We are lowering our fair value estimate for Pfizer PFE to $42 from $47, largely based on the companys lower-than-expected 2024 guidance. Following the close of the Seagen acquisition, Pfizers guidance included COVID-19 product guidance of $8 billion, which was $5 billion lower than our expectation. Management also acknowledged the firm would be unlikely to hit its previous guidance of 6% growth rate for 2020-25 (excluding COVID-19 product sales). Despite the falling outlook, Pfizer reiterated support for the dividend, which we believe is secure and will likely support the stock valuation.
The lower COVID-19 product guidance is the key driver for our lowered fair value estimate. We continue to expect a long-term tail for COVID-19 vaccine Comirnaty and COVID-19 treatment Paxlovid, but we are cutting our projections based on Pfizers guidance and the trend of lost market share to Moderna thats been seen over the past few months. While there is a potential upside to our COVID-19 product sales projections, as Pfizer management may be reacting a bit to missed overly optimistic 2023 COVID-19 sales guidance, we still see the stock as undervalued with the lowered COVID-19 sales projections.
The cost-cutting plans Pfizer set out earlier in the year to adapt to the receding COVID-19 pandemic look on track, and they should help improve margins in 2024 and 2025. The company will likely cut $4 billion in operating costs by the end of 2024. These cuts should fall to the bottom line rather than be redeployed to other initiatives. The ability to significantly cut costs and adapt to scale helps increase returns and reinforce the firms moat.
The Seagen acquisition is largely closing in line with our expectations. Seagens $3.1 billion sales guidance for 2024 is largely similar to our expectations. However, the $0.40 earnings hit expected in 2024 from the deal is slightly worse than our expectations.
MORN DODFX VINIX VWILX TSVA EGO WU Brightstart429plan MRO VZ MOAT T NKE CMCSA GOOG
The author or authors do not own shares in any securities mentioned in this article. Find out about Morningstars editorial policies.
The world may be out of the thick of the COVID-19 pandemic, but humans still share the globe with countless pathogens. Here are some of the ways viruses shaped 2023. Olivia Taussig-Rees for NPR hide caption
The world may be out of the thick of the COVID-19 pandemic, but humans still share the globe with countless pathogens. Here are some of the ways viruses shaped 2023.
Yes, the pandemic state of emergency is over. But that doesn't mean that SARS-CoV-2 and other threatening viruses have vanished. Our viral coverage this year included a series on "Hidden Viruses" and a surprising theory about the workings of long COVID that was the most popular post of the year for Goats and Soda with over 1 million views. Here are our most read stories of the year with a viral theme.
Long COVID brain fog may originate in a surprising place, say scientists
Spillovers of a virus from animals to humans may not be as rare as scientists used to think. Here are some of the possible human cases documented since November 2021 Oliver Uberti for NPR hide caption
Scientists studying the causes of long COVID symptoms are proposing a surprising pathway through the gut. Their research weaves together several prominent lines of evidence on what might be driving the condition with its stubborn neurological symptoms such as brain fog, memory loss and fatigue. Published October 24, 2023.
Another Nipah outbreak in India: What do we know about this virus and how to stop it?
Nipah virus, known to spread from bats to human, has broken out in the state of Kerala. Here's what we know about the current cases and the ongoing efforts to quash this potentially fatal disease. Published September 15, 2023.
9 diseases that keep epidemiologists up at night
The World Health Organization keeps a list of viruses and bacteria with pandemic potential to guide scientists, governments and organizations as they invest energy and funds to study and stop the pathogens most likely to cause the greatest devastation to humans. We take a closer look at the 9 diseases on the current list. Published January 29, 2023.
How do pandemics begin? There's a new theory and a new strategy to thwart them
Animals carry millions of pathogens, so it's a daunting task to find the one with the greatest potential to spark a pandemic. Now scientists are rethinking the way they hunt for that next new virus. One point is that viral "spillover" from animals to people may be much more common than thought. Published February 15, 2023.
A new flu is spilling over from cows to people in the U.S. How worried should we be?
Pigs and goats likely catch it too. It's been found in humans' noses in the American Southwest and in the air at airports and at chicken farms in Malaysia. Published March 29, 2023.
