Category Archives: Vaccine Hesitancy Rate

Vaccine skepticism and disregard for containment efforts go hand in hand

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Coronavirus, Coronavirus Mutation, Infection Control, Infection Control Plan, Infectious Virus, Mortality, National Strategy, Pandemic, Partisanship, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Scientists, Vaccine, Vaccine Distribution, Vaccine Hesitancy Rate • Leave a comment
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It seems pretty clear the path the United States is on. Within a few months, everyone who wants to be vaccinated against the coronavirus will be, save for those below the minimum age for which vaccines are available. For everyone else, the pandemic Wild West will continue, with the country hopefully somewhere near the level of immunity that will keep the virus from spreading wildly but with large parts of the population — again, including kids — susceptible to infection.

That really gets at one of the two outstanding questions: How many Americans won’t get the vaccine? If the figure is fairly low, the ability of the virus to spread will be far lower. If it’s high, we have a problem. And that’s the other outstanding question: How big of a problem will the virus be, moving forward?

We know that even as vaccines are being rolled out, cases are slowly climbing. While the number of new infections recorded each day is well off the highs seen in the winter, we’re still averaging more cases on a daily basis than we saw even a month into the third wave that began in September. A lot of people are still getting sick, and, even with most elderly Americans now protected with vaccine, a lot more people will probably die.

Data released by Gallup this week shows that both of the questions posed above share a common component. It is, as you probably suspected, those who are least willing to get vaccinated who are also least likely to take steps to contain the virus.

Gallup asked Americans about their vaccination status, finding that about a fifth had been fully vaccinated and an additional 13 percent partially vaccinated. More than a quarter of respondents, though, said they didn’t plan to get vaccinated. It was those in that latter group who were least likely to say that they were completely or mostly isolating in an effort to prevent the virus spreading.

It was also those skeptics who were least likely to say that, in the past seven days, they had avoided crowds, group gatherings or travel. If you’re not inclined to get vaccinated, it is at least consistent that you would be similarly disinclined to take other steps aimed at limiting the spread of the virus.

Gallup didn’t break out those groups by party, but it’s clear that few of them are Democrats. Data from YouGov, compiled on behalf of Yahoo News, shows that Democrats (and those who voted for Joe Biden in particular) are more likely to say that they have already received a vaccine dose.

Among those who hadn’t yet received a dose, Democrats were far more likely to indicate that they planned to do so as soon as possible. Among Republicans, half of those who haven’t been vaccinated say that they don’t have any plans to do so at all.

One reason is that Republicans are simply less worried about the virus. More than half say that they’re not very worried about it or not worried at all. Among those who voted for Donald Trump, the figure is over two-thirds. By contrast, more than three-quarters of Democrats say that they are at least somewhat worried about the virus.

In the YouGov polling, 60 percent of Republicans say that the worst of the pandemic is behind us. They’re also much more likely to say that restrictions aimed at preventing the spread of the virus — mask mandates, limits on indoor dining — should be lifted immediately.

As we mentioned Thursday, there are two ways to achieve herd immunity. One is fast and safe: widespread vaccinations. The other — people contracting the virus — is slow and dangerous. The path the United States is on will take us to a place where much of the country has opted for the first option and the rest, the latter.

So the question again becomes: How many people will die, both over the short term and the long term, as a result of those choices?

AstraZeneca stumbles again in it its vaccine rollout

Posted on by • Posted in Coronavirus, Coronavirus Mutation, Food and Drug Administration (FDA), Pandemic, Supply Chain, Supply Chain Cold Logistics Network, Vaccine, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, World Health Organization (WHO) • Leave a comment

https://mailchi.mp/3e9af44fcab8/the-weekly-gist-march-26-2021?e=d1e747d2d8

U.S. Health Officials Raise Concerns Over AstraZeneca Vaccine Data - WSJ

It was a relatively quiet week on the COVID front—so quiet that President Biden held his first White House press conference last week and wasn’t asked a single question about the pandemic, which continues to be a race between vaccinations and virus variants.

Not that nothing happened this week: it was a rocky week for AstraZeneca, which was hoping to change the narrative over its vaccine, which has stumbled in its rollout in Europe, by reporting positive results from US trials.

