Category Archives: Vaccination

It’s Official: CDC Recommends Public Wear Face Masks

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Coronavirus, Crisis, Crisis Management, Health Policy, Infection Control, Infectious Virus, Leadership, Pandemic, Public Health, Public Safety, Vaccination, Vaccine • Leave a comment

https://www.medpagetoday.com/infectiousdisease/covid19/85800?xid=NL_breakingnewsalert_2020-04-04&eun=g885344d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=CDCMasksAlert_040420&utm_term=NL_Daily_Breaking_News_Active

A computer rendering of the coronavirus

Stresses use of cloth coverings, not medical grade, for ordinary people.

The CDC is now recommending that everyone should wear a cloth face covering when out in public places to protect others in case they are unknowingly infected with the virus.

Late Friday night, the agency updated its consumer-facing web page for COVID-19 self-protection as follows:

  • Cover your mouth and nose with a cloth face cover when around others.
  • You could spread COVID-19 to others even if you do not feel sick.
  • Everyone should wear a cloth face cover when they have to go out in public, for example to the grocery store or to pick up other necessities.
  • Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
  • The cloth face cover is meant to protect other people in case you are infected.
  • Do NOT use a face mask meant for a healthcare worker.
  • Continue to keep about 6 feet between yourself and others. The cloth face cover is not a substitute for social distancing.

Because there is currently no vaccine nor approved treatment, the agency stressed that the best strategy for preventing illness is still to avoid exposure to the virus. Even asymptomatic people can spread coronavirus to others, the CDC stressed.

During a White House briefing on Friday evening, President Trump underscored the CDC’s advice to Americans who are not clinicians, that they not wear “medical-grade or surgical -grade” masks. These are now in shortage at many hospitals, forcing administrators to adopt last-ditch strategies to extend supplies.

But Trump said he has no plans to follow the recommendation himself to wear a mask in public. “I’m choosing not to do it,” he said at the Friday briefing.

The SARS-CoV-2 virus is transmitted primarily through person-to-person contact from people who are in close contact, meaning less than 6-feet apart; through respiratory droplets, projected in a sneeze or cough that land in the mouths and noses of people nearby and can be inhaled into their lungs, but importantly the virus can also be transmitted through talking.

Researchers reported earlier in the week that the coronavirus could be spread through normal breathing and speech. Large droplets remain one method of transmission, when they are inhaled by a person nearby or through contact with a contaminated surface and later touching one’s face. However, researchers noted that tiny particles in the air can also carry the virus.

Former FDA Commissioner Scott Gottlieb, MD, recommended last weekend that “everyone, including people without symptoms, should be encouraged to wear nonmedical fabric face masks while in public.”

While asymptomatic transmission of the virus outside of China was discovered in late January, White House officials had initially suggested that it was not an important driver of transmission. “You really need to just focus on the individuals that are symptomatic,” HHS Secretary Alex Azar told ABC News in March.

 

Drivers of health and the coronavirus

Posted on by • Posted in Coronavirus, Health Policy, Health System, Pandemic, Social Determinants of Health, Social Distancing, Vaccination, Vaccine • Leave a comment

Drivers of health and the coronavirus

Truck drivers under increased pressure due to coronavirus

I don’t have time for a fully formed post or column on this, but I want to make note of a few ways in which the COVID-19 pandemic is intersecting with drivers of health (which include social determinants and health system factors). The following list is not necessarily exhaustive and my focus is on the U.S.

  • Right now the health system cannot offer anything to prevent the consequences of COVID-19 infection. Prevention is entirely within the realm of public health measures and personal behaviors. In this way, this is a lot like HIV/AIDS before the mid-1990s. If one were engaged in an exercise of attributing COVID-19 deaths to various factors, personal behavior — degree of social distancing, hand washing, etc. — would get a significant share.
  • But, individuals do not fully control their own COVID-19 destiny. Not everyone can avoid all risk of exposure. Food and other necessities need to be brought into the house. We want some people to work (e.g., health care workers, those involved in producing and transporting food and medical supplies). Not everyone can control the behavior of everyone else in their household. Teens and young adults might sneak out, despite what their parents say.
  • Among those at highest risk will be people who don’t have the privilege of working from home. They need income and can’t get it without leaving the house. Peeling this onion leads back to the customary markers of socioeconomic status (education, income, rank/class, etc.) as drivers of health.
  • Those with privilege are more likely to find ways to get testing, care, and going forward, probably will be among the first (after health care workers) to get vaccinated. This is how it has always been in the U.S.
  • Policy clearly plays a role. Where leaders were slower to implement changes to increase or require social distancing, outbreaks are more widespread (relative to the counterfactual of those changes made sooner). Even national policy makers were slow to recognize the importance of preparing for a pandemic. Mistakes were made. Balls were dropped. So, policy/government is a driver, of course.
  • Finally, the health system clearly plays a role, not in prevention but in treatment. People can be saved, if the resources are there to save them and they can be accessed. Where and for whom health care is more available and accessible, people will be better off. This is complex because of the intersection of the effectiveness of health care, its accessibility (which is reduced for people losing job-based insurance, otherwise un- or under-insured, or without the resources to pay cost sharing, etc.), and the degree to which the health system has prepared for such a pandemic (which intersects with policy and health economics). So, the health system should get some blame/credit for deaths/saved lives, but it’s not so clear how much.

