The Delta variant’s impact on the health system, the economy and the psyche of America has been chilling. Since July 1:
Cases and hospitalizations have soared: both hit six-month peaks last week–the 7-day moving average of hospital admissions (6,244) and 7-day moving average of new cases (72,493).
The stock market has dropped from record highs: the S&P 500 closed Friday at 4,433, down .8% from its July high. The NASDAQ closed at 14,483, down 2.4% from its July high and the Dow closed at 31,195, down 11% from its July peak
Consumer confidence has slipped: the Morning Consult Consumer Confidence Index dropped 4.6%– “the sharpest 3-week decline in the ICS since November 2020 when the third wave of the coronavirus was roaring through much of the U.S.”
They are coincident with otherwise positive news: strong second quarter earnings in corporate America, a slow-down in consumer prices, record levels of merger-acquisition activity in fintech, healthcare and Big Tech and strong GDP growth projections for 2021 and 2022.
But the 2020 pandemic exposed two fundamental flaws that could thwart these and the 2021 Delta variant has amplified both:
The Politics of Science
At an event in Nashville Saturday, Republican House leader McCarthy characterized the CDC as “the political arm” of Democrats. Vigorous exchanges between Sen. Rand Paul (R-KY) and Anthony Fauci, MD (Director, U.S. National Institute of Allergy and Infectious Diseases) showcase alternative facts about testing, masks and vaccines. Governors in many states have overridden public health directives from the CDC in favor of their own predispositions, suspicions and political posturing. Though the public’s still inclined to trust its physicians, mixed messages about testing, masks and vaccines from scientists and experts coupled with the complexity of efficacy and effectiveness studies have confused the public. And in states with low vaccine rates, it has become an intense matter of government vs. individual freedom.
The Conundrum of Mandates
Today, 30% of the U.S. population is unvaccinated (CDC)and half of these are not likely to be (Axios-Ipsos). Incentives to get vaccinations have had marginal impact: prizes like free beer and lottery tickets have done little to mitigate vaccine hesitancy. Carrots haven’t worked despite science showing vaccines and masking reduce risks for large majorities of adults and kids. By contrast, sticks like vaccine mandates required by employers might: we’ll soon know as “jabs for jobs” pushes employers into the public health spotlight. Americans do not like mandates; employers like them less. But herd immunity is unlikely until at last half of the 93 million currently unvaccinated take action. And it’s unlikely pandemics, like polio, smallpox and even the seasonal flu can be mitigated without them.
Yesterday, without much notice, the two-year suspension of the federal debt ceiling expired: it was set at $22 trillion in 2019 and today sits at $28.5 trillion…and that’s before a $1.2 trillion infrastructure and possible $3.5 trillion package are added by Congress.
The news cycle today will feature two lead stories– last minute changes to the infrastructure bill which will be heralded as a rare display of bipartisanship and the looming threat of the Delta virus. There’s little controversy about the need for repairs to roads and bridges, but the unknowns about the Delta variant and back-to-school timing make matters more complicated.
How the Delta variant is managed by state and federal public health leaders in concert with local hospitals and caregivers, how employers and school systems choose to influence vaccinations, and how media disable sensationalism in favor of science and common sense are keys to the normalcy we thought near just 30 days ago.
It might prove to be a blessing in disguise if these two flaws are addressed.
P.S. The 314-page Opioid Settlement Agreement announced July 20 earmarks $26 billion over 18 years for opioid abatement programs to be administered by states. It represents 4% of annual revenues for the four litigant companies (Johnson & Johnson, Cardinal Health, McKesson and Amerisource Bergen). Last year, 70,000 died from opioid addiction and 50,000 babies were born to moms with Opioid Addiction Disorder. Clinical studies show physical and behavioral complications for these kids that continue into their adulthood and significant costs for state Medicaid budgets that cover 60% of these kids. Action items:
Hospitals that care for these neonates face enormous staffing challenges and operating losses. Hospitals should seek funds for NAS abatement programs. Inconsistency in treatment methodologies and variability in hospital services for NAS babies in hospitals is problematic.
As part of a multi-state effort, hospitals should collaborate in the development of the Neonatal Abstinence Syndrome Registry to facilitate research about the health and wellbeing of these children as they age.