After a press release announcing that the vaccine was found to be 79 percent effective against symptomatic COVID, an independent review board called the results into question, pointing out that the report was based on data that had not been fully updated. That earned a swift and unusual rebuke from the National Institutes of Health (NIH), forcing the company to correct its findings—to 76 percent.

A relatively minor difference, but the dust-up served to further undermine confidence in the company’s COVID jab, especially troubling in Europe where hesitancy and distribution have been a vexing problem, and concerns about blood clots associated with the AstraZeneca shot caused several countries to pause inoculations. Given the supply of already-approved vaccines from other manufacturers in the US, it’s not clear that the AstraZeneca shot will play a big role here, but it is critical in other parts of the world, especially as part of the global COVAX initiative targeted at developing countries, since the vaccine can be stored at normal refrigerator temperatures.

The company’s set-to with American regulators also highlighted another challenge that’s become common during the COVID pandemic: conducting scientific review by press release, as the global emergency has required the otherwise slow-moving research community to move at lightning pace.

Meanwhile, back at that relatively dull White House press conference, one piece of encouraging news: President Biden doubled his “first 100 days” goal for vaccinations to 200M shots, a goal that seems wholly achievable, given that 2.5M Americans are being vaccinated every day, on average.

Experts take pro-vaccine message to right-wing skeptics

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Experts take pro-vaccine message to right-wing skeptics

Stick your vaccine up your arse' – the Covid-19 vaccine, the science and the sceptics

Top public health experts and officials are developing new strategies to reach out to the conservatives most skeptical of or hesitant about receiving a coronavirus vaccine.

The efforts are targeting supporters of former President Trump, who have emerged as the most significant hurdle to widespread vaccination.

The officials and experts are making appearances on Fox News and Newsmax and taking part on panels with prominent conservative politicians to reach out to vaccine skeptics on the right.

And the public health experts are not taking an antagonistic approach either. They say many conservatives have legitimate questions about COVID-19 vaccinations that are worth listening to and answering.

“These are folks who really feel disrespected. They feel that COVID and the vaccines and the response has been politicized and weaponized, in their words,” said Tom Frieden, the former director of the Centers for Disease Control and Prevention under President Obama. “They feel deeply alienated from the government.”

Up to now, the main problem with increasing vaccinations has been one of supply and demand, but administration officials expect that to change shortly. 

“We are approaching the point where we will have a sufficient supply of vaccines for everybody in the United States to have the chance to get immunized by the end of May,” Francis Collins, director of the National Institutes of Health (NIH), said in an interview with The Hill on Wednesday. 

At that point, convincing skeptical conservatives to get a shot could mean the difference between the U.S. achieving herd immunity and resuming normal life or variants of COVID-19 getting second and third winds, leading to new lockdowns or restrictions on life.

As Collins puts it, “the hesitancy will begin to become the defining factor on whether we reach herd immunity or not.”

“I think that means this has to be the moment where we really pull into this conversation all of the trustworthy voices,” he added.

A recent CBS poll found a third of Republicans said they would not be vaccinated, compared to 10 percent of Democrats. A “PBS NewsHour” poll showed similar results: Nearly half of U.S. men who identify as Republicans said they have no plans to get vaccinated.

The underlying mistrust comes after a year in which Trump and his allies played down the severity of a virus that has killed more than half a million Americans already. 

Circumstances have conspired to allow that skepticism to grow: The coronavirus arrived later in more rural, conservative enclaves than it did in liberal metropolitan areas like Seattle, New York and Detroit, giving some the sense that they had been locked out of the economy to protect against a virus that was not yet present in their community.

Julie Morita, executive vice president of the Robert Wood Johnson Foundation, who advised the Biden transition team on COVID-19 issues, said she has been surprised to see how political vaccine hesitancy has become.

In the past, Morita said, public health officials have focused on race and ethnicity. “We didn’t really look at politics or political affiliation,” she said.

Morita said her message remains the same, but that she has had to focus on where to deliver it. She recently co-wrote a Fox News op-ed answering some of the common questions about the available COVID-19 vaccines and urging people to get the shots when they’re available.

