Older patients shrink from elective procedures as COVID-19 surges

 

• Older people appear less willing to undergo elective procedures as the number of U.S. COVID-19 cases has risen, according to a survey by analysts at investment firm Needham & Company.

• A November poll of 251 individuals with an average age of 61 years found 27% of respondents are willing to have elective procedures. That's down from a similar poll in September when 37% of respondents were willing.

• That deterioration in consumer readiness to seek and follow through with care comes as medtech companies including Hologic, Johnson & Johnson and Zimmer Biomet have run campaigns aimed at giving people the confidence to re-engage with the healthcare system.

The pandemic's impact on volume of elective procedures has changed since the virus first shut down economies early this year. After an initial wave of deferrals enforced by governments or individual hospital systems, a key factor in the recovery of medtech sales became the willingness of patients themselves to follow through on procedures amid concerns of being exposed to the virus.

Analysts at Needham began tracking the sentiments of older patients in May, at which time 13% of the surveyed individuals were willing to have an elective procedure. Willingness increased over the summer, culminating in 37% of people in September saying they would undergo surgery that month if needed.

Come the middle of September, the U.S. was typically reporting fewer than 40,000 COVID-19 cases a day. Now, about two months later, the U.S. began averaging more than 150,000 cases a day. The Needham survey contains evidence the surge has dented the confidence of patients in the safety of seeking elective surgeries.

In addition to the 10 percentage point drop in the proportion of people willing to immediately undergo surgery, the survey tracked a decline in the fraction of patients who plan to have an elective procedure by the end of the year. In the November survey, 53% of people who need an elective procedure said they plan to have the surgery this year, compared to 64% of respondents to the September poll.

The latest survey found most of the procedures are expected to take place before the second half of next year but it will be some time before all are completed. “We expect a meaningful portion of people will continue to act with an abundance of caution which could result in a recovery with a long tail,” the Needham analysts wrote.

If the analysts are right, medtech companies exposed to elective procedures face a long wait for the normalization of demand. The rollout of vaccines could accelerate the process, notably by reducing infection rates and thereby tackling the main factor in decisions about whether to undergo surgery. However, the survey suggests vaccine uptake may be gradual, with 43% of people saying they will wait for full FDA approval and 39% saying they do not know when, if ever, they will get the jab.

Medtech companies are proactively trying to get patients to undergo delayed procedures. Hologic in August offered women who completed a mammogram appointment the chance to win a private, virtual performance by Sheryl Crow. J&J kicked off an educational campaign in September, followed by Zimmer Biomet in November.

https://www.healthcaredive.com/news/older-patients-less-willing-to-have-elective-procedures-as-covid-19-surges/589503/

5 major airlines roll out digital health passport for travelers

 

• Following a successful trial with United Airlines in October, four more major airlines plan to roll out a digital health pass for international travel, called CommonPass, in December.
• The technology launched by the Commons Project Foundation and the World Economic Forum allows travelers to document their COVID-19 status electronically and present it when boarding an airplane or crossing a border.
• CommonPass as operated by the CommonTrust Network, a nonprofit aimed at giving people digital access to health information, including vaccination records and lab results, using interoperable standards like HL7 FHIR. It includes hundreds of health systems and hospitals, along with accredited labs and other providers, in the U.S. and worldwide.

As the world continues to grapple with the pandemic, countries face the quagmire of how to safely reopen borders for travel and commerce. Many airlines and destinations require COVID-19 test results for travel ahead of a vaccine, but there's no standard result format or verification system.

The fragmented set of requirements for entry and exit in a country, plus the range of different test types required by different governments, has resulted in a confusing system for airlines, immigration officials and passengers to navigate, experts say. The bevy of types of documentation and requirements can lead to health check errors and even fraud, threatening a country's efforts to contain coronavirus spread.

​Digital tech is one avenue to harmonize standards in verifying passenger data pre-flight or pre-entry, proponents say. A handful of groups are working at so-called digital health passes to try to allow travel while ameliorating fears of virus transmission during the pandemic.

On Tuesday, the Airport Council International, a group representing almost 2,000 airports around the world, and JetBlue, Lufthansa, Swiss International Airlines, United Airlines and Virgin Atlantic joined the CommonTrust Network.

United was the first U.S. carrier to trial CommonPass, on an transatlantic flight Oct. 21 from London's Heathrow airport to Newark airport in New Jersey. That was followed by another trial on a Cathay Pacific Airways flight between Hong Kong and Singapore in November. Both trials were successful, according to the groups.

Next month, CommonPass will be available for JetBlue, Lufthansa, Swiss International Airlines, United Airlines and Virgin Atlantic passengers flying out from New York, Boston, London and Hong Kong.

