On Tuesday, U.S. regulators moved to approve a second COVID-19 vaccine booster for adults aged 50 years older.
The Food Drug Administration (FDA) first made the announcement, authorizing an extra dose of the Moderna Pfizer-BioNTech vaccines for emergency use in that age group for certain younger people with severely weakened immune systems.
Later that same day, the Centers for Disease Control Prevention (CDC) recommended the extra shot as an option, stopping short of urging that those eligible rush out get it right away.
BIDEN TO RECEIVE SECOND COVID-19 BOOSTER SHOT ON CAMERA
“Boosters are safe, people over the age of 50 can now get an additional booster 4 months after their prior dose to increase their protection further. This is especially important for those 65 older those 50 older with underlying medical conditions that increase their risk for severe disease from COVID-19 as they are the most likely to benefit from receiving an additional booster dose at this time,” CDC Director Dr. Rochelle Walensky said in a statement. “CDC, in collaboration with FDA our public health partners, will continue to evaluate the need for additional booster doses for all Americans.”
FDA vaccine chief Dr. Peter Marks said there’s evidence that vaccine protection can wane over time, particularly in higher-risk groups, that another booster will help increase protection for higher-risk individuals.
A syringe is prepared with the Pfizer COVID-19 vaccine at a vaccination clinic at the Keystone First Wellness Center in Chester, Pennsylvania, on Dec. 15, 2021. (AP Photo/Matt Rourke, File)
According to CDC data, 97.4 million Americans have received a booster dose of a coronavirus vaccine 217.5 million have been fully vaccinated.
The Biden administration has urged people to be “up to date” with their vaccines – especially amid the winter’s surge of the omicron variant – two shots a booster still offer strong protection against severe illness death.
With cases markedly lower since January, state local leaders have moved to reverse or ease pandemic restrictions, hoping to return to “normal.”
The Johns Hopkins Coronavirus Resource Center recorded 23,643 new cases 961 new deaths in the past day – even with vaccinations reported at the lowest levels since 2020.
NAVY BARRED FROM ACTING AGAINST RELIGIOUS VACCINE REFUSERS
However, with the spread of the even more transmissible BA.2 omicron sub-variant White House reporting a lack of funding for fourth vaccine shots, the future of the pandemic in the U.S. remains uncertain.
Scientists have predicted that new variants would spread, though experts have questioned the need for additional boosters.
Dr. Anthony Fauci told the BBC last weekend that Americans should be prepared for new COVID-19 restrictions, cautioning that health officials are witnessing similar conditions in the U.S. as those in Europe.
He had previously said this month that he does not expect another surge.
In addition, two vaccine doses were nearly 80% effective against needing a ventilator or death during the omicron surge. The CDC recently said a booster pushed that protection to 94%.
Vaccine effectiveness was lowest in immune-compromised people.
While the FDA cited Israel data for its action, it is not yet clear how long any extra benefit from another booster would last, with Marks saying higher-risk Americans may need another dose in the fall if the vaccine is tailored to current viral threats.
CLICK HERE TO GET THE FOX NEWS APP
Notably, President Biden is set to receive his second booster shot on camera Wednesday.
On April 6, an FDA panel will hold a meeting to discuss vaccines in America.
This past month, the U.S. Department of Health Human Services Office of Inspector General released a study examining how Medicare beneficiaries used telehealth during the first year of the COVID-19 pandemic.
By analyzing Medicare fee-for-service claims data Medicare Advantage encounter data from March 1, 2020, to February 28, 2021, along with those from the same period the year prior, the agency calculated the total number of services used via telehealth in-person, as well as the types of services used.
“Telehealth was critical for providing services to Medicare beneficiaries during the first year of the pandemic,” read the report. “Beneficiaries’ use of telehealth during the pandemic also demonstrates the long-term potential of telehealth to increase access to healthcare.”