PrecisionLifes Dr Sayoni Das, a computational biologist who leads the research and development of bioinformatics pipelines that generate biological insights from PrecisionLifes core technology and support drug discovery programmes, details a new study. Using combinatorial analysis, genetic variants associated with long COVID have been identified and, furthermore, it has been found that TLR4 antagonists may be a potential candidate for repurposing long COVID treatment.
There is an extensive array of symptoms associated with long COVID, with the most common being fatigue and post-exertional malaise, cognitive dysfunction, mood disturbances and respiratory problems. This is likely indicative of the heterogeneous nature of the disorder, and it is this complexity and diversity of clinical presentation and effects across multiple organ systems, that has made efforts to identify genetic risk factors using traditional genomic analysis approaches extremely challenging.
Although many studies have investigated the genetic risks underlying long COVID, only one genome-wide association study (GWAS) has identified a single risk locus around the lead variant in the FOXP4 gene. However, studies that use combinatorial analytical approaches to identify genetic risk factors in similarly heterogenous populations have demonstrated more success, for example in severe COVID-19 and ME/CFS.
Combinatorial analytics approaches identify combinations of features that together are associated with the disease phenotype in patient sub-groups, capturing the non-linear effects of interactions between multiple genes. These signals are distinct from and complementary to the monogenic, linear additive associations of single SNPs found by GWAS.
The PrecisionLife combinatorial analysis platform enables hypothesis-free identification of combinatorial features, known as disease signatures, which may include multiple SNP genotypes and/or other multi-modal features in combination. These disease signatures capture both the linear and non-linear effects of genetic and molecular interaction networks and enable the identification of associations including those that are only relevant to a subgroup of patients that influence disease risk, prognosis and/or therapy response.
The combinatorial approach is considerably more sensitive than GWAS and requires much smaller patient populations. It enables identification of novel genetic associations and mechanisms that may only be relevant to a subgroup of patients, leading to more novel associations than GWAS when analysing the same datasets.
In complex heterogenous diseases, such as long COVID, CNS disorders, autoimmune, cardiovascular, respiratory, and metabolic diseases, these non-linear combinatorial signals, and disease signatures, are significantly more important in understanding causative disease biology than in relatively monogenic disorders.
Using combinatorial analytics, we identified genetic disease signatures (ie, combinations of genetic variants significantly associated with the development of long COVID) in two subpopulations of long COVID patients who had experienced either severe disease or a fatigue dominant phenotype.
We identified 73 genes linked to long COVID, of which nine genes have prior associations with acute COVID-19, and 14 were differentially expressed in a transcriptomic analysis of long COVID patients. Comparison of the long COVID analysis with our previous combinatorial analysis of ME/CFS patients from UK Biobank identified nine genes in common.
Pathway enrichment analyses revealed that the biological pathways most significantly associated with the 73 long COVID genes were mainly aligned with neurological and cardiometabolic diseases. The genes unique to Severe long COVID cohort were largely associated with immune pathways such as myeloid differentiation and macrophage foam cells while genes unique to the Fatigue Dominant cohort were enriched in metabolic pathways and processes such as MAPK/JNK signalling and cellular respiration.
We generated strong mechanism of action hypotheses for the role of these genes in the development of long COVID. Additionally, causal insights into the specific effects of key SNPs/genes on disease biology were generated by expanded genotype analysis of the disease signatures. Generation of such insights at scale using a hypothesis-free approach is a unique capability of the PrecisionLifes platform.
43 genes were identified to be strongly associated with the severe long COVID population who reported the greatest degree of symptoms experienced. The genes unique to the severe long COVID patients were found to be associated with immune pathways such as myeloid differentiation, macrophage foam cells and lipid signalling pathways. The greater number of genes involved in immune response in the Severe long COVID cohort could be indicative of a more severe form of SARS-CoV-2 acute infection. This may potentially arise as a result of patients experiencing higher viral loads than average, as we identified four genes that have been functionally linked to SARS-CoV-2 host response and/or acute severe COVID-19.
