COVID-19 Update | March 2, 2021

Staff Contact: Mat Reidhead or Jackie Gatz

Understanding the drivers of the likelihood of individuals failing to receive the required second booster dose of Pfizer and Moderna COVID-19 vaccines will be critical in optimizing allocations of the newly approved single-dose Johnson and Johnson vaccines. Through March 1, 56,720 individual Missourians have not received booster doses within the manufacturer-prescribed window of 21 days for Pfizer and 28 days for Moderna. This accounts for roughly 6.5% of all individuals who have received any dose in Missouri. Due to high frequencies of ShowMeVax records missing race, it is difficult to evaluate completed booster rates along demographic lines. However, a near-monotonic relationship exists between poverty of the recipient’s ZIP code and the percent of total vaccine recipients that are overdue for the booster dose. This signals the potential for the single-dose J & J vaccines to be an effective strategy in fully protecting socially vulnerable populations. Additionally, while the distribution of vaccines to date has been driven by phase-eligible individuals and not the total population, a pattern is emerging that suggests an inverse relationship between poverty and the percent of total doses received to date across Missouri’s communities. The continued monitoring of this disparity will be critical as the state aims to increase vaccine acceptance in underserved communities.

Staff Contact: Jackie Gatz or Keri Barclay

The U.S. Food and Drug Administration issued an emergency use authorization for the third vaccine for the prevention of COVID-19. The EUA allows the Janssen COVID-19 vaccine to be distributed in the U.S for use in individuals 18 years of age and older. Overall, the vaccine was approximately 67% effective in preventing moderate to severe/critical COVID-19 occurring at least 14 days after vaccination and 66% effective in preventing moderate to severe/critical COVID-19 occurring at least 28 days after vaccination.

The vaccine is supplied in multidose vials, with five doses available per vial. The vaccine is administered intramuscularly as a single 0.5ml dose and does not require a booster dose. Unpunctured multidose vials of the Janssen vaccine can be stored at 2°C to 8°C (36°F to 46°F), and should be protected from light and not be stored frozen. Unpunctured vials of the Janssen vaccine may be stored between 9°C to 25°C (47°F to 77°F) for up to 12 hours. Vials that have been punctured, after the first dose, should be stored between 2°C to 8°C (36° to 46°F) for up to six hours or at room temperature (maximally 25°C/77°F) for up to two hours. Discard the vial if vaccine is not used within these times.

Janssen/Johnson & Johnson published a fact sheet for health care providers and recipients with additional information. The Missouri Department of Health and Senior Services, along with Dr. Randall Williams, issued a standing order to support usage.

Staff Contact: Jackie Gatz or Keri Barclay

The U.S. Food and Drug Administration announced that it is allowing undiluted frozen vials of the Pfizer-BioNTech COVID-19 vaccine to be transported and stored at conventional temperatures commonly found in pharmaceutical freezers for a period of up to two weeks. This reflects an alternative to the preferred storage of the undiluted vials in an ultra-low temperature freezer between -80ºC to -60ºC (-112ºF to -76ºF). The change is reflected in updates to the Fact Sheet for Healthcare Providers Administering Vaccine.

Staff Contact: Jackie Gatz or Daphney Partridge

Last week, Gov. Parson announced the expansion of vaccination to Phase 1B – Tier 3 eligible Missourians, beginning Monday, March 15. Parson said that the move would increase the eligible population to 3.5 million. Tomorrow, March 3, MHA will hold a member-only event with Rob Dixon, Director of the Missouri Department of Economic Development, who will outline the state’s plan and next steps – including the role of hospitals – for Phase 1B – Tier 3 activation.

Staff Contact: Mary Becker

The Ad Council and COVID Collaborative revealed their COVID-19 Vaccine Education Initiative, “It’s Up To You.” Representing one of the largest public education efforts in U.S. history, more than 300 major brands, media companies, community-based organizations, faith leaders, medical experts and other trusted messengers are supporting the campaigns designed to reach distinct audiences. Creative assets in English and Spanish will appear nationwide across broadcast TV, digital, radio, out-of-home and social media, and in partnership with a wide range of organizations to inform the development and distribution of culturally resonant content for Black and Hispanic audiences. Organizations are welcome to participate by using the available “open source” toolkits and promoting the campaign website GetVaccineAnswers.org.

Staff Contact: Mary Becker

Keri Barclay, MHA’s Manager of Clinical Preparedness, worked last weekend for her local hospital, Harrison County Community Hospital, and EMS providers to vaccinate the community in Bethany, Mo. During the regional event coordinated by the RIT and local public health agencies, more than 1,000 Pfizer booster doses were provided to complete everyone’s vaccine series.

