This report from the Missouri Hospital Association is designed to help you stay abreast of recent developments related to COVID-19.

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Dashboard Spotlight

Herd Immunity Or A New Normal?

Staff Contact: Mat Reidhead or Jackie Gatz

A new debate is emerging in the scientific community on whether herd immunity against COVID-19 is achievable, or whether a new normal of living with the virus is more likely. Herd immunity refers to the concept in virology where the portion of the population having protection — induced from vaccination or previous infection — is large enough to prevent transmission of the disease. Unfortunately, the novel SARS-CoV-2 coronavirus and its vaccines are so novel that data supporting the possibility of herd immunity are clouded in uncertainty. For starters, estimates on the portion of the population needing protection range widely from 60% to 85%. Furthermore, due to large rates of asymptomatic cases, no one knows what the actual infection rate is, although the Centers for Disease Control and Prevention estimates it to be 4.6 times the known infection rate in the U.S. Additionally, the duration of seropositive protection is unknown, as is the efficacy of the vaccines against emerging variants. Other significant barriers underly the fact that the vaccines are not currently approved for children who make up one-fifth of the population and unanticipated sources of vaccine hesitancy — particularly along political lines — are becoming manifest.

Considering these unknowns, it is important to emphasize the words “crude estimates” in the following analysis designed to project possible dates when the critical mass of Missourians with either form of protection will converge with estimates required to induce herd immunity. Inputs include known rates of infection, CDC estimates of latent infections and known rates of vaccine series completion by Missouri residents. By March 21, 9.3% of Missouri’s total population had tested positive with diagnostic or antigen tests — using CDC estimates on unreported cases suggests the true disease burden to be 42.8% of Missourians with potential seropositive protection. On the same date, 690,000 Missourians (11.2% of the population) had completed the vaccine series. Assuming the same portion of the population with protection from a previous infection sought out the vaccines infers that 6.4% of the population has vaccine-induced protection without seropositivity from a previous infection. Using the average daily percent change in known infections and vaccine series completion between Feb. 1 and Mar. 21, 2021, to impose linear projections on the data suggests that 65% of Missourians will have some form of protection against COVID-19 by July 6. Following recent linear trends, the analysis suggests the mid-level estimate required for herd immunity of 75% would be reached by Sept. 22, and 85% of the population would have some form of protection by Dec. 22. While it is important to have targeted dates to anticipate, it also is important to understand that any one of the myriad assumptions underlying this analysis are subject to change — for example, another surge in cases, or vaccine demand becoming more anemic would significantly alter convergence dates.

MHA and HIDI will continue to monitor the data and update these projections and underlying modeling accordingly. It is critically important that Missourians continue to stave off complacency with continued masking, physical distancing and hand hygiene in addition to becoming vaccinated when eligible.

Crude Estimates of Herd Immunity Achievement in Missouri

Vaccine Updates

AstraZeneca Provides Vaccine Update

Staff Contact: Keri Barclay or Kara Amann-Kale

Yesterday, AstraZeneca announced its intent to seek emergency use authorization from the U.S. Food and Drug Administration for its COVID-19 vaccine. This was based upon their conclusions form the U.S. Phase III trial that demonstrated statistically significant vaccine efficacy of 79% at preventing symptomatic COVID-19 and 100% efficacy at preventing severe disease and hospitalization. However, hours later, the National Institute of Allergy and Infectious Disease was notified by the Data and Safety Monitoring Board of “outdated information from that trial, which may have provided an incomplete view of the efficacy data.” NIAID is urging AstraZeneca to work with the DSMB to update the efficacy data and make it publicly available as soon as possible.

Missouri Baptist Medical Center Shares Patient Story

Staff Contact: Mary Becker

In March 2020, Kaven Swan was treated for COVID-19 at Barnes-Jewish Hospital. In a video posted by Missouri Baptist Medical Center, Swan shares his experience, thanking the BJC team members for their care saying, “There were hundreds of people there that day, but they made me feel like I was the only patient.” After getting his vaccination, Swan asked how he could give back to the team that saved his life. As an advocate for the entire BJC team, he is sharing his story and has volunteered at a BJC vaccination clinic.

