U.S. FOCUS ON HEALTHCARE AND COVID-19 PANDEMIC
2021 started with a new president, Joseph Biden, who has made a commitment that healthcare and the coronavirus pandemic will be a priority for his administration. He promised to work to maintain and improve the Affordable Care Act (ACA), which he was instrumental in getting passed when he was vice-president. He vowed to rejoin the World Health Organization (WHO) and focus on implementing a robust coronavirus plan that will manufacture and distribute personal protective equipment, testing equipment, and other needed supplies, as well as set processes in place to administer the vaccines that are so urgently needed.
Within three days of the inauguration, President Biden signed eight executive orders (EOs) related to the COVID-19 crisis. These EOs define his direction and goals for dealing with the pandemic and will allow departments and agencies to quickly move to address immediate needs.
1. Requirement to wear masks and social-distance on federal property; Also “encouraged” mask wearing across America; Launch a 100-day masking challenge
• TIP: N95 or surgical masks are best or wearing two masks (tight fitting first, then a looser one on top); try to avoid masks with vents
2. Coordination of a government-wide COVID-19 response and creation of a response coordinator to advise the president and manage the distribution of vaccines, tests and supplies; there is a $25 billion budget for vaccine production, purchase and disbursement of free COVID-19 vaccines
• NOTE: Let patients know vaccines are free. This has not been communicated clearly.
3. Expand access and support research for COVID-19 treatments; increase support for critical care and long-term care facilities
4. Promote data-driven response to COVID -19 by “facilitating the gathering, sharing and publication of COVID-19 related data” to inform decision-making and public understanding of the pandemic
5. Support the governors’ deployment of the National Guard to prevent the spread of COVID-19; this will be fully funded by the Federal Emergency Management Agency (FEMA)
6. Strengthen the public health supply chain by invoking the Defense Production Act (DPA) to provide needed supplies; request department heads to assess the nationwide availability of personal protective equipment and resources needed to distribute COVID -19 tests and vaccines; develop a strategy to manufacture supplies for “future pandemics and biological threats”
• The DPA allowed the White House to sign contracts with six diagnostic companies to make at least 61 million at-home or point-of-care coronavirus tests available by summer; allow the Defense Department to deploy more than 1,000 active military personnel to support state vaccination sites; Increase the supply of critical personal protective gear; expand the manufacturing of supplies, such as surgical gloves – about 1 billion gloves will be manufactured per month by the end of the year; Give Pfizer priority access to two components it needs to manufacture its COVID-19 vaccine.
7. Establish the COVID -19 Health Equity Task Force to address social inequities and “disparities in outcomes caused by race, ethnicity and other factors” exacerbated by the pandemic; make recommendations regarding the allocation of resources and funding
8. Establish a new pandemic testing board to “promote diagnostic, screening and surveillance testing”; facilitate the distribution of free COVID-19 tests to those without comprehensive health insurance
• NOTE: Let patients know tests are free for those without comprehensive health insurance.
President Biden’s main goal initially though is to manufacture and/or acquire vaccines, deliver them, and get the vaccines administered as quickly as possible. He set a goal of providing 100 million vaccine shots in his first 100 days.
VACCINES AND THE ROLLOUT PROCESS
Vaccines were first administered on December 14, 2020, with 3,529 doses the first day. During the next 38 days, through January 20, 2021, there were 16.5 million vaccinations administered (634,615 doses/day). As the vaccine rollout progressed, from January 20 through February 14 (26 days), there were 36.4 million additional doses given (1.4 million doses/day). This initial success prompted President Biden to increase his goal to 150 million doses in the first 100 days. Is that possible?
At 100 million doses in 100 days, all adults could be fully vaccinated (2 doses) by spring 2022. However by increasing that to 130 million doses, all adults could be fully vaccinated by the end of 2021. But increasing it to 150 million doses could mean that the overwhelming majority of adults (perhaps 70-85%) could receive the vaccine by late summer or fall of 2021. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, President Biden’s chief medical adviser and member of his COVID-19 Task Force, said this level of vaccination will be enough to significantly slow the spread of the virus and protect the vulnerable who were not vaccinated or whose vaccinations had not been effective. Of course, a vaccination for children under the age of 18 will also have to be completed and approved. It is hopeful that can be accomplished by September, if the clinical trials are successful.
