Rare Masking Holdout Flips; Telehealth Company Exodus; COVID Antiviral Access Issues

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

D.C. Finally Dumps Mask Mandate

Washington, D.C.’s recent repeal of its indoor public mask mandate is already generating controversy, Kaiser Health News reports. The District officially made masks optional on Monday, up to the discretion of businesses, leading some to worry while others are celebrating the change.

“I’m very exhausted with arguing with people about masks,” said the owner of a bar that will not require people to wear masks but will insist they be vaccinated. “Once a week, at least, there’s some kind of argument with some customer.”

The District has typically acted cautiously throughout the pandemic. It was one of the few remaining entities (cities or states) still mandating indoor masking. But Mayor Muriel Bowser’s decision to remove the mandate was announced the same day that the neighboring suburban Montgomery County (Maryland) announced it was reinstalling a mask requirement.

The District is now treating COVID-19 as endemic, according to the mayor’s office. The mandate has been scrapped because hospitalization and death rates are very low.

Bowser has declined to engage with several city council members who have questioned the policy change. Her office is offering public health advice based on vaccination status.

Public health experts’ reactions are mixed. “It makes sense,” said Lynn Goldman, dean of the Milken Institute School of Public Health at George Washington University. “At the same time,” she added, “we don’t really know how it’s going to go.”

Said Michael Osterholm, PhD, MPH, director of the University of Minnesota’s Center for Infectious Disease Research and Policy: “We do not understand why surges start or stop. …Why they start and stop surely can’t be tied to human mitigation strategies. What can be tied to those is how big those surges get.”

Telehealth Company Exodus

The sudden departures of Talkspace leaders has many analysts wondering about the company’s future, even as it still sits on hoards of cash, according to STAT News.

The virtual behavioral health company lost several top executives over the past week — including chief operating officer Mark Hirschhorn, and co-founders Oren and Roni Frank. The latter two were also board members. (Hirschhorn had previously resigned from his executive position at Teladoc in 2018 amidst allegations of misconduct.)

Talkspace went public via a merger earlier this year with Hudson Executive Investment Corp, a special purpose acquisition company, earning an initial valuation of $1.4 billion. The company’s market cap as of Monday was valued at $315 million, a drop of more than 35% over last week.

Analysts wondered if Talkspace can maintain an advantage it gained by becoming an early player in the booming mental health telemedicine space when it launched in 2012.

The company is planing to transition from marketing directly to consumers, to attracting employers and insurance plans. Its consumer-focused business slowed during the third quarter and it missed analysts’ expectations.

Talkspace is still sitting on $223 million in cash, however. The company “is fortunate to have the resources to work its way through what should be fixable problems, although execution and timing of turnaround are key uncertainties,” analysts wrote.

Will Access Be an Issue for COVID Antivirals?

When antiviral treatments for COVID-19 come to market, they may not be accessible to the people who need them most, according to STAT News.

Pfizer and Merck are hoping to have their treatments on the market soon, pushing for emergency use authorization (EUA). While they are expected to be largely subsidized by the federal government, it may not otherwise be easy for many patients to get them. Skeptics cited the usual process for procuring medications as an impediment; sick patents will often not be able to wait to see a doctor and get a prescription.

“These are medications that need to be started within three days of developing symptoms. It can take you longer than three days to get an appointment,” said Céline Gounder, MD, an NYU professor who served on President Biden’s COVID advisory board.

The potential medications are promising. No patient in either company’s clinical trials died after being treated with a full course. The trials focused on unvaccinated people with at least one risk factor for developing severe disease.

The Biden administration has earmarked $5.3 billion for the Pfizer treatment and $1.2 billion for the Merck treatment, pending FDA authorization. In September, HHS ruled that pharmacists can prescribe, dispense, and administer COVID therapeutics.

The FDA is scheduled to meet Tuesday November 30 to discuss Merck’s antiviral, while Pfizer recently asked for an EUA.