CommonPass isn't the only digital health pass being tested. One called AOKpass developed by the International Chamber of Commerce is currently being used between Abu Dhabi and Pakistan. And global airline lobby International Air Transport Association also announced recently its own digital health pass, called the IATA Travel Pass, is in the final development phase and will come to market for Apple and Android devices next year.

Public health officials have urged people to cease non-essential travel as the U.S. faces a rising surge in COVID-19 cases going into the holiday season, typically air carriers' busiest time of year. Yet many states and countries are allowing outside travel, with varying requirements for entry.

Some destinations, such as Hawaii and France, are allowing travelers to skip a two-week quarantine period if they show a negative COVID-19 test result within 72 hours of departure. Some, like Abu Dhabi and Croatia, are more stringent, requiring a negative test result within 48 hours of departure, while a handful including Brazil and Turkey don't have any barriers to entry at all.

​As a result, many major carriers, including United and American, are offering COVID-19 tests at the airport, nearby drive-through locations or mail-in tests.

https://www.healthcaredive.com/news/5-major-airlines-to-roll-out-digital-health-passport-for-travelers-next-mon/589810/

CMS expands ability for hospital-level care at home; sees Thanksgiving surge

 

• CMS is expanding the ability of hospitals to treat their acute care patients at home ahead of an expected surge in COVID-19 hospitalization following the Thanksgiving holiday, when many Americans ignored public health advice against gatherings.
• The guidance released last week also tweaks earlier changes allowing ambulatory surgical centers to provide greater inpatient care by stating 24-hour nursing services need to be available only when a coronavirus patient is at the center.
• Six health systems were immediately granted waivers for the new Acute Hospital Care At Home program to treat more than 60 acute conditions. CMS said it has been in discussion with other hospitals and expects new applications to be submitted.

Public health experts warned this weekend the worst surges of COVID-19 could be in the coming weeks, as community spread is extensive throughout the country as many in the U.S. still traveled to be with family for Thanksgiving.

And hospitals are already stretched to the brink, scrambling to create additional ICU capacity ahead of the expected jump in hospitalizations that typically follows record-high case counts.

The new acute-care at home program builds on the Hospitals Without Walls initiative CMS launched in March, which allowed facilities to provide inpatient services in other buildings like hotels or dorm rooms.

CMS said that under the program, 85 ASCs are providing inpatient care, and it predicts the additional flexibilities just announced will prompt more to enter.

The new guidance focuses on at-home care for conditions that can often warrant a hospital stay, like asthma, pneumonia, congestive heart failure and chronic obstructive pulmonary disease.

Such services existed before the coronavirus pandemic and were growing. Health systems have turbocharged those plans as the COVID-19 crisis continued and telehealth use in general boomed. 

Intermountain Healthcare announced a hospital-at-home service in June and Universal Health Services partnered with Bayada a month later to provide post-acute home care.

At-home care is often preferred by patients, especially during the pandemic when hospital care means friends and family cannot be present. Some research has shown it to be less costly and result in fewer readmissions.

Patients can only be admitted for at-home acute care from an emergency room or inpatient bed, and they will receive at least two in-person visits a day from a registered nurse or paramedic. Hospitals are also required to perform screening for non-medical factors that could impede at-home care like not having working utilities or a risk for domestic violence.

The six health systems participating at launch — Brigham and Women's Hospital in Massachusetts; Massachusetts General Hospital; Hunstman Cancer Institute in Utah; Mount Sinai Health System in New York City; Presbyterian Healthcare Services in New Mexico; and UnityPoint Health in Iowa — cover multiple major metro areas.

The Association of American Medical Colleges applauded the move, but warned capacity isn't the only difficulty hospitals are facing. Healthcare workers are needed to treat patients and operate specialized equipment, but they are facing sickness themselves, along with burnout from the unprecedented requirements.

"Although teaching hospitals are uniquely prepared to deal with public health emergencies, the nation’s health care workforce is stretched thin on the front lines of this pandemic," AAMC wrote.

Although clinicians have learned more about the best ways to treat COVID-19 since the early days of the pandemic, patients often require a hospital stay and can quickly end up in the ICU. Capacity in those wards varies greatly across the country, and hospitals in previous hot spots have found themselves overwhelmed.

This can force a facility to curtail or halt lucrative elective procedures, which some have had to do. That can be a major financial drag for hospitals, which have reported lower volumes as people avoid routine care.

The trend continued in October, as hospitals reported falling volumes and margins amid rising expenses. So far this year, total expenses per adjusted discharge have increased 14% year over year, according to the latest flash report from Kaufman Hall.

And the Jefferies hospital traffic index for last week showed flat volumes — down more than 2% from the post-recovery high — amid rising COVID-19 cases.

https://www.healthcaredive.com/news/cms-expands-ability-for-hospital-level-care-at-home-as-thanksgiving-surge-e/589812/

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