We identified five genes that were strongly associated with risk of development of long COVID in both the Severe and the Fatigue Dominant cohorts using our hypothesis-free approach. In addition, 23 genes identified in the Severe cohort were significantly associated with disease in the Fatigue Dominant cohort using hypothesis-driven analyses. To understand the biological differences underpinning these two clinical manifestations, we analysed the differences in pathways between the genes uniquely associated with the Severe and Fatigue Dominant cohorts.
When we evaluated the degree of similarity between the genes associated with ME/CFS and long COVID, we identified nine genes that were previously associated with ME/CFS. One of these genes is the CLOCK gene that is an important regulator of circadian rhythm, disruptions of which have been associated with impaired mitochondrial function and pain among other things. Dysregulated mitochondrial function results in the inability to meet energy demands in response to stressors such as exercise and can result in the post-exertional malaise that is a hallmark of both ME/CFS and Fatigue Dominant long COVID. We also identified the genes ATP9A and INSR in long COVID that we had hypothesised contributes to dysregulated insulin signalling in subgroups of ME/CFS patients. Type 2 diabetes-related signalling pathways and insulin resistance were also a key theme within the genes associated with long COVID.
42 genes were found to be potentially tractable for novel drug discovery approaches for long COVID, of these 13 genes have drugs in clinical development pipelines. We are currently evaluating these repurposing opportunities for use in treating long COVID and/or ME/CFS.
We identified the TLR4 gene as an attractive repurposing candidate with potential to protect against long term cognitive impairment pathology caused by SARS-CoV-2. Our analysis indicated disease signatures linked to TLR4 were strongly associated with development of long COVID in 52 percent of the Severe cohort. There is additional supporting evidence that inhibition of TLR4 in a mouse model prevents long term cognitive pathology caused by SARS-CoV-2 and some clinical studies have already shown that antagonising TLR4 signalling inhibits inflammatory cytokine storms and reduces mortality rates in hospitalised COVID-19 patients.
About the author
Dr Sayoni Das
SVP Bioinformatics at PrecisionLife
Sayoni leads the research and development of bioinformatics pipelines that generate biological insights from PrecisionLifes core technology and support drug discovery programmes.
She is a computational biologist with a background in bioprocess engineering and biotechnology. Sayoni received a PhD in Computational Biology from University College London where she developed a protein function prediction method that was ranked among the top methods in two consecutive protein-function prediction challenges.
Prior to joining PrecisionLife, Sayoni developed tools for interpretation of genetic variants as part of her post-doctoral research and served as project coordinator for a large academic structural bioinformatics project.
If it seems like everyone is sick right now, its not just all in your head. According to the Centers for Disease Control and Prevention (CDC) over a dozen U.S. states are experiencing higher-than-usual rates of infections this winter. Of course, COVID-19 is on the rise again, yet another indicator that the pandemic isn't truly over. Recent CDC data reports COVID hospitalizations are up 17% and deaths are up 25% from last week. But respiratory syncytial virus (RSV) cases are also elevated," in addition to pneumonia and flu cases. There's a lot going around right now, making a lot of people wonder, is this normal?
Similar to the urban myth with children, which is that more kids are getting sick more frequently post-pandemic, a similar belief is circulating that more people are getting more sick in post-pandemic winters. In July 2023 the CDC estimated 77.5% of the U.S. population had antibodies from at least one COVID-19 infection, meaning only 1 in 4 had yet to get the infection.
As Salon has previously reported, severe cases of COVID can trigger a hyperinflammatory response called a "cytokine storm" so intense that it seems to exhaust the T cells and decrease their number. More recently, there has been evidence to suggest this can affect the immune system fighting future infections from both COVID-19 and other diseases as well.
Previously, experts were seeing the consequences of measures that the country took to mitigate the spread of COVID-19. Social distancing, masking, school closures not only worked for the coronavirus, but they also helped prevent people from other respiratory viruses such as the flu. Indeed, flu numbers hit a record low in the 2020-2021 season. The number of children in pediatric intensive care units for bronchiolitis and pneumonia also plummeted between April and June 2020. Viruses seemingly came back with vengeance. But is it possible that COVID-19 has left us more vulnerable to other illnesses and more COVID-19 infections?