“U.S. Consumer Sentiment Sinks as Delta Variant Cases Rise”; July 28, 2021; Morning Consult
“The State of the Nation: a 50 State COVID-19 Survey”; July 27, 2021; The COVID States Project
“Masks and critical race theory: Kevin McCarthy slams Democrats at Tennessee Statesmen’s Dinner”; August 1, 2021; Tennessean
7-day moving average of hospital admissions: 6,244 (2,402,156 million 8/1/20-7/30/21)
New cases: total 101,171; 7-day moving average 72,493
Vaccinations: One dose 191,498,983 (57.7% of population, 69.9% of 18+); fully vaccinated 165,757,423 (49.6%,60.5% of 18+):
Deaths: 610,873 (301 yesterday: 90% had not been vaccinated)
35% of U.S. counties have high levels of community transmission.
Saturday, Florida reported more than 21,000 new cases: the state represents 6.5% of the U.S. population and accounts for about 21.4% of the country’s new cases.
Study: Mood Disorders Associated with Higher Covid Mortality
In this systematic review and meta-analysis of 21 studies involving 91 million people, individuals with preexisting mood disorders, compared with those without mood disorders, had significantly higher odds for COVID-19 hospitalization and death. There were no associations between preexisting mood disorders and risk of COVID-19 infection or severe events.
“Individuals with preexisting mood disorders are at higher risk of COVID-19 hospitalization and death and should be categorized as an at-risk group on the basis of a preexisting condition.”
Ceban et al “Association Between Mood Disorders and Risk of COVID-19 Infection, Hospitalization, and Death Systematic Review and Meta-analysis”; July 28, 2021; JAMA Psychiatry
Efficacy of Pfizer/BioNTech Covid Vaccine Slips to 84% after Six Months, Data Show
New data show that the efficacy of the Pfizer/BioNTech Covid-19 vaccine dropped from 96% to Death 84% over six months fueling Pfizer’s case that a third booster shot may be needed eventually. The data — which were released in a preprint and not peer-reviewed — suggest that the vaccine was 91% effective overall at preventing Covid-19 over six months. Efficacy seemed to fall by an average of 6% every two months after doses were administered, the 44,000-person study found, with a peak of 96% efficacy within two months of vaccination. At the same time, the overall efficacy of the vaccine against severe disease, including those with low blood oxygen levels, was 97%.
“Pfizer’s CEO Says Efficacy Drops to 84% After Six Months”; July 28, 2021; CNBC
Poll: Majority Support Vaccine Mandates
In the June/July poll, 64% of respondents said that they’d support government vaccine requirements—up from 62% in April or May. A majority of every demographic subgroup except Republicans said they’d support vaccine requirements. Only 45% of Republicans said they approve of such mandates
“The State of the Nation: A 50-State COVID-19 Survey”; July 27, 2021; The COVID States Project
Axios: 3 in 10 Vaccine Resistant
According to the most recent Axios/Ipsos Coronavirus Index:
7 in 10 U.S. adults said they’d taken the vaccine. Of the remaining 30% (93 million Americans):
One-fourth said they’re “very or somewhat likely” to take the shots, but haven’t yet.
A fourth say they’re not likely to do it but haven’t ruled it out.
Half say they’re not at all likely to get vaccinated.
Half in the most persuadable group is Black or Hispanic, whereas the most resistant group is overwhelmingly white. The dug-in opponents also identify more solidly as Republican, and are disproportionately concentrated in the South.
They’re most likely to say they don’t consume traditional mainstream news, and they’re most likely to distrust authority figures or institutions, including the Centers for Disease Control and Prevention, President Biden and state governments.
“Americans growing more concerned about COVID-19, yet unwilling to take additional safety precautions or change behavior”; July 20, 2021; Ipsos
U.S. News and World Report Best Hospitals
The 2021-2022 U.S. News and World Report rankings for Best Hospitals in the U.S. is based on data about 4750 hospitals in 15 adult, 10 pediatric and 17 surgical/medical specialties. This year, the methodology changed including 7 new procedures and conditions, including heart attack, kidney failure, and pneumonia. Measures of whether patients treated at the hospital reflect the racial and ethnic diversity of the community were also provided. Highlights:
Mayo Clinic in Rochester, Minn., has once again took the top spot, the sixth year in a row.
175 hospitals were nationally ranked in at least one specialty and 531 were ranked among the best regional hospitals.
The Top 20 “Honor Roll” are large organizations (at least $3 billion in revenues) located in urban markets and operate as not-for-profit academically affiliated health systems. The bi-coastal dominance is once evident in the Honor Roll: 7 are in the I-95 Boston to Baltimore corridor and 4 are based in the San Francisco/Los Angeles metros.
