Our research team breaks down this week’s top healthcare news.
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.
March 11 marks one year since the World Health Organization declared COVID-19 a pandemic and when schools, businesses, and other public entities in parts of the U.S. where the virus was surging began to shutter and stay-at-home orders were issued. At that point, there were 125,000 confirmed cases worldwide, and 5,000 deaths.*
As of this publication, one year later, there have been nearly 118 million confirmed cases and 2.6 million deaths worldwide. The U.S. has seen nearly one-quarter of the worldwide cases (29 million) and 20 percent of the deaths (over 500,000). What initially appeared to be a dangerous but short-lived inconvenience has become a global tragedy that has not yet reached its final act. In its wake, the world has experienced general economic catastrophe, widespread job loss, and the “decimation of women in the workplace” (as Forbes has phrased it), confirmation that health disparities persist and that the mental health crisis is growing, among other challenges. Many public health experts believe we are far from returning to a life that resembles anything close to “before-COVID.”
However, our overtaxed healthcare system has seen areas of improvement since last March. Healthcare providers have a better understanding of the virus and the variety of ways it can impact a body, as well as more effective, tested approaches for alleviating symptoms and treating patients. There are fewer shortages of testing supplies and personal protective equipment (PPE). Safety precautions enabling non-COVID patients to receive in-person medical care have been employed across the country and patient volumes have largely returned in many places. Finally, the distribution of multiple vaccines and the vaccination process is underway, despite persistent challenges and barriers.
The COVID-19 statistics have appeared to move in a positive direction in recent weeks, with cases, deaths, and hospitalizations declining in many parts of the country and among many segments of the population. However, The Atlantic cautions that because of limitations on data gathering and reporting, these trends should not lead the country to be overly optimistic. Furthermore, emerging data suggests another surge may be looming, particularly as new variants of the virus spread.
Therefore, one year from the pandemic’s declaration, the U.S. finds itself in a mixed state, eager to move beyond this past year but with many milestones yet to pass.
*Note: early COVID-19 statistics may be understated as testing capabilities were severely limited at the time.
While we have made progress, we are only now taking stock of what transpired over the past year, in part because data is still being gathered and clinicians, scientists, and public health professionals have barely had a chance to pause even briefly for reflection as the pandemic has worn on.
There are some initial lessons learned, however. Seattle, the first epicenter of the virus in the U.S., has shown a lower overall infection rate and mortality rate from COVID-19 compared to almost every other major municipality in the country. The New Yorker cites wide agreement among elected officials there about the reasons: “community mindedness and trust in science and expertise,” as well as the ability for leaders to fall “in line behind restrictions they knew would upend the lives of their constituents” but put public health first. These factors were (and still are) lacking in other parts of the U.S., as mask-wearing became politicized, local and state leaders bickered about public health policies, “COVID fatigue” led to a lower rate of adherence to preventive measures, and businesses in some areas were allowed to re-open in an attempt to salvage what was left of the local economy.
Overall, it seems like the world is moving in the right direction, that we are emerging from this horrific year. Lessons from places like Seattle are beginning to emerge, but it is unclear what impact they will have. Is the U.S. prepared for the inevitable next pandemic? This country is arguably better prepared than we were a year ago, knowing what to expect with a pandemic like COVID-19. But we still lack a consistent, appropriately resourced, science-based response and a general public acceptance and support for what is required, however difficult. These are the requirements to emerge from this pandemic and avoid a future unknown virus progressing to pandemic status.
In determining vaccination priority, there was much discussion that certain groups were disproportionately affected by COVID and thus should be some of the first prioritized to receive the vaccine. In practice, it has been much more difficult to ensure certain groups receive priority access.
An analysis from the Rural Policy Research Institute showed that 111 rural counties do not have a single pharmacy providing vaccines. People living in these areas are often reliant on a mobile clinic or forced to drive long distances (twice if getting a vaccine that requires two doses) to gain access. Some of this issue comes from the closure of more than 1,200 independent rural pharmacies between 2003 and 2018 from consolidation of larger retailers or by mail pharmacy options. As convenient as prescription deliveries by mail may be, the vaccine cannot be administered by mail.
In addition to limited access to the vaccine experienced broadly, Black communities face the legacy of bias in the medical community. A recent Kaiser Family Foundation poll showed that only 35 percent of Black Americans wanted to be vaccinated as soon as possible or had already been vaccinated, compared to 53 percent of white Americans.
To vaccinate the vulnerable members of the community may require reexamining and modifying the current prioritization schedule, determining vaccine distribution type based on population and location requirements, and trying different approaches from those historically used for vaccination campaigns. Some states are already modifying their prioritization schedule and adding specific vulnerable groups to their prioritized list. For example, Michigan has announced that people who are homeless are now an eligible population to receive vaccination.
