Year Two of the pandemic is widely described as a race between vaccines on the one hand and the coronavirus and its variants on the other. A global race with epic stakes.
You can come up with all kinds of sports metaphors for where we are right now: First and ten on the 50-yard-line at the 2-minute warning. At deuce in the fifth set of a tennis match. Dueling marathoners at mile 24, sizing each other up for the home stretch. Playing soccer in overtime and heading toward penalty kicks.
Yet what the vaccines and the virus are fighting over, and racing toward, is us, our bodies, ourselves. The virus can make us sick, the vaccines will help protect us. And we are the ones who are in position to determine the outcome. A vaccine with the best of intentions does no good sitting in a refrigerator; it needs a willing arm. An infection can’t be opportunistic without opportunity; it needs a susceptible host.
We have a choice, and choices matter.
Happy Earth Day and Happy National Volunteer Week. Love the planet and thank a volunteer. And get vaccinated when you can. You’re now eligible.
This issue of the Coronavirus Briefing is 2,442 words long and will take you 8 minutes to read.
What’s trending now
The pandemic is leaving its imprint on life in general and healthcare in particular.
· The pandemic has given new momentum to the hospital-at-home (HAH) model, Diane Eastabrook notes in McKnight’s Home Care Daily News. The model allows acute hospital-grade care to be provided at home for patients with conditions such as asthma, pneumonia, heart failure, and now COVID-19. The Medicare-Medicaid program has granted 116 waivers to hospital systems to put HAH to work, Eastabrook notes.
· Telemedicine’s moment has come and is likely here to stay. What will it mean for patients with cancer or blood disorders? Steven Fein, founder and medical director of the telemedicine service HemeOncCall, shares his view of the future in an interview with Hematology Advisor’s Tori Rodriguez. In some televisits, he says, it will be patients in the hospital with the doctors connecting remotely.
· There’s actually a category in the federal lexicon known as health center look-alikes (LALs). These are community health centers that provide primary care to underserved and vulnerable populations but are not formal grantees of the HHS Health Center Program. Doesn’t matter, they’re getting money this time around, some $150 million in American Rescue Plan funds, to help 100 look-alikes strengthen COVID-19 vaccination efforts and expand testing and treatment.
· One in five workers in the U.K. feel they’re getting less career recognition while working remotely even though they’re working harder at home, Jessica Brown reports in People Management. Experts suggest that businesses stop defining performance and commitment by the hours an employee spends on in-person “face time.” .
· TSA issues a handy little daily summary of “traveler throughput.” Freely translated, that means human beings going through security at airports. That number has exceeded 1 million every day since March 11 of this year, roughly 10 times the volume of a year ago. The snapshot from Tuesday of this week shows 1,082,443 travelers, a quantum leap ahead of the 92,859 on April 20 of pandemic-stricken 2020, but still less than half the April 20, 2019 volume of 2,227,475.
· U.S. airlines are planning to open up some flights to Europe in May, June and July. You’re in luck if you want to go to Greece, Iceland or Croatia, but you’d better be vaccinated first.
· The American Academy of Pediatrics and Children’s Hospital Association have been tracking COVID-19 cases in kids for a full year now. Their latest tally shows a total of 3.6 million cases in children, accounting for about 1 in 7 infections across all age groups. Although severe infection is rare in the pediatric population, 1% are hospitalized. And more needs to be learned about COVID’s long-term effects on physical and mental health.
· In considering what’s trending, it’s also relevant to consider what’s not. Despite high hopes, the use of convalescent plasma to treat patients with COVID-19 does not appear to be gaining traction. The National Institutes of Health discontinued a trial last month when convalescent plasma did no harm but also didn’t much help in patients with mild to moderate COVID-19 symptoms.
The Takeaway:
Change happens. It’s a good thing that we are an adaptable species.
Reality check
We’re learning what works and what needs fixing.
· No vaccine is 100% effective; infections will occur in some people who have had their shots. The heartening news is that, for COVID-19 vaccines, the number of breakthrough infections reported so far is relatively small—5,814 cases from mid-December to mid-April, when 75 million people were fully vaccinated. Nearly half (45%) of the breakthrough infections were among people 60 or older. The CDC cautions that the actual number of breakthroughs is higher; cases are missed when testing isn’t done, especially with asymptomatic or mild infections. Still, the bottom line remains: These vaccines work.