Viruses like the flu and RSV are starting to spread earlier than in pre-pandemic winters, hence the perceived increase in prevalence.
Having COVID is a risk factor for RSV and respiratory illness, Dr. Rajendram Rajnarayanan, of the New York Institute of Technology campus in Jonesboro, Arkansas, told Salon, pointing to a study published last October in the journal Family Medicine and Community Health. The study found that prior COVID infections can make children five and under more vulnerable to RSV.
But Rajanarayanan said we have yet to pin down what the exact mechanism is behind this relationship. We need to invest some more money to study what's going on.
He emphasized this is just one study involving children. However, separate studies on adults have found that having COVID-19 can be a risk factor for Type 2 diabetes. A previous COVID-19 infection put people over the age of 50 at an increased risk for herpes. COVID-19 can also trigger an episode of high blood pressure.
These are comorbid conditions for having other conditions, Rajnarayanan said. And in a way, it sets you up for failure for the next season.
Want more health and science stories in your inbox? Subscribe to Salon's weekly newsletter Lab Notes.
In the 2010s, leading up to the pandemic, flu hospitalizations varied each year between 12,000 to 710,000 people. Taking a closer look, flu and pneumonia deaths in the winter of 2022-2023 were higher than in winter 2019-2020, right as the coronavirus took off. This year, according to data from early December, the CDC estimates that there have been at least 26,000 hospitalizations, and 1,600 deaths from flu so far this season.
Dr. William Schaffner, a professor of infectious disease at Vanderbilt University Medical Center, told Salon hes seeing an uptick in influenza, COVID and RSV hospitalizations locally, in addition to common cold viruses swirling around. But its hard to say if post-pandemic what we are seeing is more people getting sick. Instead, he theorized, whats happening is that viruses like the flu and RSV are starting to spread earlier than in pre-pandemic winters, hence the perceived increase in prevalence.
What happened last year, and to a degree this year, is that both influenza and RSV started early, Schaffner said. And some of them may have to do with coming out of COVID as the viruses have new opportunities to spread.
When a person catches the flu it can weaken the immune system even further, making it more difficult for the body to fight off other infections or illnesses.
Schaffner said he doesnt think that when a healthy person gets COVID-19, that automatically primes or impairs the immune system so that people are more prone to catch another respiratory virus. However, he pointed out that for people with long COVID, they seem to be having a chronic inflammatory response and an altered immune system. This could make them more vulnerable to other respiratory illnesses, he said.
But for the average person, those who recover from COVID, there seems to be no alteration in their immune system, he said. They still respond to other infections and other vaccines in a normal way COVID doesnt seem to predispose you to more viral infections.
Instead, the issue is that there are a lot of viruses that are going around simultaneously, and this could be wreaking havoc on peoples immune systems as theyre having to work harder to fight off multiple viruses spreading around the country.
Dr. T. Ryan Gregory, an evolutionary and genome biologist at the University of Guelph in Canada, told Salon concurrent infections, like having the flu and COVID-19, are worse for a persons immune system than just having one infection.
A recent COVID infection might provide temporary immunity to the next COVID reinfection, he added. But as with many other viruses, it could make people more susceptible to secondary infections for a while.
Despite the myth that the immune system becomes weak if its not exposed to pathogens, suggesting that its good for a persons immune system to be periodically exposed to viruses, experts have said thats not the case. Immune systems are far more complex. For example, when a person catches the flu it can weaken the immune system even further, making it more difficult for the body to fight off other infections or illnesses.
At minimum, adding a third virus [COVID-19] along with flu and RSV increases the chances of a coinfection, which makes things worse, Gregory said. It can also increase the severity of infections with other viruses in people who have recently recovered from one of the others.
The good news is that there are vaccines to protect against all three viruses circulating COVID-19, influenza, and RSV for those over the age of 60.
Our vaccines have been underutilized this season, Schaffner said. It is not too late to be vaccinated but do not delay in order to be protected through December and into the New Year.
Rep. Jim Jordan, R-Ohio, discusses Dr. Anthony Faucis upcoming testimony in front of House Republicans about the origins of COVID-19 on Varney & Co.
