NYC Nears High Covid-Alert Level, May Consider Requiring Masks

https://www.bloomberg.com/news/articles/2022-05-16/nyc-may-reach-high-covid-alert-level-consider-requiring-masks

  • City strongly recommends masks in public indoor places for now
  • About 8% of people tested for Covid in city have been positive

New York City is preparing to hit a high Covid-transmission level in the coming days that would have it reconsidering mask requirements in public places.

“If NYC’s Alert Level is raised to High, the City will consider requiring face masks in all public indoor settings,” according to guidance on the city health department’s website.

New cases per 100,000 people over the last seven days surpassed 300 citywide, with Staten Island the highest at 390, followed by Manhattan at about 366. A month ago, the citywide rate was less than 200 per 100,000. About 8% of people tested for Covid-19 over the last seven days have been positive. 

Earlier in May the city moved to a medium alert from low.

“New York City is preparing to potentially enter a high COVID-19 alert level in the coming days and strongly recommends that all New Yorkers mask up in public indoor settings to protect themselves and others,” according to a statement Monday from Mayor Eric Adams’s office.

A high level is reached when new Covid hospital admissions over seven days surpass 10 per 100,000 and the percentage of staffed inpatient beds occupied by Covid-19 patients is greater than 10%, according to guidance from the US Centers for Disease Control and Prevention.

Masks Indoors

New York City’s new admissions are at 9.2 per 100,000 and increasing, while 3.85% of inpatients beds were occupied by Covid-19 patients as of May 10.

Under a high alert level, in addition to masking indoors, New Yorkers are recommended to limit gatherings to small numbers and get tested if they have symptoms, were exposed, traveled or were at a large event. 

The city is distributing 16.5 million at-home Covid tests over the next month in an effort to prepare for another wave. The increase in tests will bring the total amount distributed to more than 36 million.

Most of the US remained at a low Covid community transmission-level as of May 12, with medium and high alerts mostly concentrated in the northeast, CDC data show. The nationwide case rate is 185 per 100,000 in the past seven days, up from 66 a month earlier. The rate surged to more than 1,700 per 100,000 during the omicron surge in January. 

COVID-19 hospitalizations up in 39 states 

COVID-19 hospitalizations are up 20 percent nationwide over the last 14 days, with 39 states and Washington, D.C., reporting an increase. 

Nationwide, COVID-19 cases increased 58 percent over the past 14 days, according to HHS data collected by The New York Times. Reported case counts may be directionally helpful at this point of the pandemic, given the use of rapid, at-home COVID-19 tests that result in under-counting.

“I think that we’re dramatically undercounting cases,” former FDA commissioner Scott Gottlieb, MD, told CBS News April 11. “We’re probably only picking up one in seven or one in eight infections.”

Hospitalizations are up 20 percent nationwide over the last 14 days, with a daily average of 19,694 people hospitalized with COVID-19 as of May 12. The CDC is keeping a close eye on the acuity of hospitalizations, with Director Rochelle Walensky, MD, noting that the agency is seeing less oxygen use, fewer ICU stays and no increase in associated death compared with earlier periods of the pandemic.

Here are the 14-day changes for hospitalizations in each state and Washington, D.C., reporting an increase, along with their daily average hospitalizations: 

Hawaii: 64 percent (92 hospitalizations)  

Maine: 61 percent (222)

Montana: 58 percent (25)

Massachusetts: 55 percent (703)

Pennsylvania: 47 percent (1,104)

Alaska: 45 percent (38)

Connecticut: 42 percent (337)

Michigan: 42 percent (812)

Rhode Island: 40 percent (87) 

Wisconsin: 39 percent (314) 

Delaware: 37 percent (188)

Iowa: 36 percent (113)

New Hampshire: 35 percent (112)

New York: 31 percent (2,627)

Virginia: 31 percent (383)

Minnesota: 28 percent (404)

Florida: 28 percent (1,380)

New Jersey: 27 percent (707)

Maryland: 25 percent (458) 

West Virginia: 24 percent (120)

Illinois: 23 percent (815)

Nevada: 23 percent (161) 

Ohio: 22 percent (734) 

Oregon: 20 percent (284)

Kentucky: 19 percent (249)

Washington, D.C.: 19 percent (84) 

Colorado: 18 percent (170) 

Vermont: 17 percent (64)

Indiana: 15 percent (297)

California: 14 percent (1,463) 

South Carolina: 13 percent (127)

Louisiana: 11 percent (65)

Kansas: 7 percent (79)

Georgia: 5 percent (576)

North Carolina: 5 percent (877) 

Utah: 4 percent (72)

Idaho: 4 percent (45)

Missouri: 3 percent (384) 

Nebraska: 2 percent (76) 

Arkansas: 2 percent (97) 

The 14-day changes for cases in each state reporting an increase, along with their daily average cases, can be found through HHS data collected by The New York Times here. Seven-day changes for cases in each state can be found here.

