A CDC study found that immunocompromised patients make up most of those hospitalized for monkeypox, Covid-19 surges have been associated with an increase in heart attack deaths, and more in this week's roundup of monkeypox and Covid-19 news.

Monkeypox:

• Almost all patients who have been hospitalized for monkeypox in the United States have had compromised immune systems, most often due to HIV, according to a new CDC report. In the report, researchers analyzed 57 case reports of patients hospitalized for monkeypox between Aug. 10 and Oct. 10. Of these patients, roughly 95% were men, and more than two-thirds were Black. In addition, 82% had HIV, and around a third had a CD4 count of less than 50, which indicates severe immunosuppression. A few other patients also had conditions that have been linked to weakened immune systems, including cancer, solid organ transplants, and pregnancy. In total, a third of the patients were admitted to the ICU, and 12 deaths were recorded, with five confirmed to be from monkeypox complications. "Monkeypox and H.I.V. have collided with tragic effects," said Jonathan Mermin, CDC's lead scientist on monkeypox. Currently, the agency is urging clinicians to test all sexually active patients with suspected monkeypox for HIV and to consider giving all "highly immunocompromised" patients, especially those with advanced HIV, early access to monkeypox treatments. (Mandavilli, New York Times, 10/27; Sun/Nirappil, Washington Post, 10/26)

Covid-19:

• According to new models from the University of Washington's Institute for Health Metrics and Evaluation (IHME), Covid-19 death rates are likely to remain relatively stable this winter. In a recently published policy brief, IHME estimated the Covid-19 infection-fatality rate to be below 0.2% as of Oct. 17, and that daily Covid-19 deaths will reach a high of 335 by Feb. 1, 2023. "Many people have been exposed to COVID-19, either through infection or through vaccination, [so we don't expect] a high hospitalization rate and high mortality rate," said Ali Mokdad, a professor at IHME and chief strategy officer for population health at the University of Washington. "We will see a little bit of a rise, but it will not be as high as what we have seen in the past." However, even with more stable death rates throughout the winter, the United States may see roughly 30,000 deaths from Covid-19 by Feb. 1. In addition, there is a potential for both flu and Covid-19 cases to surge this year, which could overwhelm hospitals. "I wouldn't say we're in a good position, because our hospitals have been under a lot of pressure," Mokdad said. "It's possible we'll have a bad flu season, so the combination of the two could still overwhelm hospitals, especially in areas where you have high-risk people." (Fiore, MedPage Today, 10/26)

• Covid-19 surges have been associated with a significant rise in deaths from heart attacks. According to a new study from Cedars-Sinai's Smidt Heart Institute, heart attack deaths increased by 14% during the first year of the pandemic, and acute myocardial infarction-associated mortality has continued to be higher than normal throughout the pandemic. In particular, the increase in heart attack deaths was most prominent for individuals ages 25 to 44, increasing by 29.9%. In comparison, the risk of heart attack death increased by 19.6% for those ages 45 to 65 and 13.7% for those ages 65 and older. "There is something very different about how this virus affects the cardiac risks," said Susan Cheng, director of the Institute for Research on Healthy Aging in the department of cardiology at the Smidt Heart Institute and one of the study's authors. "The difference is likely due to a combination of stress and inflammation, arising from predisposing factors and the way this virus biologically interacts with the cardiovascular system." (Taylor, Becker's Hospital Review, 10/25)

• Pfizer plans to sell its Covid-19 vaccine, which was developed with BioNTech, in the U.S. commercial market for roughly $110 to $130 per dose. Currently, the company is still in negotiations with insurers, but expects discussions will lead to a final list price in the projected range. According to the Wall Street Journal, the U.S. government paid $19.50 per dose for the Pfizer-BioNTech Covid-19 vaccine under its first contract, then $30.50 per dose under its most recent supply deal announced over the summer. According to Angela Lukin, Pfizer's U.S. president, the new commercial price reflects the value of the vaccine, manufacturing costs, and an additional cost of switching to single-dose rather than multi-dose vials. A commercial rollout of the vaccines could begin early next year, depending on when the company's government contracts expire, and the existing U.S. supply is depleted. In the future, Lukin said she expects both private and public health insurers to cover the full cost of the vaccines, and eligible U.S. residents without insurance will be to apply for Pfizer's income-based assistance program to reduce the cost of the vaccines. (Hopkins, Wall Street Journal, 10/20; AP/Modern Healthcare, 10/21)

• Covid-19 contributed to a quarter of all maternal deaths in the United States in 2020 and 2021, according to a new report from the U.S. Government Accountability Office (GAO). Two years prior to the pandemic, the number of maternal deaths per month ranged from the mid-50s to the mid-60s, but CDC data showed that this increased to a monthly average of 85 between January 2020 and December 2021. In the report, GAO noted that there were widening disparities in maternal deaths by race. In particular, Black and Hispanic women saw greater increases in their maternal death rates compared to white women between 2019 and 2021. Maureen Phipps, CEO of the American College of Obstetricians and Gynecologists, said the report's findings confirm expectations that the pandemic would worsen the United States' maternal death crisis. "These new data through 2021 give us cause for serious concern with significant increases in maternal deaths among Black and Latino individuals as well as increases in mortality overall," Phipps said. (Hassanein, USA Today, 10/19; Choi, The Hill, 10/19)

• Novavax recently announced that a late-stage trial of its Covid-19 booster increase neutralizing antibody levels up to 34 times higher than primary vaccination alone among adults. There was also a "significant boost" in antibodies against omicron and its subvariants BA.1, BA.2, and BA.5. The same study also found that the booster increased neutralizing titers 2.7-fold among adolescents ages 12 to 17. According to Novavax, the prototype booster was well tolerated among the study's participants, and side effects were largely mild to moderate. (Twenter, Becker's Hospital Review, 10/13)