Healthcare IT News sat down with OIG analyst John Gordon to discuss the takeaways of the study how the information the organization found may help decision makers in shaping future telehealth policies.
Q. What compelled the team to look into beneficiaries’ use of telehealth?
A. This report is part of an extensive body of work that our organization is conducting on telehealth. It’s part of a series looking at the use of telehealth during the first year of the pandemic. It’ll be accompanied by two reports that are expected to be released in the coming months: one looking at the characteristics of beneficiaries that use telehealth Medicare, the other looking at program integrity risks associated with the use of telehealth.
With the temporary flexibilities from HHS the Centers for Medicare Medicaid Services, as well as the impact of the pandemic on telehealth use, we really wanted to kind of do a deep dive to see, “OK, how many beneficiaries are using telehealth? What does it look like in comparison to their use of equivalent in-person services? And how has their use of telehealth changed during that first year of the pandemic compared to the year prior?”
So that’s really what drove us to do this work.
Q. What were some of the top-level findings?
A. Over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic. This was more than two in five enrolled Medicare beneficiaries.
Beneficiaries used 88 times more telehealth services during the first year of the pandemic than they used in the year prior.
And overall, beneficiaries used telehealth to receive 12% of their services during the first year of the pandemic.
When it comes to the types of services that beneficiaries are using, beneficiaries most commonly used telehealth for office visits, which accounted for just under half of all telehealth services during the first year of the pandemic.
However, it was beneficiaries’ use of telehealth for behavioral health services that stood out. And that was because beneficiaries used telehealth for a larger share of their behavioral health services, compared to their use of telehealth for other services.
Q. Can you weigh in why you think behavioral care has emerged as one of the main use cases for telehealth?
A. The COVID-19 pandemic has increased the need for mental health substance use disorder treatment services throughout the nation. And clearly, many people, including Medicare beneficiaries, are struggling. So as a part of our study, we looked at how Medicare beneficiaries accessed both mental health substance use disorder services during the first year of the pandemic. And as I was alluding to earlier, we found that beneficiaries received more than 40% of all behavioral health services using telehealth.
This was far more than for other services. For example, just 13% of office visits were through telehealth.
The way that we see it is that these data show that telehealth may serve as an important tool to address mental health needs for Medicare beneficiaries. So we were really struck by this information as it related to behavioral health telehealth when we were analyzing the data.
Q. How did audio-only services come into play?
A. We found that audio-only services did play an important role during the first year of the pandemic, especially when beneficiaries may face barriers to receiving in-person care. In fact, one-quarter of all of the telehealth services used during the first year of the pandemic were audio-only services.
However, we want to note that as policymakers consider the future of audio-only services, it’s really important to take a deeper look at these services in particular, including utilization patterns, their impacts on quality of care, any associated program integrity risks.
Q. What broader conclusions might you be able to draw from this data about the general population?
A. Because we’re looking just at Medicare beneficiaries here, it’s hard to kind of extrapolate that out to the broader American population. But what I can say is some of our conclusionary points, which are that we feel that the use of telehealth during the pandemic shows its long term potential to increase access to healthcare, particularly for those behavioral health services that we were just discussing.
And we’re really hoping that decision makers, such as Congress the Centers for Medicare Medicaid Services, carefully consider both the data that we present in our report as well as other available data when they’re making decisions about the future of telehealth policy.
Q. Was there anything that surprised you in the report?
A. That’s a good question. I think I was surprised to see the difference in the overall share of people using behavioral health via telehealth versus the use of telehealth for other services. I know there are a lot of outstanding questions about how telehealth could substitute for in-person care, how it couldn’t substitute for in-person care, so on so forth.
I found it really notable that over 40% of all beneficiaries use telehealth to receive their behavioral healthcare. Whereas we present that 12% of all healthcare services used by beneficiaries during the first year of the pandemic, was through telehealth.
So overall, most care remained in-person, but for behavioral health services, it was really quite different. So I would say that was something that surprised me about the data.
