Tag Archives: Healthcare

COVID-19 often goes undiagnosed in hospital workers; virus may impair heart functions

By Nancy Lapid

(Reuters) – The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

COVID-19 often undiagnosed in front line hospital workers

A high proportion of COVID-19 infections among U.S. healthcare personnel appear to go undetected, according to a report on Monday in the Morbidity and Mortality Weekly Report of the U.S. Centers for Disease Control and Prevention. Between April and June, among more than 3,000 front line workers in 12 states, roughly 1 in 20 had antibody evidence of a previous COVID-19 infection, but 69% of those infections had never been diagnosed. Among those with antibodies to the novel coronavirus, about one-third did not recall having symptoms in the preceding months, nearly half did not suspect that they had been infected, and some two-thirds had never had a positive COVID-19 test. Infections among front line healthcare personnel may be going undetected, the study authors say, because some infections may be only minimally symptomatic or asymptomatic and also because personnel with symptoms may not always have access to testing. COVID-19 antibodies were less common among workers who reported using a face covering for all patient encounters and more common among those who reported a shortage of personal protective equipment. The researchers call for more frequent testing of healthcare personnel and universal use of face coverings in hospitals.

Virus may impair heart’s beating, contracting

Following recent reports that the new coronavirus can invade heart muscle cells comes the discovery that infected cells show impairments in function. In test tube experiments, researchers infected “myocytes,” or heart muscle cells, with the new coronavirus and found that before the infected cells die, they progressively lose their “electrophysiological and contractile properties.” This means they have trouble transmitting the electrical impulses that regulate heartbeats and shortening or lengthening their fibers so the heart can expand and contract to pump blood. In a paper posted online Sunday on bioRxiv ahead of peer review, the researchers note that their test tube experiments likely do not exactly replicate what happens with cells in the body, and more research is needed to confirm their findings. Still, they say, their results suggest that cardiac symptoms in COVID-19 patients are likely a direct effect of the virus and warn that “long-term cardiac complications might be possible … in patients who recover from this illness.”

Eye symptoms common in children with COVID-19

Children with COVID-19 often have non-serious eye symptoms like itching, discharge, or pink eye, a study from China suggests. Among 216 children hospitalized with COVID-19 in Wuhan, the epicenter of the outbreak there, 23% had these kinds of eye issues, doctors found. Eye problems were more common in children with other symptoms such as cough or fever. In all cases, the eye problems were mild and eventually went away either without treatment or with “minimal” eye drops, researchers reported in JAMA Ophthalmology. It is reassuring that most of the children had other symptoms first, said Dr. Douglas Fredrick, chief of pediatric ophthalmology at the Mount Sinai Health system in New York City, who was not involved in the study. If conjunctivitis, or pink eye, were always among the first symptoms, “we’d be more worried that children could spread this by pink eye from one child to another,” he told Reuters. Still, he said, the study doesn’t completely rule out that type of transmission.

Cell phone activity may predict COVID-19 spread

Cell phone use patterns suggest that when people stay home, coronavirus infection rates go down, researchers say. For a study published on Monday in JAMA Internal Medicine, they analyzed publicly available de-identified cell phone activity and location data collected between January and May from 2,740 counties across the United States. After mid-February, when the coronavirus outbreak began, cell phone activity declined significantly in workplaces, stores and restaurants, and mass transit stations and increased in homes – with the greatest initial changes seen in areas with higher rates of COVID-19. Two weeks after cell phone activity shifted away from workplaces and retail locations, the counties with the most pronounced changes had the lowest rates of new COVID-19 cases. “Perhaps reassuringly,” the researchers said, cell phone activity at grocery stores and in areas classified as parks was not strongly associated with rates of growth in COVID-19 cases. They speculate that publicly available cell phone location data might help health offices better predict COVID-19 growth rates and inform decision about where to implement shutdowns and re-openings.

(Reporting by Nancy Lapid and Linda Carroll; Editing by Bill Berkrot)

COVID-19 can wipe out health care progress in short order: WHO

By Emma Farge

GENEVA (Reuters) – More than 90% of countries have seen ordinary health services disrupted by the COVID-19 pandemic, with major gains in medical care attained over decades vulnerable to being wiped out in a short period, a World Health Organization survey showed.

