12.11.20
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Past issues are available in the Media Library.
Two recent articles that included the thoughts of nationally recognized COVID-19 experts attracted my attention this week. Combined, they provide cogent account of where hospitals, the health care system and our communities are now and the challenges ahead.
Last week, I wrote about COVID-19 vaccines. One story — a question and answer story in The New Yorker with Atul Gawande — relates to that issue. However, the context provided by the other — a column in The Washington Post by Ashish K. Jha — provides important context.
Missouri, and large parts of the nation, are seeing significant increases in COVID-19 positivity rates. Historically, these rates have been an indicator for future hospitalizations. According to Jha, the rates are correlating less since Nov. 1. Jha illustrates the disconnect saying, “On Nov. 1, the COVID Tracking Project’s seven-day average showed about 80,000 new cases — which we would predict should lead to about 2,800 new hospitalizations a week later, by Nov. 8. Instead, there were 2,600, a little fewer than expected. On Nov. 15, we had 146,000 new cases, which should have resulted in about 5,100 new hospitalizations by Nov. 22. However, there were fewer than 3,700. This pattern of declining rates of hospitalization continued through the end of November.”
Jha reasons that the disconnect between the ratio of positive cases and hospitalizations are related to capacity challenges resulting in “rationing” of bed space that earlier in the pandemic would not have been necessary. He explains further, “The decision whether to admit a patient depends on two things: clinical judgment and bed availability. Critically ill patients will always be admitted. But as hospitals start to fill up, less sick patients — younger COVID patients, or those whose oxygen levels haven’t yet sunk critically low — get sent home.”
As hospitals in Missouri reach maximum capacity, these decisions are being made in real time and with implications not only for patients, but the workforce. “Some health care workers are retiring or switching professions. Others are sharing tearful videos on social media, agonized by patients who refuse to believe in the disease that is killing them.” Jha wrote. “All of them are frustrated by the failure to take more effective action against the virus.”
This week’s announcement from the U.S. Food and Drug Administration that the Pfizer vaccine will receive emergency use authorization will be perceived by many as the beginning of a light at the end of the tunnel. Vaccines may arrive as early as next week, and when final federal authorization is received, health care workers on the front line will be among the first eligible recipients.
However, according to Gawande, we are far from the end of our struggle with the virus. He told The New Yorker, “This is an undertaking on another scale from anything we’ve been doing in the last year. We have deployed north of 120 million coronavirus tests in the course of eight months. This is going to be 330 million vaccinations, done twice, and hoping to accomplish it in the course of six months or less.”
We’re already seeing the last-minute complications in Missouri and are working through the state’s planning to help hospitals operationalize it.
Here’s what I think. We will continue to experience high rates of infection through the New Year’s holiday and will have significant capacity challenges throughout the winter months. A vaccine is not a panacea; it’s an important next step. The only way to address the capacity challenge is to double down on prevention efforts while we step up vaccination efforts. These two combined actions will help reduce the toll on health care workers and save a lot of lives.
We’ve reached a critical phase of the pandemic. However, we have some very difficult days ahead.
Let me know what you think.
Herb B. Kuhn
MHA President and CEO
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