Pfizer on Wednesday forecast 2024 sales that could be as much as $5 billion below Wall Street expectations, a move top executives said provided a more reliable view of its COVID-19 business than it had this year, driving shares down 9% to a 10-year low.
Pfizer's COVID-19 vaccines and treatments revenues, which peaked at $57 billion, are now expected to be $8 billion in 2024. That compares to the $13 billion analysts had foreseen and is down from Pfizer's lowered forecast for $12.5 billion in 2023.
Pfizer's COVID-19 vaccines and treatments revenues, which peaked at $57 billion, are now expected to be $8 billion in 2024. (REUTERS/Dado Ruvic / Reuters)
"We want to be conservative," Pfizer Chief Executive Officer Albert Bourla said on a conference call with investors. "We want to be reliable so we won't create uncertainty (again), which was the case, unfortunately, this year."
It also forecast 2024 adjusted profit in the range of $2.05 to $2.25 per share, lower than analysts' expectation of $3.16.
TEXAS ATTORNEY GENERAL KEN PAXTON SUES PFIZER, ALLEGES PHARMA GIANT LIED ABOUT COVID VACCINE EFFICACY
The drugmaker's shares, already down over 44% this so far this year, fell 8.7% in morning trading and were set to erase over $14 billion in market capitalization, if losses continued through the day.
Shares of Moderna and Pfizer's German partner in the vaccine, BioNTech SE, fell 5% each.
The lower forecasts come a day after the drugmaker said it would reorganize its cancer division to include the acquisition of Seagen. It also raised its cost-cut target by $500 million on Wednesday.
The U.S. drugmaker expects annual revenue in the range of $58.5 billion to $61.5 billion, compared with analysts' average estimate of $63.17 billion, according to LSEG data.
JPMORGAN PREDICTS A GRIM OUTLOOK FOR THE STOCK MARKET NEXT YEAR
The COVID-19 vaccine and antiviral pill Paxlovid helped Pfizer bring in over $100 billion in revenue in 2022. Pfizer had originally forecast sales of $21.5 million in COVID sales for 2023, but had to cut that forecast by more than 40% to around $12.5 billion.
The COVID-19 sales targets "likely represent a floor for 2024 sales," said J.P. Morgan analyst Chris Schott.
Paxlovid and the COVID-19 vaccine helped Pfizer bring in over $100 billion in revenue in 2022. (Joe Raedle/Getty Images / Getty Images)
The drop in COVID product sales had also forced Pfizer to launch a program to cut jobs and expenses, which is now expected to save at least $4 billion a year by the end of 2024.
Pfizer had said on Tuesday that Chief Commercial Officer Angela Hwang would step down, and the company would reorganize its commercial business, not including oncology, into two divisions, one focused on the United States and the other on the rest of the world.
GET FOX BUSINESS ON THE GO BY CLICKING HERE
Pfizer's $43 billion deal for cancer drugmaker Seagen, which is expected to close on Thursday, is expected to add $3.1 billion to revenue next year.
Citi analyst Andrew Baum said that Pfizer's management is acting with increasing urgency to address its weak stock performance. However, the absence of promising high-potential pipeline assets makes it difficult for the company as several Pfizer products are expected to go off patent in the next few years.
Specialty
Please choose I'm not a medical professional. Allergy and Immunology Anatomy Anesthesiology Cardiac/Thoracic/Vascular Surgery Cardiology Critical Care Dentistry Dermatology Diabetes and Endocrinology Emergency Medicine Epidemiology and Public Health Family Medicine Forensic Medicine Gastroenterology General Practice Genetics Geriatrics Health Policy Hematology HIV/AIDS Hospital-based Medicine I'm not a medical professional. Infectious Disease Integrative/Complementary Medicine Internal Medicine Internal Medicine-Pediatrics Medical Education and Simulation Medical Physics Medical Student Nephrology Neurological Surgery Neurology Nuclear Medicine Nutrition Obstetrics and Gynecology Occupational Health Oncology Ophthalmology Optometry Oral Medicine Orthopaedics Osteopathic Medicine Otolaryngology Pain Management Palliative Care Pathology Pediatrics Pediatric Surgery Physical Medicine and Rehabilitation Plastic Surgery Podiatry Preventive Medicine Psychiatry Psychology Pulmonology Radiation Oncology Radiology Rheumatology Substance Use and Addiction Surgery Therapeutics Trauma Urology Miscellaneous
SPOKANE, Wash. The United States has filed a complaint against a Spokane property management company, alleging that the company fraudulently claimed hundreds of thousands of dollars in rent assistance intended to support struggling renters during the COVID-19 pandemic.