The Geneva-based body has frequently warned about other life-saving programs being impacted by the pandemic and has sent countries mitigation advice, but the survey yielded the first WHO data so far on the scale of disruptions.

“The impact of the COVID-19 pandemic on essential health services is a source of great concern,” said a report on the study released on Monday. “Major health gains achieved over the past two decades can be wiped out in a short period of time…”

The survey includes responses from between May and July from more than 100 countries. Among the most affected services were routine immunizations (70%), family planning (68%) and cancer diagnosis and treatment (55%), while emergency services were disturbed in almost a quarter of responding countries.

The Eastern Mediterranean Region, which includes Afghanistan, Syria and Yemen, was most affected followed by the African and Southeast Asian regions, it showed. The Americas was not part of the survey.

Since COVID-19 cases were first identified in December last year, the virus is thought to have killed nearly 850,000 people, the latest Reuters tally showed.

Researchers think that non-COVID deaths have also increased in some places due partly to health service disruptions, although these may be harder to calculate.

The WHO survey said it was “reasonable to anticipate that even a modest disruption in essential health services could lead to an increase in morbidity and mortality from causes other than COVID-19 in the short to medium and long-term.” Further research was needed.

It also warned that the disruptions could be felt even after the pandemic ends. “The impact may be felt beyond the immediate pandemic as, in trying to catch up on services, countries may find that resources are overwhelmed.”

(Reporting by Emma Farge; Editing by Mark Heinrich)

New York City ahead of curve on COVID-19, but faces risks going into fall: experts

By Carl O’Donnell

NEW YORK (Reuters) – New York City, once an epicenter of the novel coronavirus outbreak, has managed to contain the virus as it reopens, but faces risks of an uptick in cases in the fall, public health experts told Reuters.

The city’s success comes from a mix of high rates of compliance with local and federal public health guidance and also substantial immunity among the general population, a result of the severity of the outbreak in March and April, according to public health experts based in New York City.

“There was an alignment in New York with the state government, the healthcare system and the media on what to do – namely, lock everything down,” said Mark Jarrett, chief quality officer at Northwell Health. “The lockdown didn’t please everyone but was really well accepted.”

That contrasts with other parts of the country, where political opposition to mask wearing and lockdowns is more widespread, Jarrett added.

The rate of contagion also declined more quickly because the initial outbreak left between 25% and 50% of New Yorkers with some level of immunity, said Maria Lima, associate dean for research at the City University of New York School of Medicine.

New York is at risk for an uptick in cases as schools reopen and cold weather pushes more people indoors, the experts said.

“The big challenge is schools reopening, recreating that density anew,” which had been reduced by social distancing, said Troy Tassier, a professor of economics at Fordham University who specializes in epidemiology.

After peaking in early April at a seven day average of more than 5,000 cases per day, New York City has reduced its daily case count to an average of less than 200, according to city data.

The percentage of people tested who turned out to have the virus declined from around 70% in late March to less than 1%, and confirmed deaths have declined from over 500 per day in April to the low single digits.

The United States as a whole continues to struggle to contain the virus, clocking upwards of 45,000 cases per day. Total cases have surpassed 5.5 million and more than 170,000 people have died.

(Reporting by Carl O’Donnell in New York; Editing by Daniel Wallis)

U.S. unfreezing Venezualan assets to help opposition fight COVID-19: Guaido

CARACAS (Reuters) – Venezuela’s opposition said on Thursday the United States has granted it access to millions of dollars of frozen Venezuelan government funds to support efforts to combat the spread of COVID-19 in the country.

The U.S. Treasury Department had approved the release of the funds, the opposition said in a statement without specifying the total amount.

The statement said part of the released funds would go to pay some 62,000 health workers $300. During a live appearance on Twitter on Thursday night, opposition leader Juan Guaido said health workers could register accounts to receive payments of $100 a month starting Monday.

Healthcare workers in Venezuela can earn as little as $5 a month.

Guaido first announced the additional support for healthcare workers four months ago, but distribution required a permit from the Office of Foreign Assets Control (OFAC), as the frozen funds were held by the New York Federal Reserve.

The opposition plans to distribute the funds using AirTM, a digital payment platform, but on Thursday, the website was blocked in Venezuela.

