COVID-19 Update | January 12, 2021

Staff Contact: Mat Reidhead or Jackie Gatz

Throughout the course of the pandemic in Missouri, patients have benefited from marked improvement in clinical understanding and treatment of COVID-19, thus reducing both length of stay and mortality for COVID-19 patients. At the same time, the clinical acuity and complexity of COVID-19 patients in Missouri have remained relatively stable. Between April and June, COVID-19 patients in Missouri were hospitalized for 9.7 days on average. Between July and September, the average length of stay fell to 7.5 days, a 23% reduction, which has been critical in freeing up scarce resources such as inpatient and ICU beds, particularly during the November surge in cases and hospitalizations. Additionally, between April and June, 16% of Missouri COVID-19 patients died during their hospitalization. Between July and September, the mortality rate fell to 9.8%, a 39% reduction. During the same period, the risk-adjusted ALOS that accounts for patients’ age, demographic characteristics, social determinants of health and clinical comorbidities decreased by just one-half day. This suggests that the improvement in ALOS and mortality have been a result of improved clinical effectiveness and not changes in the underlying risk factors of COVID-19 patients.

Staff Contact: Mary Becker

As the Missouri state COVID-19 vaccination plan progresses through its phases, MHA has created and compiled resources to aid hospitals in communicating vaccine safety and efficacy. As new information becomes available, our vaccine-specific web page will be continuously updated — please check back frequently to ensure you are distributing the most up-to-date information.

The following vaccine resources are available.

• eSignatures and sample social media
• A Do’s and Don’ts flyer for individuals seeking the vaccine
• Polling information on Missourians’ receptivity to the vaccine
• On-demand, vaccine-specific education (or webinar recordings) from MHA
• A sample letter that hospitals can use to communicate with your community

Please note that the state’s vaccine website, MoStopsCOVID.com, also has excellent resources available for your use.

Staff Contact: Jessica Stultz

As we collaborate on the public health response to the COVID-19 pandemic, we continue to evolve with the ever-changing situation. To be as responsive as possible to the health and wellness needs of the American people – today, Tuesday, Jan. 12, additional data fields for health care personnel and patient vaccinations were announced in updated guidance as optional fields in TeleTracking. For more information, please review the TeleTracking release notes at U.S. Healthcare COVID-19 Portal Help.

Staff Contact: Dave Dillon

Yesterday, MHA released new polling reviewing Missourians’ attitudes regarding COVID-19 vaccination and their sentiments about expected fairness in vaccine distribution. The research suggests that only 58% of Missourians are very or somewhat likely to seek a COVID-19 vaccine immediately when it becomes publicly available — a troubling figure for efforts to achieve widespread immunity.

The data finds challenges and bright spots among the sample population. For example, researchers found middle-aged voting adults, Republicans and those who identify as conservative as least likely to seek a vaccine immediately. However, seniors are more supportive with 79% of the survey sample very or somewhat likely to get the vaccine. Although 60% of African Americans are likely to seek a vaccination, they also are more likely to believe that the vaccine will not be distributed fairly.

The research was conducted to help identify opportunities for vaccine education. Although public vaccination efforts have not begun, the research offers several geographic and demographic targets where increased education could benefit the overall effort.

Staff Contact: Leslie Porth or Jackie Gatz

The Biden administration’s COVID-19 vaccine aim is to release nearly every available dose when he takes office – a break with the current strategy of holding back half of U.S. vaccine production to ensure second doses are available. Biden’s team is confident that if they release nearly all available doses, people will be able to complete the two-dose regimen as planned. Dr. Celine Gounder, a member of Biden’s coronavirus advisory board, said, “I want to be very clear that we are not recommending that the second dose be delayed, so people should still get their second dose of the Pfizer vaccine at 21 days, of the Moderna vaccine at 28 days.”

