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Saturday, October 10, 2020

Trump’s COVID-19 experience doesn’t prove anything - The Verge

"Trump’s COVID-19 experience doesn’t prove anything

Illustration by Alex Castro / The Verge
President Donald Trump says he’s recovered from COVID-19. Outside doctors say it’s too soon for him to return to public events, he’s coughing on Fox News, and he’s taking a potent steroid that can mask symptoms — but Trump says he’s not sick anymore. And he’s crediting that recovery to an experimental drug made by the company Regeneron, which he said on Wednesday was a “cure.” 
“They gave me Regeneron, and it was, like, unbelievable. I felt good immediately,” he said in a video recorded at the White House. 
There’s no evidence that the Regeneron drug had anything to do with how good Trump did or did not feel. There’s hardly any data that the drug, which is a cocktail of artificial antibodies against the coronavirus, works at all. So far, all we have are a few bits of information on a small group of patients that were published in a press release. Trump was also given two other drugs, the antiviral remdesivir and the steroid dexamethasone. There’s no reason to believe the Regeneron drug — which is actually named REGN-COV2; Regeneron is the name of the company that produces it — was the thing responsible for how he said he felt. For a single patient, there’s no way to tell for sure. 
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Antibody treatments could be a good way to treat COVID-19. The strategy is similar to convalescent plasma, which contains coronavirus antibodies generated by recovered patients. Instead of an unpredictable mixture of antibodies in blood, though, the drugs are concentrated cocktails of a few specific antibodies that seem to be particularly good at blocking the virus. Another pharmaceutical company, Eli Lilly, also has an antibody drug in development. 
But neither drug has been tested thoroughly enough to say if it helps, hurts, or does nothing at all. Trump’s wild claims about Regeneron’s candidate could make finding answers harder. That’s what happened last time he talked up a treatment strategy — remember hydroxychloroquine? Trump’s constant promotion of the anti-malarial drug, and the controversy around it, made people reluctant to enroll in clinical trials that were designed to figure out if it actually worked.
Trump also pressured federal agencies to quickly push out hydroxychloroquine. Experts worry that something similar could happen with Regeneron’s antibody therapy. Trump is already pushing the Food and Drug Administration to authorize it quickly. The circumstances of his treatment also could skew the clinical trial process: he got the drug under compassionate use, which makes untested and experimental products available to people who are seriously ill. Heralding it as a cure makes it seem as if we know more about it than we actually do, while simultaneously leaving the impression that VIPs like the president can skip the line, while the rest of us run the risk of getting a placebo in a clinical trial. 
In reality, though, we still don’t know if someone who gets the drug is better off than someone who gets a placebo. That’s what a trial is for. Hopefully, the drug works — but anyone who claims to have answers right now is just making things up. 
Here’s what else happened this week. 


In one group of over 500 hospitalized COVID-19 patients, nearly a third had some kind of confusion or delirium. These sorts of mental problems show up in other viral infections, as well, and could be triggered by inflammation. (Pam Belluck / The New York Times)
Researchers around the world are taking pictures and building models of the tiny, destructive virus. The images are helping them understand how it attacks cells and makes copies of itself. (Carl Zimmer / The New York Times)
The virus is killing more people than stroke, Alzheimer’s, diabetes, kidney disease, and most other conditions that end up fatal. Right now, only heart disease and cancer are deadlier. (Youyou Zhou and Gary Stix / Scientific American)


Pharmaceutical companies have to track vaccine clinical trial participants for at least two months before they ask the Food and Drug Administration to authorize their candidates, new guidelines from the agency say. This all but guarantees there won’t be an approval by election day — and could give people more confidence that the vaccines are being carefully evaluated. (Sydney Lupkin / NPR)
Like Regeneron, Eli Lilly published a press release showing that its antibody drug can keep some people with COVID-19 from needing to be hospitalized. But the benefits were small, and the data isn’t published in a medical journal. (Matthew Herper / Stat News)
In the US, Black people are more likely to be hospitalized with and die from COVID-19 than white people. Because of historic mistreatment by the medical community, though, they’re the least likely group to trust a vaccine and are reluctant to sign up for clinical trials. Community leaders are trying to encourage participation to ensure that the vaccines aren’t only tested on white people. (Jan Hoffman / The New York Times)


Former Indiana State football player Larry Brown was on a ventilator for 50 days. He’s been in rehab for months. He doesn’t know if he’ll ever be the same again. “Right now, I’m just trying to understand the new normal,” Brown told the Associated Press. (Tom Murphy / Associated Press)
Isaiah Marquez-Greene’s sister was killed in the mass shooting at Sandy Hook Elementary in Newtown, Connecticut. He wasn’t sure if his parents would be able to endure sending him back to his boarding school during a pandemic. (John Woodrow Cox / The Washington Post)

More than numbers

To the more than 36,933,166 people worldwide who have tested positive, may your road to recovery be smooth.
To the families and friends of the 1,068,995 people who have died worldwide — 213,795 of those in the US — your loved ones are not forgotten.
Stay safe, everyone."

Trump’s COVID-19 experience doesn’t prove anything - The Verge

Wednesday, October 07, 2020

How Much Would Trump’s Coronavirus Treatment Cost Most Americans?

""How Much Would Trump’s Coronavirus Treatment Cost Most Americans?

Even for those with insurance, surprise bills for things not covered can add up fast.

By Sarah Kliff  Oct. 7, 2020Updated 9:31 a.m. ET

White House Coronavirus Outbreak

President Trump’s physician Dr. Sean Conley, with other medical staff members, briefing reporters outside Walter Reed National Military Medical Center on Saturday. While Mr. Trump did not have to worry about the costs of his care, many Americans who have been ill with Covid-19 face large medical bills.