According to the Attorney's Office for the Eastern District of Washington, between 2021 and 2022, All Star Property Management "falsely and fraudulently sought and obtained T-RAP (Treasury Rent Assistance Program) relief funding for more than 30 tenants for which All Star was not eligible."
During the pandemic, congress established T-RAP to give landlords and property management companies an opportunity to apply for federal funding for a tenants past due and projected unpaid rent.
The company shared those proceeds with Arlin Jordan, who owned several properties under All Star. During this time, Jordan was serving time in prison for drugging and raping a tenant. But, he continued to own and receive income from five Spokane properties managed by All Star.
The complaint went on to accuse All Star and Jordan of claiming "falsely inflated rent amounts" higher than tenants' actual rent. In addition, both are accused of falsely representing T-RAP funds as rent assistance, which resulted in them collecting double and even triple rent for the same tenant for the same month.
Building safer and stronger communities in Eastern Washington requires that residents have access to safe, secure, and affordable housing, U.S. Attorney Vanessa Waldref said. Landlords and property management companies need to play by the rules, especially when they claim precious and limited rent assistance funds intended to protect members of the community struggling under the weight of a deadly pandemic. We will continue to work with our law enforcement partners to hold accountable those who abuse critically-important housing support programs.
KREM ON SOCIAL MEDIA:Facebook|Twitter|Instagram|YouTube
DOWNLOAD THE KREM SMARTPHONE APP DOWNLOAD FOR IPHONE HERE|DOWNLOAD FOR ANDROID HERE
HOW TO ADD THE KREM+ APP TO YOUR STREAMING DEVICE
ROKU:add the channel from theROKU storeor by searching for KREM in the Channel Store.
Fire TV: search for "KREM" to find the free app to add to your account. Another option for Fire TV is to have the appdelivered directly to your Fire TVthrough Amazon.
To report a typo or grammatical error, please emailwebspokane@krem.com.
Frerieke / Flickr cc
Ameta-analysis of 12 studies shows that 30% of COVID-19 survivors have persistent symptoms 2 years after infection, the most common of which are fatigue, cognitive problems, and pain.
For the study, published yesterday in the Journal of Infection, an international team led by a researcher from Universidad Rey Juan Carlos in Madrid, Spain, searched the literature for observational and case-control studies of long COVID 2 years after infection. The studies, published up to October 1, 2023, were from Europe, China, and the United States.
The sample included 7,912 hospitalized and non-hospitalized COVID-19 survivors; the average age was 59.5 years, and 50.7% were women. Up to 54% of patients had at least one underlying medical condition, with high blood pressure (34.0%) and obesity (22.4%) the most common.Long-COVID symptoms were evaluated at an average follow-up of 723 days.
The most common post-COVID symptoms 2 years post-infection were fatigue (28.0%), cognitive impairment (27.6%), and pain (8.4%). Psychologic problems such as anxiety (13.4%), depression (18.0%), and disturbed sleep (20.9%) were also prevalent.
The most common respiratory and general symptoms were fatigue (28.0%), runny nose (8.2%), and shortness of breath (5.7%). Prevalent neurologic and cognitive symptoms were dizziness and vertigo (6.7%) and impaired sense of smell (5.3%) and taste (4.9%).
This plethora of post-COVID symptoms can be explained by several mechanisms attributed to SARS-CoV-2 such as viral persistence, long-lasting inflammation, autoimmunity, reactivation of latent infections, alteration in gut microbiota, microvascular thrombosis, or others.
Stomach pain was the most common gastrointestinal symptom (6.7%); headache (8.9%) and muscle pain (8.1%) were the most prevalent pain symptoms; and hair loss was the most common dermatologic symptom (7.4%).