“Whether you’re a community of color, or whether you’re a conservative, these are the questions that people ask and want to have the answers to before they get vaccinated,” Morita said. “I don’t feel like that’s a shifted message as much as maybe we’re just able to get it into a more conservative news outlet.”

Convincing a group of people who did not vote for the president presents a challenge to a Democratic administration. So President Biden has been outsourcing the message. 

Appearing on Hugh Hewitt’s radio show this week, Anthony Fauci, the director of the National Institute for Allergy and Infectious Diseases, said he doesn’t shy away from conservative outlets that may not be friendly.

“I say yes to a wide variety of requests. I’ve been on Fox multiple times, so I don’t shy away from that, no,” Fauci said.

Health officials are increasingly convinced that successful messaging is not going to come from politicians or government officials but from doctors, clergy and trusted community leaders.

Last month, Frieden participated in focus groups with vaccine-hesitant Republican voters led by veteran GOP pollster Frank Luntz. 

The groups, first reported by The Washington Post, showed vaccine-hesitant conservatives were not swayed by Republican politicians like House Minority Leader Kevin McCarthy (Calif.) or former New Jersey Gov. Chris Christie — or even by Trump himself. 

Instead, Frieden said, the message that moved the hesitant to the accepting hit closer to home: Their doctors took the vaccine when it was offered.

“You listen to the audience, you understand where they are and you address their concerns. And that’s the same thing we have to do for Trump voters who are reluctant to get vaccinated or African Americans or Latinx or vegans who don’t want to get vaccinated,” Frieden said.

Morita said she thinks the same efforts and resources that go into convincing communities of color should also be directed at conservatives.

“High-level government officials espousing the importance of vaccines and sharing their experiences with it is really important but it’s not sufficient,” Morita said. 

Support for Trump and a distrust of the government is not the only reason conservatives might be reluctant to accept the vaccine. Many are concerned about how quickly the vaccines were developed. 

Still others object on religious grounds, which is where Collins, the NIH director, comes in.

A devout Christian who is open about his faith, Collins has become an ambassador to the faith community. He spends hours a day talking to faith leaders, assuring them of the vaccine’s soundness and science.

Collins told The Hill he frames the decision to get vaccinated in religious terms.

“Is this a love your neighbor moment? Yes, it is,” Collins said. “And whatever faith you are, the Golden Rule seems to apply, and the Golden Rule would say, for your neighbor or for your family, for your neighbors down the street who may be vulnerable, this is something you can do for them.”

Enthusiasm for getting Covid vaccine is growing

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KFF COVID-19 Vaccine Monitor: February 2021

More than half of adults in the U.S. (55%) say they’ve already gotten one dose of Covid-19 vaccine or they’re eager to get one as soon as they can, an increase in acceptance from January (47%), a new poll reports. About 1 in 5 people are waiting to see how the vaccine rollout goes, but don’t rule out vaccination. Another 1 in 5 people are more reluctant: 7% would get vaccinated only if required by work, school, or some other activity, and 15% say no to vaccine under any circumstance. The increase in eagerness spans all demographic groups, but Black adults and young adults under age 30 were most likely to say they want to wait and see.

The pandemic’s coming new normal

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Photo illustration of the Freedom from Want image by Norman Rockwell with all the participants of the dinner wearing surgical masks.

As both vaccinations and acquired immunity spread, life will likely settle into a new normal that will resemble pre-COVID-19 days— with some major twists.

The big picture: While hospitalizations and deaths are tamped down, the novel coronavirus should recede as a mortal threat to the world. But a lingering pool of unvaccinated people — and the virus’ own ability to mutate — will ensure SARS-CoV-2 keeps circulating at some level, meaning some precautions will be kept in place for years.

Driving the news: On Tuesday, Johnson & Johnson CEO Alex Gorsky told CNBC that people might well need a new coronavirus vaccine annually in the years ahead, much as they do now for the flu.

  • Gorsky’s comments were one of the clearest signals that even as the number of vaccinated people rises, the mutability of SARS-CoV-2 means the virus will almost certainly be with us in some form for years to come.

Be smart: That sounds like bad news — and indeed, it’s much less ideal than a world in which vaccination or infection conferred close to lifelong immunity and SARS-CoV-2 could be definitively conquered like smallpox.