“U.S. News Best Hospitals”; U.S. News
J.D. Power: Consumer Adoption of Retail Health Increasing
J.D. Power released its 2021 U.S. Pharmacy Study last Wednesday. Highlights:
51% of customers at retail pharmacies used health and wellness services in the past year vs.48% in 2020 and 43% in 2019.
Customers who use at least one health and wellness-oriented service provided by their pharmacy each spend an average of $5 more than those who do not use these services ($28 vs. $23, respectively). Overall satisfaction and brand advocacy also significantly increase when customers utilize health and wellness services, with overall satisfaction scores climbing 24 points (on a 1,000-point scale) and NPS scores increasing by 10 points.
Satisfaction scores and Net Promoter Scores “increased notably” when patients used health and wellness services.
26% of brick-and-mortar customers and 27% of mail-order customers had accessed their pharmacy’s app.
“Retail Health and Wellness Services Surge in Popularity, Driving Significant Gains in Pharmacy Customer Satisfaction, J.D. Power Finds”; July 28, 2021; BusinessWire
BMJ Study: Almost Half of Drugs Authorized through FDA Accelerated Use Lack Evidence
Of 253 drugs authorized through the FDA’s accelerated approval pathway, 112 have not been confirmed as clinically effective.
At the end of 2020, 24 of those 112 drugs have been on the market for more than 5 years, and some have been on the market for more than 2 decades. However, only 16 drugs authorized through the accelerated approval pathway — established in 1992 — have been withdrawn.
“FDA’s accelerated drug approval process plagued by missing efficacy data and questionable evidence”; August 2, 2021; British Medical Journal
Urban Institute: SNAP Program does not Cover Meal Costs in 4 of 10 U.S. Counties
Federal nutrition subsidies (Supplemental Nutrition Assistant Program) don’t cover the average meal cost ($2.41) in more than 40.5% of U.S. counties, even after Congress temporarily increased benefits 15%, a new study found. Before the temporary increase to the maximum benefit, the maximum subsidy did not cover the cost of a low-income meal in 96% of U.S. counties. Half of the 40 million SNAP recipients are children.
In the 20 counties with the largest gap between maximum SNAP benefits and the average cost of a low-income meal, average low-income meal costs range from $3.23 to $6.16, or 64% to 213% higher than the SNAP benefit per meal.
“How Far Did SNAP Benefits Fall Short of Covering the Cost of a Meal in 2020?”; July 21, 2021; Urban Institute
Rural Health Getting Attention
In 2016, Georgia implemented the Rural Hospital Tax Credit Program which allows taxpayers to receive a tax credit for contributions to qualifying rural hospitals in the state. Researchers analyzed the association of the tax credit program with the financial health of 136 rural hospitals pre and post the program’s introduction. Two years after implementation, program participation was associated with a 23% increased probability of good or excellent financial health and a 6.7% increase in total margin.
Related: In the coming year, the Centers for Medicare and Medicaid Services will begin implementing the Community Health Access and Rural Transformation (CHART) model. This model allows rural health care organizations to receive budget-based payments by participating in one of two tracks: the Accountable Care Organization (ACO) Transformation Track or the Community Transformation Track. The ACO track is based on Medicare’s ACO Investment Model for health systems in rural and underserved areas, whereas the community track is based on hospital global-budget models, including the Pennsylvania Rural Health Model.
Joseph T. Kannarkat, Eric T. Roberts, “Health Care Budgets for Rural Providers — Opportunities for Payment Reform”; July 27, 2021; New England Journal of Medicine
Apenteng et al, “Assessment of the Financial Health of Rural Hospitals After Implementation of the Georgia Rural Hospital Tax Credit Program “; July 23, 2021; JAMA Network
Lawmakers Back Provider Relief Fund Deadline Extensions
Providers that received HHS COVID-19 relief funds would get until the end of the year or the end public health emergency to spend that money under a bipartisan bill (Provider Relief Fund Deadline Extension Act) introduced last Wednesday by Sens. Michael Bennet (D-Colo.) and Kevin Cramer (R-N.D.) authored the legislation following HHS’ decision to require some healthcare providers to spend their relief dollars by June 30.
Congress and President Donald Trump enacted the Provider Relief Fund last year to help providers weather the pandemic. Congress authorized $178 billion for the temporary program, but HHS has yet to distribute $43 billion.
“Sens. Cramer, Bennet Introduce Bipartisan Bill to Extend Deadline for Health Care Providers to Use Relief Funds” July 29, 2021; cramer.senate.gov