Fundamentally, it’s interesting how much we are reliant on collective resources — government through policy and shared health care infrastructure. The best thing we can do for ourselves individually is to engage in safe behaviors. But we also need collective action for our future well being. Yes/and, not either/or.

 

 

 

4 ETHICAL DILEMMAS FOR HEALTHCARE ORGANIZATIONS DURING THE COVID-19 PANDEMIC

Posted on by • Posted in Health Policy, Health System, Healthcare Ethics, Hospital, Hospital Industry, Infection Control, Infectious Virus, Intensive Care (ICU), Leadership, Medical Utility, Pandemic, Physician, Public Health, Public Safety, Quarantine, Rationing Care, Triage, Vaccination, Vaccine, Ventilators • Leave a comment

https://www.healthleadersmedia.com/clinical-care/4-ethical-dilemmas-healthcare-organizations-during-covid-19-pandemic

Image result for 4 ETHICAL DILEMMAS FOR HEALTHCARE ORGANIZATIONS DURING THE COVID-19 PANDEMIC

There has already been rationing of testing in the United States and rationing of critical care resources is likely if severely ill COVID-19 patients surge significantly.

KEY TAKEAWAYS

Rationing of care for novel coronavirus patients has been reported in China and Italy.

Medical utility based on scientific patient profiles should guide decisions to ration critical care resources such as ventilators, medical ethicist James Tabery says.

In a pandemic, public health considerations should drive decisions on prioritizing who is tested for disease, he says.

The novel coronavirus (COVID-19) pandemic is raising thorny medical ethics dilemmas.

In China and Italy, there have been reports of care rationing as the supply of key resources such as ventilators has been outstripped by the number of hospitalized COVID-19 patients. China, the epicenter of the pandemic, has the highest reported cases of COVID-19 at more than 80,800 as of March 17, according to worldometer. Italy has the second-highest number of COVID-19 cases at nearly 28,000 cases.

The severest form of COVID-19 includes pneumonia, which can require admission to an ICU and mechanical ventilation. “Those are not just things, there are expertly trained healthcare workers who man those domains. There just isn’t enough of these resources than what we anticipate needing,” says James Tabery, PhD, associate professor in the University of Utah Department of Philosophy and the University of Utah School of Medicine’s Program in Medical Ethics and Humanities.

He says the COVID-19 outbreak poses four primary ethical challenges in the healthcare sector.

1. TREATMENT

In the United States, caring for the anticipated surge of seriously ill COVID-19 patients is likely to involve heart-wrenching decisions for healthcare professionals, Tabery says. “The question is how do you ration these resources fairly? With treatment—we are talking about ICUs, ventilators, and the staff—the purpose is you are trying to save the severely sick. You are trying to save as many of the severely sick as you can.”

The first step in managing critical care resources is screening out patients who are unlikely to need critical care and urging them to self-quarantine at home, he says.

“But eventually, you bump up to a place where you not only have screened out all of the folks who are at low risk of serious illness, but you have millions of people across the country who fall into high-risk groups. If they get infected, many are going to need access to ventilators, and the way you do that ethically is you screen patients based on medical utility,” Tabery says.

Medical utility is based on scientific assessments, he says. “You basically look at the cases and try to evaluate as quickly and efficiently as possible the likelihood that you can improve a patient’s condition quickly.”

Rationing of critical care resources would be jarring for U.S. clinical staff.

Under most standard scenarios, a patient who is admitted to an ICU and placed on mechanical ventilation stays on the machine as long as the doctors think the patient is going to get better, Tabery says.

However, the COVID-19 pandemic could drive U.S. caregivers into an agonizing emergency scenario.

