The U.S. has had relatively few cases of influenza (flu) over the last few years, likely due to a combination of decreased travel and in-person activities and increased mask use. Since immunity to flu wanes rapidly and strains differ from year to year, many experts fear that this year we could see a higher rate of flu illness. Mortality rates are higher in those who get flu and COVID-19 simultaneously.
Flu pandemics generally start in Asia in our summer and travel east to North America by fall. This year flu cases increased earlier than usual in Australia, which could mean increased earlier risk in North America. In the Northern hemisphere, influenza cases tend to start in October and peak in late January or early February. Flu is a major cause of time away from work.
Implications for employers:
My twitter feed is littered with promotional tweets about full-body MRI scans for early detection of cancer or other abnormalities. These scans occasionally find an undetected cancer, but they have an exceptionally high rate of false positives. People can suffer real harm if they need an operation to address a finding that would have posed no danger to them. There is no study showing survival benefit, improved health or decreased cost in a population that receives full-body MRI scanning. The cost of the MRI and follow-up tests will increase total cost of care for a population and this will not be offset by future savings.
Implications for employers:
Hepatitis C is a terrible disease that causes liver failure and liver cancer. Fourteen thousand a year die of this disease in the U.S., and it is the number one reason for liver transplants in the U.S., Europe and Japan. Hepatitis C is often associated with intravenous drug use, and many with hepatitis C are insured by Medicaid or incarcerated. Still about 20% of those with positive tests are covered by private insurance.
Hepatitis C is also curable, with drugs that were very expensive when they were first introduced but are now available as generics. Treatment per case is now often under $30,000, which is substantially less than the cost of treating advanced liver disease. But not enough people are treated.
Researchers at the Centers for Disease Control and Prevention reviewed a large database that included around 6,500 people who had a positive hepatitis C test with private insurance, and found that only 35% filled a prescription for antiviral drugs within a year of diagnosis.
Implications for employers:
Uncontrolled high blood pressure increases risk of premature heart attack and stroke and other vascular disease. Unfortunately, hypertension is very common, many who have high blood pressure are unaware, and the majority of adults with hypertension do not have their blood pressure under good control, generally meaning blood pressure of under 120/80.
Researchers randomized 2,101 people with newly diagnosed, poorly controlled hypertension to receive either a “smart” home blood pressure monitor with associated smartphone app, or a home blood pressure monitor with no app. There were no other interventions for either group, and no blood pressure readings were reported to treating physicians. The good news is that each group showed a decrease in systolic blood pressure. Slightly more of those with the app (32% versus 29%) achieved the target of blood pressure of 140/90 or less. Participants reported they were satisfied with either device.
Implications for employers:
Formal reported U.S. cases of COVID-19 are down almost 20% from two weeks ago, though these represent only a small portion of total cases and hospitalizations and intensive care stays are down slightly. Laboratory test positivity rate remains high (16%), and 93% of counties have a high transmission rate. The Biden administration is likely to extend the pandemic health emergency until January 2023, which delays Medicaid disenrollment for as many as 14 million people.
Researchers in Switzerland studied the rate of COVID-19 infections in healthcare workers exposed to patients with COVID-19 for a year from September 2020. All workers wore at least surgical masks, and about 22% always wore respirators (the European equivalent of N95 masks). Those who always wore the better quality well-fitted masks were about 40% less likely to get infected.
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Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.