  • With more contagious variants spreading rapidly, “the next 12 weeks are likely to be the darkest days of the pandemic,” says Michael Osterholm, the director of the University of Minnesota’s Center for Infectious Disease Research and Policy.
  • But the apparent effectiveness of the vaccines in preventing hospitalizations and death from COVID-19 — even in the face of new variants — points the way toward a milder future for the pandemic, albeit one that may be experienced very differently around the world.

Details: From studying what happened after new viruses emerged in the past, scientists predict SARS-CoV-2 will eventually become endemic, most likely in a seasonal pattern similar to the kind of coronaviruses that cause the common cold.

  • That’s nothing to sneeze at — literally, it will make us sneeze — but as immunity levels accumulate throughout the population, our experience of the virus will attenuate, and we’ll be highly unlikely to experience the severe death tolls and overloaded hospitals that marked much of the past year.

Yes, but: The existence of a stubborn pool of Americans who say they won’t get vaccinated — as well as the fact that it may take far longer for children, whom the vaccines have yet to be tested on, to get coverage — will give the virus longer legs than it would otherwise have.

  • “This will be with us forever,” says Osterholm. “That’s not even a debate at this point.”

What’s next: This means we can expect the K-shaped recovery that has marked the pandemic to continue, says Ben Pring, who leads Cognizant’s Center for the Future of Work.

  • With the virus likely to remain a threat, even if a diminished one, “those who are more stuck in the analog world are really going to continue to struggle,” he says.
  • Health security will also become a more ingrained part of daily life and work, which means temperature checks, masks, frequent COVID-19 testing and even vaccine passports for travel are here to stay.

The catch: That’s not all bad — the measures put in place to slow COVID-19 have stomped the flu and other seasonal respiratory viruses, and if we can hold onto some of those benefits in the future, we can save tens of thousands of lives and billions of dollars.

  • If the inequalities seen in the early phase of the vaccine rollout persist, COVID-19 could become a disease of the poor and disadvantaged, argues Mark Sendak, the co-founder and scientific adviser for Greenlight Ready, a COVID-19 resilience system that grew out of Duke Health.
  • Sendak points to the example of HIV, a disease that is entirely controllable with drugs but continues to exert a disproportionate toll on Black Americans, who take pre-exposure prophylactic medicine at much lower rates.

“If we go back to ‘normal,’ then we have failed.”

— Mark Sendak

What to watch: Whether the vaccine rollout can be adapted to reach hard to find and hard to persuade populations.

  • The Biden administration announced yesterday that it will start delivering vaccines directly to community health centers next week in an effort to promote more equity in the vaccine distribution process.
  • As the administration rolls out new COVID-19 plans, it needs to “invest in the community health care personnel” who can ensure that no one is left behind, says Sendak.

The bottom line: While SARS-CoV-2 has proven it can adapt to a changing environment, so can we. But we have to do so in a way that is fairer than our experience of the pandemic has been so far.

“I got the vaccine…now what can I do?”

Posted on by • Posted in Asymptomatic Transmission, Centers for Disease Control & Prevention (CDC), Coronavirus, Coronavirus Mutation, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Herd Immunity, Infection Control, Infection Control Plan, Infectious Virus, Leadership Messaging, Messaging, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Scientists, Social Distancing, Vaccine, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vulnerable Populations • Leave a comment

https://mailchi.mp/85f08f5211a4/the-weekly-gist-february-5-2021?e=d1e747d2d8

Image result for after the vaccine covid

A family member in her 70s called with the great news that she received her first dose of the COVID vaccine this week. She mentioned that she was hoping to plan a vacation in the spring with a friend who had also been vaccinated, but her doctor told her it would still be safest to hold off booking travel for now: “I was surprised she wasn’t more positive about it. It’s the one thing I’ve been looking forward to for months, if I was lucky enough to get the shot.” 

It’s not easy to find concrete expert guidance for what it is safe (or safer?) to do after receiving the COVID vaccine. Of course, patients need to wait a minimum of two weeks after receiving their second shot of the Pfizer or Moderna vaccines to develop full immunity.