The more contagious omicron subvariant BA.2 makes up 68.1 percent of new cases in the U.S., according to the latest estimates from the CDC. New Jersey has the highest proportion of BA.2 cases of all states, according to the latest ranking of states by the subvariant’s prevalence.

President Joe Biden signed into law March 15 a sweeping $1.5 trillion bill that funds the government through September. The legislation did not include COVID-19 funding the White House had requested from Congress because of partisan disagreement about offsetting the funding.

The current lack of funding is affecting resources for COVID-19 testing and treatment. The Health Resources and Services Administration stopped accepting providers’ claims for COVID-19 testing and treatment of the uninsured March 22 because of a lack of sufficient funds, and stopped accepting claims for the vaccination of uninsured people April 5. The federal government is also cutting back shipments of monoclonal antibody treatments to states by 30 percent, and the U.S. supply of those treatments could run out as soon as May. 

US may see ‘pretty sizable’ fall COVID-19 surge, Dr. Ashish Jha warns

The U.S. may see a “pretty sizable wave” of COVID-19 infections this fall and winter as the virus continues to evolve and immunity wanes, White House Covid-19 Response Coordinator Ashish Jha, MD, said May 8 on ABC News‘ “This Week.”

Federal health officials are looking at a range of disease forecasting models, which suggest the U.S. could experience a large surge in late 2022, similar to the last two winters, according to Dr. Jha. On May 6, the White House projected 100 million COVID-19 infections could occur this fall and winter, according to The Washington Post.

If we don’t get ahead of this thing … we may see a pretty sizable wave of infections, hospitalizations and deaths this fall and winter,” he said. “Whether that happens or not is largely up to us as a country. If we can prepare and if we can act, we can prevent that.”

More funding to purchase COVID-19 vaccines and therapeutics will be crucial to stave off a potential surge, according to Dr. Jha. The Biden administration is asking Congress for an additional $22.5 billion in emergency aid to support these efforts. 

“If Congress does not do that now, we will go into this fall and winter with none of the capabilities that we have developed over the last two years,” Dr. Jha said.

Covid deaths no longer overwhelmingly among the unvaccinated as toll on elderly grows

Unvaccinated people accounted for the overwhelming majority of deaths in the United States throughout much of the coronavirus pandemic. But that has changed in recent months, according to a Washington Post analysis of state and federal data.

The pandemic’s toll is no longer falling almost exclusively on those who chose not to or could not get shots, with vaccine protection waning over time and the elderly and immunocompromised — who are at greatest risk of succumbing to covid-19, even if vaccinated — having a harder time dodging increasingly contagious strains.

The vaccinated made up 42 percent of fatalities in January and February during the highly contagious omicron variant’s surge, compared with 23 percent of the dead in September, the peak of the delta wave, according to nationwide data from the Centers for Disease Control and Prevention analyzed by The Post. The data is based on the date of infection and limited to a sampling of cases in which vaccination status was known.

As a group, the unvaccinated remain far more vulnerable to the worst consequences of infection — and are far more likely to die — than people who are vaccinated, and they are especially more at risk than people who have received a booster shot.

“It’s still absolutely more dangerous to be unvaccinated than vaccinated,” said Andrew Noymer, a public health professor at the University of California at Irvine who studies covid-19 mortality.“A pandemic of — and by — the unvaccinated is not correct. People still need to take care in terms of prevention and action if they became symptomatic.”

A key explanation for the rise in deaths among the vaccinated is that covid-19 fatalities are again concentrated among the elderly.

Nearly two-thirds of the people who died during the omicron surge were 75 and older, according to a Post analysis, compared with a third during the delta wave. Seniors are overwhelmingly immunized, but vaccines are less effective and their potency wanes over time in older age groups.

