U.S. Elective Surgery

Key points from this report:

 

  • Recovery expected in surgeries: Overall admissions and surgeries are running at 90% and 91% of pre-pandemic levels, respectively. Though the Delta variant did cause a sequential slowdown, surgeries are expected to recover in Q4 and into 2022.
  • New COVID-19 antiviral pills: Pfizer and Merck have presented data that can reduce the risk of hospitalization by 89% and 50%, respectively. Both studies saw all high-risk patients recover with no deaths. The U.S. FDA advisory committee will give their views on emergency use authorization of Merck’s pill by the end of November.
  • Reopening beneficiaries: Though elective surgery ideas were negatively impacted in Q3 by the Delta variant, results were better than feared. Management commentaries are positive heading into Q4 with sequential growth expected.
  • High COVID-19 exposure: The majority of leading ideas through Q3 came from Tools and Bioprocessing as they were benefiting from vaccine production. We believe Avantor (AVTR), Bio-Rad (BIO), Catalent (CTLT), Danaher (DHR), and Repligen (RGEN) need time to digest major moves higher earlier this year. Look for all to remain above their rising 200-DMA to remain constructive long term.
  • Elective surgery/reopening ideas: We believe the following ideas can beat Q4 consensus: ABMD, ALGN, CNMD, DXCM, EW, GMED, INMD, INSP, ISRG, NVST, PCRX, PEN, PGNY, PODD, SYK, TNDM.

Market View

The U.S. market remains in a Confirmed Uptrend. The S&P 500 and Nasdaq found support near their respective
10-DMA, eventually closing ~1% off all-time highs for the week. Support below this level remains the rising 21-
DMA (S&P 500: 4,603; Nasdaq: 15,515). The distribution day count remains low at three and one, respectively.

Market View

The U.S. market remains in a Confirmed Uptrend. The S&P 500 and Nasdaq continue to set new all-time highs

after a week of broad-based accumulation. Indices are 1-2% above the first level of support at their rapidly ris-
ing 10-DMA (S&P 500: 4,620, Nasdaq: 15,602). The distribution day count remains low, at two and one, re-
spectively.

Market View

The U.S. market remains in a Confirmed Uptrend. The S&P 500 and Nasdaq have now both broken out to new
all-time highs. There are multiple levels of support below current prices, including the prior highs (S&P 500:
4,545; Nasdaq: 15,403) before the sharply rising 10- and 21-DMA. Distribution has mostly been avoided for
two weeks with the count at five and four, respectively, with three expiring on each next week.

O’Neil Health Care Weekly

XLV jumped nearly 3% off support last week and is now sitting directly under 50-DMA resistance. All other sectors as well
as the major averages have been able to regain this level over the last two weeks. The RS line has turned back up on this
bounce, but still remains in a longer-term downtrend.

Market View

The U.S. market is in a Confirmed Uptrend. The S&P 500 made a new all-time high Thursday showing instant
progress after regaining its 50-DMA last week. The Nasdaq also continued its push higher earlier in the week
before pulling back Friday to close ~2% off all-time high resistance of 15,403. We continue to view the 50-DMA
as a key level of short-term support, though both the 10- and 21-DMA are now crossing above that level. The
distribution day count stands at five each, with one day expiring on both at the end of next week.

O’Neil Health Care Weekly

XLV was able to rally off logical support near the top of its prior base and rising 200-DMA. It now faces resistance at the
rolling 50-DMA. Despite the move higher, the ETF is still significantly lagging the S&P 500 and all other sectors over the
last two months. Therefore, we recommend a more selective approach within the sector.

IPO Rewind

Winners (annualized gain of 30% or greater)
• Median market cap at IPO was 65% higher than the median market cap of losers.
• Median revenue growth was 39% the year before IPO. However, it has declined to 31% and 22% in the year of IPO and year after IPO, respectively.
• A significant number are still losing money, but nearly half of them are improving toward profitability after the IPO.