“When there are 10 people in the emergency room waiting to get on a ventilator, it is entirely feasible that you would be removing people from ventilators knowing that they are going to die. But you remove people from ventilators when your evaluation of the medical situation suggests that patients are not improving. If a patient is not improving, and it doesn’t look like using this scarce resource is a wise investment, then you try it out on another patient who might have better luck,” he says.

2. TESTING

There has been rationing of COVID-19 testing in the United States since the first novel coronavirus patient was diagnosed in January.

While there are clinical benefits to COVID-19 testing such as determining what actions should be taken for low- and high-risk patients, the primary purpose of testing during a pandemic is advancing public health, Tabery says.

“The primary purpose of the test is pure public health epidemiology. It’s about keeping track of who has COVID-19 in service of trying to limit the spread of the disease to other people. When that is the purpose, the prioritization isn’t so much about who is at greatest risk. It’s about who is more likely to interact with lots of people, or who is more likely to have interacted with more people.”

A classic example of rationing COVID-19 testing based on public health considerations is the first reported infection of an NBA player, he says.

“For the Utah Jazz player who had symptoms, it made sense to test him very quickly because it was clear that he had interacted with a lot of people. Once he tested positive, the testing of the other players was not because public health officials thought the players were more valuable than the average person on the street. It was because the players had come into contact with more people than the average person on the street.”

3. HEALTHCARE WORKERS

The COVID-19 pandemic involves competing obligations for healthcare workers, Tabery says. “On the one hand, they have a set of obligations that inclines them to go to work when they get the call. On the other hand, healthcare workers have their own interests—they don’t want to get sick, which can incline them not to work,” he says.

“The punchline is there is an ethical consensus that healthcare workers have a prima facie duty to work because of everything that has been invested in them, because of their unique position where not just anybody can replace them, because society looks to them to serve this function, and because they went into this profession and are expected to go into work,” he says.

However, the obligation of healthcare workers to show up for their jobs is not absolute, Tabery says. “If hospitals don’t have personal protective equipment, they are in no position to tell their staff to show up and work. If a hospital cannot provide even a basic level of safety for their employees to do their job, then they are turning their hospital not into a place to treat patients—they are turning it into a hub to exacerbate the problem.”

4. VACCINE

When a vaccine becomes available, policymakers, public health officials, and healthcare providers will face rationing decisions until there is sufficient supply to treat the entire U.S. population, Tabery says.

“When the vaccine comes out, the first group you are going to want to prioritize are healthcare workers, who are at risk of getting infected by doing their jobs and saving lives. You would also want to prioritize people who serve essential functions to keep society going—the people who keep the water running, the lights on, police, and firefighters. Then you want to start looking at the high-risk groups,” he says.

 

 

 

 

Experts agree that Trump’s coronavirus response was poor, but the US was ill-prepared in the first place

Posted on by • Posted in 2020 Election Issues, ACA, Centers for Disease Control & Prevention (CDC), Coronavirus, Health Insurance Benefit Design, Health Insurance Coverage Adequacy, Health Policy, Health System, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Hospital, Hospital Industry, Infection Control, Infectious Virus, Life Expectancy, Market Consolidation, Market Failure, Market Power, Mortality, Out of Pocket Expenses, Out-of-Network, Pandemic, Public Health, Public Safety, Safety Net Hospitals, Safety-Net Providers, Sick Leave, Surprise Bills, Underinsured, Uninsured, Vaccination, Vaccine • Leave a comment

https://theconversation.com/experts-agree-that-trumps-coronavirus-response-was-poor-but-the-us-was-ill-prepared-in-the-first-place-133674?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20March%2017%202020%20-%201565314971&utm_content=Latest%20from%20The%20Conversation%20for%20March%2017%202020%20-%201565314971+Version+A+CID_6ce2ffeb273f535ccdcb368c4649a7ee&utm_source=campaign_monitor_us&utm_term=Experts%20agree%20that%20Trumps%20coronavirus%20response%20was%20poor%20but%20the%20US%20was%20ill-prepared%20in%20the%20first%20place

As the coronavirus pandemic exerts a tighter grip on the nation, critics of the Trump administration have repeatedly highlighted the administration’s changes to the nation’s pandemic response team in 2018 as a major contributor to the current crisis. This combines with a hiring freeze at the Centers for Disease Control and Prevention, leaving hundreds of positions unfilled. The administration also has repeatedly sought to reduce CDC funding by billions of dollars. Experts agree that the slow and uncoordinated response has been inadequate and has likely failed to mitigate the coming widespread outbreak in the U.S.