Experts say they are not surprised that vaccinated seniors are making up a greater share of the dead, even as vaccine holdouts died far more often than the vaccinated during the omicron surge, according to the CDC. As more people are infected with the virus, the more people it will kill, including a greater number who are vaccinated but among the most vulnerable.

The bulk of vaccinated deaths are among people who did not get a booster shot, according to state data provided to The Post. In two of the states, California and Mississippi, three-quarters of the vaccinated senior citizens who died in January and February did not have booster doses. Regulators in recent weeks have authorized second booster doses for people over the age of 50, but administration of first booster doses has stagnated.

Even though the death rates for the vaccinated elderly and immunocompromised are low, their losses numbered in the thousands when cases exploded, leaving behind blindsided families. But experts say the rising number of vaccinated people dying should not cause panic in those who got shots, the vast majority of whom will survive infections. Instead, they say, these deaths serve as a reminder that vaccines are not foolproof and that those in high-risk groups should consider getting boosted and taking extra precautions during surges.

“Vaccines are one of the most important and longest-lasting tools we have to protect ourselves,” said California State Epidemiologist Erica Pan, citing state estimates showing vaccines have shown to be 85 percent effective in preventing death.

“Unfortunately, that does leave another 15,” she said.

‘He did not expect to be sick’

Arianne Bennett recalled her husband, Scott Bennett, saying, “But I’m vaxxed. But I’m vaxxed,” from the D.C. hospital bed where he struggled to fight off covid-19 this winter.

Friends had a hard time believing Bennett, co-founder of the D.C.-based chain Amsterdam Falafelshop, was 70. The adventurous longtime entrepreneur hoped to buy a bar and planned to resume scuba-diving trips and 40-mile bike rides to George Washington’s Mount Vernon estate.

Bennett went to get his booster in early December after returning to D.C. from a lodge he owned in the Poconos, where he and his wife hunkered down for fall. Just a few days after his shot, Bennett began experiencing covid-19 symptoms, meaning he was probably exposed before the extra dose of immunity could kick in. His wife suspects he was infected at a dinner where he and his server were unmasked at times.

A fever-stricken Bennett limped into the hospital alongside his wife, who was also infected, a week before Christmas. He died Jan. 13, among the 125,000 Americans who succumbed to covid-19 in January and February.

“He was absolutely shocked. He did not expect to be sick. He really thought he was safe,’” Arianne Bennett recalled. “And I’m like, ‘But baby, you’ve got to wear the mask all the time. All the time. Up over your nose.’”

Jason Salemi, an epidemiologist at the University of South Florida College of Public Health, said the deaths of vaccinated people are among the consequences of a pandemic response that emphasizes individuals protecting themselves.

“When we are not taking this collective effort to curb community spread of the virus, the virus has proven time and time again it’s really good at finding that subset of vulnerable people,” Salemi said.

While experts say even the medically vulnerable should feel assured that a vaccine will probably save their lives, they should remain vigilant for signs of infection. As more therapeutics become available, early detection and treatment is key.

When Wayne Perkey, 84, first started sneezing and feeling other cold symptoms in early February, he resisted his physician daughter’s plea to get tested for the coronavirus.

The legendary former morning radio host in Louisville had been boosted in October. He diligently wore a mask and kept his social engagements to a minimum. It must have been the common cold or allergies, he believed. Even the physician who ordered a chest X-ray and had no coronavirus tests on hand thought so.

Perkey relented, and the test came back positive. He didn’t think he needed to go to the hospital, even as his oxygen levels declined.

“In his last voice conversation with me, he said, ‘I thought I was doing everything right,’” recalled Lady Booth Olson, another daughter, who lives in Virginia. “I believe society is getting complacent, and clearly somebody he was around was carrying the virus. … We’ll never know.”

From his hospital bed, Perkey resumed a familiar role as a high-profile proponent for vaccines and coronavirus precautions. He was familiar to many Kentuckians who grew up hearing his voice on the radio and watched him host the televised annual Crusade for Children fundraiser. He spent much of the pandemic as a caregiver to his ex-wife who struggled with chronic fatigue and other long-haul covid symptoms.

“It’s the 7th day of my Covid battle, the worst day so far, and my anger boils when I hear deniers talk about banning masks or social distancing,” Perkey wrote on Facebook on Feb. 16, almost exactly one year after he posted about getting his first shot. “I remember times we cared about our neighbors.”