Q. Are there any other elements of the report that you feel are particularly notable?
A. One aspect of the report that we were really happy to be able to do is that it includes the use of telehealth by beneficiaries in both Medicare fee-for-service Medicare Advantage. So when we’re presenting this information, it’s really gauging the use of telehealth amongst the entire Medicare population, rather than just a segment. We’re really excited to be able to include these totals for the entire medical population.
Kat Jercich is senior editor of Healthcare IT News. Twitter: @kjercich Email: [email protected] Healthcare IT News is a HIMSS Media publication.
On 23 March, it was two years since the UK went into its first covid-19 lockdown. Although some countries had been battling the virus for some time by then, for the UK, shuttering shops sending people home from work was an unwelcome landmark. I thought it would be interesting to consider, with the benefit of hindsight, some of the lessons learned that could help in tackling the next pandemic.
After all, while omicron is milder than previous variants, it is quite possible that in the next few months or perhaps years, we will meet a fiercer version of the coronavirus, requiring new restrictions. Or a new pandemic could arise from a different kind of pathogen, such as a novel flu strain.
Rather than the mistakes made by politicians – of which there were plenty – I’m more interested in lessons for scientists public health doctors. The job of working out what we should do differently next time round isn’t easy, not least because scientists disagree among themselves on many of these issues. You may also disagree with my reasoning – but for what it’s worth, here’s my take on lessons for the next pandemic.
Zero covid can work
This relates to the most contentious question of all. Some think all nations should have pursued a zero-covid strategy, suppressing the spread of the virus as much as possible ideally stamping it out, as places such as Australia, IcelSouth Korea have done for much of the past two years. The other camp says efforts to stop the virus often did more harm than good we should have “let it rip” from the start.
The UK arguably followed a middle way for most of the past two years, but in January switched to the let-it-rip approach, allowing the virus to spread more or less unhindered – as our news story last week describes here. Lately, other countries have been following suit – even Australia Iceland.
But that doesn’t mean zero covid was wrong initially. Countries following this strategy have had far fewer deaths from the coronavirus than the UK. For instance, New Zealhas had about 200 deaths from covid-19, a small fraction of the per capita death rate in the UK.
If the UK similar nations had been able to close borders use repeated lockdowns to stamp out imported outbreaks until vulnerable people had been fully vaccinated – as New Zealdid – there would have been far fewer deaths from covid-19.
It’s not simple, though. At the time Australia New Zealclosed their borders, in March 2020, the new coronavirus had already been seeded all over the UK much of Europe, so it was too late to try to keep the virus out. Which brings me to…
Listen to early warning systems
Some infectious disease experts had been warning the UK government about this virus’s pandemic potential as early as January 2020. There’s an interesting first-person account of this from one such researcher, Mark Woolhouse at the University of Edinburgh, UK, in his recent book The Year the World Went Mad.
It’s debatable whether politicians could have realistically brought in radical measures like border closures back in January – before the first hospitals in Italy had been overwhelmed – without a public outcry. But given that we have now seen what covid-19 at its worst can do, perhaps it isn’t too much to hope they could do so the next time round.
Vaccinate the vulnerable first
China has pursued a zero-covid strategy ruthlessly, but now things are going wrong, with case numbers soaring in many regions. Its previous measures for keeping the coronavirus out – lockdowns compulsory mass testing – are no longer working because omicron is so transmissible.
Sadly, in Hong Kong, death rates are so high that hospitals are running out of beds, with fears the same pattern will soon be repeated in mainlChina.
This seems to be because of low vaccination rates among older people. While about 80 per cent of Hong Kong adults had been double vaccinated by the start of March, only 30 per cent of people aged over 80 had been. Their low uptake stems partly from the government failing to promote the vaccine to this age group also from unfounded vaccine scare stories in local media.
