In an age of unprecedented change, staying current has never been more important. Our team at Chartis is curating news most relevant to the healthcare industry and tracking the topics that are trending on seven key issues: high reliability care, digital and advanced technology, financial sustainability, health disparities, the health ecosystem of the future, partnerships, and the provider enterprise. Each week, we break down what’s happening and why it matters.
As reported last week, new COVID cases from the Omicron variant are reaching levels never before seen during the pandemic. Hospitalizations thus far have been mostly of unvaccinated patients, but there are growing numbers of hospitalizations amongst those vaccinated but not yet boosted. Data released from the United Kingdom indicates waning protection from Omicron after two doses, with one study showing 10 percent effectiveness at preventing symptomatic infection 20 weeks after full vaccination. The same study indicated booster shots increase effectiveness to 75 percent.
A study released by The Ragon Institute last week presented similar findings. Full vaccination regimens without boosters did not produce necessary antibodies to neutralize the Omicron variant. Researchers compared blood samples of those fully vaccinated with one of the three U.S. approved COVID vaccines to those who had received a third booster vaccination. Alejandro Balazs, principal investigator, noted,“We detected very little neutralization of the Omicron variant pseudovirus when we used samples taken from people who were recently vaccinated with two doses of mRNA vaccine or one dose of Johnson & Johnson, but individuals who received three doses of mRNA vaccine had very significant neutralization against the Omicron variant.”
Both Pfizer CEO Albert Bourla and Moderna CEO Stephane Bancel shared this week that the companies are working on boosters specifically targeting Omicron and Delta. Borula indicated initial doses would be ready in March, though it remains unclear if a variant specific vaccination will be necessary. Bancel shared that government demand is high for an Omicron booster, and that the Moderna vaccine will enter clinical trials soon, with a target release of this fall.
Thus far booster uptake rates have lagged initial vaccination rates. Many in the U.S. are tired and frustrated from mask and quarantine policy updates, and some are distrustful of initial recommendations, wary that they may change again. The point must be reinforced that vaccinations and now boosters remain a key tool to the fight against COVID.
In fact, according to a model released from the Commonwealth Fund, boosters could have a significant impact on the time until U.S. Omicron cases peak, hospitalizations, and deaths. In December boosters were administered at a rate of 770,000 doses per day. The model indicates that doubling the pace of booster administration could reduce peak daily cases by nearly 20 percent, and tripling booster rates could reduce peak cases by 30 percent. Importantly, tripling daily booster administration could also shorten the timeframe with over 20,000 daily hospitalizations from 6 weeks to 3 weeks, significantly reducing the taxing burden to the healthcare system.
Whether a fourth booster of the current vaccine will be necessary still remains to be seen. Data from the United Kingdom showed protection against severe illness was still significant 3 months after a third shot. Israel, alternatively, decided that a fourth dose for those with high exposure rates, like healthcare workers, and those most at-risk, including persons over 60 and the immunocompromised, was necessary. The World Health Organization (WHO) has pushed for increased vaccination efforts to the rest of the world first to help prevent additional variant progression and save lives. Dr. Anthony Fauci has noted that while a fourth vaccination is certainly conceivable, more data is still needed on the durability of protection and that the focus now should be on getting everyone who is able vaccinated and boosted, as “boosters are critical in getting our approach to Omicron to be optimal.”
The term “shadow pandemic” has emerged in recent months, referring to increasing rates of violence against women, adolescents, and children during the COVID-19 pandemic. A systematic review and meta-analysis of 18 studies found that officially reported domestic violence increased by 7.9% internationally and 8.1% in the United States after stay-at-home orders were implemented.
In one weekend, calls to domestic violence helplines went up by 65% in the United Kingdom, per a United Nations (UN) report. In NYC, caseloads doubled at the city’s domestic violence agency as victims of domestic violence were “trapped at home with their abusers” during the lockdowns, as reported by the World Economic Forum. It should be noted that estimates of domestic violence rates are likely to be low — the UN estimates that less than 40% of women who experience violence seek any kind of help, and less than 10% of those who do go to the police.
The term “shadow pandemic” alludes to the correlation between the coronavirus pandemic and the apparent rise of domestic violence rates — those rates have followed the path of the pandemic, like a shadow follows a person. Others have used the term slightly differently, implying that domestic violence is not adequately addressed, left in the shadows, in part because of underreporting, because it is a sensitive topic, and because of the difficulty in addressing something that mostly occurs in a private space. And now, that “pandemic” is becoming overshadowed by COVID, as women’s shelters and programs are scaled back due to virus containment efforts and lack of staff, healthcare professionals are prioritizing COVID care, and depleted law enforcement departments are focusing on more serious crimes.
The Director of WISE Collective stated in the Independent Online in 2020, “An existing pandemic that is known to the powers that be has now become a shadow of the COVID‐19 pandemic. It cannot be a shadow, it should not be a shadow.” A representative from Human Rights Watch commented at a United Nations Girls Education Initiative event, “It’s not a ‘shadow.’ It’s there. It’s very obvious. It just takes acceptance to turn it into the pandemic that it really is.”
While there are likely a multitude of varying reasons behind the worldwide uptick in reported domestic violence, public health and policy experts have regularly pointed to:
As the world continues to fight the COVID-19 pandemic, efforts should be made to help address the domestic violence pandemic, the rate of which appears to be increasing in relation to COVID-19, especially when stay-at-home or lock-down orders are imposed. More generally, women need extra support as they have disproportionately been affected by the pandemic — losing more jobs than men and bearing more of the childcare and homeschooling burdens than men, per a report by Brookings, among others.
Yet to date, per the Global Health 50/50 Report, fewer than 2 in 10 COVID-19 health programs consider gender in their design or are tailored to gender in any way. Several advocates for health equity, including Think Global Health (part of the Council on Foreign Relations), insist that gender analysis is essential in the development of programs related to COVID-19. Gender analysis “requires asking how socially constructed roles and identities affect vulnerability to and experiences of an outbreak.” While it is concentrated on differences between women/girls and boys/men, it also takes into account inequities related to sexuality, race, ethnicity, and religion.
As is stated in the Think Global Health report, “Gender inequities exacerbate outbreaks…and responses that do not incorporate gender analysis exacerbate inequities.” Similarly, leaders at the Lancet Commission on Gender-Based Violence and Maltreatment of Young People urged, “…amidst the ‘pandemic within a pandemic’ of violence against women and children, it is more urgent than ever that policy makers tailor their policy responses…to help avert the human calamity and economic sinkhole of violence.”
If progress toward health equity between women and men made over the last few decades is to be sustained and advanced rather than shattered by the pandemic, and if the domestic violence “shadow pandemic” is to be acknowledged and adequately addressed, programs that are geared towards women’s specific needs during the pandemic are vital.
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