Chartis Top Reads – Week of August 8 - August 14, 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

As COVID-19 case rates increase, so has the proportion of children testing positive. In May 2020, 3 percent of new COVID-19 cases reported were children. However, in the week of July 29-August 5, 2021, nearly 94,000 new COVID cases were reported among children, according to the American Academy of Pediatrics — which is 15 percent of the nearly 624,000 new cases reported that week. A contributor to this rise in new pediatric COVID cases could be increased testing in children; another could be the high transmissibility of the now very prevalent Delta variant. A third driver could be lower vaccination rates in children compared to adults.

Many children have been inoculated already: roughly 10 million children are fully vaccinated, representing 41 percent of 16 and 17 year-olds, and 29 percent of 12-15 year-olds. These are strong numbers, though lower than the adult fully vaccinated rate of 57 percent. The 48 million children under the age of 12 in the U.S. are not yet eligible to be vaccinated. Pfizer is expected to receive approval for children ages 5 through 11 sometime in October, with Pfizer vaccines for children age 6 months to 5 years likely to be approved shortly thereafter, according to a Business Insider report. Based on the progress of the Moderna and Johnson & Johnson clinical trials, their vaccines for younger children won’t likely be approved until 2022.

Throughout the pandemic, there has been a commonly held belief that COVID does not infect children at the same rate as adults, nor does it have the same potentially devastating health effects and mortality rates. However, this may be changing. An increasing number of COVID-positive children are admitted to a hospital and some into an intensive care unit. As was reported recently in the New York Times, “Some doctors on the front lines say they are seeing more critically ill children than they have at any previous point of the pandemic and that the highly contagious Delta variant is likely to blame.”

Furthermore, new data and reports are revealing that some teens who were infected by COVID are experiencing lingering effects like fatigue, brain fog, dizziness, and sleep disturbance, all of which mirror what has been referred to in adults as “long COVID.” For young adults, it does not appear that this longer-term condition impacts only those who had severe cases of COVID. One physician at Boston Children’s Hospital stated in a recent New York Times article that profiled several young adults experiencing these symptoms, “kids who had COVID and weren’t hospitalized, recovered at home, and then they have symptoms that just never go away — or they seem to get totally better and then a couple of weeks or a month or so after, they develop symptoms.”

Why It Matters

With schools opening imminently if they have not already, the trends in new COVID cases and hospitalizations among children are being closely scrutinized, as is the emerging information on short- and long-term impacts. Some states and school districts are still debating how they will operate — with or without a vaccine mandate, mask mandate, and/or social distancing precautions and requirements. Some colleges and universities are requiring students to be vaccinated to return to campus, while others have opted against this measure.

For schools with younger students who are not eligible for vaccination, the debate over mask wearing has become even more heated than it was last school year. Many child-centered and/or pediatric clinical associations, such as the American Academy of Pediatrics have recommended mask wearing in schools or daycare settings for anyone over the age of 2 years old, particularly as the Delta variant spreads the virus more rapidly. Others argue that mask-wearing is more harmful to some children than is worth the protection they provide if worn correctly, such as restricted sight due to fogged up glasses, increased anxiety, and difficulty communicating or reading emotions since speech is harder to hear and facial expressions are mostly covered. A recent opinion piece in the Wall Street Journal provides a comprehensive account of this perspective.

As the mask (and vaccine) debate continues for children in schools, some state directives are being overridden by local schools or school districts. For example, in Texas, Governor Greg Abbott signed an executive order prohibiting schools from requiring masks, but the Houston Independent School District’s superintendent has said he will move to mandate mask wearing, per a report by CNN.

Regardless of whether children eligible for vaccines should be required to get one to attend school, or whether mask wearing should be mandated in schools, recent pieces in The Atlantic underscore that the absolute best thing that can be done to protect children at this point is to increase the adult vaccination rate. The logic is as follows: children spend much of their time with adults, and therefore if all or most adults surrounding them are vaccinated, the children’s exposure to COVID will decrease, and child infections and hospitalizations will decrease. The data are indeed showing that states with the lowest adult vaccination rates, such as in the South, are experiencing capacity constraints in pediatric inpatient and intensive care unit beds.

