It was a quiet week for new information, at least from my perspective. I didn't see any strikingly new COVID-19 data that hadn't already been discussed at various advisory meetings or appeared online earlier. This week promises some items of interest including FDA VRBPAC meetings for review of Moderna and Janssen vaccine booster doses.
In the meantime, help us avoid at least one form of twindemic by getting flu vaccines for yourselves and your patients.
Bias in Healthcare Continues
An article in the Journal of the Acquired Immune Deficiency Syndrome caught my eye. Investigators enrolled 160 non-pediatric frontline care providers (OB/GYN, family medicine, internal medicine, emergency medicine, and preventive medicine) from 48 "hotspot counties" for HIV infection. Enrollees needed to be aware of HIV pre-exposure prophylaxis (PrEP) and serve populations that included adult Black women. They were randomized to receive 1 of 4 online vignettes and state their likelihood of discussing and prescribing PrEP to the patient in the vignette. The 4 stories were identical except for a history of injection drug use (does/does not) and race (Black/White). The providers also completed the validated Color-Blind Racial Attitudes Scale (CoBRAS). Stated briefly, the investigators did find a significant relationship between patient race and provider racism score with respect to provider expectations of patient adherence to PrEP which in turn appeared to affect their willingness to discuss and provide PrEP. High scores on CoBRAS (i.e. more tendency toward racial bias) correlated with more positive expectations for adherence by the White patient versus the Black patient. The study itself has many limitations, including the problem that answers to an online scenario may not represent real world practice behavior, but it is a cautionary reminder to all of us to be aware of intrinsic bias in medical practice.
Prediciting Flu
In the best of times, predictions of the extent and severity of an upcoming influenza season are, in my opinion, equally well served by astrologists or palm readers as by public health experts (OK, slight exaggeration). It wasn't a big surprise that we had basically no influenza in the US this past winter, but no one has any good idea of what to expect with influenza in the coming months. Recent experience in the southern hemisphere was relatively mild, but that information hasn't been very reliable in the past in predicting rates in the northern hemisphere. The fact that we have so many more individuals who were not exposed to influenza last year would suggest we are in trouble this winter, especially if we see low vaccination rates. Bottom line? The reason you see no web links in this paragraph is because I've found no convincing information that anyone has a line on what to expect in the coming months. Again I say please push those flu vaccines!