Chartis Top Reads – Week of July 25 - July 31, 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.

COVID-19 In Brief

Due to the increase in COVID-19 cases, the majority of which are the delta variant, the Centers for Disease Control and Prevention (CDC) is recommending universal masking indoors in high-transmissibility areas, even for those already vaccinated. Nearly half of the counties in the United States are currently high-transmission counties. Some of the highest transmission locations are currently the entire states of Florida and Arkansas, and much of the rest of the southern and western states, including urban areas like Miami and Los Angeles.

Last week the Dow tumbled nearly 800 points in response to the delta variant’s growth and impact on the United States. Though the Dow recovered later in the week, there remains significant uncertainty about whether the economy will recover at the pace many were projecting earlier this spring. Much of the recovery likely hinges on continued increases in vaccination rates and school re-openings in the fall, which would allow a return to the labor force for many, especially women in their thirties and forties.

Eighteen months into the pandemic, there are now multiple very effective vaccines to prevent COVID-19 but still limited choices for treatments for those infected. The antiviral Remdesivir has had good results but must be given intravenously inside a hospital and is only effective if given very early in disease progression. Other immune-suppressing drugs and steroids have had success in reducing inflammatory and immune response in severely ill patients. Now, Pfizer, Merck, and Japanese company Shionogi are racing to show their antivirals are safe and effective at reducing COVID’s impact with pills that can be taken at home. While vaccinations are still the best method at preventing the spread of new cases, better treatment options would still be a vital breakthrough in the fight against COVID-19.

The American Hospital Association (AHA), Association of American Medical Colleges, Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, and other top healthcare organizations have called for mandatory vaccinations for all healthcare workers as COVID cases surge in the United States in order to protect patients and other healthcare personnel. The AHA also noted they support hospitals and health systems adopting mandatory vaccination policies for employees. Houston Methodist was one of the first health systems to require vaccination. Nearly 25,000 employees complied with the policy and 150 were terminated or resigned after their lawsuit was dismissed. The Department of Justice also concluded in a recent opinion that vaccine requirements “even when the only vaccines available are those authorized under EUAs” are legal.

The State of COVID-19

The Buzz This Week

COVID vaccines are doing what they were made to do — preventing COVID spread and severe disease. Thus far the data shows they are doing so incredibly well. With the high transmissibility of the delta variant and the fact that many locations have lifted indoor mask mandates, experts have noted that you will either be vaccinated or get COVID-19. But for some people, it may be both. That is completely expected — those cases are anticipated cases, not vaccine failures.

Breakthrough asymptomatic cases are very different from breakthrough disease that causes COVID symptoms and in extreme cases, hospitalizations, which are much rarer. The vast majority of positive COVID cases post-vaccination have been extremely mild, preventing hospitalization and death, an indication that the vaccine is doing exactly what it is supposed to do. The original goal of the vaccine was actually to “prevent disease or decrease its severity in at least 50 percent of people who are vaccinated,” a metric that has been wildly exceeded. Unpublished Centers for Disease Control and Prevention (CDC) data shows just over 150,000 symptomatic breakthrough cases of more than 156 million fully vaccinated Americans: less than 0.10 percent. Even with new variants, vaccines remain highly effective at preventing disease progression. A study by Public Health England showed the Pfizer-BioNTech vaccine was 88 percent effective at stopping the delta variant from causing symptoms.

Why It Matters

Why are some people who have been fully vaccinated still getting infections? Vaccinations, while magnificently effective thus far, are not a perfect shield from COVID. There are nuances and differences between people, experiences, and immune systems. The goal of the vaccine is not to stop 100 percent of infections but to build on the body’s current defense system to make it better able to fight the disease at each step and weaken any impact the virus has. In the best case, and in most real-world cases currently, no infection occurs at all. In some cases, especially in the immunocompromised or because of a particularly transmissible variant like delta, the virus is able to evade some antibodies and cause mild disease, but to a much lesser extent than if there was no protection at all.

Preventing every single COVID infection, even those that are asymptomatic, through the vaccine would require a much higher immune load, and necessary requirements may vary between people. It would be extremely difficult to execute and significantly more costly and time-consuming. The focus is on reducing symptoms, improving recovery time, preventing long haul symptoms, decreasing spread, and thwarting the majority of cases in a safe and time-sensitive manner — all of which it appears the vaccination does. Vaccinations, even when they do not prevent all infections, provide the best possible protection against the virus and an even better defense than we originally thought.

Provider Enterprise

The Buzz This Week

The nursing and healthcare professional shortage in the United States has been present for years. In 2019, nursing ranked as the third most in-demand job of any profession in the United States. Shortages vary by state and type of nurse. In California, for example, one forecast projects a registered nurse deficit of nearly 45,000 by 2030.

COVID-19 brought new challenges to the healthcare workforce supply.

First, there has been the direct impact of the virus on workers: A Kaiser Health News analysis from April 2021 found that more than 3,600 healthcare workers died over the course of the first year of COVID-19 in the United States.

Second, the virus has spiked in different geographies at different times, challenging the country’s ability to meet demand and supply balance. In some cases, such as when New York experienced a high number of COVID-19 cases in the early days of the pandemic, healthcare workers from other states could offer their support, moving temporarily from other locations to help. As the pandemic progressed and the surge areas became more dispersed, it became harder for available workers to spread across the country, supplementing existing supply as the healthcare workforce was increasingly spread thin.

    Third, the mental health toll of the pandemic has had a substantial impact on healthcare workers. A Kaiser Family Foundation/Washington Post poll from February 11 – March 7, 2021, found that more than half of frontline healthcare workers said “worry and stress related to COVID-19 has led to adverse health impacts … three in ten have needed mental health care.” This has contributed to an increase in departure from the healthcare workforce, further decreasing available workers.

    Why It Matters

    The years-long deficit of nurses and other healthcare workers in the United States has been exacerbated by the impact of COVID-19. Health systems, post-acute providers, and other healthcare entities are relying on both old and new tactics to attract workers to meet the COVID and non-COVID-related healthcare demands they are facing. These include paying highly elevated salaries for “traveling nurses” and other out-of-area workers, many times the typical pay rate of a local worker; offering financial incentives, such as $5,000-$25,000 sign-on bonuses; providing assistance in paying off student debt; providing paid parental leave and/or a 401K match; and offering other financial benefits — historically hefty bonuses for workers that can make a base pay as little as $12 per hour.

    A Massachusetts-based healthcare staffing company said that they have heard from nurses that they want “increased health and malpractice insurance, retirement plans, wellness services, childcare discounts, and help with necessities like groceries … Making this kind of investment can go a long way to ensure that workers feel protected and appreciated." A Connecticut-based academic health system is providing coaches to new nurses, as part of a Clinical Nurse Transition program, to improve morale, increase support, and ideally to increase retention — especially during the continuation of the pandemic.

    The approaches to attracting and retaining nurses and other healthcare workers is changing the staffing market landscape and dynamics and increasing competition for workers. Health systems and other providers will need to be creative in their approaches to recruitment and retention, and acknowledge that the “market rate” to secure healthcare workers has changed. However, no approach will solve the longer-term problem of the under-supply of these types of workers, which needs to increase materially to serve this country’s population in the foreseeable future.


      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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