Advocacy

MHA Requests Extension Of Waivers

Staff Contact: Jane Drummond

MHA submitted a letter to Gov. Parson urging him to extend both the statewide emergency declaration and the regulatory waivers that have been granted during the course of the COVID-19 pandemic. The governor’s emergency declaration is set to expire Wednesday, March 31, and provides authority for the state waivers that hospitals have utilized to respond to COVID-19.

MHA asked that the governor also consider allowing a 60-day winding-down period before the expiration of any waivers, which the Centers for Medicare & Medicaid Services indicated it will do with the federal waivers.

Government Action

FEMA Updates COVID-19 Public Assistance Policy

Staff Contact: Andrew Wheeler

The Federal Emergency Management Agency updated its policy, “Coronavirus Pandemic: Medical Care Eligible for Public Assistance.” The updated policy increases the federal cost share to 100%, focuses funding on high-risk communities and underserved populations, and provides details on eligibility for funding of vaccination programs.

FEMA Offers COVID-19 Funeral Assistance

Staff Contact: Jackie Gatz

Beginning in April, the Federal Emergency Management Agency will provide financial assistance for COVID-19-related funeral expenses incurred after Jan. 20, 2020. To be eligible for assistance, the death must have occurred in the U.S., including territories, and the death certificate must indicate the death was attributed to COVID-19. FEMA will begin accepting applications in April, but the agency encourages those applying to keep and gather information, such as the death certificate, funeral expense documents and proof of funds received from other sources. Additional information is being added to the FEMA website as details are finalized.

Education

NETEC Offers Ebola Webinar

Staff Contact: Keri Barclay

The National Emerging Special Pathogen Training and Education Center is hosting a webinar, “Ebola in the Age of COVID,” at noon CDT Wednesday, March 24. Discussions will include current Ebola outbreaks, identification and isolation of possible Ebola patients, medical countermeasures, and vaccine initiatives. In addition, personal protective equipment guidelines and workflow for the care of Ebola patients will be reviewed. This is a timely offering, and interim guidance on risk assessment and management of persons with potential Ebola virus exposure is available from the Centers for Disease Control and Prevention. Online registration is available.

Rural Resources

RHC COVID-19 Testing FAQs And Data Submission Reminder

Staff Contact: Andrew Wheeler

Hospitals that own and operate Rural Health Clinics received funding to assist with the cost of COVID-19 testing. The Health Resources and Services Administration published FAQs that are specific to the RHC COVID-19 testing program. RHCs also are required to report the number of COVID-19 tests conducted each month. February data is due Wednesday, March 31.

Testing, Reporting & Treatment

FDA Authorizes AI Armband For COVID-19 Screening

Staff Contact: Keri Barclay

The U.S. Food and Drug Administration granted an emergency use authorization to Tiger Tech Solutions for a COVID-19 screening tool that utilizes a digital armband and Artificial Intelligence algorithms to detect biomarkers for possible COVID-19 infection. The armband is authorized for use in conjunction with temperature monitoring and utilizes technology similar to fitness trackers that look for data indicating a person’s blood could be clotting more easily than normal. Hypercoagulation — combined with other signs — has been linked to COVID-19 infections and could help identify asymptomatic infected persons over the age of 5. The device is not diagnostic and does not replace COVID-19 testing. The COVID Plus Monitor, according to the FDA, does show that the device matched up with the findings of diagnostic tests 98.6% of the time in finding positive cases in a hospital and 94.5% of the time when ruling out negative cases.

COVID-19 Update | March 23, 2021

This report from the Missouri Hospital Association is designed to help you stay abreast of recent developments related to COVID-19.

Dashboard Spotlight

Herd Immunity Or A New Normal?