COVID-19 Update | February 23, 2021

Staff Contact: Mat Reidhead or Jackie Gatz

On Feb. 20, Missouri marked the watershed milestone of 1 million COVID-19 vaccine doses administered in the state since the mass vaccination campaign began nine weeks earlier on Dec. 14, 2020. The process has been wrought with unanticipated logistical challenges; however, the state has significantly improved on the velocity of doses administered to eligible individuals, despite challenges posed by extreme weather in mid-February. One such challenge is in vaccinators reserving booster doses for individuals who received prime doses at their clinic location. Anecdotal evidence suggests individuals eager to become fully inoculated against COVID-19 will register for vaccines at multiple locations and fail to notify their prime dose vaccinator when they receive their booster dose at another provider. Evaluating the state’s ShowMeVax COVID-19 vaccine administrative data quantifies the magnitude of this challenge.

By Feb. 22, more than 703,000 individuals had received at least one vaccine dose managed by the state. Nearly half of those individuals (46.5%) had received both prime and booster doses for full protection against the disease. Among the 326,784 individuals completing both doses, 11.1% received their booster shot at a clinic location different from where they received their prime dose. This infers at maximum, vaccinators may be reserving 36,273 booster doses for patients who received a prime dose at their clinic, but completed the process elsewhere — this is 3.5% of the total number of doses administered in the state thus far. However, the ShowMeVax system is built around individual system- or corporate-level providers, typically with multiple clinic locations operating under the larger provider-level licensure. For example, Walgreens Pharmacy is a licensed provider operating more than 100 individual clinic locations in Missouri. Only 1.9% of fully inoculated individuals received their booster dose at a provider other than where they received the prime dose. Assuming clinics under the same provider umbrella have the ability to share vaccination data through electronic medical records, this would infer that 6,209 doses may be unnecessarily reserved for individuals receiving booster doses via different channels. In other words, the scale of this perceived challenge likely accounts for between 0.6% and 3.5% of the total doses administered in the state to date.

Staff Contact: Daniel Landon

Five major manufacturers of COVID-19 vaccine told the U.S. House Energy and Commerce Committee’s Oversight and Investigations subcommitte that they expect a significant increase in vaccine supply. Their testimony projected an increase of 140 million doses through the next five weeks. Some of the increase would result from increasing the number of doses per vial, subject to regulatory authorization.

Staff Contact: Jackie Gatz or Kara Amann-Kale

The Centers for Disease Control and Prevention released the first month of vaccine safety monitoring data — derived from VAERS and V-safe monitoring systems — for Pfizer and Moderna vaccines in the U.S. Cases of anaphylaxis after receipt of both authorized vaccines have been observed, though rarely; anaphylaxis rates are comparable with those reported after receipt of other vaccines. No unexpected patterns of reactions or other safety concerns have been identified during early monitoring. The CDC and U.S. Food and Drug Administration will continue to monitor the safety of COVID-19 vaccines to inform vaccination policy and to maintain public confidence.

Staff Contact: Mary Becker

Dr. Amy Patel, Medical Director of Liberty Hospital Women’s Imaging, addresses swollen lymph nodes in the armpit, which is a normal side effect caused by the COVID-19 vaccine. Because of the more pronounced lymph nodes, Dr. Patel advises women to space out the timing for getting routine screening mammograms and a COVID-19 vaccine. She also encourages open communication with care providers regarding symptoms.

Staff Contact: Daniel Landon or Rob Monsees

The state Senate took a final vote on legislation to create new protections from liability related to the COVID-19 pandemic. Senate Bill 51 passed with two additional votes, 20-13, but in a separate vote failed to receive the 23 votes needed for the legislation to take effect immediately on enactment and approval by the governor. Without supermajority approval of an “emergency clause,” the law will not take effect until Aug. 28, 2021. The bill now moves to the House of Representatives for consideration.

Staff Contact: Daniel Landon or Jane Drummond

The U.S. Department of Health and Human Services issued a notification that inadvertent violations of HIPAA privacy standards in using web-based scheduling systems for COVID-19 vaccination appointments will not incur federal penalties. The announcement reiterates a policy statement issued by the Trump administration in December 2020.

Staff Contact: Jackie Gatz or Keri Barclay

The U.S. Food and Drug Administration issued a safety brief to inform health care providers and the general public about the limitations of pulse oximeters. While pulse oximeters may be useful for estimating blood oxygen levels, these devices have limitations that can result in inaccurate readings. Patients with conditions such as COVID-19 should not rely solely on pulse oximeter measurements to monitor their health at home as they are not a substitute for a medical diagnosis by a health care provider. Several factors can affect the accuracy of these devices, such as poor circulation, skin thickness, skin pigmentation, skin temperature, current tobacco use and fingernail polish.

Staff Contact: Jackie Gatz or Kara Amann-Kale

The Region VII Disaster Health Response System is hosting a webinar at 2 p.m. CST Thursday, March 4, on understanding behavioral health issues in a pandemic. This offering will focus on the critical need to address these issues during the pandemic, as well as resources to support behavioral health and COVID-19 fatigue among health care workers. Registration is required.