“You have to be very bad to block an account for men and women who are giving everything with conviction to protect our people when they are going to receive a bonus,” said Guaido.

The opposition leader added healthcare workers would be sent a manual with the steps to download a virtual private network (VPN) so they could circumvent the restrictions. AirTM also tweeted instructions how to use a VPN.

Guaido has been recognized by more than 50 countries as Venezuela’s rightful president after assuming an interim presidency in 2019 on the grounds that Maduro’s 2018 re-election was fraudulent.

In July, the opposition obtained permission to distribute $17 million in funds frozen in the United States that would be channeled through international health organizations to purchase supplies for medical workers.

The license also approves another $4.5 million to support Venezuelans at risk of death, an opposition press release said.

Venezuela is suffering economic collapse and its crumbling health system has so far registered 37,567 cases of COVID-19 and 311 deaths, although experts say the number is likely to be higher due to widespread insufficient testing.

(Reporting by Sarah Kinosian; Editing by Simon Cameron-Moore)

Flu season prep, complicated by COVID-19, starts early this year

By Carl O’Donnell

(Reuters) – Healthcare providers, including CVS Health Corp., are kicking off flu vaccinations early, ordering extra shots and aiming to add tests that check for both the annual flu and COVID-19, pharmacy executives and experts told Reuters.

Flu vaccination for the fall has taken on increased urgency because of the potential for serious complications if patients contract both viruses at once.

Vaccine makers will provide nearly 200 million flu vaccines to the United States this year, potentially 20% more than is typical, said LJ Tan, chief strategy officer for the Immunization Action Coalition, a nonprofit that promotes vaccination.

CVS expects to more than double the number of flu shots it provides to around 18 million people and Walgreens Boots Alliance Inc. is stockpiling extra vaccines, the companies told Reuters.

Drugmaker AstraZeneca Plc. on Thursday announced its first shipment of its FluMist vaccine in the U.S. and said it has increased production of doses in the U.S. by over 25% more than previously planned.

Failure to inoculate for the flu could also strain the United States COVID-19 testing capacity, which is still below the 6-10 million daily tests needed, Reuters has reported.

“If we can eliminate the dynamic of people getting symptoms and their first reaction is ‘is this the seasonal flu or is this COVID,’ it can take demand off of COVID-19 testing,” CVS Chief Executive Larry Merlo told Reuters.

Merlo added that CVS is working to obtain tests that screen for both viruses simultaneously. U.S. regulators approved a joint COVID-19 and flu test in July.

The same people who are most vulnerable to risks from COVID-19, such as the elderly and those with respiratory conditions, are also at greatest risk for the flu, Tan added.

The U.S. healthcare system is already expected to be strained in the fall by a resurgence in COVID-19. The Institute for Health Metrics and Evaluation is anticipating an uptick in COVID-19 cases in the coming months, resulting in around 300,000 total deaths by December, up from the current figure of roughly 160,000, and a nearly 75% increase in hospitalizations.

There is evidence that social distancing measures for COVID-19 reduce the transmission rate of the flu as well, according to the U.S. Centers for Disease Control and Prevention, meaning that continued measures in the U.S. could potentially slow flu transmission this season.

However, efforts to inoculate patients for the flu could be complicated by the need to safeguard patients and healthcare workers from COVID-19.

“If a patient has a fever or other symptoms associated with illness, they will be referred to their healthcare provider and immunizations will be deferred,” a Walgreens spokeswoman told Reuters.

CVS plans to begin inoculating patients earlier than usual – possibly by the end of this month – to get a jump start on preparing for this year’s flu season, which usually starts around October.

However, studies show there is a risk that getting inoculated against the flu too early can leave a patient vulnerable to contracting the virus later on in winter, if the shot wears off.

Other physicians are also starting this month, though it will still take months to fully distribute all the needed inoculations, Tan said.

The flu vaccine “comes out over time so you want to make sure people continue to seek flu vaccines” through Thanksgiving and beyond, Tan said.

(Reporting by Carl O’Donnell; Editing by Peter Henderson, Aurora Ellis and Bernadette Baum)

Google’s $2.1 billion Fitbit deal hits roadblock as EU opens probe

By Foo Yun Chee

BRUSSELS (Reuters) – Alphabet unit Google’s bid to take on Apple and Samsung in the wearable technology market by buying Fitbit hit a hurdle on Tuesday as EU antitrust regulators launched an investigation into the $2.1 billion deal.

