COVID-19 Update | May 25, 2021

Staff Contact: Mat Reidhead or Jackie Gatz

The COVID-19 pandemic has introduced an accelerant to the child and adolescent mental health crisis in the U.S. Survey data on high school students from the Centers for Disease Control and Prevention show that in the decade leading up to the pandemic, students experiencing persistent sadness or hopelessness increased by 42% (from 26% in 2009 to 37% in 2019), students with suicide ideation increased by 36% (14% to 19%), students with suicide planning increased by 46% (11% to 16%) and students attempting suicide increased by 50% (6% to 9%).

While survey data on children’s mental health during the pandemic are not yet available, hospital emergency department claims data are suggestive of the profound impact of the pandemic on pediatric stress induced by fear, social isolation, remote learning and residual factors, such as family financial stress and the contemporary discourse on politics and social injustice. Since COVID-19 first arrived in Missouri in March 2020, the portion of child and adolescent ED visits for obsessive-compulsive, anxiety and stress disorders have increased by 104%; visits for major depression have increased by 62%; and visits for suicide attempt or ideation have increased by 64%.

Recognizing the varied warning signs of emotional stress in children and being aware of resources are critical steps in preventing mental health crises and suicides among children and adolescents. For life-threatening situations, call 911 or visit the nearest hospital emergency room. If a child is experiencing thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255, or text “START” to 741-741.

NOTICE: The state of Missouri retired its ShowMeStrong Recovery site and dashboards on May 24. The data and dashboards continue to be available on the Missouri Department of Health and Senior Services website.

Staff Contact: Daniel Landon

Gov. Parson and key leaders of his administration participated in a conference call yesterday with the MHA membership on the state’s response to the COVID-19 emergency. Noting that it was the final scheduled call, the governor thanked Missouri hospitals for their engagement and collaboration in responding to the pandemic. The state also is winding down some of its COVID-19 response functions as vaccination demand and disease metrics decline. To date, 4.5 million doses of vaccine have been administered in Missouri, and 2.5 million Missourians have initiated vaccination. The Pfizer vaccine now is available in smaller quantities, with new guidance available regarding its temperature and storage requirements. The Parson administration encourages vaccinators to “stay in the game” so that vaccination is available and convenient for those who seek it. State officials are considering whether to offer vaccination incentives and what they might be. A member query raised considerations for structuring vaccination incentives.

Staff Contact: Kara Amann-Kale or Jackie Gatz

Changes related to the Pfizer-BioNTech COVID-19 vaccine were announced this week that make the vaccine more accessible to vaccinators, as vaccination efforts have shifted from volume to convenience.

• The U.S. Food and Drug Administration authorized undiluted, thawed Pfizer-BioNTech vaccine vials to be stored in the refrigerator (2°C to 8°C) for as long as one month. Previously, storage in the refrigerator was authorized for as long as five days. The Fact Sheet for Health Care Providers Administering Vaccine has been updated to help front-line staff understand the revised storage time.
• In June, vaccinators will be able to order the Pfizer vaccine in quantities of 450 doses. The ancillary kits shipped with these orders will be packaged either for adult or pediatric administration, and vaccinators will have to indicate which they would like to receive. The shipping container for the 450-dose orders cannot be used for vaccine storage. Instead, vaccine must be transferred to appropriate storage upon receipt and the shipping container returned to the manufacture. Vaccinators also can continue to place orders for 1,170 doses. The Missouri Department of Health and Senior Services vaccine order form will be updated to reflect these changes.

Staff Contact: Kara Amann-Kale or Jackie Gatz

With vaccine supply abundant and also nearing expiration dates, the Missouri Department of Health and Senior Services issued COVID-19 wastage guidance for vaccinators. Vaccinators with vaccine nearing expiration should attempt to use or redistribute vials for expedited use before expiration. Hospitals are reminded to use the EMResource COVID-19 Excess Vaccine Supply for Redistribution query to list vaccine that is available for transfer. If vaccine expires before use, vaccinators should dispose of the vaccine and report it as wastage. This is a change in recent guidance.

