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

What Went Wrong with COVID in L.A.?

In a nutshell, pretty much everything, .

Los Angeles has become the new U.S. epicenter of the COVID-19 pandemic thanks to a combination of COVID-19 fatigue, large numbers of essential workers exposed on the job, high population density, inconsistent political messaging, to name just some of the contributing factors.

The news outlet interviewed 31 epidemiologists, public health experts, and public officials to piece together reasons for the area's surge, where the idea of rationing care has been floated across its hospitals.

Cases started to tick up in early November, and by Thanksgiving week, 4,000 people were testing positive each day in L.A. County. Now, the average is 14,000 new cases per day. It's estimated that 1 in 95 people in the county are currently infected with coronavirus, and there were 9,400 deaths when the article published late last week.

Factors that went into this perfect COVID storm include colder weather, where the virus thrives and where people are forced indoors, boosting spread.

Then there's the fact that L.A. County is home to more than 10 million people, many of whom are essential workers and who live in some of the most dense neighborhoods in the nation. L.A. has a huge manufacturing sector and two of the biggest ports in the nation, and these workers are often cramped into close quarters, the paper reported.

In addition to high population density, it's common for working-class families of four or five people to live in a one-bedroom apartment given that housing costs are so high, according to the Times.

A patchwork of inconsistent or arbitrary policies may have also played a role in the surge. There has been dissent among local public health officials, and residents have pushed back when playgrounds were closed or small outdoor gatherings were banned while indoor retail businesses were allowed to remain open.

In addition, the more contagious "U.K. variant" of the virus has been found in the state.

Finally, Californians hadn't witnessed as much devastation first-hand, so they may have had a false sense of security as virus cases started to rise in early November.

"People get tired," said Grant Colfax, MD, San Francisco's public health director. "This has been a long 10 months and I think people started to let their guard down a little more, because we were in relatively good shape."

Monoclonal Antibodies Going Unused

The two monoclonal antibody therapies that the FDA authorized for emergency use in COVID-19 are sitting largely unused on pharmacy shelves across the country, .

That's mainly due to a "lukewarm response from infectious disease specialists, who say they want more clinical trial data before using them on a regular basis," the Journal reports.

Healthcare providers are administering just 20% of the monoclonal antibody doses they receive each week, Operation Warp Speed officials told the Journal.

Massachusetts General Hospital, for instance, received about 275 doses of Eli Lilly's bamlanivimab, but only 10% of those have been administered so far. The hospital also got a small supply of Regeneron's casirivimab/imdevimab combo, but that hasn't been used at all yet.

The National Institutes of Health found insufficient data to recommend for or against the use of monoclonal antibodies in COVID-19, and the Infectious Diseases Society of America recommends against routine use of bamlanivimab. Another issue for hospitals: neither product is authorized for use in hospitalized patients.

In addition to specialists being unable to discern which patients will benefit most, there's a lack of interest and awareness from primary care doctors, as well as a shortage of space to administer the drugs -- which need to be infused over a 2-hour time period.

Patients Forced into Binding Arbitration

As private equity takes over more physician practices, more patients must agree to give up rights to a jury trial in case of disputes over their care, resolving them through binding arbitration instead, .

The advantages for corporate? Arbitration is conducted in private, so brands can avoid negative publicity. Decisions are often more favorable to corporations than they would be in jury trials, in which jurors may be more sympathetic to injured patients than to Wall Street titans.

Also, arbitrated malpractice payouts can be limited. In Florida, for example, the maximum pain-and-suffering award is $250,000.

Bloomberg gives the example of a Florida ob/gyn practice in a large medical group bought up by Lindsay Goldberg, a New York private equity firm. Jessie Harrell, a patient of the practice and a lawyer, was handed a form she recognized as one she'd previously argued against in court.

The document wanted her to agree to binding arbitration -- but it had been found legally unenforceable in the case she argued before the Florida Supreme Court.

Despite that, women who sign are likely to assume the form is enforceable, one defense attorney told Bloomberg.

"There's nothing inherently wrong with investors buying medical firms, as long as doctors can practice the way they always had," Harrell said. But, "what seems like a business decision can affect patient care if it's using this position of trust that doctors have to mislead patients to do something that's not in their best interest."

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