Hospitals inundated by COVID cases try unique staffing, urge fed flexibility

 U.S. hospitals, stretched to the brink from the highest surge of coronavirus cases the country has yet seen, are halting elective procedures, turning to novel staffing arrangements and asking for more flexibility from the federal government.

The number of hospitalized COVID-19 patients exceeded 100,000 for the first time Wednesday, nearly doubling spring's peak, according to the COVID Tracking Project.

This time healthcare staff are in increasingly short supply, with outbreaks spread nationwide and many physicians exhausted, burned out or sick with the novel coronavirus themselves. Coronavirus patients also typically require more staff than those admitted with other illnesses, hospital leaders have said.

Mayo Clinic and Cleveland Clinic have reported more than 1,000 workers sidelined by the virus this week. Cleveland Clinic is among several systems that have said they are again curtailing or stopping elective procedures to free up resources for COVID-19 patients.

In a Wednesday letter to HHS, the American Hospital Association urged more flexibility around healthcare staffing and how providers allocate limited resources, asking CMS to waive the threat of enforcement action on hospitals that do not send in the daily COVID-19 data reporting requirements.

AHA also seeks to quell staffing shortages by expanding the physician supervision requirement "to include all nurse practitioners providing care within the scope of their license and privileges" and allocating funds to help front-line staff with child care, housing and travel expenses.

"These steps would allow providers to focus resources entirely on the pandemic response," AHA said in its letter.

Some state governments are lending support to health systems, such as Arizona, where Gov. Doug Ducey allocated $80 million to bolster hospital staffing levels and award bonuses to healthcare workers through the Coronavirus Aid, Relief, and Economic security Act.

Arizona's Health Department is working to secure an additional 500 nurses through the month with additional staffing to last throughout January, according to a release.

The state's largest system, Banner Health, predicts it will reach 100% capacity on licensed beds within a week and will remain above that level for the entire month and into January, Chief Clinical Officer Marjorie Bessel said during a Wednesday press conference.

While flu season is typically busier, "operating above 125% of licensed bed capacity is absolutely not typical, nor is it desirable, especially for a prolonged period as we are forecasting," Bessel said.

Banner recently contracted with 1,500 out-of-state workers and is working to recruit for 900 more.

It's unclear how easily systems will be able to recruit the staff they're trying to, with travel nurse demand outpacing supply and hospitals having to pay much higher rates than in the past.

Banner plans to redeploy some of its corporate staff to hospital settings wherever it can, Bessel said.

"There are many additional activities that our front-line staff could use, so assistance with things like answering telephones, running errands, potentially visiting with a patient and using the iPads so that patients can have a meeting or a Zoom call or FaceTime with their family members," Bessel said.

"We will be putting anybody who's willing to go back into the healthcare setting in the hospital to work to provide helping hands if they do not have a certification for healthcare," Bessel said.

AHA's letter asks HHS to direct federal agencies to encourage cross-training healthcare workers to ease the burden.

"For example, cross-training can prepare clinicians to work in different settings and can be used to prepare administrative support staff to meet the increased demands associated with COVID-19 patients," AHA said.

It also wants CMS to suspend its routine survey process and quality data reporting requirements that it previously waived this spring but since reinstated.

HHS should also coordinate with the Department of Defense, which has "skilled nurses and doctors capable of offering necessary assistance, as well as the resources and equipment, such as navy medical ships and field hospitals that can provide critical relief where appropriate," AHA said.

https://www.healthcaredive.com/news/hospitals-inundated-by-covid-19-cases-try-unique-staffing-urge-more-federa/591528/

GE Analyst Lifts Price Target After Health Care Segment Update

 Kieran Murphy, the CEO of General Electric Company’s GE 2.64%  GE Healthcare division, said in an update that management expects low-to mid-single-digit revenue growth in 2021, given rising COVID-19 cases globally, according to BofA Securities.

The General Electric Analyst: Andrew Obin maintained a Buy on General Electric and raised the price target from $11 to $13.

The General Electric Thesis: COVID-19 has accelerated the adoption of the company’s health care software platform Edison, which includes both GE and third-party software, Obin said in a Friday note. 

“The outlook is also supported by backlog growth and stable trends in scans/machine,” the analyst said. 

“GE is rolling out several new products with artificial intelligence including the first FDA-approved AI-based image reconstruction (Air Recon DL), embedded AI in mobile x-ray scanners (Critical Care Suite) and ultrasound (Logiq E-10),” he said. 

BofA raised its earnings estimates for the fourth quarter by 1 cent to 7 cents per share and for 2021 to 35 cents per share, to reflect “Healthcare’s better trajectory.”

https://www.benzinga.com/analyst-ratings/analyst-color/20/12/18653024/general-electric-analyst-lifts-price-target-after-health-care-segment-update

Who will pay $40B in COVID-19 debt owed to utility companies?