· The nation’s long-term care system is “deeply flawed, chronically underfunded, and in need of reform,” making this the perfect time to set things right, says Robert Kramer, CEO of Nexus Insights and former head of the National Investment Center for Seniors Housing & Care. Amy Novotney has more on Kramer’s views in McKnight’s Senior Living.
· Geriatricians are proposing a new approach to managing COVID-19 outbreaks in nursing homes, Alicia Lasek reports in McKnight’s Long-Term Care News. The physicians recommend an escalated program of care for patients with a COVID-19 syndrome that includes low-grade fever, weight loss, delirium and fatigue, along with high blood sodium, low white blood cells, and acute kidney injury. The medical team of generalists and specialists can then respond accordingly.
· How has the pandemic affected the mental health of teenagers? Let us count the ways. In a national poll of parents, 46% said their teenager has shown signs of a new or worsening mental health condition since the pandemic began, and 75% say COVID-19 has had a negative impact on their child’s opportunity to interact with friends. In addition, 1 in 3 teen girls and 1 in 5 boys have experienced new or worsening anxiety since March 2020. Psychiatry Advisor’s Mary Beth Maslowski reviews the survey findings with neuropsychologist Wilfred van Gorp.
· Lilly’s monoclonal antibody bamlanivimab is no longer authorized as monotherapy for mild to moderate COVID-19, per Lilly’s request and the FDA’s action, Brian Park reports in MPR. The decision is based on the emergence of resistant variants of the SARS-CoV-2 virus.
Treatments are still available for mild-to-moderate COVID-19 at risk of progressing to severe disease, including the cocktails of bamlanivimab plus etesevimab (Lilly) and casirivimab plus emdevimab (Regeneron). As Diana Ernst notes in MPR, the NIH now recommends both combinations.
· The NIH also wants to know if repurposed prescription and OTC drugs can help treat mild to moderate cases of COVID-19, Lasek writes in McKnight’s LTC News. The NIH is funding a phase 3 trial of half a dozen drugs that are currently on the market, noting that “medications that can be self-administered at home to reduce COVID-19 symptoms are critically needed.” The list of drugs to be included in the study is still being finalized but the medications will be oral or inhaled formulations.
What’s next
We are making a transition from an unvaccinated to a semi-vaccinated to what we can hope will be a well-vaccinated world. Is there a GPS for this?
· We’ll be hearing a lot more about regular COVID testing as a way of life, in order to identify infection sooner rather than later and allow people who test positive to isolate before infection can spread. Rapid tests for use at home, including Abbott’s BinaxNOW and Quidel’s QuickVue, will soon be available OTC.
· The pandemic has changed the world of travel, and Expedia is trying to change with it, Alison Weissbrot writes in Campaign. The company has rebranded itself, pivoting from a booking and reservations platform to the “ultimate travel companion” providing “a higher order relationship with someone who can guide them at every step.” Details are embedded in Expedia’s new app.
· The DTC travel brand Away, perhaps best known for its hard-shell suitcases, was forced to rethink its messaging and positioning after air travel evaporated in 2020, Mariah Cooper reports in Campaign. As Americans took to “nomad” traveling and camping, Away switched its focus to promote day trips, road trips and weekend getaways. The brand also cashed in on the pandemic pet-adoption trend by introducing its first pet carrier.
· The resort town of Jackson Hole, Wyoming is expecting a busy summer season. That’s one reason why St. John’s Health in Jackson Hole is offering a $600 bonus to all full-time employees (prorated for part-timers) who are fully vaccinated by May 31. St. John’s has 880 eligible employees; as of mid-April, 74% had been vaccinated.
President Biden on Wednesday announced that federal tax credits are available for businesses and nonprofits with fewer than 500 employees that give workers paid time off to get vaccinated or to recover from vaccination side effects. The credit is up to $511 per day for up to 80 hours (10 days) of paid sick leave between April 1 and September 30.Here’s a fact sheet on the credit from the IRS.
Employer tax credits are also available if workers need to take time off to get tested for COVID-19; have COVID-19 symptoms and are going to the doctor; are under quarantine or isolation order by the government or a doctor or are caring for someone who is; or have to care for a child when school or a child care facility is closed due to COVID-19.