The move by the European Commission on Tuesday came despite Google’s pledge last month not to use the fitness tracker’s data for advertising purposes in a bid to address competition concerns.

The EU antitrust enforcer said the data pledge was insufficient to allay its worries.

“The proposed transaction would further entrench Google’s market position in the online advertising markets by increasing the already vast amount of data that Google could use for personalization of the ads it serves and displays,” the Commission said.

It singled out online search and display advertising services and ad tech services, where analytics and digital tools are used in digital advertising, as two areas that would be affected by the deal.

It said data collected via wrist-worn wearable devices appeared to be an important advantage in online advertising, and the deal would give Google an edge in personalizing search engine ads and making it difficult for rivals to compete.

Ultimately this would result in higher prices for advertisers and publishers.

The investigation will also focus on digital healthcare and whether Google would make it difficult for rival wearables to function with its Android smartphone operating system.

The Commission will decide by Dec. 9 whether to clear or block the deal.

Google said the combination of its and Fitbit’s hardware would increase competition in the sector where players include Apple, Samsung, Xiaomi, Huawei and others.

“This deal is about devices, not data. We’ve been clear from the beginning that we will not use Fitbit health and wellness data for Google ads,” Rick Osterloh, senior vice president for devices and services, said in a statement.

“As we do with all our products, we will give Fitbit users the choice to review, move or delete their data.”

The deal has drawn criticism from healthcare providers, wearables rivals and privacy advocates.

Fitbit has a 3% share of the global wearables market as of the first quarter of 2020, far behind Apple’s 29.3% share, and also trailing Xiaomi, Samsung and Huawei, data from market research firm International Data Corp showed.

(Reporting by Foo Yun Chee; Editing by Jan Harvey)

Military helps worn-out nurses, sicker patients in California COVID-19 effort

By Sharon Bernstein

SACRAMENTO, Calif. (Reuters) – All day long, as Air Force nurse Major Pinky Brewton cares for patients struggling to breathe in California’s COVID-19 ravaged San Joaquin Valley, fears for her family simmer underneath her cool exterior.

Once back in her Stockton hotel room, seeing her seven-year-old on Facetime, the relief is overwhelming.

“He’s breathing!” Brewton said. “That’s the first thing I see as a nurse. How well is my son breathing?”

Over the past two weeks, the U.S. Department of Defense has sent nearly 200 medics and logistics experts to the Valley. The military has also sent nearly 600 personnel to Texas, where a surge in COVID-19 cases is crushing hospitals along the Rio Grande Valley and elsewhere in the state.

The teams of nurses, doctors and technicians work extra shifts, treating sicker-than-usual hospital patients. Many are so weak from oxygen deprivation they can barely eat.

In the San Joaquin Valley agricultural region, intensive care units overflowed as cases surged earlier this summer. In some counties, as many as 28% of test results were positive.

At Dameron hospital in Stockton near the state capital of Sacramento, every nurse was soon deployed on a new COVID-19 floor, said Jennifer Markovich, the facility’s chief nursing officer.

“There wasn’t a slow ramp up. In the space of two weeks we just saw a significant increase in patients … and really started to see those staffing needs really escalate.”

CHAPLAINS, MENTAL HEALTH EXPERTS

When staffing agencies lacked healthcare workers, the hospital turned to the state, Markovich said. Under the Federal Emergency Management Agency, Brewton’s team of 20 military nurses and respiratory therapists came on board in mid-July.

About 160 Air Force medical staff have been sent to California so far, with about 100 in San Joaquin Valley, coordinated by 25 U.S. Army logistics experts trained in responding to nuclear, chemical and biological attacks.

Chaplains and mental health experts were added to relieve stress in a system stretched to its limits.

The teams, mostly stationed at Travis Air Force Base north of San Francisco, were easily absorbed into the rotations and work cultures of the Valley hospitals, said Lieutenant Colonel Ryan Gassman, who commands the California teams.

“It’s not like we have any Air Force tents that are set up outside,” Gassman said. “We are truly jumping into the staff in each of these hospitals to help support in any way, shape or form that we can.”