 

• Utility companies (NYSEARCA:XLU) across the U.S. have allowed COVID-affected residential and small business customers to defer paying their power bills without the threat of losing service, but any economic recovery will be weighed by potentially huge debts to utilities - debts that have yet to be addressed anywhere.
• Residential and small business customers could owe as much as $40B to their utilities by next March, and state regulators still must decide whether the indebted customers, all utility customers, investors, taxpayers - or some combination of those groups - should pay, UtilityDive.com reports.
• As an example, Duke Energy expects COVID-reduced load, along with diminished revenues from waived payments and fees to lead to $0.25-$0.35 in reduced earnings per share for 2020, which equates to estimated losses of $180M-$260M.
• Day-to-day system needs are being met, but longer-term "accessibility or reliability of service" could be hurt by investments deferred to meet "more pressing near-term cash flow issues," says University of Florida Public Utility Research Center Director of Energy Studies Theodore Kury.
• ETFs: XLU, UTG, VPU, BUI, GUT, FUTY, IDU, RYU, FXU, UPW
• Potentially relevant company tickers include NEE, DUK, SO, D, AEP, EXC, SRE, XEL, WEC, PEG, ES, AWK, ED, PCG, DTE, EIX, PPL, ETR, AEE, CMS, FE
• https://seekingalpha.com/news/3641605-who-will-pay-40b-in-covidminus-19-debt-owed-to-utility-companies

Testing of U.S. blood donations to ID SARS-CoV-2-reactive antibodies: Dec 2019-Jan 2020

 Sridhar V Basavaraju, MD, Monica E Patton, MD, Kacie Grimm, Mohammed Ata Ur Rasheed, PhD, Sandra Lester, PhD, Lisa Mills, PhD, Megan Stumpf, Brandi Freeman, PhD, Azaibi Tamin, PhD, Jennifer Harcourt, PhD ... 

Clinical Infectious Diseases, ciaa1785, https://doi.org/10.1093/cid/ciaa1785

PDF: https://academic.oup.com/cid/advance-article-pdf/doi/10.1093/cid/ciaa1785/34598046/ciaa1785.pdf

Abstract

Background

SARS-CoV-2, the virus that causes COVID-19 disease, was first identified in Wuhan, China in December 2019, with subsequent worldwide spread. The first U.S. cases were identified in January 2020.

Methods

To determine if SARS-CoV-2 reactive antibodies were present in sera prior to the first identified case in the U.S. on January 19, 2020, residual archived samples from 7,389 routine blood donations collected by the American Red Cross from December 13, 2019 to January 17, 2020, from donors resident in nine states (California, Connecticut, Iowa, Massachusetts, Michigan, Oregon, Rhode Island, Washington, and Wisconsin) were tested at CDC for anti-SARS-CoV-2 antibodies. Specimens reactive by pan-immunoglobulin (pan Ig) enzyme linked immunosorbent assay (ELISA) against the full spike protein were tested by IgG and IgM ELISAs, microneutralization test, Ortho total Ig S1 ELISA, and receptor binding domain / Ace2 blocking activity assay.

Results

Of the 7,389 samples, 106 were reactive by pan Ig. Of these 106 specimens, 90 were available for further testing. Eighty four of 90 had neutralizing activity, 1 had S1 binding activity, and 1 had receptor binding domain / Ace2 blocking activity >50%, suggesting the presence of anti-SARS-CoV-2-reactive antibodies. Donations with reactivity occurred in all nine states.

Conclusions

These findings suggest that SARS-CoV-2 may have been introduced into the United States prior to January 19, 2020.

https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1785/6012472

In the End, States Determine Who Will Get COVID Vaccines First

 Vaccines against COVID-19 have arrived with unprecedented speed. At least three candidates appear to be extremely effective and are likely to be approved in the U.S. in coming weeks. By the end of December, the U.S. Centers for Disease Control and Prevention (CDC) estimates the U.S. will have enough vaccines to treat 20 million people. Britain this week approved the vaccine made by Pfizer and BioNTech.

But for the first time in modern U.S. history, not everyone who wants a vaccine will be able to get one immediately. Figuring out who gets the first shots in that country and who has to wait is the job of an obscure CDC panel known as the Advisory Committee on Immunization Practices (ACIP). This week they announced their first official COVID vaccine distribution guidelines.

The committee makes such plans for all newly approved vaccines, but never before has ACIP had to work so fast. In its December 1 meeting, the committee voted 13 to one that the approximately 21 million health care workers in the country should be the first to receive any new COVID vaccine, along with residents of long-term care facilities like nursing homes. But deciding who comes second, and third, and even further back in the priority line, is trickier, as health experts weigh factors such as vulnerabilities of specific groups and whether immunizing others can have an outsize effect in stopping the harm to larger society caused by the disease.