In rural areas, even if there is a pharmacy, it is not guaranteed that the pharmacy is part of the networks approved by the federal or state government to be local vaccine providers. Streamlining the application process can help local community pharmacies get approved, but rural access to the vaccine may also be improved by prioritizing distribution of the Johnson & Johnson vaccine, given fewer temperature requirements and the single dose regiment.
Because of the historical bias, Black Americans may look outside the medical establishment for guidance on medical issues. Black churches, one of the most trusted institutions in the Black community, may have better likelihood of reaching and educating Black members about the positive impact and safety of the vaccine. A group of Black pastors in the San Francisco Bay area has been meeting with public health officials and epidemiologists to pass on the best education materials and information to their congregations. Many clergy are getting vaccinated and sharing their experience with their congregations to encourage others to get vaccinated as well, even suggesting that social distancing and taking the vaccine make you a good steward of the community. However, some Black pastors, while anxious to help get their congregation vaccinated, do not want to encourage vaccination now if their members are not able to access the limited vaccine supply, so are delaying their message until more vaccines are distributed.
In April 2020, the New York Times published an article titled, “Where Have All the Heart Attacks Gone?,” observing that in the Northeast, where COVID-19 was surging, non-COVID emergencies, such as heart attacks and stroke were experiencing a sharp drop. The authors didn’t believe the general rate of heart attacks and strokes had suddenly declined organically but rather hypothesized that the public’s fear of contracting COVID-19 in a medical center setting was outweighing the perceived need to get medical care, even in emergency and could lead to dire consequences.
In August 2020, this hypothesis was supported as researchers in Denver published a study finding cardiac arrests occurring in the home more than doubled in the two weeks after Colorado enacted a stay-at-home mandate compared to historical data. In fact, the number of people who died at home from cardiac arrests in Denver during those two weeks was higher than the total COVID deaths in the same geography over the same time period.
These articles prompted many public health messages encouraging patients to still seek care in an emergency and citing the many safety precautions being enacted to protect non-COVID-infected patients from contracting the virus in the hospital setting.
Foregoing emergency care was the short-term, headline-grabbing impact of COVID-19 on health and mortality in the general population. But a potentially larger impact may be seen in the long term, as routine primary care visits, chronic disease management visits, disease screenings, and vaccinations have been delayed.
Recent data from the Health Care Cost Institute show that childhood immunizations in aggregate were down 60 percent in mid-April 2020 compared to 2019. Cancer screenings —such as mammograms, colonoscopies, and PSA tests (used for prostate cancer screening) — were down about 80 percent, 90 percent, and 70 percent, respectively, for that same time period comparison. While telehealth visits increased dramatically for behavioral healthcare, many hypothesized that the full impact of COVID-19 on mental health issues and substance abuse would be substantial and could not be adequately addressed due to the rise in incidence and lack of healthcare access, and that a “sizable minority could be left with mental health problems that outlast the pandemic”, per a BBC piece from October. Employers have taken note as well — in a recent survey of nearly 500 employers conducted by Willis Towers Watson, less than one-third of employer respondents believe their well-being programs have been effective, and more than half (54 percent) noted that stress and burnout posed the biggest challenges to well-being.
As we move ahead in time from when the pandemic first arrived in the U.S., untreated acute episodes and their outcomes are not likely to be the only impact of foregone medical care. Delayed routine visits and screenings will likely translate into a worsening of health status for some, a progression of diseases that might have been identified sooner, and even a rise in mortality rates. These effects will impact how hospitals and physicians provide care going forward, assuming the population may be sicker overall than before, and the impact of COVID-19 on population health may be felt for years.
As an executive at Willis Towers Watson stated from an employer perspective, “The pandemic has taken its toll … many employers expect these effects will continue in a post-vaccine environment.” Dr. Kristen Kendrick, a board-certified family physician in Washington, D.C., and a health and media fellow at NPR and Georgetown University School of Medicine, provides a health professional perspective: patients should no longer delay routine appointments as many safety measures for COVID are in place. In particular, she recommends five appointments should not be missed: cancer screening, appointments for new red-flag symptoms, follow-up for chronic disease, mental health management, and sexual health management. Providers will need to help communicate this to the general population to prevent an even larger negative impact on long-term health status.
Applying behavioral health insights, this paper presents a strategy for healthcare leaders to communicate and operate in ways that address patients’ and employees’ pandemic-inspired anxieties and fears, alleviate tension, and foster stability.
The rapid spread of COVID-19 in rural communities and the pre-existing rural hospital closure crisis have left 453 hospitals vulnerable to closure, on top of the 135 hospitals that have closed since 2010.
This provider planning guide outlines ways to optimize access and enhance communication to encourage patients to seek urgent and elective screening.