Chartis Top Reads – Week of January 2 - January 8, 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.


Week of January 2 - January 8, 2021

Published January 7, 2021


COVID-19 Update

The Buzz This Week

The United States saw over 1 million new COVID-19 positive cases on Monday, a higher number than any previous point in the pandemic. While the number likely represents backlogged cases from the holidays, the weekly average has now surpassed half a million cases per day. Approximately 1 percent of all Americans have tested positive for COVID in the last week alone, with Omicron representing over 95 percent of new cases, according to the Centers for Disease Control and Prevention (CDC).

While cases continue to soar, thus far in the United States and other countries with high Omicron cases, hospitalizations and deaths have not matched historic numbers. In South Africa, where scientists discovered the variant, cases have been rapidly falling as quickly as they initially rose. Even more promising is that one study showed that patients during South Africa’s current Omicron wave have been 73 percent less likely to have severe disease than during Delta.

Omicron’s weakened virulency thus far appears to come from the anatomy of its mutations. Multiple studies have shown the mutated spike protein has made the Omicron variant less likely to infect the lungs, instead preferring the upper respiratory track, and therefore often presenting as a less severe but much more transmissible disease. Omicron also seems to be able to evade antibodies well but not the T-cells and B-cells of vaccinated or recently infected people, meaning the variant is getting through first lines of defense and spreading, but those with some levels of immunity can quickly fight off the virus.

Why It Matters

Omicron might signal a turning point in the pandemic. The variant is likely to follow a similar pattern as in South Africa, with a very high peak and case numbers that fall equally quickly. A study from Hong Kong last week also indicated that having Omicron provided strong immunity against other variants. With record case numbers, mild infection, and growing immunity, the Omicron surge may pass swiftly. It may also be further evidence that the COVID virus will now become endemic.

Currently, we are amid extreme rising case numbers, which is translating into increasing hospitalizations and death, mainly in general inpatient units since a lower proportion of these patients require care in an intensive care unit (ICU), as reported in a recent New York Times piece. With a denominator of case numbers as large as the current one, even with smaller percentages of people facing severe illness, the number of hospitalizations could still be significant enough to overwhelm the healthcare system. Omicron’s overwhelming number of cases in a short window is also likely to continue to cause significant disruption as people without severe illness are out of work and school.

The next several weeks are likely to see continued impact from Omicron and high healthcare utilization, but what comes after? Some experts believe that vaccination, previous infection rates, and high levels of Omicron transmission will improve population immunity to the point that once a peak is reached there will be a rapid decline in hospitalizations and deaths even with breakthrough cases, regardless of future variants. Others believe the nature of the pandemic will be dependent on the next mutations. Many experts have noted that we may need ongoing boosters modified to better match new variants to prevent future surges. While we cannot be certain about the next phases of the pandemic, there may be reason for optimism about the future.

Provider Enterprise

The Buzz This Week

The new flood of COVID-19 patients is challenging already strained hospitals across the country, which have been experiencing a shortage in health professionals — especially nurses — since the pandemic began, and even before that. This shortage is being driven by:

  • Nurses leaving their jobs to travel to healthcare facilities in high-demand locations, enticed by paychecks many multiples above their current pay, as has been described in previous editions of Top Reads.
  • Nurses leaving the profession, as described in a previous Top Reads piece. They are worn out by the pandemic, dissatisfied by their work, and/or drawn to better paying alternatives that don’t require much training.
  • Nurses choosing not to be vaccinated, despite requirements from their employer or the state in which they work. Though initially overstated, this is now having some effect.
  • Most recently, nurses getting sick from the new COVID variant, forced to quarantine for five days and only return to work if they are symptom free.

Some examples of and comments pertaining to the staffing shortage include:

  • In New Jersey, Health Commissioner Judy Persichilli suggested that “the shortage is due to staff being out sick and added that hospitals and nursing homes are planning for the loss of 30% of their staff at minimum.”
  • In Illinois, a record number of COVID cases are filling hospital beds. Omar Lateef, president and CEO of Rush University Medical Center, stated, “We’ve had the highest number of retirements… We’ve had a high amount of burnout, and so that is one of the reasons that there is such an incredible need for staffing.”
  • In Seattle, both hospitals and nursing unions have expressed alarm. Susan Stacey, RN, Chief Executive for Providence Inland Northwest Washington, stated, “I’ve been a nurse for 38 years, and I’ve not seen a staffing challenge as difficult.” UW Medicine is postponing all non-urgent surgeries until later this month, citing a desire to maximize resources dedicated to COVID patients, including hospital beds and staff.
  • Rural health experts have warned that the staffing shortages are particularly dire in rural areas, where the population is often older and sicker, and where the local hospitals cannot match pay rates offered in suburban or urban hospitals. As one rural hospital CEO stated in a Pew report, “It’s just very difficult to compete with some of the size and scale that bigger systems have.”

Why It Matters

As the nursing staffing shortage continues and worsens, hospitals will face a number of challenges. Costs will increase as hourly rates and salaries will have to rise to retain and potentially attract additional nurses and signing bonuses will become more of the norm. Measures will need to be put into place to support the staff who are present in healthcare facilities, ensuring that they have adequate resources for their daily jobs and for mental health support as the pandemic wears on. In some cases, services may need to be temporarily or permanently halted so staff can be reallocated to cover COVID patients and others, and safety can be assured with adequate staffing levels.

When the pandemic first arrived, elective surgeries and other non-emergency services were halted to make room for COVID patients and to help prevent the spread of the virus. Now, some hospitals and other providers are shuttering services and citing staffing shortages as the reason. One Indiana hospital has discontinued its obstetrics services, Mercyhealth has applied to end inpatient care at one of its Illinois hospitals, CitiMD has temporarily closed 31 sites in the New York City area, and more than 150 mental health inpatient beds have closed in Massachusetts in the last 10 months.

While some states have requested assistance from their National Guard units, and others are asking for nursing staff coverage from their health departments, there likely isn’t going to be an adequate solution in the near-term. Public health departments, community health centers, and other health-related organizations will be crucial in providing resources and services to keep people healthier and out of the hospital. In addition, investments in technologies and efforts to organize staff and services to capture economies of scale will be important to relieve staffing pain points. An example of this last point is remote patient monitoring (RPM). While only appropriate for certain types of patients, nurses can monitor multiple patients at once. Patient-to-nurse ratios can run from about 15:1 for more acute patients requiring higher intensity monitoring and an increased level of remote interaction with nurses (per a study with home care patients in 2018), to 50:1 or more for more general monitoring of less acute patients (as in Mayo Clinic’s 2021 study monitoring COVID-19 patients, or the Connected Cardiac Program at Mass General Brigham, then Partners HealthCare).


    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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