Public health specialists who have worked on vaccine plans say the immense effects that COVID has had on the country make these decisions challenging. “We don't have everything in place, because we've just never faced this before,” says physician Helene Gayle, president and CEO of the Chicago Community Trust, who co-chaired a committee evaluating COVID vaccine priorities for the U.S. National Academies of Sciences, Engineering, and Medicine. “In my lifetime, there's never been such a huge challenge to major swathes of the population that also has such societal impact.”

Lawrence Gostin, a health law expert at George Washington University, says there is virtually universal agreement that health care workers should get the vaccine first. This group is one of the most likely to acquire the virus because of their exposure to infected patients. Health care workers have put themselves at the front lines and their well-being ensures that other patients are treated. This follows the recommendations of an October report from Gayle’s committee.

Still, when Britain approved the Pfizer/BioNTech vaccine, the country’s Joint Committee on Vaccination and Immunisation did not give health care workers the highest priority. Instead, it recommended that long-term care residents receive the very first vaccines. The committee cited this population’s very high risk of infection and death; in one study of four nursing homes, more than a quarter of residents died over the course of two months.

In the U.S., nursing homes account for nearly half of all COVID deaths. Still, including long-term care facility residents in the first group, known as phase 1a, was a more contentious point of discussion at the recent ACIP meeting. Committee members questioned whether this population, which tends to have weaker immune systems, might not respond as well to a vaccine. The lone dissenting vote on the initial distribution plan, infectious disease expert Helen Keipp Talbot of Vanderbilt University, said she felt there was not enough data on the vaccine’s safety and efficacy in this group, and was concerned that U.S. federal agencies’ surveillance systems weren’t sufficient to track these people’s outcomes.

Choosing the second group—people who could begin receiving vaccines in about a month—will present even more difficulties. Current plans put forward by the CDC suggest essential workers—a population of about 87 million—will be in this category, known as phase 1b. The following phase, 1c, which could start in about three months, would include the approximately 153 million people who have high-risk medical conditions and those over age 65.

But those plans are not final, and ACIP will continue to meet and hammer out details after the FDA approves each new vaccine and as more doses become available. For now, the committee has to consider several factors, says Jeffrey Duchin, a former ACIP member who now directs public health efforts in Seattle and King County in Washington State. Foremost is the scientific evidence about which populations are most likely to spread the disease and who is most likely to have severe effects. Epidemiological models suggest there is little difference in spread whether a vaccine is first given to high-risk adults, essential workers or people over the age of 65.

Deciding among these groups, therefore, may come down to factors such as logistics and ethical principles like access to health care. People from racial minority groups, for instance, comprise a high percentage of essential workers with a high chance of exposure. Because these groups have historically had less access to health care and because COVID is far more likely to be fatal in nonwhite Americans, ethical principles might suggest such underserved populations be prioritized, Duchin says.

Others have argued that vaccines be specifically targeted to minority ethnic groups, regardless of whether they are essential workers, in order to make up for historical inequities. “I think there is a very strong ethical justification for giving considerable advantage to people who are socially vulnerable, and I would go further and give explicit priority to racial minorities,” Gostin says. “COVID has really amplified public concerns about racial and social injustice.”

But Gostin concedes that such a strategy would face political and legal risks. Surveys have shown that Black Americans, for instance, are already skeptical about receiving a new COVID vaccine, reflecting a broader distrust of experimental treatments among minority populations. And a conservative-leaning U.S. Supreme Court would be likely to strike down any plan based explicitly on race, if that plan were challenged in a lawsuit. Targeting the vaccine to essential workers and people in underserved communities, Gostin says, might be a more viable strategy.

One question that should be relatively easy to resolve is determining which health conditions put people in a high-risk group. The CDC has amassed a large amount of data on conditions like diabetes and morbid obesity that increase the risk of severe COVID complications, and conditions like asthma that only slightly increase the risk. This list, Gayle says, will allow public health officials to prioritize the people whose preexisting conditions put them at most risk.

Logistical issues may dictate some of the allocation as well. The Pfizer vaccine, for instance need to be stored at –70 degrees Celsius, a temperature generally only achievable at health care centers. So getting this vaccine to rural populations could prove challenging.

Ultimately, the implementation of allocation decisions is not done by ACIP. It comes down to state and local jurisdictions. The federal advisory committee can recommend a vaccination triage scheme, but the CDC can’t force states to follow it. Still, Sara Rosenbaum, a legal expert at George Washington University, expects that states will accept the plans. “I’d be surprised if they fought prioritization,” she says, noting that, historically, local public health agencies have always followed federal vaccination guidelines. 

But the CDC plans will need to allow local public health officials some flexibility in determining who is part of a particular group, for instance who qualifies as an essential worker or member of a disadvantaged population. Gostin agrees that flexibility is necessary, but is concerned that “it’s a recipe for hundred different responses across America.” He notes that during this year many state and local governments have failed to follow federal guidelines on COVID testing and mask requirements: “We’ve seen American federalism fail spectacularly.”