Staff Contact: Andrew Wheeler

MHA previously released a COVID-19 Vaccine Administration billing, coding and payment reference sheet. The Congressional Research Service now has released a reference sheet, “COVID-19 Vaccine: Financing for Its Administration.” In the reference sheet, the CRS defines patients and providers, and includes information about how payers should cover vaccination claims.

Staff Contact: Sarah Willson

The Centers for Medicare & Medicaid Services extended QSO-21-13-Hospitals an additional 30 days through Monday, March 22. In January, the agency issued QSO-21-13-Hospitals limiting complaint surveys to those meeting the Immediate Jeopardy threshold and extending certain compliance deadlines. In addition, direction was provided to hospitals to report to their State Survey Agency if they are considering and if they have implemented crisis care standards.

Staff Contact: Dave Dillon

On Feb. 20, Missouri passed the milestone of more than 1 million administered doses of COVID-19 vaccine. MHA shared an update from hospital leaders regarding progress in the High Throughput Health Care vaccination program, as well as hospitals’ independent and coordinated large scale vaccination events. According to the state’s daily update, nearly 47,000 doses have been delivered since the 1 million milestone.

This week also saw the nation’s COVID-19 death toll exceed 500,000. The first deaths in the U.S. were recorded in February 2020. According to the Kaiser Family Foundation, the disease has killed at least 100,000 people in the past five weeks and was the leading cause of death in the country in January.

Staff Contact: Jackie Gatz or Keri Barclay

The Centers for Disease Control and Prevention published a Morbidity and Mortality Weekly Report with additional information on the importance of wearing a well-fitted mask to reduce the transmission of COVID-19. Medical procedure masks are intended to provide source control and to block splashes. The amount which they reduce aerosolized particles varies significantly, in part because air can leak around the edges or side gaps. Results from recent CDC experiments demonstrated that a medical procedure mask alone blocked 56.1% of particles, and a cloth mask alone blocked 52.4% of particles from a simulated cough. When cloth masks are combined with procedural masks, 85.4% of particles are blocked. Most notably, for those who cannot tolerate double masking or when double masking is impractical, a knotted and tucked medical procedure mask blocked 77% of aerosolized particles.

Staff Contact: Stacie Hollis

The Centers for Disease Control and Prevention’s National Personal Protective Technology Laboratory published an updated list of counterfeit and misrepresentation of NIOSH-approved respirators.

Staff Contact: Kendra Hanauer or Dave Dillon

The most recent edition of the “COVID-19 and Delayed Care” series reviews the influence of delayed care on substance use disorder and neonatal abstinence syndrome. Researchers found between March and October 2020, emergency department treatment for opioid and substance use declined by 5.6%, or 621 fewer ED visits in the state. Similarly, 7.5% fewer inpatient visits — representing 576 fewer individuals — occurred. In addition, recent data released by the Centers for Disease Control and Prevention indicates that in the 12 months leading to June 2020, 81,003 Americans died from drug overdose — a record death toll. Opioid use during pregnancy can harm a developing fetus and lead to withdrawal symptoms after delivery. Comparing 2019 and 2020 data, researchers found a 20.9% increase in NAS during the COVID-19 pandemic.

Detection and treatment of SUD and NAS can significantly improve patient outcomes. Hospitals and community organizations are encouraged to share these important messages communitywide. Working together, we can remind Missourians that there is no reason to delay care, and that rescheduling regular health screenings may save lives.

Staff Contact: Keri Barclay

The U.S. Department of Health and Human Services and the Office of the Assistant Secretary for Preparedness and Response oversees the allocation and distribution of COVID-19 therapeutics authorized by the U.S. Food and Drug Administration for emergency use. The two monoclonal antibody therapies that received EUA and were managed through allocation were bamlanivimab and the therapeutic cocktail casirivimab/imdevimab. Fair and efficient access of monoclonal antibody treatments to the communities and facilities that need them always has been the primary goal in this response. There is no shortage in supply of these drugs, and there is enough on hand to meet the needs of all treatment facilities. For this reason, both therapeutics (bamlanivimab and casirivimab/imdevimab) now are being made available through direct ordering only. All treatment sites meeting EUA requirements now must order bamlanivimab and casirivimab/imdevimab (when available for shipping) directly from AmerisourceBergen Corporation, the drugs’ sole distributor. The products remain free of charge to requesting sites. Treatment sites should review the direct ordering process guide and place orders directly with ABC.

Staff Contact: Jill Williams

Front-line health care workers impacted by the COVID-19 health crisis can apply for copayment assistance through a new HealthWell fund for behavioral health treatments. During a 12-month period, HealthWell will provide as much as $2,000 in financial assistance for out-of-pocket treatment copayments for prescription drugs, counseling services, psychotherapy and transportation to manage COVID-19-related behavioral health issues. Health care workers with incomes of up to 500% of the Federal Poverty Level are eligible. Additional details, including an online application, are available.