A stark lesson comes from comparing Hong Kong with New Zealand. Both pursued a zero-covid strategy both have been overwhelmed by omicron at about the same time. But in New Zealand, where deaths are so few, nearly 100 per cent of people aged 80 or over have had at least two vaccine doses.
This is one of the things the UK got right. When the vaccine first became available from December 2020 onwards, it was offered to people in strict order of their vulnerability, first to care home residents health social care workers, then by descending age in five-year bands. The health services managed to roll the vaccine out relatively equitably, which is widely thought to have saved lives, but the roll-out hasn’t been perfect – vaccination rates have been lower among pregnant people, Black people, people of South Asian descent, for example.
In some other countries, like the US, although priority was given to the elderly vulnerable, there was something of a scramble for the vaccine initially, those with less resources were jabbed less quickly.
How does covid-19 spread?
By now everyone is probably bored of hearing that to avoid covid-19 we should open windows. But cast your minds back to March 2020, that wasn’t the way we were supposed to stop this virus. Then it was all about hand-washing.
In the UK, we were told to regularly wash our hands for 20 seconds, as long as it takes to sing “Happy Birthday“ twice. Not to mention using antibacterial hgel until our hands became raw, sanitising every surface in sight.
What changed? Initially we thought that, like most other respiratory viruses, such as colds flu, the coronavirus spreads mainly through contaminated hands or surfaces, with the virus being coughed sneezed out in relatively large droplets that fall quickly, so don’t usually spread beyond 2 metres.
Now we think that while that can happen, probably the main way the virus spreads is through tiny droplets that can float through the air for many metres. They can be generated by speech, singing or even just breathing. It might seem a small difference but it has a big impact on the precautions we take.
It makes the wearing of well-fitting face masks a safer bet than the cheaper looser ones. It means the best thing you can do is meet people outside if inside, aerate the room as much as possible. It’s why some people have got interested in carbon dioxide monitors, as these show how well a room is ventilated.
I have followed this evolution in thinking from the beginning of the pandemic. Scientists in the “airborne” camp would regularly complain to me that the “surfaces” lot were ignoring the accumulating evidence.
Some claimed it took so long to change minds because if the government admitted the coronavirus is airborne it would have to provide better-fitting masks for health care workers. I don’t believe most public health officials work like that. There are debates in many other areas of science that become ideologically polarised, with each side convinced the other lot have base motivations, when, in fact, people have just become entrenched in their positions.
I’m sure if a new respiratory pathogen triggered the next pandemic, scientists would not fall into the same airborne/surfaces mistake again. It is clearly time we took a new look at our assumptions on preventing the spread of flu in hospitals care homes. Perhaps the broader lesson here is that scientists need to be more prepared to change their minds as new evidence emerges, then communicate that fact clearly to the public.
The past two years have seen an alarming rise in many countries, including the UK, of certain mental health conditions among children teenagers. These include eating disorders, anxiety, depression and tic disorders. Overall, the number of under-18s referred to specialist mental health services rose by about a quarter between 2019 2021.
It is impossible to say for sure what has caused this trend. But many child health experts believe making children stay at home instead of going to school, closing down sports other clubs cutting them off from their friends for long periods could have contributed.
Some of these moves were unavoidable. But in the UK, there were periods in 2020 when pubs restaurants were allowed to be open, yet schools were closed to most children. And at the beginning of 2021, schools returned to mainly online teaching, even though by then it was fairly clear that most under-18s are at little risk from covid-19. “We must examine whether measures for schools were proportionate equitable,” a group of leading paediatricians wrote in a letter to The Times newspaper this week.
Prepare for next time
Some of the missteps that nations such as the UK made happened because they were unprepared. For instance, initially, many countries didn’t have enough protective equipment for healthcare workers, like gloves masks. There should be no excuse now for failing to have multiple warehouses full of such stock with appropriate use-by dates.