It is also possible that vaccinations could be completed even sooner if:
AFTER THE VACCINES ARE GIVEN
This is all very encouraging and gives us hope that we will be able to return to “some” sense of normalcy in the foreseeable future. However, it is important to remember that acquiring two doses of the vaccine, does not mean you are free to return to “normal” – not wearing a mask, forgetting about social distancing, and gathering in large crowds. Yes, it is safer be around other people, but you can still get COVID-19. You may not be as sick or need to be hospitalized, but you still must be careful. The virus is very transmissible and virulent. As of mid-February we only have 52.9 million people who have received both doses, which is less than 20% of those who need vaccination.
We need to continue to wear masks, socially distance, and avoid gathering in large crowds. However, there is a big advantage to getting both doses. 10-14 days after the last shot, you can be around other people who have also had both shots. This means, you may be able to visit with other family members, like grandparents, that you have not been able to see. Just make sure it is in small groups of people who have also been fully vaccinated. Some people may want to start traveling again, but precautions need to be taken, as others who are traveling may not have been fully vaccinated.
There is also another advantage to receiving both doses. The CDC updated quarantine recommendations say that people exposed to COVID-19 do not need to quarantine, if they meet all 3 of these requirements:
If all three criteria are not met, the person should follow current quarantine guidelines.
So an end is in sight, even though it is still 6-8 months away. By late summer or fall, if things continue to go as planned, we may be able to begin to go back to our “new normal.” It will never be the same as our old normal, but it will be wonderful to be able to go out, socialize, and hug people again. It may seem like a long time yet, but we have made it through the last year, so I’m sure we can make it through another few months, especially when we can begin to see the light.
COVID-19 RESOURCE LIST
I know it is difficult, when working with patients all day, to find time to look for reliable, updated resources to provide to your patients, so I have included a list of informative, easy-to-use, interactive websites. They provide educational material for all aspects of COVID-19: general information, toolkits, guidelines, statistics, vaccinations, clinical trials and current treatments. I hope you will find it useful.
CDC COVID-19 Website: An excellent site with various information that is easy to find. It is worth taking some time to review the site to find information that you may need for your patients/clients. This is just a few of the many topics available. Many are offered in printable documents to use in a class setting.
COVID Data Tracker: CDC statistics website showing Cases, Deaths, Trends, Forecasting), Research & Surveillance (Antibodies, Wastewater, Genomics), and Special Populations (Pregnancy, Race & Ethnicity, Birth Outcomes, and Risk Factors); vaccine progress by state, the number of vaccines delivered vs. administered, and the number of people who have received 1 and/or 2 vaccine doses.
CDC Guidance Documents: 168 items (travel, school, etc.) that can be selected by audience and topic.
CDC V-safe Tool: A CDC smartphone-based tool that provides personalized health check-ins after receiving a COVID-19 vaccine to identify potential safety concerns; Information can be sent to the CDC; It has a reminder for second vaccine doses, but it does not schedule vaccine appointments.
CDC Clinical Trials: CDC website showing available COVID-19 trials
NIH Clinical Trials: NIH website showing available COVID-19 trials
The Coronavirus Vaccine Tracker: A great website that shows the progress of vaccines being developed. The information is updated routinely, so it is good for reviewing new developments.
The Coronavirus Drug and Treatment Tracker: A great website that shows 24 drugs & treatments being evaluated for effectiveness and safety. Good for reviewing new developments. It lists current approved treatments, those widely used, promising & tentative treatments, and those not promising, and frauds.
Johns Hopkins Coronavirus Resource Center: Vaccine statistics from each state’s official dashboard. Includes percentage of fully vaccinated residents; information about cases, testing, contact tracing; and an interactive tool about vaccine development.
FDA COVID-19 Vaccines: Detailed information about vaccines (basics, authorizations, guidance, FAQs)
NEJM COVID-19 Resources: Detailed general COVID-19 information
NEJM Vaccines: Detailed vaccine information
NIH COVID-19 Resources: Information on 17 COVID-19 topics
NIH COVID-19 Treatment Guidelines: Updated on a routine basis; also offers a PDF of guidelines.