In addition to five hospitals in the San Joaquin Valley, military teams have also been deployed to the Los Angeles area and Rancho Mirage in Riverside County east of Los Angeles.

COVID-19 cases in California began climbing after Memorial Day, which health officials attributed in part to family gatherings without masks or physical distancing measures. Statewide, cases have topped 500,000, and over 9,000 Californians have died.

California, Texas, Florida and Arizona are among several hotspot U.S. states for a second wave of coronavirus cases.

FRAGILE HOSPITALS

In the San Joaquin Valley, a perfect storm of cultural, political and economic issues led to a crush of cases in a fragile rural and smaller-city hospital system.

The region is heavily Latino, a group making up 39% of California’s population but accounts for 56% of COVID-19 infections and 46% of deaths in the most populous U.S. state. Agricultural businesses that have not provided protective equipment to workers, or implemented social distancing or rules requiring masks has led to increased infections. Large family gatherings and multi-generational households have led to fast and deadly transmission, often to vulnerable older relatives.

The Valley, which includes the oil drilling and agricultural area around Bakersfield, and farmlands around Fresno, is generally more conservative than the rest of the state, and many local and congressional leaders have opposed rules requiring masks and social distancing.

The resulting toll is stark. As of Friday, only 20 intensive care unit beds were available for new patients in all of San Joaquin County, which has a population of nearly 800,000.

“The first thing I saw were really, really sick patients,” nurse Brewton said, describing her first day at Dameron. “The acuity of these patients are far more than what we see on a typical medical floor.”

(Reporting by Sharon Bernstein; editing by Bill Tarrant and Richard Chang)

Long-term complications of COVID-19 signals billions in healthcare costs ahead

By Caroline Humer, Nick Brown and Emilio Parodi

NEW YORK (Reuters) – Late in March, Laura Gross, 72, was recovering from gall bladder surgery in her Fort Lee, New Jersey, home when she became sick again.

Her throat, head and eyes hurt, her muscles and joints ached and she felt like she was in a fog. Her diagnosis was COVID-19. Four months later, these symptoms remain.

Gross sees a primary care doctor and specialists including a cardiologist, pulmonologist, endocrinologist, neurologist, and gastroenterologist.

“I’ve had a headache since April. I’ve never stopped running a low-grade temperature,” she said.

Studies of COVID-19 patients keep uncovering new complications associated with the disease.

With mounting evidence that some COVID-19 survivors face months, or possibly years, of debilitating complications, healthcare experts are beginning to study possible long-term costs.

Bruce Lee of the City University of New York (CUNY) Public School of Health estimated that if 20% of the U.S. population contracts the virus, the one-year post-hospitalization costs would be at least $50 billion, before factoring in longer-term care for lingering health problems. Without a vaccine, if 80% of the population became infected, that cost would balloon to $204 billion.

Some countries hit hard by the new coronavirus – including the United States, Britain and Italy – are considering whether these long-term effects can be considered a “post-COVID syndrome,” according to Reuters interviews with about a dozen doctors and health economists.

Some U.S. and Italian hospitals have created centers devoted to the care of these patients and are standardizing follow-up measures.

Britain’s Department of Health and the U.S. Centers for Disease Control and Prevention are each leading national studies of COVID-19’s long-term impacts. An international panel of doctors will suggest standards for mid- and long-term care of recovered patients to the World Health Organization (WHO) in August.

YEARS BEFORE THE COST IS KNOWN

More than 17 million people have been infected by the new coronavirus worldwide, about a quarter of them in the United States.

Healthcare experts say it will be years before the costs for those who have recovered can be fully calculated, not unlike the slow recognition of HIV, or the health impacts to first responders of the Sept. 11, 2001 attacks on the World Trade Center in New York.

They stem from COVID-19’s toll on multiple organs, including heart, lung and kidney damage that will likely require costly care, such as regular scans and ultrasounds, as well as neurological deficits that are not yet fully understood.

A JAMA Cardiology study found that in one group of COVID-19 patients in Germany aged 45 to 53, more than 75% suffered from heart inflammation, raising the possibility of future heart failure.

A Kidney International study found that over a third of COVID-19 patients in a New York medical system developed acute kidney injury, and nearly 15% required dialysis.

