A new iteration of the American Health Care Act (AHCA), the challenge of sepsis in US hospitals, a predictive map that identifies which species are likely to harbor the next human virus, how one Canadian researcher mail-ordered his way to horsepox, and a focus on how gonorrhea is on the way to becoming untreatable comprise the top 5 articles of the week for the week.
The latest (and last?) version of the AHCA still calls for significant cuts to Medicaid, starting in 2025, ending the funds for expansion of the program under the ACA in 2024. Notably, though, the new bill includes the so-called “Cruz-Lee Amendment” (named for its authors, Ted Cruz of Texas and Mike Lee of Utah), which would enable insurers to offer plans that do not meet all of the requirements set forth in the ACA, including protection for people with preexisting conditions. The idea is that this will allow insurers to offer cheaper plans to healthier people.
Interestingly, Senator Lee has, The Hill notes, indicated that he was not involved in the drafting of this version of the bill—or his namesake amendment—and that he will need to review the revised text before determining whether he will support it.
In a nod to moderates, The Hill reports, the new version of the AHCA includes $70 billion in funding to help sick people enrolled in ACA plans manage costs, and it adds $70 billion to the $112 billion already earmarked for premium reduction. However, the tax credits offered under the ACA to offset premium costs have been further reduced.
Continue reading about the new iteration of the AHCA, here.
Recently, research findings, government action, and global public health initiatives have focused new attention on an age-old problem—sepsis, and its related complications.
Sepsis, a diagnosis that dates to ancient Greece, remains a significant public health challenge. A meta-analysis published last year suggests there may be as many as 30 million new cases annually, resulting in more than 6 million deaths worldwide (although the authors admit that these may, in fact, be underestimates, given that they were unable to obtain data from poorer countries, where the vast majority of the world’s population lives). Here in the United States, septicemia is still one of the most common diagnoses which result in hospital stays. Data collected for the Healthcare Cost and Utilization Project (HCUP), and posted in June 2017, indicates that hospital stays related to septicemia increased from 518,000 in 2005 to 1.514 million in 2014 (accounting for 4.3% of hospital stays)—an increase of 192.3%
Read more on the challenge of sepsis, here.
Based on bat population estimates, the EcoHealth Alliance researchers have identified South and Central America as well as parts of Asia as hotspots of so-called “missing zoonoses,” or currently undiscovered viruses that could be passed along to humans. Although these hotspots have been documented in color-coded heat-maps developed by the team, they emphasize that bats’ potential role as transmitters of viruses ultimately depends on the level of contact they have with humans—including any activity that alters their habitat (such as development) or disturbs their ecology (such as hunting).
The findings also document a similar potential role for primates in Central America, Africa, and Southeast Asia—and map areas of possible heightened risk for disease emergence and host-to-human transmission. In general, the authors believe that conservation efforts designed to protect potential host species can help reduce the risk for zoonotic disease, at least in part by serving to limit human-host interactions. Future projects by the EcoHealth Alliance team will involve targeting field surveillance efforts around the world to identify emerging disease threats in both animals and humans.
Learn more about the predictive map, here.
The online shopping industry is booming and it looks like mail-order pathogens for scientific experiments may be following suit. In fact, Canadian researchers, led by virologist David Evans, PhD, recently announced that they had synthesized horsepox virus through mail-order DNA. Although the team is small and has little specialized knowledge, half a year and $100,000 allowed them to build a cousin of smallpox.
As you can imagine, this experiment and its results are getting a lot of attention for several reasons. Firstly, anything done with a relative of variola (smallpox) implies that the experiment would also be successful with smallpox. This fact alone is a heated topic given the debate around the safety and potential destruction of the last remaining smallpox samples. Secondly, Dr. Evans’ research underscores another ongoing debate regarding dual-use research of concern (DURC). DURC applies to research that can be reasonably anticipated to provide knowledge, information, products, or technology that could pose a threat.) Thirdly, this experiment highlights potential gaps within oversight of the life sciences.
Although Dr. Evans’ horsepox experiment has not been officially published yet, it is already drawing controversy for the aforementioned reasons. Dr. Evans’ work with horsepox is a reminder of the experiments that first drew attention to DURC, such as one in which the poliovirus was reconstituted from scratch. Not only does this horsepox experiment highlight the debate regarding the oversight of life sciences in terms of DURC, it also highlights other research that could increase gain-of-function (GoF). (The reader may remember that GoF research has come under fire after several studies showed GoF research enhanced pandemic potential, resulting in a halt to federal funding for GoF research until guidelines could be established.)
Continue reading about how one researcher mailed-ordered horsepox, here.
Gonorrhea can be prevented if individuals engage in safer sex practices. In fact, with more information, education, and communication, researchers hope that individuals will be able to identify associated symptoms and thus, receive the treatment that they need. The problem is, there are no rapid point-of-care diagnostic tests available for gonorrhea, and, often, those who are infected do not present with any telltale signs of infection; this means that they can remain untreated and develop serious complications.
To add to these issues, many times if an individual presents with symptoms that are similar to those associated with gonorrhea, many practitioners proactively treat them accordingly, even though they may not be infected with gonorrhea. This misdiagnosis, and unnecessary prescribing are also contributing factors to the growing resistance of the bacteria.
“To control gonorrhea, we need new tools and systems for better prevention, treatment, earlier diagnosis, and more complete tracking and reporting of new infections, antibiotic use, resistance, and treatment,” Dr. Marc Sprenger, Director of Antimicrobial Resistance at WHO commented in the news release. New antibiotics and diagnostic tools that are capable of predicting “which antibiotics will work on that particular infection” are needed in order to cut down on the alarming numbers, he concluded.
Learn more about how gonorrhea is becoming untreatable, here.