorithm-based automated text messaging system saved a life twice a week during the first wave of the COVID-19 pandemic and overall, the patients who enrolled in that system were 68 percent less likely to die than those not using it. These reduced mortality rates were the same for all major racial and ethnic subgroups enrolled in the program. The findings are published in Annals of Internal Medicine.

Modeled after a system developed by a team at Penn Medicine to keep tabs patients with chronic obstructive pulmonary disease (COPD), the text messaging system, called COVID Watch, used text messages to monitor symptoms and symptom severity in patients quarantined at home with COVID-19. Those with concerning conditions were escalated to a small team of health care providers to determine next steps for care, including hospitalization, if needed.

Researchers from the University of Pennsylvania enrolled 3,488 patients in COVID Watch and 4,377 in the usual care group to compare outcomes at 30 days. They found that 3 patients in COVID Watch group died within 30 days of their enrollment compared to 12 in the control group. At 60 days after enrollment, 5 people within COVID Watch died compared to 16 not using the system. They also found that more than one third of the deaths in the usual care group occurred outside the hospital versus none among those in COVID Watch. Patients in the COVID Watch cohort also were more likely to present to the hospital, and they presented an average of 2 days earlier than those in usual care.

According to the study authors, the benefits seen by COVID Watch patients potentially could be explained by increased access to and use of telemedicine and more frequent and earlier trips to the hospital when symptoms worsened. The COVID Watch team plans to see if the approach can be applied to helping people with other conditions manage their health at home.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author, M. Kit Delgado, MD, MS, please contact Frank Otto at Frank.Otto@pennmedicine.upenn.edu.

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2. ‘Esperanza Patient’ possible case of natural cure of HIV infection without stem cell transplant 

Case raises hopes that a sterilizing cure could be induced in larger numbers of people living with HIV

Abstract: https://www.acpjournals.org/doi/10.7326/L21-0297              

Editorial: https://www.acpjournals.org/doi/10.7326/M21-4336               

URL goes live when the embargo lifts

A patient diagnosed with HIV-1 infection in 2013 may have achieved a natural sterilization cure without stem cell transplantation. Genome-intact and replication-competent HIV-1 were not detected over 8 years of follow up despite analysis of massive numbers of cells from blood and tissue. These observations raise the possibility that a sterilizing cure may be an extremely rare but possible outcome in HIV-infection. The findings are published in Annals of Internal Medicine.

Antiretroviral therapy (ART) can effectively suppress viral replication in HIV-1 but a sterilizing cure during natural disease is currently considered elusive. A sterilizing cure refers to the complete elimination of replication-competent proviruses and has only ever been achieved by 2 patients, both of whom had leukemia and underwent allogenic hematopoietic stem cell transplants. A small subgroup of patients living with HIV, frequently called “elite controllers” have undetectable virus via polymerase chain reaction (PCR) assay, but reservoirs of replication-competent HIV-1 persist.

Researchers from Ragon Institute of MGH, MIT and Harvard and INBIRS Institute (UBA-CONICET) conducted a detailed investigation of an elite controller with undetectable virus after more than 7 years without ART. The investigators looked for viral particles in more than 1.5 billion cells from blood and tissue samples taken over a more than 4-year period. At no point was replication-competent virus detected, suggesting a naturally occurring sterilization cure. According to the researchers, these findings raise hopes that a sterilizing cure can be induced in larger numbers of people living with HIV. This patient is being referred to as the Esperanza Patient.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding authors, Xu Yu, MD, MS, please contact Mr. Zachary Manickas-Hill at zmanickas-hill@mgh.harvard.edu and with Natalia Laufer, MD. PhD, please contact her at nlaufer@fmed.uba.ar.

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3. Physicians miss many opportunities to provide flu vaccinations, especially among older minority populations

Abstract: https://www.acpjournals.org/doi/10.7326/M21-1550   

URL goes live when the embargo lifts

Clinicians are missing opportunities to vaccinate Medicare patients against influenza, despite widespread availability of vaccines and no copayment for patients. In addition, disparities persist in vaccination uptake based on factors including the presence of high-risk illness as well as the beneficiary’s race and ethnicity. The findings are published in Annals of Internal Medicine.

Medicare beneficiaries, including seniors and adults with high-risk conditions, are among the populations who are most susceptible to severe influenza infections and complications. Despite the accessibility of the influenza vaccine, uptake among Medicare beneficiaries was only 50.5 percent during the 2018-2019 flu season.

Researchers from the Centers for Disease Control and Prevention (CDC) studied 31.6 million U.S. adults continuously enrolled under Medicare Parts A and B during the 2018 to 2019 influenza season to describe seasonal flu vaccine uptake and identify factors associated with missed opportunities for vaccination. The researchers found that only about half of Medicare beneficiaries aged 19 or older had received an influenza vaccine during the 2018 to 2019 flu season. Individuals with at least one high-risk condition accounted for 89.3 percent of those vaccinated but did not account for more than 60 percent of the high-risk cohort. Researchers also observed disparities in vaccination status based on race and ethnicity, with far more White beneficiaries being vaccinated compared with Black and Hispanic beneficiaries. The researchers noted many missed opportunities during which all beneficiaries, including those at highest risk, could have been vaccinated but were missed both by primary care and specialty providers. The researchers suggest that public health officials, policymakers, and clinicians engage in sustained, population-specific messaging to increase vaccination rates in vulnerable populations and overcome barriers to and complete influenza vaccination during routine appointments. Pharmacies could also close the vaccination gap, with nearly 60 of beneficiaries without underlying risk conditions receiving the influenza vaccination from a pharmacy.

Media contacts For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the lead author, Bo-Hyun Cho, PhD, please contact Katherina Grusich at yhb3@cdc.gov or Kristen Nordlund at hok4@cdc.gov.

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4. Fewer work hours, more mental health treatment seeking contributing factors to reduced depression trend in medical residents

Abstract: https://www.acpjournals.org/doi/10.7326/M21-1594              

Editorial: https://www.acpjournals.org/doi/10.7326/M21-4077              

URL goes live when the embargo lifts

A cohort study of physicians in residency training reveals that the increase in depressive symptoms during first-year residency has decreased substantially over a 13-year period between 2007 and 2020. These findings suggest that recent changes made to the residency experience have reduced negative mental health impacts on medical interns. The study was published in Annals of Internal Medicine.

Researchers from the Michigan Neuroscience Institute, University of Michigan surveyed 16,965 participants from 645 residency institutions to assess how the increase in depressive symptoms with residency has shifted over time and to identify parallel trends in factors that have previously been associated with resident physician depression. The researchers noted a 25% decrease in the development of depressive symptoms over time and identified four factors that were associated with decreasing depressive symptoms among residents: decreased work hours, increased quality of faculty feedback, longer total sleep time, and increased mental health treatment. Most notably, authors found resident work hours decreased by 7 to 8 hours per week over time and that interns in 2019-2020 were almost three times as likely to seek out mental health services than interns in 2007-2008. Despite the overall improvement, more than a third of residents still experience depression during their first year of professional training. The authors suggest that additional focus from policy makers, residency institutions and individual physicians on the four factors identified in the study could result in further improvements in mental health among resident physicians and  could help to reduce depression in other populations of health care workers.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author, Srijan Sen, MD, PhD, please contact Kara Gavin at kegavin@med.umich.edu.

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