In a perfect world — and, boy, don’t we have a ways to go to reach that status? — there would be Hepatitis C testing alongside every fall flu-shot location, primary-care providers would do screenings as a matter of course, and people would disabuse themselves of the false stigma around this pernicious disease.
“It’s a lethal disease that is altogether curable,” nurse practitioner Tanda Ferguson, who heads the liver clinic at Yakima’s Memorial Cornerstone Clinic, told us. “People don’t even know they have it.”
But Washington state now is taking steps toward a more perfect world in terms of health care — the Hepatitis C Virus, in particular. Last week, Gov. Jay Inslee signed a directive that coordinates state and local governmental efforts to eradicate HCV, which, at its most extreme, causes liver failure and cancer, by 2030. Washington is the first state to do so.
Such a multi-pronged approach is needed, too. Officials say more than 65,000 Washingtonians are living with Hepatitis C, which can be cured through treatment but not prevented by vaccination. Between 2012 and 2017, infections rose 126 percent from the previous five-year period. The state’s numbers hew to alarming national statistics showing that, since 2010, new HCV cases have increased by 350 percent, according to the Centers for Disease Control and Prevention. Some 41,000 new cases were reported in 2016, up 21 percent from 2015.
The increase, some experts say, might be linked to greater education about and more robust testing for the blood-borne disease. People are starting to recognize that Hep C, as medical providers call it, is not just a plague spread among IV drug users — as many long believed. Rather, the virus can be transmitted via blood transfusions, dental procedures, unsanitary tattooing conditions, and accidental needle pricks — but not by casual contact.
One reason Baby Boomers are often advised to get tested is because, in decades past, health care professionals weren’t so mindful of how the disease could spread. Many a person eligible for an AARP card can recall lining up at school in the 1950s and ‘60s to receive shots from a vaccination “gun;” it made the process faster but, unwittingly, exposed children by using the same needle.
“So back then, if the kid in front of you in line had Hep C,” Ferguson said, “then there’s a good chance you now have it, too. Same thing with Vietnam veterans. Prior to 1968, they reused needles on soldiers.”
It’s not just the stigma of the disease that keeps people from getting tested for HCV, Ferguson said. It’s that many of those infected do not show symptoms until the latter stages of liver disease. Ferguson said that HCV patients are unlikely to physically manifest the disease until their liver function ebbs to 10 to 20 percent.
But even at that point, she says, people often can be successfully treated and regain function without having to undergo liver transplant. The CDC reports that, with treatment, 95 percent of HCV patients can be cured after either one or two rounds of prescription drugs. At Memorial Cornerstone Clinic, Ferguson said the success rate is “equal to or better than” national levels.
Early treatment is key, though. And, thanks to a 2016 class-action lawsuit representing 28,000 patients, Washington State’s Health Care Authority was ordered by a federal court to treat all Medicaid patients with HCV, rather than waiting until they were severely ill to receive the cure — apparently a cost-saving move by the agency. After the federal ruling, HCA has reportedly treated 300 more Medicaid patients each month, for a total of 500 per month.
Now that more Washington patients have access to treatment, the focus is on reducing the often-prohibitive price of curative drugs. Reducing prices is one of the major points of Inslee’s directive. In 2016, a three-month treatment of the drug Harvoni could cost as high as $90,000. Today, there are four additional drugs that treat HVC on the market. The cost is slowly coming down.
“They are still too expensive,” Jason McGill, a health-advisory policy adviser to the governor, said at last week’s news conference. “but with competition, we can drive a better deal.”
Outreach to the community might also reduce costs, McGill said. If more people are tested and if HCV is caught earlier before severe medical problems arise, he said it could save the state hundreds of millions of dollars.
But only if people are made aware.
“We’ve got to make sure that at-risk populations particularly have education and preventative services,” Inslee said, “and people that need testing get testing.”
“Everybody,” Ferguson said.
• Members of The Yakima Herald-Republic editorial board are Bob Crider and Sam McManis.