But then what? Yes, we all need to continue to wear masks in public, since vaccines haven’t been proven to reduce or eliminate COVID transmission—and new viral variants up the risk of transmission. But should vaccinated individuals feel comfortable flying on a plane? Visiting family? Dining indoors? Finally going to the dentist?
 
It struck us that the tone of much of the available guidance speaks to public health implications, rather than individual decision-making. Take this tweet from CDC director Dr. Rochelle Walensky. A person over 65 asked her if she could drive to visit her grandchildren, whom she hasn’t seen for a year, two months after receiving her second shot. Walensky replied, “Even if you’ve been vaccinated, we still recommend against traveling until we have more data to suggest vaccination limits the spread of COVID-19.” 

From a public health perspective, this may be correct, but for an individual, it falls flat. This senior has followed all the rules—if the vaccine doesn’t enable her to safely see her grandchild, what will? It’s easy to see how the expert guidance could be interpreted as “nothing will change, even after you’ve been vaccinated.”

Debates about masking showed us that in our individualistic society, public health messaging about slowing transmission and protecting others sadly failed to make many mask up.

The same goes for vaccines: most Americans are motivated to get their vaccine so that they personally don’t die, and so they can resume a more normal life, not by the altruistic desire to slow the spread of COVID in the community and achieve “herd immunity”. 

In addition to focusing on continued risk, educating Americans on how the vaccinated can make smart decisions will motivate as many people as possible to get their shots.

Disparities may worsen as vaccine eligibility widens

Posted on by • Posted in Coronavirus, Coronavirus Mutation, Health Equity, Health Inequity, Pandemic, Priorities, Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Social Determinants of Health, Vaccine, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vulnerable Populations • Leave a comment

https://mailchi.mp/85f08f5211a4/the-weekly-gist-february-5-2021?e=d1e747d2d8

Early data on vaccine distribution by race and ethnicity show a mismatch between those population groups receiving the vaccine, and those that have been hardest hit by the pandemic. As the graphic above shows, Black and Hispanic Americans have thus far been vaccinated at considerably lower rates in many states compared to their share of population as a whole—and these disparities are likely to worsen as states shift focus to senior populations for priority access, moving away from prioritizing essential workers, who tend to be more racially diverse.

The White population skews older, which stands to widen disparities in the near-term. Another compounding issue: vaccine hesitancy.

A recent Morning Consult poll found that, despite an overall increase in overall vaccine willingness, Black Americans remain the most hesitant, with only 48 percent willing to get the vaccine.

Meanwhile, Black and Hispanic Americans continue to be disproportionately impacted by COVID, with hospitalization and death rates nearly three to four times greater than those of White Americans.

Hesitancy will become an increasingly urgent problem as larger swathes of the population become eligible for vaccination, especially given that communities of color tend to be younger, as shown above.

How soon can we achieve immunity through vaccinations?

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Over the weekend I realized that my son Henry, born in June 2019, has lived more than half of his life in the pandemic era. He’s too young to be cognizant of it, of course, but my wife and I are acutely conscious of the experiences his older brother had already enjoyed by the time he was Henry’s age, things that are impractical or impossible in the moment.

He’s not alone in that, of course. Most Americans are experiencing some ongoing deprivations because of the pandemic. (Most of those for whom the pandemic is not imposing unusual restrictions are, ironically, probably contributing to the pandemic’s extent and duration.) Just about everyone in the United States is eagerly scanning the horizon for signs of normalcy — as we have been for months, occasionally spotting oases that too often turn out to be mirages.

So when will we return to some semblance of normal? It’s hard to say with certainty. The best tool we have to reach that point, though, is the broad deployment of the vaccines approved for emergency use by the government. But even the existence of those vaccines can’t completely answer the question.

For example, the rate at which the vaccines are deployed makes a massive difference. A pace of 2 million shots per day as opposed to 1 million seems like a subtle distinction but, obviously, means achieving immunity for recipients twice as fast.

What level of immunity is necessary is a question of its own. Do we need 70 percent of the country to have been immunized? Or, as infectious-disease expert Anthony S. Fauci has recently said, is the figure closer to 80 or 85 percent?