Staff Contact: Jackie Gatz or Mat Reidhead

A recent Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report noted the disparity of vaccination coverage between urban and rural counties. The report noted that residents of rural communities are at an increased risk for severe COVID-19-associated morbidity and mortality. In addition, COVID-19 vaccination coverage was lower in rural counties (38.9%) than in urban counties (45.7%), and disparities persisted among age groups and by gender. The disparities in COVID-19 vaccination access and coverage between urban and rural communities can hinder progress toward ending the pandemic. The report encourages all health care providers to collaborate with community partners to identify and address barriers to COVID-19 vaccination in rural areas.

Staff Contact: Keri Barclay or Kara Amann-Kale

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices COVID-19 Vaccine Safety Technical Work Group reviewed reports of myocarditis following administration of mRNA vaccines. The group reported that the relatively few cases appear to occur in the following instances.

• predominantly in adolescents and young adults
• more often in males than females
• more often following dose two than dose one
• typically within four days after vaccination

Reports of myocarditis following vaccination do not differ from expected in baseline rates, and cases may be unrelated to vaccination. The CDC safety group will continue to investigate, but it shared this information to enhance clinical recognition and management of myocarditis following COVID-19 vaccine administration. This shows the strength of the surveillance systems, such as the Vaccine Adverse Event Reporting System, in place to monitor vaccine safety.

Staff Contact: Keri Barclay or Kara Amann-Kale

MHA, in coordination with the Missouri Department of Health and Senior Services’ Bureau of Immunization, is hosting an informational webinar to increase hospitals’ awareness of the forthcoming COVID-19 vaccinator audits. These in-person visits by DHSS staff are at the direction of the Centers for Disease Control and Prevention and are tentatively scheduled to begin Thursday, July 1. The webinar will take place the week of June 7. Watch your email for additional details.

Staff Contact: Keri Barclay

The Centers for Disease Control and Prevention is hosting a Clinician Outreach and Communication Activity call, “Underlying Medical Conditions and Severe COVID-19: Evidence-based Information for Health Care Providers,” at 1 p.m. CDT Thursday, May 27. This call will provide updates to what has been learned about the risk factors for severe COVID-19 outcomes, describe the methods used to rate the evidence linking conditions to severe COVID-19, review the evidence on risk for conditions included and provide resources for health care providers caring for patients with underlying medical conditions.

Staff Contact: Sarah Willson or Jane Drummond

The Centers for Disease Control and Prevention’s masking guidelines for unvaccinated and fully vaccinated individuals, in conjunction with the Centers for Medicare & Medicaid Services infection control guidance, reinforces the requirement for continued screening and masking in hospitals. In addition, the American Hospital Association recently published an article highlighting the continued masking requirements. MHA will continue to monitor guidance and inform members of changes.

Staff Contact: Jackie Gatz

The Frontline Families Scholarship Fund was established to provide educational assistance to the surviving family members of front-line health care workers and volunteers who lost their lives in the fight against COVID-19. The scholarship program is not competitive; all eligible applicants will receive awards. The following individuals may apply for the scholarship.

• children of front-line health care workers who worked in medical facilities and lost their lives to COVID-19
• high school seniors or graduates, or current college undergraduates
• students who plan to enroll in full-time or part-time undergraduate study at an accredited two- or four-year college, university or vocational-technical school for the entire upcoming academic year

Staff Contact: Jill Williams

The Health Resources and Service Administration announced a second round of grant funding to support the community-based workforce to increase vaccine access. The purpose of the program is to establish, expand and sustain a health care workforce to prevent, prepare for and respond to COVID-19. This includes community health workers, patient navigators and social support specialists to educate and assist individuals in accessing and receiving COVID-19 vaccinations. The program intends to address persistent health disparities by offering support and resources to vulnerable and medically underserved communities, including racial and ethnic minority groups and individuals living in areas of high social vulnerability.