"This plethora of post-COVID symptoms can be explained by several mechanisms attributed to SARS-CoV-2 such as viral persistence, long-lasting inflammation, autoimmunity, reactivation of latent infections, alteration in gut microbiota, microvascular thrombosis, or others," the study authors wrote.
They added that population-based studies using homogeneous data-collection procedures are needed to further refine estimates of the prevalence of long COVID.
A survey of more than 6,600 physicians in Sweden shows that general practitioners (GPs) who managed COVID-19 patients were twice as likely to report severe symptoms of exhaustion, often the first sign of burnout. The study was published today in BMC Primary Care.
The study was based on data gleaned from the Longitudinal Occupational Health survey in Health Care Sweden (LOHHCS), and researchers used the Burnout Assessment Tool (BAT) to assess severe symptoms of exhaustion.
Though much attention was paid to the stress and trauma experienced by emergency and critical care doctors in the early months of the pandemic, GPs were seeing and diagnosing COVID-19 patients while also caring for patients who had other conditions. The authors said the dual nature of the GPs' role in the pandemic may have uniquely primed those doctors for burnout.
In this study, burnout was defined as "the inability to perform, as indicated by exhaustion and cognitive and emotional impairment, together with the unwillingness to perform, as indicated by mental distancing." Exhaustion is characterized by both mental and physical fatigue, or feeling drained, tired, and weak.
The researchers administered the survey in spring 2021 to 1,013 GPs in Sweden, and they found exhaustion in 14.4% of respondents. The prevalence was 16.4% among female GPs and 11.6% among male GPs, and 17.0% in junior GPs, compared with 13.8% in senior GPs.
19.9% of GPs who reported excess workload due to the pandemic also had severe symptoms of exhaustion.
GPs who managed COVID-19 patients had a significantly higher prevalence of severe exhaustion symptoms: 16.7%, compared with 7.8% in GPs who did not see COVID patients.
"Furthermore, 19.9% of GPs who reported excess workload due to the pandemic also had severe symptoms of exhaustion, and amongst those who stated that their workload was unchanged, the prevalence was 11.5%," the authors found.
In all survey responses, GPs who reported a lack of support from management were more exhausted. Severe exhaustion was reported in 29.1% of those who said they had poor managerial support, compared with 12.8% of doctors who said they had good support.
In several models built by the authors, GPs who managed COVID-19 patients were more than twice as likely to report severe symptoms of exhaustion compared to those who did not manage COVID-19 patients (odds ratio [OR],2.32; 95% confidence interval [CI], 1.39 to 3.90).
On top of that, being a female GP treating COVID patients was linked to a 54% higher risk of exhaustion (OR,1.54; 95% CI, 1.05 to 2.26).
GPs who reported their management had provided unsatisfactory working conditions had the highest risk of exhaustion (OR,3.37; 95% CI, 2.00 to 5.67).
The authors of the study said GPs in Sweden may have experienced higher stress and exhaustion because of their unique role in treating elderly citizens.
"In Sweden during the COVID-19 pandemic, the situation within elderly care was ethically demanding for GPs, entailing difficult medical decisions regarding the frail and elderly," the authors wrote.
"For instance, Swedish GPs responsible for care in nursing homes have been accused of denying COVID-19 patients hospital-based care, and even guilty of euthanasia. Further, there has been criticism about the fact that relatives of palliative-care residents were not involved in the end-of-life care."
A new Omicron variantJN.1may be on the rise.
According to updated data from the Centers for Disease Control and Prevention (CDC), COVID-19 levels are spiking in the U.S.
Recent data shows a 17.6% rise in COVID-related hospital admissions, as well as a 25% rise in COVID deaths. Test positivity and emergency room visits have also increased, at less drastic rates.
Last Friday, the CDC published an update on the JN.1 Omicron subvariant. The strain now makes up between 15% and 29% of current COVID cases. In late October, JN.1 made up less than 0.1% of cases.
According to the CDC, this rise indicates that JN.1 may be more transmissible than other strains.
However, the new report stressed that we do not know to what extent JN.1 may be contributing to these increases or possible increases through the rest of December.
That said, experts are concerned about the combination of holiday gatherings, low COVID vaccine rates, and a new, transmissible variant.