As a health policy expert, I agree with this assessment. However, it is also important to acknowledge that we have underfunded our public health system for decades, perpetuated a poorly working health care system and failed to bring our social safety nets in line with other developed nations. As a result, I expect significant repercussions for the country, much of which will disproportionately fall on those who can least afford it.

Decades of underfunding

Spending on public health has historically proven to be one of humanity’s best investments. Indeed, some of the largest increases in life expectancy have come as the direct result of public health interventions, such as sanitation improvements and vaccinations.

Even today, return on investments for public health spending is substantial and tends to significantly outweigh many medical interventions. For example, one study found that every US$10 per person spent by local health departments reduces infectious disease morbidity by 7.4%.

However, despite their importance to national well-being, public health expenditures have been neglected at all levels. Since 2008, for example, local health departments have lost more than 55,000 staff. By 2016, only about 133,000 full-time equivalent staff remained. State funding for public health was lower in 2016-2017 than in 2008-2009. And the CDC’s prevention and public health budget has been flat and significantly underfunded for years. Overall, of the more than $3.5 trillion the U.S. spends annually on health care, a meager 2.5% goes to public health.

Not surprisingly, the nation has experienced a number of outbreaks of easily preventable diseases. Currently, we are in the middle of significant outbreaks of hepatitis A (more than 31,000 cases), syphilis (more than 35,000 cases), gonorrhea (more than 580,000 cases) and chlamydia (more than 1,750,000 cases). Our failure to contain known diseases bodes ill for our ability to rein in the emerging coronavirus pandemic.

Failures of health care systems

Yet while we have underinvested in public health, we have been spending massive and growing amounts of money on our medical care system. Indeed, we are spending more than any other country for a system that is significantly underperforming.

To make things worse, it is also highly inequitable. Yet, the system is highly profitable for all players involved. And to maximize income, both for- and nonprofits have consistently pushed for greater privatization and the elimination of competitors.

As a result, thousands of public and private hospitals deemed “inefficient” because of unfilled beds have closed. This eliminated a significant cushion in the system to buffer spikes in demand.

At any given time, this decrease in capacity does not pose much of a problem for the nation. Yet in the middle of a global pandemic, communities will face significant challenges without this surge capacity. If the outbreak mirrors anything close to what we have seen in other countries, “there could be almost six seriously ill patients for every existing hospital bed.” A worst-case scenario from the same study puts the number at 17 to 1. To make things worse, there will likely be a particular shortage of unoccupied intensive care beds.

Of course, the lack of overall hospitals beds is not the most pressing issue. Hospitals also lack the levels of staffing and supplies needed to cope with a mass influx of patients. However, the lack of ventilators might prove the most daunting challenge.

Limits of the overall social safety net

While the U.S. spends trillions of dollars each year on medical care, our social safety net has increasingly come under strain. Even after the Affordable Care Act, almost 30 million Americans do not have health insurance coverage. Many others are struggling with high out-of-pocket payments.

To make things worse, spending on social programs, outside of those protecting the elderly, has been shrinking, and is significantly smaller than in other developed nations. Moreover, public assistance is highly uneven and differs significantly from state to state.

And of course, the U.S. heavily relies on private entities, mostly employers, to offer benefits taken for granted in other developed countries, including paid sick leave and child care. This arrangement leaves 1 in 4 American workers without paid sick leave, resulting in highly inequitable coverage. As a result, many low-income families struggle to make ends meet even when times are good.

Can the US adapt?

I believe that the limitations of the U.S. public health response and a potentially overwhelmed medical care system are likely going to be exacerbated by the blatant limitations of the U.S. welfare state. However, after weathering the current storm, I expect us to go back to business as usual relatively quickly. After all, that’s what happened after every previous pandemic, such as H1N1 in 2009 or even the 1918 flu epidemic.

The problems are in the incentive structure for elected officials. I expect that policymakers will remain hesitant to invest in public health, let alone revamp our safety net. While the costs are high, particularly for the latter, there are no buildings to be named, and no quick victories to be had. The few advocates for greater investments lack resources compared to the trillion-dollar interests from the medical sector.

Yet, if altruism is not enough, we should keep reminding policymakers that outbreaks of communicable diseases pose tremendous challenges for local health care systems and communities. They also create remarkable societal costs. The coronavirus serves as a stark reminder.

 

 

Measles deaths ‘staggering and tragic’

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Health Policy, Infectious Virus, Measles, Preventable Disease, Vaccination, World Health Organization (WHO) • Leave a comment

https://www.bbc.com/news/health-50659893?fbclid=IwAR3gBbcdBh9DpvLZetL7k8uvV5VXxk5TBy1bNtDYeRKEcpGy2Xx58ydn39s

Measles

More than 140,000 people died from measles last year as the number of cases around the world surged once again, official estimates suggest.

