Monday Roundup

David Ermer–COVID-19, COVID-19 testing, COVID-19 vaccine, Patient safety, Rx coverage, U.S. Healthcare–
Photo by Sven Read on Unsplash
  • On the COVID-19 front, David Leonhardt in the New York Times provides valuable insights on how to think about COVID-19 cases that have broken through vaccinations. “

Different vaccinated people are going to make different decisions, and that’s OK. I find the risk of breakthrough infections to be small enough that I’m not going to make major changes to my behavior.

I would feel differently if I lived in a community with a lower vaccination rate — or if I lived with somebody who was vulnerable to Covid because of an immunodeficiency. And the current surge in cases has changed my thinking. I will again wear a mask sometimes when in close contact with strangers, even if it has little tangible effect. The main reason to do so, as Dowdy said, is to contribute to a shared sense that we have entered a worrisome new phase of the pandemic.

  • Fierce Healthcare reports that “Dozens of healthcare professional organizations including the American Hospital Association, America’s Essential Hospitals and the Association of American Medical Colleges have released joint or individual statements calling for providers to implement mandatory COVID-19 vaccination policies for healthcare personnel.” The Wall Street Journal adds that “A significant uptick in Covid-19 cases across the U.S. is leading to new vaccination mandates for public employees, with the Department of Veterans Affairs on Monday becoming the first federal agency, California the first state, and New York the first major city to announce requirements for their workers. “epartment of Veterans Affairs Secretary Denis McDonough said healthcare personnel who work in or visit Veterans Health Administration facilities or provide direct care to people the VA serves would have eight weeks to get vaccinated. Officials in the state of California and New York City said Monday they would require their workers to either be vaccinated against Covid-19 or be tested at least weekly for the virus. California’s order, which also applies to those who work in healthcare settings, goes into effect in August. The New York City mandate begins after Labor Day.”
  • The Wall Street Journal also reports “The U.S. has purchased 200 million additional Covid-19 vaccine doses from Pfizer Inc. and partner BioNTech SE at a higher price than previous deals. The U.S. is paying about $24 a dose, according to Pfizer, up from the $19.50 that the government paid in its earlier deals to supply the country. The deal brings the total purchased from the U.S. to 1 billion doses. The companies said they expect to deliver 110 million of the additional doses by the end of the year, with the rest by the end of next April.  While demand has largely stalled in recent weeks, additional demand could open up if the vaccine is cleared for use in younger children. Pfizer is testing the vaccine in children under 12 years old, and has said it hopes to begin having data available before the end of the year.  The new agreement is in addition to the one announced last month for 500 million doses that the U.S. is scheduled to donate to the rest of the world.”
  • In this regard, the Washington Post reports that “Federal regulators have requested that vaccine companies expand their trials to test coronavirus shots in several thousand school-aged children before seeking [emergency use authorization] — a move intended to assess whether a rare inflammation of the heart muscle that has been seen in young adults shortly after vaccination is more common in younger age groups.”
  • STAT News provides its perspective on the current surge. STAT suggests that this surge is accelerating faster than last summer’s surge which is not surprising because the Delta variant is much more contagious that the variant in circulation last summer.
  • The Department of Health and Human Services (“HHS”) has announced that it ‘will invest more than $1.6 billion from the American Rescue Plan to support testing and mitigation measures in high-risk congregate settings to prevent the spread of COVID-19 and detect and stem potential outbreaks.’
  • Today, in commemoration of “the 31st anniversary of the Americans with Disabilities Act (ADA), (HHS) and the U.S. Department of Justice (DOJ) jointly published guidance on how “long COVID” can be a disability under the ADA, Section 504 of the Rehabilitation Act, and Section 1557 of the Affordable Care Act.  The guidance is on the HHS website and on the DOJ website.

Also today, HHS announced phase 2 of the HPV vaccination campaign for young adults.

Currently, only 40% of young adults in the United States have received one or more doses of the human papillomavirus (HPV) vaccine, and only 22% have completed the vaccine series.i The HHS Office of the Assistant Secretary for Health’s Office on Women’s Health is launching the second phase of the HPV VAX NOW campaign to address this gap. The initial campaign launched on January 6, 2021 to support healthcare providers who counsel young adults in Mississippi, South Carolina, and Texas by providing resources to promote effective HPV vaccine recommendations. The second phase of the campaign will target young adults ages 18–26 in the same three states, with the long-term goal of empowering all to complete the HPV vaccine series.

In health equity developments

  • The American Academy of Actuaries has released a paper on health equity from an actuarial perspective that is worth a gander.
  • Patient Engagement HIT discusses how “a new study [in the New England Journal of Medicine] revealing unequal opioid and pain medication prescription access between White and Black patients is calling into question the prevalence of implicit bias in medicine.” The researchers concluded that “We do not know whether or how these differences affect patient outcomes, because both opioid underuse and overuse can cause harm. We do know that skin color should not influence the receipt of pain treatment. “Our overall observations and system-specific reporting should prompt action by providers, health system administrators, and policymakers to explore root causes, consequences, and effective remediation strategies for racially unequal opioid receipt.”
  • In that regard, Kaiser Health News discusses the pros and cons of state and local government monitoring of opioid prescriptions.

When efforts to establish Missouri’s statewide monitoring program stalled, St. Louis County established one in 2017 that 75 local jurisdictions agreed to participate in, covering 85% of the state, according to the county health department. The county now plans to move its program into the state one, which is scheduled to launch in 2023.

Dr. Faisal Khan, director of the county department, said he has no doubt that the St. Louis program has “saved lives across the state.” Opioid prescriptions decreased dramatically once the county established the monitoring program. In 2016, Missouri averaged 80.4 opioid prescriptions per 100 people; in 2019, it was down to 58.3 prescriptions, according to the CDC.

Khan acknowledged that a monitoring program can lead to an increase in overdose deaths in the years immediately following its establishment because people addicted to prescription opioids suddenly can’t obtain them and instead buy street drugs that are more potent and contain impurities.

But he said a monitoring program can also help a physician intervene before someone becomes addicted. Doctors who flag a patient using the monitoring program must then also be able to easily refer them to treatment, Khan and others said.

“We absolutely are not prepared for that in Missouri,” said Winograd, of NoMODeaths. “Substance use treatment providers will frequently tell you that they are at max capacity.”

The FEHBlog would rather see expansion of treatment facilities that loosening standards on opioid prescribing.