Chartis Top Reads – Week of April 18 - April 24, 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:
Variants and New Surges

The Buzz This Week

According to the Centers for Disease Control and Prevention (CDC), the running seven-day average of new COVID-19 cases has been increasing since March 20, despite continued vaccination efforts across the country. Hot spots have emerged, such as in Michigan, where four hospitals reached 100 percent capacity last week as they care for the typical volume of non-COVID patients alongside a large uptick in COVID cases.

There are a few differences in this latest wave of COVID:

  • The new variants that appeared in other parts of the world are now present and entrenched across the U.S. On March 27, the proportion of the B.1.1.7. variant among all new cases eclipsed the proportion of the original strains seen in the U.S. Variants are thought to be more transmissible and are likely one of the factors contributing to the rise in cases.
  • Younger people are getting sick. The older age brackets of the population were hit the hardest during the first waves of COVID, but much of that population was prioritized for vaccination. As of this week, about 65 percent of adults aged 65 and older have been vaccinated. The proportion of vaccinated people in younger age brackets is much lower, changing the demographic of patients that hospitals are seeing. Dr. Rob Davidson, an Emergency Medicine physician based in Fremont, Michigan, was quoted in Modern Healthcare stating, “The fortunate thing that's going on now versus the wave in the fall and last summer… is that they are younger. We are seeing 40-year-olds and some in their 50s. … We aren’t seeing as many people go into the ICU.”
  • The death rate continues to drop. There are likely multiple factors behind this, including the fact that hospitals and physicians are more equipped with supplies and a better understanding of the virus when treating patients, and because the patients are younger and less frail, with fewer comorbidities.

Why It Matters

With the first wave of COVID, most hospitals and physicians drastically reduced non-emergency services in order to make room for COVID patients (and not infect non-COVID patients) — and they suffered financially as a result. Many parts of the country forced businesses to close or set social distancing requirements to reduce capacity, also causing economic hardship, particularly for small businesses. Because of the financial impact of the first surges, it is unlikely that hospitals will close units treating non-COVID patients, which will put a strain on capacity in surge areas like Michigan and will require careful protocols to keep COVID and non-COVID patients separate while in the hospital so the infection doesn’t spread. It is also unlikely that states and municipalities will reinstate closures. Precautionary measures will therefore be reduced, potentially helping the virus to continue to spread.

This current scenario makes it all the more important to accelerate the vaccination process, especially in the younger age brackets that are most impacted at the moment, and to continue precautionary measures like mask-wearing and social distancing. The vaccine is helping the U.S. move in the right direction, but, as Dr. Barry Bloom from the T.H. Chan School of Public Health at Harvard aptly said in a recent Wall Street Journal article regarding this latest surge, “The virus is trying to survive.”

In looking ahead to the future, some public health experts warn that elevated federal funding granted during COVID isn’t scheduled to continue, and that the “boom-bust” funding pattern centered around major public health crises is not proactive but reactive. It does not create a strong, sustainable public health infrastructure that will prepare the U.S. for a future pandemic or public health crisis.

The State of COVID-19:
J&J Vaccine and Women’s Health

The Buzz This Week

Out of nearly 7 million Americans who received the Johnson & Johnson COVID-19 vaccine, six women between the ages of 18 and 48 experienced a rare blood-clotting disorder, cerebral venous sinus thrombosis (CVST). AstraZeneca’s vaccine, predominantly in use in Europe, is also a viral vector vaccine and has seen similar blood-clotting cases, though they were also extremely rare. Now, after pausing J&J vaccinations, the U.S. is examining the data to determine how to proceed. A decision is expected this Friday, with the two most likely options being restriction of the shot to certain cohorts, such as those over age 50 or allowing all adults to receive the vaccine with an added warning of the risks. The pause caused some disruption in the race to vaccinate as many people as quickly as possible, and some are concerned it will worsen hesitancy to receive any of the vaccinations.

Why It Matters

What is clear is that developing severe venous thrombosis after the J&J vaccine is extremely rare, and the same safety concerns have not appeared in the data for and should not be extrapolated to the Pfizer and Moderna vaccines. The risk of getting clotting problems from many other things is much higher — including hormonal birth control, smoking, or getting COVID — though some of those types of blood clots are different. While CVST has only presented in about one in a million cases, experts are concerned that the rate may be higher in certain populations than others, specifically women under the age of 50.

One suggestion that has been offered is making J&J a male-only vaccine because of the data seen thus far. However, some experts have cautioned against this because there may not yet be enough data to tell which groups are truly at risk. In order to understand the impact on various groups, researchers need to look at gender, age, race, medical history, and other demographic factors as well as determine the root cause of the blood clots. That is currently very difficult to do with a very limited number of cases. Making the assumption that the association of young women and blood clots is correct off of limited data could lead to excluding large populations who could benefit from the vaccine from accessing it and missing adverse events in those who do not identify as women.

If there is varying risk for different age or gender groups after more data is examined, messaging will become vitally important. In locations where COVID is surging, taking a vaccine may still present relatively low risk. As more is learned, we must acknowledge what real risk exists and seek to minimize it. At the same time, we must be careful not to sensationalize vaccine risks and appropriately weigh those against the risks of contracting COVID.


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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Past Top Reads

Chartis Top Reads – Week of April 18 - April 24,… - The Chartis Group