Dr. Marco Rizzi in Bergamo, Italy, an early epicenter of the pandemic, said the Giovanni XXIII Hospital has seen close to 600 COVID-19 patients for follow-up. About 30% have lung issues, 10% have neurological problems, 10% have heart issues and about 9% have lingering motor skill problems. He co-chairs the WHO panel that will recommend long-term follow-up for patients.

“On a global level, nobody knows how many will still need checks and treatment in three months, six months, a year,” Rizzi said, adding that even those with mild COVID-19 “may have consequences in the future.”

Milan’s San Raffaele Hospital has seen more than 1,000 COVID-19 patients for follow-up. While major cardiology problems there were few, about 30% to 40% of patients have neurological problems and at least half suffer from respiratory conditions, according to Dr. Moreno Tresoldi.

Some of these long-term effects have only recently emerged, too soon for health economists to study medical claims and make accurate estimates of costs.

In Britain and Italy, those costs would be borne by their respective governments, which have committed to funding COVID-19 treatments but have offered few details on how much may be needed.

In the United States, more than half of the population is covered by private health insurers, an industry that is just beginning to estimate the cost of COVID-19.

CUNY’s Lee estimated the average one-year cost of a U.S. COVID-19 patient after they have been discharged from the hospital at $4,000, largely due to the lingering issues from acute respiratory distress syndrome (ARDS), which affects some 40% of patients, and sepsis.

The estimate spans patients who had been hospitalized with moderate illness to the most severe cases, but does not include other potential complications, such as heart and kidney damage.

Even those who do not require hospitalization have average one-year costs after their initial illness of $1,000, Lee estimated.

‘HARD JUST TO GET UP’

Extra costs from lingering effects of COVID-19 could mean higher health insurance premiums in the United States. Some health plans have already raised 2021 premiums on comprehensive coverage by up to 8% due to COVID-19, according to the Kaiser Family Foundation.

Anne McKee, 61, a retired psychologist who lives in Knoxville, Tennessee and Atlanta, had multiple sclerosis and asthma when she became infected nearly five months ago. She is still struggling to catch her breath.

“On good days, I can do a couple loads of laundry, but the last several days, it’s been hard just to get up and get a drink from the kitchen,” she said.

She has spent more than $5,000 on appointments, tests and prescription drugs during that time. Her insurance has paid more than $15,000 including $240 for a telehealth appointment and $455 for a lung scan.

“Many of the issues that arise from having a severe contraction of a disease could be 3, 5, 20 years down the road,” said Dale Hall, Managing Director of Research with the Society of Actuaries.

To understand the costs, U.S. actuaries compare insurance records of coronavirus patients against people with a similar health profile but no COVID-19, and follow them for years.

The United Kingdom aims to track the health of 10,000 hospitalized COVID-19 patients over the first 12 months after being discharged and potentially as long as 25 years. Scientists running the study see the potential for defining a long-term COVID-19 syndrome, as they found with Ebola survivors in Africa.

“Many people, we believe will have scarring in the lungs and fatigue … and perhaps vascular damage to the brain, perhaps, psychological distress as well,” said Professor Calum Semple from the University of Liverpool.

Margaret O’Hara, 50, who works at a Birmingham hospital is one of many COVID-19 patients who will not be included in the study because she had mild symptoms and was not hospitalized. But recurring health issues, including extreme shortness of breath, has kept her out of work.

O’Hara worries patients like her are not going to be included in the country’s long-term cost planning.

“We’re going to need … expensive follow-up for quite a long time,” she said.

(Reporting by Caroline Humer and Nick Brown in New York; Emilio Parodi in Milan and Alistair Smout in London; editing by Michele Gershberg and Bill Berkrot)

U.S. drugmaker stocks fall ahead of Trump’s pricing executive orders

(Reuters) – Shares of U.S. drugmakers fell on Friday, ahead of executive orders by President Donald Trump aimed at lowering drug prices.

With a re-election race underway and the coronavirus pandemic raging in the country, the White House is looking to bring down drug prices by reportedly considering tying them to what consumers outside the United States pay.

The S&P 500 was down 1.3%, with drugmakers such as Regeneron Pharmaceuticals Inc. and Pfizer Inc. weighing on the index. The declines were in line with a fall in broader markets.

