Biosecurity Incident in Wuhan; Subpar RSV Surveillance; Inside Healthcare PE Firm

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

Biosecurity Incident in Wuhan

In November 2019, reports from the Wuhan Institute of Virology (WIV) made references to a biosafety incident there, according to a report by Vanity Fair and ProPublica that published simultaneously with the Senate Health, Education, Labor and Pensions (HELP) Minority Committee's report last week.

Over 5 months, the two news outlets reviewed the committee's findings and conducted their own analyses of the evidence.

Central to the investigation were more than 500 documents downloaded from WIV's website, most of which were "party branch dispatches" from 2017 to the present.

Like many scientific institutes in China, WIV is state-run and -funded, and the research carried out there "must advance the goals of the Chinese Communist Party [CCP]," the article stated. The CCP operates party branches inside the WIV that meet regularly, and these groups file reports -- intended for watchful higher-ups -- that are uploaded to the WIV website, according to the article.

The documents were analyzed for the committee by Toy Reid, who has expertise in CCP "party speak," and the news outlets verified his work with outside experts.

A dispatch from party branch members at WIV's biosafety level 4 lab dated November 12, 2019 appeared to reference a biosecurity breach, and a week later, on November 19, 2019, WIV got a visitor from Beijing.

The visit from Ji Changzheng, the safety and security director from the Chinese Academy of Sciences, was billed as a safety training seminar for a small, high-level audience, according to the news outlets. But Reid interpreted the 1.5-page summary uploaded to WIV's website on November 21, 2019 as "out of the ordinary and event-driven."

Changzheng said he had "important oral remarks and written instructions" from Chinese President Xi Jinping and Chinese Premier Li Keqiang to address a "complex and grave situation," and during the meeting references were made to "hidden" safety dangers. Reid interpreted the documents to mean that the Chinese leader himself had been briefed on an ongoing crisis at WIV.

All of the outside experts contacted by Vanity Fair and ProPublica agreed that the event appeared to be urgent, non-routine, and related to a biosafety emergency.

The report also details intense pressure from the government to produce scientific breakthroughs despite a lack of resources, and raises questions about the country's ability to perform high-level biosecurity research safely.

"The WIV is under the thumb of the party state," Reid told Vanity Fair and ProPublica. "Just because you can't see the political pressures they're under doesn't mean they're not under them. American scientists have been slow to realize that."

Subpar RSV Surveillance

The nation's surveillance systems for infectious diseases including influenza and respiratory syncytial virus (RSV) are lacking, and could benefit from more real-time information, CNN reported.

Currently, national surveillance data for RSV are based on voluntary reporting from a few dozen labs that represent about a tenth of the population. While that's usually sufficient, more local, real-time information would be helpful in an atypical "sick season," such as the current one.

Efforts are underway to build on the lessons of the COVID-19 pandemic and make key data more granular and available much more quickly. Wastewater surveillance, for instance, first identified an uptick in RSV cases in August, CNN reported.

Those analyses were conducted by a private company called WastewaterSCAN, which monitors dozens of city and county sewage systems across 20 states.

"For things like influenza and RSV, you don't necessarily have to know about every person. But it is important to know- are you starting to see circulation, is it increasing, how long are we seeing circulation for, is it peaking, and when is it going down," Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists, told CNN.

How One Healthcare Private Equity Firm Operates

Despite casting itself as a "noble force," private equity firm Welsh, Carson, Anderson & Stowe has relentlessly pursued profits in healthcare, attracting legal and regulatory challenges, according to a STAT News investigation.

Referred to as "Welsh Carson," it's one of the largest private equity firms specializing in healthcare. STAT News examined lawsuits, government audits, and financial documents, and interviewed more than 50 people about the firm to understand how it works.

The firm has recruited powerful people within the healthcare industry, such as Tom Scully, who has been with Welsh Carson for almost two decades. After a career in healthcare lobbying, Scully became head of CMS for President George W. Bush from 2001 to 2003. He now sits on boards of at least seven companies, giving the firm "unparalleled access to information and networks that directly affect their businesses," the report stated.

"People who've spent decades working in the industry are valuable because they know which companies to invest in and, once the ink is dry, how to maximize profitability," the article stated.

The investigation focused on four of the 14 companies in Welsh Carson's healthcare portfolio: a physician staffing firm, a senior care provider, a Medicaid managed care provider, and a micro-hospital chain.

Physician staffing firm U.S. Anesthesia Partners is under investigation by the Federal Trade Commission over questions about its market power, according to the report. Since anesthesiologists have equity in the company, they're driven to boost patient volumes, as higher revenues mean more profits for shareholders, including the doctors themselves, the report stated.

Elder care provider InnovAge is facing a U.S. Department of Justice fraud investigation, a Colorado fraud investigation, and shareholder lawsuits. Sources alleged serious staffing issues as the company boosted enrollees but didn't increase staff to meet demand.

The firm bought a large minority stake in a subsidiary of the Medicaid managed care provider CareSource. Being involved with CareSource's management services organization allows CareSource to continue to market itself as a non-profit to state Medicaid agencies, even as the private equity firm influences decisions about coverage, according to the report. There's concern that members will face greater barriers to care so the company can take home greater profits, STAT reported.

Finally, micro-hospital chain Emerus is facing allegations in a lawsuit filed by a patient that it significantly overcharged for lab tests. Patients interviewed by STAT complained about the high cost of care they received at the hospital because of those tests.

STAT concluded that the firm has "ruthlessly chased profit by pouring gas on companies that have capitalized on the bloat and exploitative practices within the United States' $4 trillion health care system -- often at the expense of patients, employers, and taxpayers."

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