In messages to a family group chat, he struck an optimistic note. “Thanks for all the love and positive energy,” he texted on Feb. 23. “Wear your mask.”

As is often the case for covid-19 patients, his condition rapidly turned for the worse. His daughter Rebecca Booth, the physician, suspects a previous bout with leukemia made it harder for his immune system to fight off the virus. He died March 6.

“Really and truly his final days were about, ‘This virus is bad news.’ He basically was saying: ‘Get vaccinated. Be careful. But there is no guarantee,’” Rebecca Booth said. “And, ‘If you think this isn’t a really bad virus, look at me.’ And it is.”

Hospitals, particularly in highly vaccinated areas, have also seen a shift from covid wards filled predominantly with the unvaccinated. Many who end up in the hospital have other conditions that weakens the shield afforded by the vaccine.

Vaccinated people made up slightly less than half the patients in the intensive care units of Kaiser Permanente’s Northern California hospital system in December and January, according to a spokesman.

Gregory Marelich, chair of critical care for the 21 hospitals in that system, said most of the vaccinated and boosted people he saw in ICUs were immunosuppressed, usually after organ transplants or because of medications for diseases such as lupus or rheumatoid arthritis.

“I’ve cared for patients who are vaccinated and immunosuppressed and are in disbelief when they come down with covid,” Marelich said.

‘There’s life potential in those people’

Jessica Estep, 41, rang a bell celebrating her last treatment for follicular lymphoma in September. The single mother of two teenagers had settled into a new home in Michigan, near the Indiana border. After her first marriage ended, she found love again and got married in a zoo in November.

As an asthmatic cancer survivor, Estep knew she faced a heightened risk from covid-19, relatives said. She saw only a tight circle of friends and worked in her own office in her electronics repair job. She lived in an area where around 1 in 4 residents are fully vaccinated. She planned to get a booster shot in the winter.

“She was the most nonjudgmental person I know,” said her mother, Vickie Estep. “It was okay with her if people didn’t mask up or get vaccinated. It was okay with her that they exercised their right of choice, but she just wanted them to do that away from her so that she could be safe.”

With Michigan battling back-to-back surges of the delta and omicron variants, Jessica Estep wasn’t able to dodge the virus any longer — she fell ill in mid-December. After surviving a cancer doctors described as incurable, Estep died Jan. 27. Physicians said the coronavirus essentially turned her lungs into concrete, her mother said.

Estep’s 14-year-old daughter now lives with her grandparents. Her widower returned to Indianapolis just months after he moved to Michigan to be with his new wife.

Her family shared her story with a local television station in hopes of inspiring others to get vaccinated, to protect people such as Estep who could not rely on their own vaccination as a foolproof shield. In response to the station’s Facebook post about the story, several commenters shrugged off their pleas and insinuated it was the vaccines rather than covid causing deaths.

Immunocompromised people and those with other underlying conditions are worth protecting, Vickie Estep said. “There’s life potential in those people.”

A delayed shot

As Arianne Bennett navigates life without her husband, she hopes the lesson people heed from his death is to take advantage of all tools available to mitigate a virus that still finds and kills the vulnerable, including by getting boosters.

Bennett wore a music festival shirt her husband gave her as she walked into a grocery store to get her third shot in March. Her husband urged her to get one when they returned to D.C., but she became sick at the same time he did. She scheduled the appointment for the earliest she could get the shot: 90 days after receiving monoclonal antibodies to treat the disease.

My booster! Yay!” Bennett exclaimed in her chair as the pharmacist presented an updated vaccine card.

“It’s been challenging, but we got through it,” the pharmacist said, unaware of Scott Bennett’s death.

Tears welled in Bennett’s eyes as the needle went in her left arm, just over a year after she and her husband received their first shots.

“Last time we got it, we took selfies: ‘Look, we had vaccines,’” Bennett said, beginning to sob. “This one leaves me crying, missing him so much.”

The pharmacist leaned over and gave Bennett a hug in her chair.

“He would want you to do this,” the pharmacist said. “You have to know.”