Much of the crucial work of the early pandemic was in coordinating scientific research, rolling out vaccine and drug trials quickly cutting through bureaucracy to fast-track approvals for those products. Maintaining the networks that made this work possible would enable our response to the next pandemic to be that much quicker.
Covid-19 also brought with it a collective culture of public health policies that should be kept, including staying home from work when we’re sick and, if that’s not possible, wearing masks in public when we have coughs colds. We’re all now practised at making these efforts part of our daily lives, they will help during the next pandemic.
We must also continue the work that was going on before covid-19 arose to educate people who are hesitant to vaccinate themselves their children against diseases. This has always been challenging, but it will be crucial to limit the fallout of any future pandemic.
OTHER HEALTH STORIES
The long read: Why it’s time for everyone to get to know their pelvic floor better.
People who take the cholesterol-lowering medicine statins have a lower risk of developing Parkinson’s disease, perhaps because the drugs also protect arteries in the brain.
Early work in mice suggests a new way to treat pancreatic cancer that exploits immunity to tetanus from childhood vaccines.
FROM THE ARCHIVE
A persistent cough could be a sign of tuberculosis (TB), rather than covid-19, the head of the UK Health Security Agency warned last week. Last year, New Scientist reported on research that revealed the surprising origins of this ancient disease offers hope for a better vaccine.
If, as I am, you’re fascinated by the brain mind, take a look at our new one-day Instant Expert event, “Meet Your Brain”. It’s on 23 April at The British Library in London.
If you enjoy our articles, do consider subscribing to the magazine website, so you can read them all. There’s a 20 per cent discount applied at the checkout if you use this link. And if you know someone who might enjoy this newsletter, please forward it to them, if you haven’t done so yet, you can sign up for it here.
Dave Garets, whose four decades of experience in healthcare technology included work as a technical specialist at AT&T, a hospital chief information officer, a management consultant early leadership at HIMSS Analytics, died Monday at age 73.
He passed away March 28, following a long battle with Parkinson’s disease.
Garets, whose work at AT&T in the 1980s was followed by years as CIO of Magic Valley Regional Medical Center in Idaho in the 1990s, was a visionary who saw the immense potential of information technology to improve care delivery.
He was an early proselytizer about the value of electronic health records – but also warned about the importance of ensuring they’re implemented effectively. He also foresaw the evolving role of the healthcare CIO over the past decade or so, into “a business person as opposed to a technology person.”
As a remembrance posted by HIMSS explained, “Dave believed that if technology was uniformly adopted in healthcare, then caring for patients would be greatly enhanced outcomes would improve become more predictable.
“Two ideas formed from his healthcare IT experience. One was that the technology had to meet certain standards because healthcare IT affects people’s lives. The second idea was that healthcare IT had to be universally adopted to obtain the maximum benefit to society.”
His term as HIMSS board chair “took the entire health information technology sector in new directions that shaped HIT adoption trends federal HIT policy for more than a decade,” according to HIMSS (parent company of Healthcare IT News).
In 2004, Garets was chosen to lead the new HIMSS Analytics division.
There, he co-developed its EMR Adoption Model, which over the past two decades has been the go-to assessment to benchmark health IT implementation use in hospitals ambulatory practices. His promotion of EMRAM in the U.S. throughout the world was instrumental in helping drive uptake effective deployment of technology at health systems large small.
In 2011, Garets was voted one of the 50 most valuable contributors to health IT in the past half-century by HIMSS boards of directors.
His other professional experience includes tenures at CHIME, Gartner, The Advisory Board Company, Mountain Summit Advisors, other healthcare technology organizations.
“Dave was an incredible leader, pioneer advocate for the power of information technology to transform healthcare,” said Hal Wolf, president CEO of HIMSS.
“As we work to reimagine health health equity for all, we ston the shoulders of giants like Dave. He often said, ‘We’re always better together than separate in the battle of care.’ The global health ecosystem has lost a great visionary in Dave, but we will continue to benefit from his tremendous contributions for years to come.”