Especially since schools, parents, clinical experts, scientists, districts, and states can’t agree on what children should have to do to protect themselves against COVID, the very least the adults can do is to inoculate themselves to better protect the children.

Financial Sustainability

The Buzz This Week

Last week, the United States Bureau of Labor Statistics released data from July, and the jobs report showed a rebound for the healthcare sector with an increase of over 35,000 healthcare jobs this month. The ambulatory sector saw the most growth in July, with an increase of 32,000 workers, and is now only 13,000 jobs short of its January 2020 total. Hospitals also had a strong July, adding more than 18,000 jobs after losing 7,000 in June, though the inpatient sector is still 80,000 jobs below the pre-pandemic levels of January of 2020. Nursing home employment continues its decline. Since the start of the pandemic, that sector has seen a decrease in workers every month except for one, although July’s decline was smaller than previous months. Employment across all nursing and residential care facilities is down 11 percent overall since the start of the pandemic.

In other healthcare employment news, experts expect that in the coming weeks vaccines that have already been authorized for emergency use will receive full Food and Drug Administration (FDA) approval, potentially as soon as this month. Many, including Dr. Fauci, anticipate that employer vaccine mandates will increase once that full stamp of approval is granted. For example, U.S. troops will be required to receive the vaccine starting mid-September, but should the vaccine receive full approval, then it would become immediately mandatory, according to Defense Secretary Lloyd Austin. Thirty-one percent of vaccine-hesitant consumers have also indicated that full approval would make them more likely to receive their COVID shot, according to a poll from the Kaiser Family Foundation in June. The FDA has indicated that full approval is a top priority and that it hopes to complete the review as soon as possible. But the FDA has also said that the evaluation will be just as thorough as any other FDA approval. The Pfizer vaccine is expected to receive full approval first as it’s currently furthest along in the process.

    Why It Matters

    After calls from nearly 60 medical organizations in June and July to mandate the vaccine, approximately one quarter of all U.S. hospitals did so. Many sectors in healthcare have seen significant staffing shortages, and the vaccine mandates help to keep workers safe, healthy, and employed and protect patients. California and Massachusetts put requirements in place to show proof of vaccination or regular negative COVID tests for many healthcare workers. Some health systems had to enforce their mandate, like Houston Methodist, which had 150 employees resign or be let go for refusal to comply. Each week a growing number of hospitals, health systems, and other employers are joining the list of places requiring proof of vaccination to work there. However, not all of those who want to enact a vaccine mandate have been able to do so — in some cases mandates may be dependent on location or sector.

    Seven states enacted legislation to prevent mandates. In most cases, those laws only apply to government employees or exempt healthcare facilities. But in Montana, all employers are prohibited from discriminating based on vaccination status, including hospitals. Oregon has a similar decades-old law prohibiting vaccine mandates for healthcare workers, but Governor Kate Brown issued a rule requiring healthcare workers who are not vaccinated to undergo weekly testing until the law can be changed. In Montana, healthcare workers have no such rule, and hospital leaders are worried. COVID hospitalizations are nearly double what they were two weeks ago in Montana, and existing staffing shortages are getting worse.

    Another group that has been more hesitant to enact vaccine mandates is nursing homes. Staff shortages have been so severe that any increase in requirements raises fears over increased employee turnover. According to a June survey reported by Modern Healthcare, up to 94 percent of nursing homes had staff shortages in June. Another survey from the Maine Medical Directors Association reported that more than 40 nursing homes in the state wanted to put vaccine requirements in place but felt they could not do so without losing some staff. In the long run, vaccine mandates may be exactly what is needed to prevent further staffing shortages as vaccines significantly lessen symptoms and drastically reduce hospitalizations and death. We should expect to see more mandates in the coming weeks and with full FDA approval of the vaccines.


      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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      Chartis Top Reads Week – of August 8 - August 14,… - The Chartis Group