Reflecting on the event, Keri said, “I think what makes our events stand out is the extensive teamwork throughout the NW Region Healthcare Coalition, and we have an AMAZING public health planner, Lesley Schulte. I love participating in these events because I’m able to tangibly experience the work of the MHA team that I am blessed to be a part of. It also helps me not lose a “boots on the ground” perspective and supports MHA efforts in remaining operationally helpful. At the end of the day, hospitals are here to help people. It is an amazing gift to help those people in my community rebuild from the past year, which has been difficult for all.”

At a mass vaccination event this Saturday in Harrison County, Keri will work with the local EMS unit vaccinating, monitoring and responding to any adverse reactions.

Staff Contact: Daniel Landon

The U.S. House of Representatives approved COVID-19 relief/stimulus legislation. The $1.9 trillion package includes many components affecting hospitals. Two of particular interest for Missouri hospitals address Medicaid. One authorizes substantial new federal funding for states, which implement an expansion of Medicaid eligibility after the enactment of this legislation. Missouri’s constitution calls for Medicaid expansion to begin July 1, 2021. The other resolves an inadvertent formula-driven reduction of Medicaid Disproportionate Share Hospital payments to hospitals in Missouri and some other states. Missouri hospitals would benefit by a projected $75 million. The U.S. Senate is crafting its version of the legislation.

Staff Contact: Andrew Wheeler

In accordance with an Executive Order signed by President Biden, the Centers for Medicare & Medicaid Services, the U.S. Department of Labor, and the U.S. Department of Treasury issued new guidance about diagnostic testing and vaccination coverage. The guidance also provides additional billing guidance for COVID-19-related services on behalf of the uninsured. MHA published an issue brief with additional details.

Staff Contact: Keri Barclay

Emergencies happen even in the midst of pandemics. As severe weather season is upon us, it is important to consider the implications of a response with infectious disease patients. Consider the following when sheltering in place.

• masking patients in hallways
• masking all patients and visitors who are relocated to safer spaces
• logging of persons co-located in spaces should contact tracing need to occur

In the event that there is a mass casualty incident resulting from severe weather or another scenario, the following precautions and screening for COVID-19 patients should remain in place.

• appropriate personal protective equipment for triage officers and staff
• COVID-19 screening for all patients triaged green or yellow status
• assumed person under investigation status for all patients triaged red or black status
• separate waiting areas for symptomatic patients identified in initial COVID-19 screening and triage process

All patients requiring EMS transport, either for evacuation or additional care, should be cared for with the protocols of the transferring entity. The patient’s infectious disease status should be clearly communicated to EMS staff and noted on transport documentation.

The National Academies of Sciences, Engineering and Medicine recently released guidance that identifies strategies for emergency planners and decision-makers to consider as they update their disaster plans for sheltering, mass care and evacuation amidst COVID-19.

Staff Contact: Sarah Willson

The Joint Commission announced they will return to performing unannounced surveys in hospitals as part of their accrediting body work. The Accrediting Organization notes that effective Monday, March 15, they will return to their normal suvey procedures, including onsite and unannounced surveys.

Staff Contact: Kendra Hanauer or Dave Dillon

One in 10 Missouri adults have a serious mental illness, and 40% of those adults go without treatment. The destabilizing effects of COVID-19 may have further compounded mental health challenges in the state. Researchers found there were 6,807 fewer mental health inpatient admissions in Missouri between March and September 2020 — a decline of 17.5%.

Access to mental health services is an ongoing significant challenge, especially in rural Missouri where each of Missouri’s 99 rural counties is a designated Mental Health Professional Shortage Area.

MHA, the Missouri Department of Mental Health and the Missouri Coalition for Community Behavioral Healthcare encourage hospitals, clinics and community organizations to share the importance of intervention by distributing and sharing these important messages communitywide. Working together, we can remind Missourians that there is no reason to delay care, and regular care may save lives.

This is the fifth and final installment of the “COVID-19 and Delayed Care” digital campaign. Previous releases include data on screenings for cancer, heart disease, diabetes and substance use disorder, as well as well-child visits.

Staff Contact: Jackie Gatz or Keri Barclay

Drug shortages have been a reoccurring problem in U.S. health care before the COVID-19 pandemic. To provide situational awareness, the Resilient Drug Supply Project and a panel of experts created a Critical Drug Shortage Dashboard. To track shortages of drugs related to the COVID-19 pandemic, the RDSP team compiled a list of 40 critical COVID-19 drugs, including potential antiviral treatments, intubation drugs and more, which are monitored on the dashboard.