When doing this calculation, do you include the 26 million Americans who have already had coronavirus infections? What about young people? The vaccine trials included only those age 16 and over. Those younger have constituted about a 10th of the total infections. And what vaccine are we talking about? The Pfizer and Moderna iterations require two shots; the vaccine from Johnson & Johnson requires only one.

All of these factors affect how we can figure out when the country might hit the herd-immunity mark. If we assume that young people will be included among those needed to be vaccinated — a complicated question on its own — the calculator below will allow you to figure out when immunity might be achieved at various immunization rates.

At this rate, the country would reach 70 percent herd immunity through vaccinations by Nov. 10

How we calculate this:
There are about 330 million Americans, meaning that we need 231 million to be resistant to the virus to hit 70 percent immunity. We can take out the 5.8 million Americans who’ve already been vaccinated. That leaves 211.3 million people to be vaccinated.

From there the math is straightforward: doing two-shot vaccinations at a rate of 1.5 million shots per day means it will take 282 days to complete the job.

Bear in mind that sliding the little bar to determine how quickly shots are administered is far easier than actually scaling up the infrastructure to do so. President Biden’s original target for daily vaccinations was 1 million; he recently increased it to 1.5 million. At that rate, we’re still months from resolution. But because administering the vaccine is more complicated and requires more tracking than vaccinations such as that for the seasonal flu, it’s necessarily trickier to scale up.

At this point, the more urgent concern is the efficacy of the vaccine against any variants of the virus that might emerge. Manufacturers have already noted that the vaccine works less well against a virus variant first identified in South Africa, though the vaccines are still broadly effective, particularly at protecting the recipient from severe illness or death after infection.

Well, that and the fact that a fifth of Americans said in a recent Kaiser Family Foundation poll that they won’t get the vaccine or would do so only if it was required. Happily, more Americans are now saying they’re eager to get a vaccine.

The faster we get people immunized, the better we protect against the emergence of new mutations that prove less able to be controlled by the vaccines. The faster we get shots in arms, as the phrasing has it, the faster we get back to normal.

Which would be nice for all of us, including my 1-year-old.

Michael Dowling: No one said it would be easy

Posted on by • Posted in Coronavirus, Culture, Decision Making, Health Equity, Health Inequity, Health System, Hospital, Hospital Industry, Leadership, Leadership Commitment, Leadership Culture, Leadership Intent, Leadership Messaging, Leadership Plan, Leadership Trust, Mission, Mission Critical, Pandemic, Priorities, Productivity, Public Health, Public Trust, Strategy, Vaccine, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Virtual Care Strategy, Virtual Healthcare, Virtual Hospital, Virtual Workforce • Leave a comment
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Five suggestions for technology companies, venture capitalists | Northwell Health

Hardly one month into 2021, the pressing priorities facing healthcare leaders are abundantly clear. 

First, we will be living in a world preoccupied by COVID-19 and vaccination for many months to come. Remember: this is a marathon, not a sprint. And the stark reality is that the vaccination rollout will continue well into the summer, if not longer, while at the same time we continue to care for hundreds of thousands of Americans sickened by the virus. Despite the challenges we face now and in the coming months in treating the disease and vaccinating a U.S. population of 330 million, none of us should doubt that we will prevail. Despite the federal government’s missteps over the past year in managing and responding to this unprecedented public health crisis, historians will recognize the critical role of the nation’s healthcare community in enabling us to conquer this once-in-a-generation pandemic.

While there has been an overwhelming public demand for the vaccine during the past couple of weeks, there remains some skepticism within the communities we serve, including some of the most-vulnerable populations, so healthcare leaders will find themselves spending time and energy communicating the safety and efficacy of vaccines to those who may be hesitant. This is a good thing. It is our responsibility to share facts, further public education and influence public policy. COVID-19 has enhanced public trust in healthcare professionals, and we can maintain that trust if we keep our focus on the right things — namely, how we improve the health of our communities.

And as healthcare leaders diligently balance this work, we also have a great opportunity to reimagine what our hospitals and health systems can be as we emerge from the most trying year of our professional lifetimes. How do you want your hospital or system organized? What kind of structural changes are needed to achieve the desired results? What do you really want to focus on? Amid the pressing priorities and urgent decision-making needed to survive, it is easy to overlook the great reimagination period in front of us. The key is to forget what we were like before COVID-19 and reflect upon what we want to be after.