Methodology

Death rates compare the number of deaths in various groups with an adjustment for the number of people in each group. The death rates listed for the fully vaccinated, the unvaccinated and those vaccinated with boosters were calculated by the CDC using a sample of deaths from 23 health departments in the country that record vaccine status, including boosters, for deaths related to covid-19. The CDC study assigns deaths to the month when a patient contracted covid-19, not the month of death. The latest data published in April reflected deaths of people who contracted covid as of February. The CDC study of deaths among the vaccinated is online, and the data can be downloaded.

The death rates for fully vaccinated people, unvaccinated people and fully vaccinated people who received an additional booster are expressed as deaths per 100,000 people. The death rates are also called incidence rates. The CDC estimated the population sizes from census data and vaccination records. The study does not include partially vaccinated people in the deaths or population. The CDC adjusted the population sizes for inaccuracies in the vaccination data. The death data is provisional and subject to change. The study sample includes the population eligible for boosters, which was originally 18 and older, and now is 12 and older.

To compare death rates between groups with different vaccination status, the CDC uses incidence rate ratios. For example, if one group has a rate of 10 deaths per 100,000 people, the death incidence rate would be 10. Another group may have a death incidence rate of 2.5. The ratio between the first group and the second group is the rate of 10 divided by the rate of 2.5, so the incidence rate ratio would be 4 (10÷2.5=4). That means the first group dies at a rate four times that of the second group.

The CDC calculates the death incidence rates and incidence rate ratios by age groups. It also calculates a value for the entire population adjusted for the size of the population in each age group. The Post used those age-adjusted total death incidence rates and incidence rate ratios.

The Post calculated the share of deaths by vaccine status from the sample of death records the CDC used to calculate death incidence rates by vaccine status. As of April, that data included 44,000 deaths of people who contracted covid in January and February.

The share of deaths for each vaccine status does not include deaths for partially vaccinated people because they are not included in the CDC data.

The Post calculated the share of deaths in each age group from provisional covid-19 death records that have age details from the CDC’s National Center for Health Statistics. That data assigns deaths by the date of death, not the date on which the person contracted covid-19. That data does not include any information on vaccine status of the people who died.

United States is ‘out of the pandemic phase,’ Fauci says

https://www.yahoo.com/news/united-states-pandemic-phase-fauci-094908627.html

The United States is finally “out of the pandemic phase,” the country’s top infectious disease expert said, as cases and hospitalizations are notably down and mask mandates are all but extinct.

While there are still new infections spreading throughout the country – an average of 50,000 per day as of Tuesday – the country is far from the heights of the pandemic, when daily case counts surpassed 1 million. Restrictions, too, are easing as many Americans appear to be putting the pandemic behind them. Masking requirements have been lifted across most of the country, and officials stopped enforcing a federal mask mandate in transportation settings after a judge struck down the requirement.

“We are certainly right now in this country out of the pandemic phase,” Anthony Fauci, President Joe Biden’s chief medical adviser, said Tuesday evening on PBS’s “NewsHour.”

Fauci said the United States was no longer seeing “tens and tens and tens of thousands of hospitalizations and thousands of deaths. We are at a low level right now.”

During the pandemic’s darkest moments, many wondered when the country would officially declare itself past the nationwide disaster, which has killed nearly 1 million Americans.

Fauci’s comments are likely to fuel debate about whether this is truly the moment: New cases are on the rise in the United States, and deaths are down, though they often lag spikes in cases. The Centers for Disease Control and Prevention said Tuesday that as of the end of February, nearly 60 percent of Americans – including three out of every four children – have been infected with the coronavirus. But officials cautioned that the data did not indicate that Americans have widespread immunity against the virus because of their prior infections.

While previous infections are believed to offer some protection against serious disease for most people, health experts say the best protection against infection and serious disease or death from the coronavirus is vaccination.

The coronavirus will not be eradicated, Fauci said, but can be handled if its level of spread is kept “very low” and people are “intermittently” vaccinated, though he said he did not know how frequently. And Fauci echoed warnings from the World Health Organization and the United Nations this month that worldwide, the pandemic is far from over as vaccinations lag, particularly in developing nations.

The Biden administration, meanwhile, is appealing a ruling by a Trump-appointed federal judge that struck down the federal mask mandate on transit, including on planes, though it is unclear whether they will be successful, and likely face an American public that could be unwilling to comply again.