We have a little bit more population immunity, which is making it so that its not going to be like 2020 and 2021, Jill Foster, MD, division director of pediatric infectious diseases at the University of Minnesota Medical School, told Health. "But I think were [not in] a good place right now."
Heres what you need to know about the JN.1 subvariant, how the strain might be affecting the current COVID situation in the U.S., and how to stay safe this holiday season.
Getty Images / Images By Tang Ming Tung
JN.1 is closely related to another Omicron strainthe BA.2.86 variantthat experts were monitoring earlier this year.
Actually, the only change between BA.2.86 and JN.1 is in the spike protein.
While there are still a lot of unknowns about the latest Omicron strain, experts expect JN.1 to continue to pick up momentum.
Its causing nearly a third of new cases in the U.S., and its very likely to be the dominant variant with us through the holidays, Mark Cameron, PhD, associate professor and infectious disease researcher at the Case Western Reserve University School of Medicine, told Health.
As far as symptoms are concerned, the CDC expects JN.1 to have similar severity and symptoms to other Omicron variants.
Foster shared anecdotal reports from colleges that newer variants, like JN.1, tend to produce more gastrointestinal symptoms, such as abdominal pain or diarrhea. However, that has not been confirmed by the CDC.
For now, the public health risk caused by JN.1 appears to be similar to other Omicron variants. But, pre-print data from researchers in Japan suggests that JN.1 has the potential to be skilled at evading the immune system.
Anytime you have a new virus emerge, it has to be better than the old virus, said Foster. Its either better at evading immunity or something about it makes it better at spreading.
In addition to increases in COVID-related hospitalizations, deaths, emergency room visits, and infections, the U.S. is seeing generally high COVID numbers.
Nationally, COVID activity is the highest its been so far this year. The risk varies by regionthe Northeast and West are seeing lower levels, while the Midwest is currently seeing its second-highest COVID peak ever.
Experts say its still too early to tell if JN.1 is to blame for these levels.
The increase in cases could simply be the normal ebb and flow of COVIDit tends to increase and peak in late summer, and then again around the new year, the CDC said.
We all cluster indoors together at the same time the viruses get introduced, said Foster, making infection rates for respiratory viruses generally worse in colder months.
However, JN.1s quick increase raises the question of whether it could be driving an increase in infections going forward.
Cameron explained that the general increase in COVID infections means that the virus is now reaching a wider range of people, many of whom are more vulnerable to severe disease. So even though these numbers are ticking up in tandem with JN.1s rise, it doesnt necessarily mean that the variant is more deadly.
While this years COVID increase isnt completely abnormal, experts are still concerned about what the data has shown so far.
The thing I think is going to be different this year than last year, is people really are not doing any risk mitigation, Foster said.
As of mid-November, survey data from KFF indicated that just one in five Americans has received the updated COVID shot. A Yahoo News/YouGov poll from August found that only 12% of Americans say they mask most of the time in public.
This, coupled with JN.1 and holiday gatherings, could make this years wintertime peak a perfect storm, said Foster.
Because JN.1 is so similar to BA.2.86 and other Omicron variants, all signs point to current COVID toolsvaccines, tests, and treatmentsbeing effective against the strain.
Still, that doesnt mean its completely harmless.
[A JN.1 infection] might be a mild case, a moderate case, or a case that could put someone in the hospitalthats really a product of our genetics, our immune system, and our history not only with COVID-19, but with other infections, said Cameron.
Because of this variability, its essential that people do what they can to avoid infection this holiday season.
It really is this proportion of people in the U.S. [not] keeping up with their booster series that really concerns me, said Cameron. It does show a bit of complacency with the virus continuing to evolve against us.
Foster noted that people wont likely be wearing masks at family gatherings or holiday parties. But that doesn't mean it's not worth considering.
The biggest thing people can do is, when theyre in crowded places around a lot of strangers, they wear a mask, said Foster. In particular, people should consider masking while grocery shopping or traveling, she explained.
In terms of holiday gatherings with friends and family, Foster recommends asking anyone whos sick to stay home. People dont need to show a negative test at the door, she said, but its best not to power through and attend a gathering while youre sick.