For that reason, Duchin says that ACIP will need to carefully word its recommendations in order to ensure consistency. “If vaccination strategies differ in big ways, it will lead to confusion and potentially undermine confidence in the process,” he says.

https://www.scientificamerican.com/article/who-will-get-covid-vaccines-first-and-who-will-have-to-wait1/

Moscow rolls out Sputnik V COVID-19 vaccine to most exposed groups

 Moscow began distributing the Sputnik V COVID-19 shot via 70 clinics on Saturday to the most exposed groups, marking Russia’s first large-scale vaccination against the disease, the city’s coronavirus task force said.

The Russian-made vaccine will first be made available to doctors and other medical workers, teachers and social workers because they run the highest risk of exposure to the disease.

“You are working at an educational institution and have top-priority for the COVID-19 vaccine, free of charge,” read a phone text message received by one Muscovite, an elementary school teacher, early on Saturday and seen by Reuters.

President Vladimir Putin has ordered a nationwide voluntary vaccination programme to begin next week. He said Russia will have produced 2 million vaccine doses within the next few days.

The head of the Russian Direct Investment Fund (RDIF), Kirill Dmitriev, said in an interview with the BBC on Friday that Russia expects to give the vaccine to about 2 million people this month.

“Over the first five hours, 5,000 people signed up for the jab - teachers, doctors, social workers, those who are today risking their health and lives the most,” Mayor Sergei Sobyanin wrote on his personal website on Friday.

Russia has already vaccinated more than 100,000 high-risk people, Health Minister Mikhail Murashko said earlier this week during a separate presentation to the United Nations about Sputnik V.

Among the first people signing up to the Moscow roll-out, Nadezhda Ragulina, an administrator at a Moscow clinic, said she wanted the vaccine as she had witnessed many COVID-19 patients.

“This is my decision... Some people close to me also have had an experience (of COVID-19). That’s why I want to protect myself, my relatives, to obtain the immunity,” she told Rossiya-24 state TV channel.

Moscow, a city of around 13 million people, has been the epicentre of Russia’s coronavirus outbreak. It reported 7,993 new cases on Saturday , up from 6,868 the day before and well above the daily tallies of around 700 seen in early September.

The age for those receiving shots is capped at 60. People with certain underlying health conditions, pregnant women and those who have had a respiratory illness for the past two weeks are barred from vaccination.

Russia has developed two COVID-19 vaccines, Sputnik V which is backed by the Russian Direct Investment Fund and another developed by Siberia’s Vector Institute, with final trials for the both yet to be completed.

Scientists have raised concerns about the speed at which Russia has worked, giving the regulatory go-ahead for its vaccines and launching mass vaccinations before full trials to test its safety and efficacy had been completed.

The Sputnik V vaccine is administered in two injections, with the second dose is expected to be given 21 days after the first.

Deputy Prime Minister Tatiana Golikova said on Friday that the vaccinated should avoid public places and reduce their intake of medicine and alcohol, which could suppress the immune system, within the first 42 days after the first jab.

Moscow closed down all public places including parks and cafes, with exception for delivery, in late March, with police patrolling the streets looking for whose violating the rules. Restrictions were eased from mid-June, however.

Russia as a whole reported 28,782 new infections on Saturday, its highest daily tally, pushing the national total to 2,431,731, the fourth-highest in the world.

In October, certain restrictions such as remote learning for some secondary school children and a 30% limit on the number of workers allowed in offices were introduced again.

https://www.reuters.com/article/us-health-coronavirus-russia-vaccination/moscow-rolls-out-sputnik-v-covid-19-vaccine-to-most-exposed-groups-idUSKBN28F09O

Moderna CEO confident of producing 500M COVID-19 vaccine doses in 2021

 

• According Reuters, Moderna (MRNA -3.0%) says it is comfortable it will reach 500M doses in 2021, citing comments by CEO Stephane Bancel at Nasdaq Investor Conference.
• The company has submitted marketing applications seeking emergency use authorization in the U.S. and Europe after full results from a late-stage study of the vaccine showed 94.1% efficacy. The FDA is set to hold an advisory committee meeting on December 17.
• CEO Bancel also said the company would be able to maintain a price of $37 for its vaccine doses, although it is expected to fall to $25 for big-volume supplies.
• Earlier today, Moderna extended its contract with the Israeli to supply additional 4M doses of its COVID-19 vaccine candidate.
• On Thursday, the company reaffirmed that it would supply up to 125M doses of the vaccine by Q1 of 2021.
• https://seekingalpha.com/news/3641836-moderna-ceo-confident-of-producing-500m-covidminus-19-vaccine-doses-in-2021-reuters