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.
As COVID-19 spread last year, the United States experienced a broad recession as well as an increase in underemployment and unemployment. One impact of the sudden economic downturn was an increase in the rate of food insecurity for the first time since 2010 and record child hunger levels. Data projections from Feeding America estimate that one in six children and one in eight people may experience food insecurity in 2021. Due to longstanding racial disparities, the numbers for Black individuals are even worse, with 21 percent projected to experience food insecurity, compared to 11 percent of white individuals.
Unlike past recessions, some of the largest increases in food insecurity rates have been in the wealthiest counties, which often do not have community organizations equipped to handle the increase. These areas may have operational issues to contend with as well. Many affluent counties have no foodbanks, and the ones that do exist do not have flexible operation times and are run by volunteers, often retirees who, due to their high COVID risk, significantly limited their hours. The stigma around food insecurity in these areas may mean the need is likely even greater than what is seen. Child hunger has increased nationally by 47 percent, an already staggering number, but in locations like Bergen County, NJ, and St. Charles, MO, which are affluent areas, the increases were 136 percent and 69 percent, respectively.
Food insecurity increases risk for physical, emotional, and cognitive impact, and can also contribute to other nutrition-related health concerns. Foods high in carbohydrates and refined sugars, often contributing factors to obesity and diabetes, are also some of the most inexpensive options, particularly in food deserts that have no grocery stores to provide easy access to nutritious, affordable options. Obesity and diabetes are more prevalent in Black, Latinx, and Native American households, and are two conditions correlated with more severe outcomes from COVID.
The increase in food insecurity rates also underscores the gaps in the country’s safety net. $21 billion of the federal spending on meals happened through schools and educational facilities. With schools closed, many of the avenues to distribute meals went away. The Pandemic Electronic Benefits Transfer program was created as an attempt to mitigate the loss of school meal distribution, as was the emergency increase in SNAP benefits, but both were a band-aid that did not adequately provide food security to many families. Addressing food insecurity in the longer term will require a commitment by health systems and through government policies to address health inequities. Tactics may include addressing food deserts through building grocery stores in low income areas, investing in food and agricultural programs that address disparities in nutrition, funding social services, and incorporating social determinants of health into medical education and research.
Despite media coverage on COVID-19 “long-haulers,” or those with “Long COVID,” or those with “post-viral symptoms,” there is no formal name for the condition characterized by months-long lingering effects assumed to be related to having contracted the virus. There is also a dearth of data and studies given the short time span that has passed since the first cases appeared in the United States.
This long-term phenomenon is unfortunately not uncommon: a recent research letter published in JAMA Network Open and reported recently in Market Watch found that 30 percent of COVID survivors studied for nine months reported “persistent symptoms,” including fatigue, loss of sense of smell and/or taste, and brain fog. Other studies and reports have included lingering effects, such as shortness of breath, chronic pain, mobility issues, depression, and symptoms that are similar to post-traumatic stress disorder (PTSD). In addition, the condition doesn’t appear to be restricted to those who had severe COVID-19 symptoms: per a recent piece published by Johns Hopkins, “many long-haulers appear to be individuals who experienced mild or moderate cases of COVID-19 and weren’t hospitalized.”
On Tuesday this week, a Northwestern Medicine study was published in The Annals of Clinical and Translational Neurology and referenced in the New York Times, finding that 85 percent of non-hospitalized COVID long-haulers experienced four or more neurological symptoms that impacted their daily lives for months. Two physicians involved in the study said that “many of the symptoms resembled those of people who had concussions or traumatic brain injuries or who had mental fogginess after chemotherapy.” Some experienced effects up to nine months after being diagnosed with COVID, and this timeline could extend, given that the virus hasn’t been around long enough to fully understand how long symptoms could endure.
Positive news reported this week is that vaccines may actually reduce the long-term symptoms of the COVID long-haulers. While research is just being launched, early reports from the United States and Britain suggest that long-hauler patients have reported reduced symptoms after receiving a COVID-19 vaccine. One infectious disease specialist at Columbia University has found that 40 percent of the long-hauler patients he has been treating have experienced symptom improvement after being vaccinated.
As a new and changing virus, there is still much to learn about COVID, and by definition, the long-term effects will take time to understand. Some early study results are emerging, like the Northwestern study mentioned above, and new studies are launching, including an NIH Study on “Long COVID” and The Johns Hopkins COVID Long Study, which aims to survey 25,000 long-haulers, and already had 6,500 participants as of this week.
While the extended effects of the virus and ways to mitigate them are studied, the potential major public health implications should be considered. Given the estimated proportion of long-haulers out of all COVID cases, and the fact that nearly 30 million people in the U.S. have been diagnosed with COVID (and likely more have had the virus that went undiagnosed), healthcare providers may be faced with many patients experiencing a range of long-term effects of COVID for years, which pose a challenge in themselves and potential complications to other existing conditions patients may have.
The economic impact of “Long COVID” should also be considered. First, those experiencing the sustained effects may have higher healthcare utilization and expenses for years to come, which will be expensive and also introduce the potential to preclude them from some insurance enrollment. One patient quoted in a recent Market Watch piece stated, “The cost is astronomical — astronomical — for recovery … And I don’t have a plan for how to pay this back.” Furthermore, long-term debilitating symptoms will impact a person’s ability to work, creating a potentially broader economic impact in the U.S.
The pandemic has only exacerbated the U.S. behavioral health crisis, but deploying digital behavioral health affords an opportunity to re-think the delivery of behavioral healthcare in a way that addresses the growing access issue.
Health disparities continue to be a pervasive problem within the U.S. healthcare system, leaving healthcare leaders with the question: Are we advancing the ball or taking steps backward? Our Chief Physician Executive Dr. Roger Ray talks about how to thoughtfully move toward health equity for all in this excerpt from Creating a New Healthcare.
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.