And in a less-than-subtle reminder that the coronavirus is still hanging around, the White House on Tuesday announced arguably the nation’s highest-profile coronavirus infection since former president Donald Trump, saying that Vice President Kamala Harris had tested positive and was asymptomatic. She was not considered in close contact to Biden, the White House said.

Feds poised to fight to preserve mask mandate for travel

The Department of Justice (DOJ) is appealing a Florida judge’s Monday decision to strike down the mask requirement for public transportation. Federal judge Kathryn Mizelle ruled the Centers for Disease Control and Prevention (CDC) exceeded its authority under the Public Health Service Act of 1944. Meanwhile, giddy passengers and flight crew have been discarding their face coverings as airlines, the Transportation Safety Administration, several local transit authorities, Uber and Lyft, all removed their mask requirements.  

The Gist: Despite DOJ’s appeal, which appears to be aimed at preserving its own authority to act during health crises, rather than reinstating the current mask requirement (which was set to expire in two weeks anyway), the tone of the Biden administration is clearly shifting. Earlier this week President Biden told reporters that the decision to wear a mask is “up to them,” meaning individual Americans. 

In the bumpy transition out of the emergency phase of the pandemic, we now have a patchwork of rules for masking. This is even true within healthcare facilities: some, including Houston Methodist and Iowa-based UnityPoint Health, are no longer requiring masks for visitors or employees who are not involved in patient care. 

With COVID cases now rising in 41 states as mask mandates fall, the next month will prove critical in determining whether “endemic” COVID remains manageable, or once again stresses the healthcare system and other critical infrastructure.  

Coronavirus has infected majority of Americans

But officials caution that people should not presume they have protection against the virus going forward.

Before omicron, one-third of Americans had been infected with the coronavirus, but by the end of February, that rate had climbed to nearly 60 percent — including about 75 percent of kids and 60 percent of people age 18 to 49according to federal health data released Tuesday.

The data from blood tests offers the first evidence that over half the U.S. population, or 189 million people have been infected at least once since the pandemic began — double the number reflected in official case counts. Officials cautioned, however, that the data, in a report from the Centers for Disease Control and Prevention, does not indicate people have protection against the virus going forward, especially against increasingly transmissible variants.

“We continue to recommend that everyone be up to date on their vaccinations, get your primary series and booster, when eligible,” CDC Director Rochelle Walensky said during a media briefing.

Kristie Clarke, the CDC official who authored the report, said by February, “evidence of previous COVID-19 infections substantially increased among every age group, likely reflecting the increase in cases we noted as omicron surged in this country.”

Clarke said the greatest increases took place in those with the lowest levels of vaccination, noting that older adults were more likely to be fully vaccinated.

The largest increases were in children and teenagers through age 17 — about 75 percent of them had been infected by February, based on blood samples that look at antibodies developed in response to a coronavirus infection but not in response to vaccination. That’s about 58 million children.

The blood test data suggests 189 million Americans had covid-19 by end of February, well over double the 80 million cases shown by The Washington Post case tracker, which is based on state data of confirmed infections. Clarke said that’s because the blood tests captures asymptomatic cases and others that were never confirmed on coronavirus tests.

With the omicron surge, officials had expected there would be more infections. “But I didn’t expect the increase to be quite this much,” Clarke added.

Separately, CDC is about to publish another study that estimates three infections for every reported case, she said.

Don’t pin your hopes on the “Great Regret”

Businesses who suffered from the Great Resignation, in which large numbers of workers voluntarily resigned during the pandemic looking for more fulfilling work or higher wages, are now hoping the “Great Regret” might bring workers back. According to recent surveys, over 70 percent of workers who switched employment during the pandemic found that their new jobs didn’t live up to their expectations, and nearly half wish they had their old job back.

After scores of nurses left hospital positions for travel roles, health system leaders are seeing some nurses return. One physician told us about a favorite nurse on his oncology unit who returned from over a year as a traveler, ready to settle down and be closer to family.

A chief nursing officer relayed that her system was seeing nurses who took agency positions to work toward personal financial goals, like earning a down payment for a house, wanting to come back now that they’ve reached it: “Travel roles are intense, and most nurses can’t do them forever”.

But other nursing leaders caution that they’re preparing for agency nurses to become a permanent fixture in the workforce: “More nurses will see travel as an option for different points in their career, when they have personal flexibility or need the extra money”.