President Trump’s physician Dr. Sean Conley, with other medical staff members, briefing reporters outside Walter Reed National Military Medical Center on Saturday. While Mr. Trump did not have to worry about the costs of his care, many Americans who have been ill with Covid-19 face large medical bills.Anna Moneymaker for The New York Times

The New York Times is investigating the costs associated with testing and treatment for the coronavirus and how the pandemic is changing health care in America. You can read more about the project and submit your medical bills here.

President Trump spent three days in the hospital. He arrived and left by helicopter. And he received multiple coronavirus tests, oxygen, steroids and an experimental antibody treatment.

For someone who isn’t president, that would cost more than $100,000 in the American health system. Patients could face significant surprise bills and medical debt even after health insurance paid its share.

The biggest financial risks would come not from the hospital stay but from the services provided elsewhere, including helicopter transit and repeated coronavirus testing.

Mr. Trump has praised the high quality of care he received at Walter Reed National Military Medical Center, and has played down the risk of the virus. “Don’t be afraid of Covid,” Mr. Trump tweeted on Monday, before returning to the White House. “Don’t let it dominate your life.”

Across the country, patients have struggled with both the long-term health and financial effects of contracting coronavirus. Nearly half a million have been hospitalized. Routine tests can result in thousands of dollars in uncovered charges; hospitalized patients have received bills upward of $400,000.

Mr. Trump did not have to worry about the costs of his care, which are covered by the federal government. Most Americans, including many who carry health coverage, do worry about receiving medical care they cannot afford.

For some Americans, the bills could start mounting with frequent tests. Insurers are generally required to pay for those tests when physicians order them, but not when employers do.

The Trump administration made that clear in June, when it issued guidance stating that insurers do not have to pay for “testing conducted to screen for general workplace health and safety.” Instead, patients need to pay for that type of testing themselves. Some might be able to get free tests at public sites, and some employers may voluntarily cover the costs. Others could face significant medical debt from tests delivered at hospitals or urgent care centers.

Covid tests can be expensive. Although they typically cost $100, one emergency room in Texas has charged as much as $6,408 for a drive-through test. About 2.4 percent of coronavirus tests billed to insurers leave the patient responsible for some portion of payment, according to the health data firm Castlight. With 108 million tests performed in the United States, that could amount to millions of tests that leave patients responsible for some share of the cost.

Marta Bartan, who works as a hair colorist in Brooklyn, needed a coronavirus test to return to her job this summer. She received a $1,394 bill from the hospital running the drive-through site where she was tested.

“I was so confused,” said Ms. Bartan, who is contesting the bill. “You go in to get a Covid test expecting it to be free. What could they have possibly charged me $1,400 for?”

The bills for the typical American would continue at the hospital, with the routine monitoring that any patient would receive and the drugs provided in the course of care.

Remdesivir, a new coronavirus treatment created by Gilead, costs $3,120 when purchased by private insurers and $2,340 with public programs like Medicare and Medicaid.

Mr. Trump also received an experimental antibody treatment from Regeneron. It’s currently available to clinical trial participants or to those granted a “compassionate use” exemption. In either situation, the drug would typically be provided to the patient at no charge. This will most likely change, however, when the treatment finishes trials and hits the commercial market. These types of drugs are hard to manufacture, and other monoclonal antibodies cost thousands of dollars.

Health economists are only starting to understand the full costs of coronavirus treatment, just as scientists are mapping out how the disease works and spreads. They do have some early estimates: The median charge for a coronavirus hospitalization for a patient over 60 is $61,912, according to a claims database, FAIR Health

That figure includes any medical care during the hospital stay, such as an emergency room visit that led to admission or drugs provided by the hospital.

For insured patients, that price would typically be negotiated lower by their health plan. FAIR Health estimates that the median amount paid is $31,575. That amount, like most things in American health care, varies significantly from one patient to another.

In the FAIR Health data on coronavirus patients over 60, a quarter face charges less than $26,821 for their hospital stay. Another quarter face charges higher than $193,149, in part because of longer stays.

Many, but not all, health insurers have said they will not apply co-payments or deductibles to patients’ coronavirus hospital stays, which could help shield patients from large bills.

The Upshot: Analysis that explains politics, policy and everyday life, with an emphasis on data and charts.

Uninsured patients, however, could be stuck with the entire hospital charges and not receive any discounts. While the Trump administration did set up a fund to cover coronavirus testing and treatment costs for the uninsured, The Times has reported that some Americans without health insurance have received large bills for their hospital stays.

The biggest billing risk for a patient receiving treatment similar to Mr. Trump’s would probably come from helicopter rides to the hospital.

Air ambulances are expensive and often not in major health insurance plans’ networks. The median charge for an air ambulance is $38,770, according to a study in the journal Health Affairs published this year. When the helicopter trip is out of network — as about three-quarters of them are — patients are left with a median charge of $21,698 after the insurance payout.

Taking two helicopter rides, as Mr. Trump did, could plausibly result in more than $40,000 in medical debt for patients without access to their own aircraft (though of course most people do not leave the hospital by helicopter).

The financial consequences of a coronavirus hospitalization could be long-lasting, if a new Supreme Court challenge to the Affordable Care Act is successful. That case argues that all of Obamacare is unconstitutional, including the health law’s protections for pre-existing conditions. The administration filed a brief in June supporting the challenge.

The Supreme Court hears that case on Nov. 10. If the challenge succeeds, Covid-19 could join a long list of pre-existing conditions that would leave patients facing higher premiums or denials of coverage. In that case, coronavirus survivors could face a future in which their hospital stays increase their health costs for years to come."

How Much Would Trump’s Coronavirus Treatment Cost Most Americans?