Most of the lives cut short were children aged under five.

The situation has been described by health experts as staggering, an outrage, a tragedy and easily preventable with vaccines.

Huge progress has been made since the year 2000, but there is concern that incidence of measles is now edging up.

In 2018, the UK – along with Albania, the Czech Republic and Greece, lost their measles elimination status.

And 2019 could be even worse.

The US is reporting its highest number of cases for 25 years, while there are large outbreaks in the Democratic Republic of Congo, Madagascar and Ukraine.

The Pacific nation of Samoa has declared a state of emergency and unvaccinated families are hanging red flags outside their homes to help medical teams find them.

What is measles?

  • Measles is a highly infectious virus spread in droplets from coughs, sneezes or direct contact
  • It can hang in the air or remain on surfaces for hours
  • Measles often starts with fever, feeling unwell, sore eyes and a cough followed by a rising fever and rash
  • At its mildest, measles makes children feel very miserable, with recovery in seven-to-10 days – but complications, including ear infections, seizures, diarrhoea, pneumonia and brain inflammation, are common
  • The disease is more severe in the very young, in adults and in people with immunity problems

What are the numbers?

The global estimates are calculated by the World Health Organization (WHO) and the US Centers for Diseases Control and Prevention.

They show:

  • In 2000 – there were 28.2 million cases of measles and 535,600 deaths
  • In 2017 – there were 7.6 million cases of measles and 124,000 deaths
  • In 2018 – there were 9.8 million cases of measles and 142,000 deaths

Measles cases do not go down every year – there was an increase between 2012 and 2013, for example.

However, there is greater concern now that progress is being undone as the number of children vaccinated stalls around the world.

“The fact that any child dies from a vaccine-preventable disease like measles is frankly an outrage and a collective failure to protect the world’s most vulnerable children,” said Dr Tedros Ghebreysus, director-general of the WHO.

How are the numbers calculated?

Every single case of measles cannot be counted. In 2018, only 353,236 cases were officially recorded (out of the 7.8 million estimated).

So scientists perform complex maths for each country.

They take reported cases, the population size, deaths rates, the proportion of children vaccinated and more to eventually produce a global estimate.

Dr Minal Patel, who performed the number-crunching, told the BBC: “We’ve had a general trajectory downwards for deaths, which is great. Everyone involved in vaccination programmes should be very proud.

“But we’ve been stagnating in numbers of deaths for about the past seven years, and what’s really concerning is from last year we’ve gone up, and it looks like we’ve gone backwards.”

What is going on?

In short, not enough children are being vaccinated.

In order to stop measles spreading, 95% of children need to get the two doses of the vaccine.

But the figures have been stubbornly stuck for years at around 86% for the first jab, and 69% for the second.

Why enough children are not being vaccinated is more complicated – and the reasons are not the same in every country.

The biggest problem is access to vaccines, particular in poor countries.

The five worst-affected countries in 2018 were Democratic Republic of Congo, Liberia, Madagascar, Somalia and Ukraine.

The Ebola outbreak in Liberia (2014-16) and plague in Madagascar (2017) have taken a toll on their healthcare systems.

“Democratic Republic of Congo, Somalia and Ukraine, the other countries hardest-hit by measles, each face conflicts, with DRC additionally battling a serious Ebola outbreak and rampant distrust,” Prof Heidi Larson, from the London School of Hygiene & Tropical Medicine, explained.

The other issue is people who do have access to vaccines choosing not to immunise their children.

Will things be worse next year?

It looks likely.

The number of reported cases by mid-November this year was 413,000 compared with 353,000 for the whole of last year.

What do the experts say?

Henrietta Fore, Unicef’s executive director, said: “The unacceptable number of children killed last year by a wholly preventable disease is proof that measles anywhere is a threat to children everywhere.”

Dr Seth Berkley, chief executive of Gavi, the Vaccine Alliance, said: “It is a tragedy that the world is seeing a rapid increase in cases and deaths from a disease that is easily preventable with a vaccine.

“While hesitancy and complacency are challenges to overcome, the largest measles outbreaks have hit countries with weak routine immunisation and health systems.”

Prof Larson said: “These numbers are staggering. Measles, the most contagious of all vaccine-preventable diseases, is the tip of the iceberg of other vaccine-preventable disease threats and should be a wake-up call.”