The “Great Regret” might help some hospitals lessen their reliance on agency nursing in the short-term. But building a stable clinical workforce will require addressing underlying structural challenges, through changes in education, rethinking job roles and care models, and finding ways to build individualized job flexibility and customization.   

Pandemic’s end could surge the number of uninsured kids

The formal end of the pandemic could swell the ranks of uninsured children by 6 million or more as temporary reforms to Medicaid are lifted.

Why it matters: Gaps in coverage could limit access to needed care and widen health disparities, by hitting lower-income families and children of color the hardest, experts say.

The big picture: A requirement that states keep Medicaid beneficiaries enrolled during the public health emergency in order to get more federal funding is credited with preventing a spike in uninsured adults and kids during the crisis.

  • Children are the biggest eligibility group in Medicaid, especially in the 12 states that haven’t expanded their Medicaid programs under the Affordable Care Act.
  • The lifting of the public health emergency, which was just extended to July 15, will lead states to determine whether their Medicaid enrollees are still eligible for coverage — a complicated process that could result in millions of Americans being removed from the program.

What they’re saying: The end of the continuous coverage guarantee puts as many as 6.7 million children at very high risk of losing coverage, per Georgetown University’s Center for Children and Families.

  • That would more than double the number of uninsured kids, which stood at 4.4 million in 2019.
  • “It is a stark, though we believe conservative, estimate,” said Joan Alker, the center’s executive director. “There are a lot of children on Medicaid.”

Between the lines: Not all of the Medicaid enrollees who are removed from the program would become uninsured. But parents and their children could be headed down different paths if their household income has risen even slightly.

  • Adults who’ve returned to work may be able to get insurance through their employer. Others could get coverage through the ACA marketplace, though it’s unclear whether that would come the COVID-inspired extra financial assistance that’s now being offered.
  • Most kids would be headed for the Children’s Health Insurance Program, Alker said — a prospect that can entail added red tape and the payment of premiums or an annual enrollment fee, depending on the state.

What we’re watching: Changes in children’s coverage could be most pronounced in Texas, Florida and Georgia — the biggest non-Medicaid expansion states, which have higher rates of uninsured children than the national average.

  • Congress could still require continuous Medicaid coverage, the way the House did when it passed the sweeping social policy package that stalled in the Senate over cost concerns.
  • CMS’ Office of the Actuary projects a smaller decline in Medicaid enrollment than some health policy experts are predicting — and the Biden administration continues to move people deemed ineligible for Medicaid onto ACA plans, Raymond James analyst Chris Meekins noted in a recent report on the unwinding of the public health emergency.

Why insurers, health systems are breaking up

Insurers and health systems across the U.S. have been at odds during the most recent cycle of contract negotiations, and terminated contracts are affecting thousands of patients.

As hospitals continue to recover financially from the COVID-19 pandemic and deal with higher supply costs and employee wages, many organizations have tightening margins and hope to negotiate higher rates with insurers as a result. Hospitals are also pointing to rising inflation as a reason for needing higher rates.

One recent example is Fort Lauderdale, Fla.-based Broward Health’s public breakup with UnitedHealthcare. Thousands of the insurer’s beneficiaries went out of network with Broward April 1 after the two sides failed to agree on a new contract. Broward reportedly asked UnitedHealthcare for a pay increase to the same level UnitedHealthcare pays other South Florida health systems.

UnitedHealthcare said Broward’s rate increase request would amount to 88 percent higher reimbursement for its providers in the next four years, which the insurer said was “unreasonable.” Negotiations continue, but patients are out of network in the meantime.

Blue Cross & Blue Shield of Mississippi and the University of Mississippi Medical Center let their contract expire April 1 after they failed to agree on pay rate increases, according to the Clarion Ledger. The medical center treated more than 50,000 patients in the 18 months before the contract expiration.

LouAnn Woodward, MD, vice chancellor for health affairs and dean of the medical center’s school of medicine, said the health system wants “fair reimbursement” from Blue Cross & Blue Shield to reinvest in its facilities and programs. The insurer said the medical center wanted a 30 percent overall rate increase, including a 50 percent increase for some services, according to the newspaper report.

Physician groups and surgery centers aren’t immune from insurer conflicts. Blue Cross Blue Shield of Illinois terminated its contract with Springfield (Ill.) Clinic late last year, knocking 100,000 beneficiaries out of network.