Staff Contact: Mary Becker

Boone Hospital Center in Columbia, Mo., is not only working to vaccinate their own staff, but they also have been working with local private practices and affiliate hospitals to ensure health care workers are able to receive the COVID-19 vaccine. Last week, staff from Boone shared their vaccine supply with Samaritan Hospital in Macon and Pershing Health System in Brookfield.

Phil Hamilton, R.N., M.A., CEO of Pershing Health System, said, “Today, Boone provided their own staff and vaccine to nearly 100 of our employees. This effort by Boone will expedite the protection that our health care workers needed to continue to provide care to the communities we serve. Essentially, this clinic will save lives among our staff and within the general population of our service area. We are most grateful to Boone Hospital Center for being more than a friend in this pandemic situation.”

Staff Contact: Andrew Wheeler

The U.S. Department of Treasury and Small Business Administration released updated guidelines for the Paycheck Protection Program to address the legislative changes from the Consolidated Appropriations Act. Qualifying hospitals that received a PPP payment under the first draw can apply for a second draw even if their first loan has not yet been forgiven. The deadline for the first or second paycheck protection program loans is Wednesday, March 31.

Staff Contact: Meghan Henderson or Jackie Gatz

The Centers for Medicare & Medicaid Services is hosting the next discussion in a special Nursing Home Stakeholder Call Series, “COVID-19 Vaccine Safety: A Fireside Chat with CMS, CDC and Representatives from the Front Line,” at 3 p.m. CST Wednesday, Jan. 13. This session will continue to address myths surrounding vaccine danger. There will not be a Q&A session during the call, but participants may submit questions by emailing COVID-19@cms.hhs.gov. Online registration also is available.

Staff Contact: Jackie Gatz or Keri Barclay

The University of Missouri Sinclair School of Nursing is offering a free webinar series on vaccines. The next webinar will cover COVID-19 vaccines and takes place at noon on Thursday, Jan. 21. This presentation will increase the participant’s knowledge regarding the new COVID-19 vaccines, including current recommendations regarding age at vaccination, number of doses, side effects, precautions and contraindications to vaccination safety and efficacy. In addition, the webinar on Thursday, April 15, will highlight vaccine hesitancy.

Staff Contact: Sarah Willson

The Centers for Medicare & Medicaid Services issued new laboratory guidance for State Agency and CMS Branch Location surveyors related to SARS-CoV-2 test reporting requirements. QSO-21-10-CLIA clarifies the regulations that require all Clinical Laboratory Improvement Amendments-certified laboratories performing SARS-CoV-2 testing to report all SARS-CoV-2 test results, including positive and negative results. All hospitals administering COVID-19 tests should be reporting results to the Missouri Department of Health and Senior Services. Additional information on reporting can be found on the department’s website.

Staff Contact: Sarah Willson or Jane Drummond

The Centers for Medicare & Medicaid Services launched a new platform for 1135 waiver requests and inquiries. QSO21-11-ALL announces a new web-based tool, the CMS PHE Emergency Web Portal, to assist Medicare- and Medicaid-participating providers and suppliers. The web system should be used for all 1135 waiver requests and/or PHE-related inquiries except requests related to physician self-referral (Stark Law). Stark Law inquiries should be sent here. Use of the new portal should begin immediately. CMS offers a YouTube training program on use of the new portal.

Staff Contact: Keri Barclay

In COVID-19 patients admitted to intensive care units early in the pandemic, 82% were in a comatose state at some point and 55% experienced delirium, reports a Lancet study published late last week. Previous studies have connected ICU delirium to higher costs, greater mortality risk and long-term dementia. “This is double what is seen in non-COVID ICU patients,” said Brenda Pun, DNP, R.N., of Vanderbilt University Medical Center, co-first author of the study. “It is clear in our findings that many ICUs reverted to sedation practices that are not in line with best practice guidelines,” Pun added. While benzodiazepine sedative infusions were associated with a 59% higher risk of delirium, the physical or digital presence of family was associated with a 27% decrease.