Given that the speculation of an executive order on drug pricing surfaced roughly a month ago, stocks in the healthcare sector are unlikely to take a hit in the near term, Jefferies analyst Jared Holz said.

The administration’s move would likely be viewed more as political posturing than a critical moment for the pharmaceutical industry, Holz added.

Trump, who had previously urged lawmakers to rein in drug costs, will deliver remarks and sign the executive orders at 3 p.m. EDT (1900 GMT) on Friday, according to the president’s schedule issued by the White House on Thursday.

Drugmakers often negotiate rebates or discounts on their list prices in exchange for favorable treatment from insurers and other healthcare payers. As a result, insurers and covered patients rarely pay the full list price of a drug.

Elimination of rebates is likely not included in the orders, Politico reported on Thursday.

Such an order would be positive for health insurers UnitedHealth Group Inc, Cigna Corp and CVS Health, said Mizuho analyst Ann Hynes.

Cigna and CVS were among the handful of healthcare movers in the black.

Drugmakers Johnson & Johnson and Merck & Co Inc were trading down in morning trading.

(Reporting by Manas Mishra in Bengaluru; Editing by Shinjini Ganguli)

Over 1 million: India joins U.S., Brazil in grim coronavirus club

By Zeba Siddiqui

MUMBAI (Reuters) – India on Friday became the third country in the world to record more than one million cases of the new coronavirus, behind only the United States and Brazil, as infections spread further into the countryside and smaller towns.

Given India’s population of around 1.3 billion, experts say, one million is relatively low – but the number will rise significantly in the coming months as testing increases, further straining a healthcare system already pushed to the brink.

The pandemic has surged in the country in recent weeks as it spread beyond the biggest cities, pushing India past Russia as the third-most-infected country last week.

Authorities imposed fresh lockdowns and designated new containment zones in several states this week, including the largely rural Bihar state in the east and the southern tech hub Bengaluru, where cases have spiked.

But officials have struggled to enforce the lockdowns and keep people indoors.

India recorded 34,956 new infections on Friday, taking the total to 1,003,832, with 25,602 deaths from COVID-19, federal health ministry data showed. That compares to 3.6 million cases in the United States and 2 million in Brazil – countries with less than a third of India’s population.

Epidemiologists say India is still likely months from hitting its peak.

“In the coming months, we are bound to see more and more cases, and that is the natural progression of any pandemic,” said Giridhar Babu, epidemiologist at the nonprofit Public Health Foundation of India.

“As we move forward, the goal has to be lower mortality,” he said. “A critical challenge states will face is how to rationally allocate hospital beds.”

The last four months of the pandemic sweeping India have exposed severe gaps in the country’s healthcare system, which is one of the most poorly funded and has for years lacked enough doctors or hospital beds.

The Indian government has defended a strict lockdown it imposed in March to contain the virus spread, saying it helped keep death rates low and allowed time to beef up the healthcare infrastructure. But public health experts say shortages remain and could hit hard in the coming months.

“As a public health measure, I don’t think the lockdown had much impact. It just delayed the virus spread,” said Dr. Kapil Yadav, assistant professor of community medicine at New Delhi’s premier All India Institute of Medical Sciences.

The million cases so far recorded likely left out many asymptomatic ones, he said. “It’s a gross underestimate.”

Rahul Gandhi, leader of the opposition Congress party, urged Prime Minister Narendra Modi to take concrete steps to contain the pandemic, tweeting that the number of infections will double to two million by August 10 at this pace.

Millions of migrant workers, left stranded in the cities by the lockdown in March, took long journeys home on foot, some dying on the way while others left without work or wages.

Several states including Bihar, to which many of the migrants returned, have witnessed a surge in cases in recent weeks as the lockdown has been eased to salvage a sagging economy.

Babu predicts India will not see a sharp peak and decline.

“The surges are shifting from one place to another, so we cannot say there will be one peak for the whole country. In India, it’s going to be a sustained plateau for some time and then it will go down.”

(Reporting by Zeba Siddiqui in Mumbai; Additional reporting by Chandini Monnappa, Derek Francis and Abhirup Roy; Editing by Sanjeev Miglani and William Mallard)