Eli Lilly opens up commercial sale of its monoclonal antibody treatment, Covid-19 patients who continue to test positive after five days may still be infectious, and more in this week's roundup of Covid-19 news.

Case study: Recovery clinics for Covid-19 long-haulers

• The Biden administration last week announced it reached an agreement to purchase 66 million doses of Moderna's omicron-specific booster for a fall vaccination campaign in the United States. This new purchase adds to the 105 million doses of Pfizer-BioNTech's updated booster that the federal government previously purchased. "We must stay vigilant in our fight against COVID-19 and continue to expand Americans' access to the best vaccines and treatments," said HHS Secretary Xavier Becerra. "As we look to the fall and winter, we're doing just that—ensuring Americans have the tools they need to stay safe and help keep our nation moving forward." Currently, the number of boosters purchased from both Moderna and Pfizer-BioNTech will not be enough to cover each person in the United States, but both deals include the option for additional purchases if funding becomes available. "Both Moderna and Pfizer agreements include options for a total of 600 million doses—300 million from each company — but these options can only be exercised with additional funding from Congress," an HHS press release said. (Armour, Wall Street Journal, 7/29; Gonzalez, Axios, 7/29; Vinluan, MedCity News, 7/29; AP/Modern Healthcare, 7/29)

• Long Covid may manifest in three distinct forms, each with its own set of symptoms, according to a preprint study published in MedRxiv. For the study, researchers from King's College London examined data from 1,459 people living with post-Covid syndrome, which is defined as symptoms that continue for at least 12 weeks after an initial infection. Using this data, the researchers placed patients into three main "symptom profiles." The first profile included patients who had long-term respiratory symptoms, such as chest pains, shortness of breath, and palpitations. The second profile included patients who experienced long-term neurological symptoms, including fatigue, brain fog, poor memory, and headaches. According to the researchers, patients in this group typically had been infected by the alpha or delta variants. Finally, the last group included patients who had long-term problems with their immune-related response. "These insights could aid in the development of personalized diagnosis and treatment, as well as helping policymakers plan for the delivery of care for people living with post-COVID syndrome," the researchers wrote. (O'Connell-Domenech, "Changing America," The Hill, 8/3)

• Eli Lilly this week announced it will begin commercial sales of its Covid-19 monoclonal antibody bebtelovimab. Previously, the treatment was sold to the federal government, which then provided it free or charge to patients and oversaw its allocation to states and pharmacies. However, the government will likely run out of its supply of bebtelovimab in the next few weeks, and without new funding from Congress, more doses cannot be purchased. To ensure broad access to the treatment, Eli Lilly will allow states, territories, and hospitals to purchase it directly starting the week of Aug. 15. "I don't anticipate that this will in any way stimulate usage of the product," said Daniel Skovronsky, Eli Lilly's chief scientific and medical officer. "It's more just about, how do we keep it available despite the U.S. government not being able to purchase it anymore. That's why we’re switching to a different model here." (Armour/Loftus, Wall Street Journal, 8/3)

• Covid-19 symptoms may "rebound" in almost 30% of infected individuals, according to a preprint study published in MedRxiv. For the study, researchers examined 568 Covid-19 patients who did not receive treatment for their symptoms. In total, 27% said their symptoms returned after initially improving, and another 10% said their symptoms returned after previously resolving. In addition 12% of patients experienced a "viral rebound," in which they tested positive again several days after initially testing negative. Previously, viral rebound has been documented in Covid-19 patients who had taken Paxlovid, but the study found the viral rebound can also occur in patients who have not taken the drug. "It happens all the time. People who are untreated with Covid who then feel better can get symptoms afterward," said Davey Smith, chief of infectious diseases and global public health at the University of California, San Diego School of Medicine and a study co-author. "Symptoms fluctuate, and viral antigen in the nose fluctuates, and they fluctuate with and without Paxlovid." (Bean, Becker's Hospital Review, 8/3; Lewis, NBC News, 8/3)

• A significant portion of Covid-19 patients who test positive on rapid antigen tests (RATs) after five days may still be infectious, according to a study published in JAMA Network Open. For the study, researchers from Brigham and Women's Hospital examined 40 patients with Covid-19 from Jan. 5 to Feb. 11 when the omicron subvariant BA.1 was the dominant strain in Boston. Of the patients, 75% tested positive on a rapid test on day six of their illness. Focusing on a convenience sample of 17 patients, researchers collected anterior nasal and oral swabs to see if they had culturable virus, a proxy for infectiousness. Of these patients, 12 tested positive on day six, but only six patients had culturable virus. "It's plausible that, similar to PCR testing, RATs are detecting viral shedding that is not actually capable of transmission," said Lisa Cosimi, the study's lead author. " … However, given these data, there is also a risk that individuals are leaving isolation while still infectious. We strongly agree with CDC's recommendation to wear a tight-fitting mask on days 6-10, especially if RAT positive, and to avoid areas where there is a high risk of transmission to others." (Fiore, MedPage Today, 8/3)

• North American Diagnostics (NAD) this week recalled a series of oral Covid-19 rapid antigen test kits. According to FDA, these tests are part of a Class I recall, which is designated for devices that could lead to serious injury or death. NAD did not provide sufficient data to show the tests are accurate and distributed them to consumers without proper FDA authorization. Currently, NAD has requested consumers and distributors to identify and destroy any of the affected test kits. (Robertson, Becker's Hospital Review, 8/2)