· For some senior care providers, mandating vaccination would just add another stress to an already overstressed workforce. Using the mantra “knowledge is power,” Forest Hills of DC increased staff uptake of COVID-19 vaccine from 50% to 86%, Kimberly Bonvissuto reports in McKnight’s Senior Living. “We wanted our workforce to know they were smart enough to make a decision for themselves,” said CEO Tina Sandri. “Go out and empower yourself to make a good decision for you and your family.” Vaccinated workers served as vaccination ambassadors to their colleagues.
· The list of colleges requiring students to be vaccinated against COVID-19 before they return to campus is growing. As of Wednesday, the Chronicle of Higher Education counted more than 60. Many colleges are hoping that earnest persuasion, and perhaps some incentives, will be sufficient. At the University of North Carolina at Greensboro, vaccinated students can enter a lottery, with top prizes including a meal plan or a year of free housing.
· The American College Health Association received $2 million from the CDC to support a national campaign to increase vaccine visibility on campuses while building vaccine confidence and countering misinformation. The funding will support development of a vaccine confidence toolkit for faculty and staff and a national outreach to students via social media.
· COVID-19 is emerging as a multi-organ disorder requiring ongoing care beyond the acute infection, John Schieszer writes in Endocrinology Advisor. Caring for these patients over the long haul will likely require the attention of multiple disciplines, including but not limited to pulmonology, cardiology, neurology, endocrinology, nephrology, and psychiatry.
· People who get sick with COVID-19 will experience better outcomes if they have exercised regularly, says a study of 50,000 adults by Kaiser Permanente Southern California. McKnight’s Amy Novotney notes that COVID-19 patients who were “consistently inactive” were 226% more likely to be hospitalized, 173% more likely to be admitted to an ICU and 149% more likely to die than the most active COVID-19 patients, who were in the habit of exercising for 150 minutes per week.
The Takeaway:
The pandemic is challenging us to develop new skill sets while sharpening old ones.
The rest
· With less than 100 days to go before the Tokyo Olympics start on July 23, less than 1% of the Japanese population has been vaccinated. Holding the Games even a year later is, at this point, not a sure thing.
· Mick Jagger and Dave Grohl have teamed up, virtually, on a pandemic anthem called Easy Sleazy, celebrating the end of lockdowns.
· Don Brown, author and illustrator of nonfiction graphic novels for kids, has added “A Shot in the Arm,” a history of vaccines that incorporates the COVID-19 era. It’s the latest in Brown’s series on Big Ideas That Changed the World. His body of work also includes “Fever Year: The Killer Flu of 1918” and gentler topics such as “Rocket to the Moon.”
· 64-year-old George Kelakos spent 146 days in Greenwich, Connecticut Hospital with COVID-19, including a long stretch in a coma. He left the hospital two weeks ago but is not home just yet, recovering at a rehab facility. In 2020, 67-year-old Deanna Hair was hospitalized for 196 days in Michigan, including two months on a ventilator, before going home. However, It might be hard to top the 306 days Geoffrey Woolf, 74, spent in hospital in the U.K.
· Woolf’s sons set up an audio e-reader for their father that played his favorite “comfort” book, Pride and Prejudice, during his marathon hospital stay. They’ve since started a nonprofit called Books for Dad, providing audiobooks to recovering COVID-19 patients.
Parting shot
On Earth Day, it’s fitting to ponder the new phenomenon of coronavirus litter. If you recall the photos years ago of birds hopelessly entangled in the plastic rings of six-packs of beer, you’ll relate to the latest: a tiny fish trapped inside a disposable glove and birds caught in the ear loops of face masks, amid other evidence of widespread COVID litter. National Geographic reports on the issue and cites a study from the Netherlands in Animal Biology warning that “materials designed to keep us safe are actually harming animals around us.”
… and some songs
· I Feel the Earth Move, Carole King
· It’s Not Easy Being Green, Kermit the Frog
· It’s Not Easy Being Green, Ray Charles version
Big Yellow Taxi, Counting Crows featuring Vanessa Carlton
· Let’s Stay Together, Al Green
· Going Home, from Dvorak’s New World Symphony
Happy Earth Day. Happy Volunteer Week. Happy weekend! See you back here next Wednesday for a Haymarket Vaccine Project Newsletter. Stay well.