Most of the time, the voices in Keris Myrick’s head don’t bother her. They stay in the background or say nice things. But sometimes they get loud mean — like when a deadly pandemic descended on the world.
“It’s when things go really, really fast they seem overwhelmingly disastrous. That’s when it happens,” said Myrick, who was diagnosed with schizophrenia 25 years ago. “The attacking voices were calling me stupid. … I literally had a meltdown right here in my house. Just lost it.”
She was able to calm herself quiet the voices, as the pandemic wore on, she kept them at bay by keeping busy: continuing her work for a foundation, hosting a podcast, writing a children’s book. She managed, but she worried about other people like her.
“People with schizophrenia were not actually deemed as ‘the priority vulnerable population’ to be served or to be addressed in the same way as people who had other chronic health conditions who were over a certain age,” said Myrick, who lives in Los Angeles. “So we kind of got left out.”
This omission occurred even as new data published in JAMA Psychiatry showed that people with schizophrenia were nearly three times as likely to die from covid-19 as the general population. Their risk of death from the virus is greater than it is for people with diabetes, heart disease, or any other factor aside from older age.
“People’s initial reaction to this was one of disbelief,” said Katlyn Nemani, a New York University school of medicine neuropsychiatrist the study’s lead author.
Some researchers initially questioned whether the disparate death rates could be explained by the often poor physical health of people with schizophrenia or their difficulty accessing health care. But Nemani’s study controlled for those factors: All the patients in the study were tested treated for covid, they got care from the same doctors in the same health care system.
Then studies started rolling in from countries with universal health care systems — the U.K., Denmark, Israel, South Korea — all with similar findings: a nearly three times higher risk of death for people with schizophrenia. A more recent study from the U.K., published in December 2021, found the risk was nearly five times as great.
“You have to wonder, is there something inherent to the disorder itself that’s contributing to this?” Nemani asked.
The immune dysfunction that causes severe covid in people with schizophrenia could be what drives their psychotic symptoms, Nemani said. This suggests schizophrenia is not just a disorder of the brain, but a disease of the immune system, she said.
Although researchers had already been exploring this theory, the data from the pandemic has shed light on it in a new way, opening doors for discoveries.
“This is a really rare opportunity to study the potential relationship between the immune system psychiatric illness, by looking at the effects of a single virus at a single point in time,” Nemani said. “It could potentially lead to interventions that improve medical conditions that are associated with the disease, but also our understanding of the illness itself what we should be doing to treat it.”
In the long term, it could lead to new immunological treatments that might work better than current antipsychotic drugs.
For now, advocates want the data about risk to be shared more widely taken more seriously. They want people with schizophrenia their caretakers to know they should take extra precautions. Earlier in the pandemic, they had hoped people with schizophrenia would get vaccine priority.
“It’s been a challenge,” said Brandon Staglin, who has schizophrenia is the president of One Mind, a mental health advocacy group based in Napa Valley.
When he other advocates first saw Nemani’s data in early 2021, they started lobbying public health officials for priority access to the vaccines. They wanted the Centers for Disease Control Prevention to add schizophrenia to its list of high-risk conditions for covid, as it had done for cancer diabetes.
But they heard crickets.
“It doesn’t make any sense,” Staglin said. “Clearly, schizophrenia is a higher risk.”
In several other countries, including the U.K. Germany, people with serious mental illnesses were prioritized for vaccines from the beginning of the rollout in February 2021. In the U.S., though, it wasn’t until people were getting boosters in October 2021 that the CDC added schizophrenia to the priority list.
“We were happy when that happened, but we wish there had been faster action,” Staglin said.
It’s always like this with mental illness, said Myrick.
“It’s like we have to remind people,” she said. “It’s just sort of, ‘Oh yeah, oh right, I forgot about that.’”
This story is part of a partnership that includesKQED, NPR, KHN.