Chartis Top Reads – Week of March 28 - April 3, 2021

Our research team breaks down this week’s top healthcare news.


Top Reads Overview

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.

The State of COVID-19

The Buzz This Week

There has been much positive news about COVID-19 in the last couple of weeks. National Public Radio has reported through its regularly updated COVID-19 vaccine tracking page that the United States has surpassed a rate of 3 million vaccine doses given daily. In total, 52 million, more than 15 percent of the U.S. population, has been fully vaccinated.

And yet across the country, positive cases are rising again. Hospitalizations in some parts of the country are increasing. The Atlantic posits that the U.S. may be entering its “fourth surge.” Experts such as Dr. Anthony Fauci, National Institutes of Allergy and Infectious Diseases Director, point to two drivers of the rise in cases and hospitalizations: (1) the spread of more contagious and deadly strains, such as B.1.1.7, which has had a devastating impact in the United Kingdom and Israel, and (2) a relaxing of preventive measures in many states and municipalities, such as ending mask mandates and social distancing requirements in indoor spaces, like restaurants.

The country is apparently in a push-pull tug of war of countervailing forces, threatening to reverse the progress we’ve made against the virus and increase COVID-related deaths. Centers for Disease Control and Prevention Director Rochelle Walensky stated in a White House briefing earlier this week and quoted in STAT that she was “scared” and pleaded with the public, “We are just almost there, but not quite yet. And so I am asking you to just hold on a little bit longer.” The New York Times summarizes the country’s current situation as “short-term worry, long-term optimism.”

Why It Matters

Protective measures such as mask wearing, hand washing, and social distancing are important, and the public should try to hang on a little longer, as Walensky advised. However, in some parts of the country, the loosening of restrictions may not be reversed — COVID fatigue and economic damage are very real, and the desire to return to “normal” is overwhelming.

With this in mind, the U.S. should look to its most powerful tool against COVID-19: vaccination, with three remarkably effective vaccines approved to date. To win the tug-of-war, vaccination must continue, which will require the number of Americans who do not wish to be immunized to change their mind, and those who are undecided to shift to seeking vaccination. The total number of people who are vaccine hesitant or undecided is about 46 percent, per a February 2021 consumer poll conducted by Jarrard Inc. The number does not appear to be dropping notably, which will be a problem, should the U.S. seek to hit the target vaccination rate of 70-85 percent of the population, per Dr. Fauci.

Some are also suggesting that vaccination should be targeted, focusing on higher-risk populations, geographic areas experiencing a surge, and areas where there is limited vaccine access and the total vaccination rate is substantially lower than the average — factors that would make the local population more susceptible to an outbreak or surge. As the nation witnessed with early vaccine production and distribution, this unprecedented public health effort is fraught with challenges. Successfully targeting specific populations for vaccination will be logistically difficult and has the potential to spark a negative public reaction from those expecting more vaccines that may be redirected elsewhere.

Beyond U.S. borders, the disparities in vaccine access and distribution equity are especially evident, and in many countries, like Brazil and the Philippines, targeting local high-risk populations is less a priority than simply raising the overall vaccination rate in any way possible. The Wall Street Journal reports that some countries are experiencing enormous surges due to lack of vaccines, and that “uneven vaccine distribution [will] leave swaths of the world exposed to fresh waves of infection, economically devastating lockdowns and potentially new virus strains.” While the U.S. still has a long way to go in the fight against COVID-19, there is a much larger international problem to be solved if the worldwide population and global economy is going to return to any semblance of "normal" in the next year or so.

Health Disparities

The Buzz This Week

Studies over the past few months have revealed that the economic impact from COVID-19 was shouldered almost entirely by women, especially women of color. The World Economic Forum’s Global Gender Gap Report estimated it will take an additional 36 years more than projected in 2020 for women to reach parity with men across multiple factors due to COVID’s impacts.

A new survey by Kaiser Family Foundation indicates women’s health and women’s access to care has also been disproportionately impacted. Nearly 40 percent of women have forgone routine or preventative care and testing, with almost 25 percent passing on recommended treatment. As a comparison, those same results for the men surveyed were 26 percent and 15 percent, respectively. The Centers for Disease Control and Prevention reported cervical cancer screenings were down 80 percent among 1.5 million women during the first California lockdown, and are still down 25 percent. For women who wanted and were able to receive healthcare, access to care was another hurdle. It has been more difficult to get appointments during the pandemic, and many appointments are getting postponed or canceled. 30 percent of women were unable to secure an appointment when needed, compared to 20 percent of men.

Why It Matters

Women faced inequities in health even prior to the pandemic, but a multitude of factors over the last year have made those disparities worse. Women make up the majority of caregivers, and with COVID, there were new care burdens that women predominantly took responsibility for, including home schooling, house cleaning, and caring for sick or elderly friends and relatives. In some cases, the extra burden meant women simply did not have the time to care for themselves. In more extreme examples, the obligations were so great that women could not maintain employment, which meant possible loss of health insurance, resulting in delays in care or cancelation of elective procedures entirely.

Delays in women’s health screenings have long-term implications. Cervical cancer is 93 percent preventable with screening, but was a leading cause of death among women prior to regular testing. Reduction in regular screening could lead to increases in preventable cancers down the road. Delays in care may also be resulting in increased pain and mental health burdens for women. Because many women’s procedures are not urgent or emergent, they are classified as elective, and the pandemic significantly delayed or halted elective care for months, causing backlogs in many cases. Women with PCOS or fibroids report significant pain, and without the ability to get an appointment, they have no other choice but to simply deal with the pain. The toll on women’s mental health was clear, with over half of women sharing that stress and anxiety impacted their well-being, compared to just over one-third of men.

These findings come at the end of a month dedicated to celebrating the vital role women have had in America’s history. In healthcare, significant progress has been made in the last century — female representation among providers has grown, funding for diseases primarily affecting women has increased, and female leadership among healthcare executives is higher than it has ever been. Yet focused attention must be paid to the fact that disparities persisted even prior to the pandemic and in many cases have only been made worse. Women are underrepresented in clinical trials; the U.S. ranks last in industrialized countries in maternal deaths, with women of color bearing the brunt of that burden; and as recent studies emphasize, women have forgone care they would have otherwise received in greater numbers than men in the last 12 months. Celebrating women and their historic achievements every March is a good reminder of how far we have come, but the work to eliminate inequities must continue to be carried out all 12 months of the year.


    Contributors

    Roger A. Ray. MD
    Chief Physician Executive
    [email protected]

    Alexandra Schumm
    Principal, Vice President of Research
    [email protected]

    Abigail Arnold
    Senior Research Manager
    [email protected]


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