These changes won’t occur overnight. We’ll need patience, but here are my thoughts on five key questions we need to answer to get the right results.

1. How do you enhance productivity and become more efficient? Throughout 2021, most systems will be in recovery mode from COVID’s financial bruises. Hospitals saw double-digit declines in inpatient and outpatient volumes in 2020, and total losses for hospitals and health systems nationwide were estimated to total at least $323 billion. While federal relief offset some of our losses, most of us still took a major financial hit. As we move forward, we must reorganize to operate as efficiently as possible. Does reorganization sound daunting? If so, remember the amount of reorganization we mustered to work effectively in the early days of the pandemic. When faced with no alternative, healthcare moved heaven and earth to fulfill its mission. Crises bring with them great clarity. It’s up to leaders to keep that clarity as this tragic, exhausting and frustrating crisis gradually fades.

2. How do you accelerate digital care? COVID-19 changed our relationship with technology, personally and professionally. Look at what we accomplished and how connected we remain. We were reminded of how high-quality healthcare can go unhindered by distance, commutes and travel constraints with the right technology and telehealth programs in place. Health system leaders must decide how much of their business can be accommodated through virtual care so their organizations can best offer convenience while increasing access. Oftentimes, these conversations don’t get far before confronting doubts about reimbursement. Remember, policy change must happen before reimbursement catches up. If you wait for reimbursement before implementing progressive telehealth initiatives, you’ll fall behind. 

3. How will your organization confront healthcare inequities? In 2020, I pledged that Northwell would redouble its efforts and remain a leader in diversity and inclusion. I am taking this commitment further this year and, with the strength of our diverse workforce, will address healthcare inequities in our surrounding communities head-on. This requires new partnerships, operational changes and renewed commitments from our workforce. We need to look upstream and strengthen our reach into communities that have disparate access to healthcare, education and resources. We must push harder to transcend language barriers, and we need our physicians and medical professionals of color reinforcing key healthcare messages to the diverse communities we serve. COVID-19’s devastating effect on communities of color laid bare long-standing healthcare inequalities. They are no longer an ugly backdrop of American healthcare, but the central plot point that we can change. If more equitable healthcare is not a top priority, you may want to reconsider your mission. We need leaders whose vision, commitment and courage match this moment and the unmistakable challenge in front of us. 

4. How will you accommodate the growing portion of your workforce that will be remote? Ten to 15 percent of Northwell’s workforce will continue to work remotely this year. In the past, some managers may have correlated remote work and teams with a decline in productivity. The past year defied that assumption. Leaders now face decisions about what groups can function remotely, what groups must return on-site, and how those who continue to work from afar are overseen and managed. These decisions will affect your organizations’ culture, communications, real estate strategy and more. 

5. How do you vigorously hold onto your cultural values amid all of this change? This will remain a test through 2021 and beyond. Culture is the personality of your organization. Like many health systems and hospitals, much of Northwell’s culture of connectedness, awareness, respect and empathy was built through face-to-face interaction and relationships where we continually reinforced the organization’s mission, vision and values. With so many employees now working remotely, how can we continue to bring out the best in all of our people? We will work to answer that question every day. The work you put in to restore, strengthen and revitalize your culture this year will go a long way toward cementing how your employees, patients and community come to see your organization for years to come. Don’t underestimate the power of these seemingly simple decisions.

While we’ve been through hell and back over the past year, I’m convinced that the healthcare community can continue to strengthen the public trust and admiration we’ve built during this pandemic. However, as we slowly round the corner on COVID-19, our future success will hinge on what we as healthcare organizations do now to confront the questions above and others head-on. It won’t be quick or easy and progress will be a jagged line. Let’s resist the temptation to return to what healthcare was and instead work toward building what healthcare can be. After the crisis of a lifetime, here’s our opportunity of a lifetime. We can all be part of it. 

Cartoon – Sign of the Times on Covid Vaccine Hesitancy

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Editorial cartoon: COVID-19 vaccines