Covid-19 in primary care practices
A recent paper in JAMA characterizes the SARS-CoV-2 testing landscape across primary care clinics in the United States, providing useful insight into our nation's preventative healthcare system amidst the covid-19 pandemic. The authors gleaned data from hundreds of primary care clinics and health centers across 21 states through May 31, 2020. Of the nearly two million patient visits, only 1.7 percent resulted in covid-19 tests. Of those, 28 percent tested positive. New patients were more likely to be tested than established ones.
With regards to demographics, the paper highlighted lower testing rates among patients who were Asian, non-English speaking or publicly insured, consistent with prior data highlighting a decreased likelihood of minority populations receiving testing in ERs or Urgent Care. Furthermore, Hispanic/Latinx, uninsured, and non-English speaking patients had higher rates of positive tests, also consistent with prior data about healthcare disparities in covid-19.
Additionally, the paper found that those with more comorbidities were more likely to be tested, which makes sense given our knowledge that older patients have a greater degree of risk factors for developing severe covid-19.
Perhaps most interestingly, the paper discussed a significant decline in face-to-face office visits compared to this time last year. While in some sense, this is consistent with the telehealth movement being pushed by leaders in medicine, one wonders if this will result in a decline in the preventative and population health measures normally carried out by our primary care providers.
FDA seeks to reclaim trust
It is no secret that the Food and Drug Administration (FDA) has been involved in controversy since the pandemic started, from the White House decrying regulations to retracted statements on therapeutic options. As such, it comes as no surprise that, "vaccine confidence is at an all-time low," according to Dr. Peter Marks, director of the FDA's Center for Biologics Evaluation and Research. In an effort to restore confidence, Dr. Marks partnered with the American Medical Association through a webinar, in order to outline the agency's meticulous approach to product development.
During this session, Dr. Marks outlined some key components of the FDA's strategy. To increase transparency, the FDA requires vaccine candidates make their data public before advisory committee meetings. He also discussed the pathways for product approval by Emergency Use Authorization (EUA) or biologic license application (BLA), as well as the trial data for current applicants and data requirements for consideration. He emphasized the reliance on large data sets and substantial evidence of compelling advocacy. The interview ended with a projected timeline for roll out, with frontline workers possibly seeing a vaccine product by the end of the calendar year, but called this merely, "informed speculation." Various.