Timelines Depend on Supply

President Joe Biden’s vow last Thursday to make the COVID-19 vaccine available to all Americans by May depends, as all vaccine-related timelines do, on the availability of the vaccine from the three authorized manufacturers.
  
Earlier in the week, Biden announced the U.S. had purchased 100 million more doses from Johnson & Johnson, but that order is not expected to be fulfilled until June. In Massachusetts, the state has said it expects to make vaccines available to all adults in April. But on Wednesday, DPH sent a notice saying, “Due to severely limited vaccine supply and high demand, it will take at least one month for currently eligible residents to receive a vaccine.” The statement came as 400,000 additional residents – educators, staffers, and childcare workers – became eligible to immediately receive vaccinations last Thursday. Again, depending on supply, the state’s April target and President Biden’s May deadline could be met. 
  
Another potential roadblock to those timelines, as Biden said in an address to the nation Thursday, is the changing nature of the virus itself. As the president said, “The scientists have made clear that things may get worse again as new variants of the virus spread.”
 
COVID-19 Variants 

 The new line of the COVID-19 virus named B 117 that was identified in Great Britain at the end of last year has the potential to cause “substantial additional mortality” than the previous version of the virus, according to a new study in the British journal BMJ, published March 10. B 117 is one of three COVID-19 variants that seem to spread more easily and quickly among individuals. According to the CDC, there are 3,701 cases of B 117 in the U.S. and 106 in Massachusetts as of March 9. Other variants, from South Africa and Brazil, also have been identified in the U.S. Initial data shows that the three existing vaccines in the U.S. may have some effectiveness against the variants.
  
MHA is holding a 30-minute webinar on variants this Friday, March 19, from 11 to 11:30 a.m. Need-to-Know Updates on COVID-19 Virus Variants features Robert A. Duncan, M.D., director of Hospital Epidemiology & Infection Control at the Center for Infectious Diseases at Lahey Hospital & Medical Center. He will discuss the current state of the virus, COVID-19 variants, vaccine updates, and prospects for the near future.
 
Vaccine Reactions

The success of vaccines in defeating the virus and getting the nation back on track to normalcy depends on people allowing themselves to get vaccinated. One concern that reluctant individuals have voiced relates to potential vaccine “bad reactions”. A new study in JAMA published online on March 8 can help to allay those fears.
  
“Acute Allergic Reactions to mRNA COVID-19 Vaccines” assessed survey responses from 52,805 (of 64,900) employees of Mass General Brigham (MGB), who received either the Pfizer or Moderna vaccine. The study showed that anaphylaxis (an acute, potentially dangerous allergic reaction) occurred in 16 people. One patient was admitted to intensive care, nine received an epinephrine shot, and all recovered. Three employees with prior anaphylaxis history did not seek care. Other, less serious allergic reactions (itching, rash, etc.) were reported in about 2.5% of vaccine recipients.
  
“[T]he overall risk of anaphylaxis to an mRNA COVID-19 vaccine remains extremely low and largely comparable to other common healthcare exposures,” the study authors wrote.
 
New Vaccination Website

The state’s pre-registration website went live at 3 a.m. last Friday. It allows anyone to sign up to receive the vaccine and be notified when a slot becomes available – which could be weeks depending on where the individual stands on the eligibility list. The new process is intended to alleviate the problems encountered with the previous vaccine registration process that required people to continually search for open vaccine appointments and to register each time at each site. 
  
Those frustrated with the technology process – which many other states are experiencing – may recall the shortcomings of the Affordable Care Act open enrollment website in Massachusetts in 2013. It took the better part of a year to scrap the exchange that had been created and to build a new website. The federal “Obamacare” website was initially flawed as well, prompting then-President Obama to travel to Boston in October 2013, where he rallied supporters at Faneuil Hall, saying, “Look, there’s no denying it, right now, the website is too slow, too many people have gotten stuck.”  

A public health policy threat that has hung over the head of millions of immigrants has finally been eliminated.
  
The public charge rule, conceived during the Trump Administration, introduced new federal criteria when determining whether to approve certain immigrants seeking to live legally in the United States or obtain legal status through a green card, among other immigration routes. These new criteria included health status and lack of economic resources—factors that may signal the possibility of their needing public assistance, including Medicaid. While the determination is prospective, past use of certain public benefits, including Medicaid, preceding an individual’s application for an immigration status change or admission could have been heavily weighted in the evaluation.
 
MHA joined with Baker Administration officials, patient advocates, and a wide range of others interests throughout the U.S. to strongly oppose the measure. The argument public rule opponents presented was that immigrants would avoid seeking care and healthcare coverage – even care they are entitled to – due to the fear of having their immigration status revoked by an aggressive federal government. Avoiding care leads to worsening care and concurrent rising healthcare costs.
  
Last month, President Biden signed an executive order calling for a sweeping review of federal immigration policies, including the public charge rule. That signaled the beginning of the rule’s demise, as Biden had opposed it during the campaign. Last week, the U.S. Department of Justice said it would not defend the rule against the many lawsuits that had been brought against it. The final nail in the public charge rule coffin occurred last Thursday when the Department of Homeland Security announced through publication in the Federal Register that it was formally removing the Trump Administration rule. Now, the federal government will no longer include Medicaid or Children’s Health Insurance Program enrollment in public charge determinations. 

The COVID-19 public health emergency has re-focused attention and action on the importance of care transitions within the healthcare system – especially those transitions relating to post-acute care and behavioral health. MHA, in coordination with partner organizations, created the Care Transitions COVID-19 Resurgence Planning Model, which assisted acute care hospitals in enhancing regional communication and collaboration among their acute behavioral health and post-acute care partners to support patient transitions during the COVID-19 resurgence.
  
The recommendations were informed by the work of MHA’s Post-Acute Transitions of Care & Emergency Preparedness (PATCEP) Workgroup and Case Management Workgroup and endorsed by MHA’s Continuum of Care Council. In addition to MHA acute care hospitals, post-acute care hospitals, inpatient psychiatric facilities, community-based behavioral healthcare organizations, and state partners, the following groups participated in MHA’s PATCEP and contributed to the Care Transitions COVID-19 Resurgence Planning Model: Assisted Living Association of Massachusetts; Association for Behavioral Healthcare; Conference of Boston Teaching Hospitals; The Home Care Alliance of Massachusetts; Hospice & Palliative Care Federation of Massachusetts; Massachusetts Association of Behavioral Health Systems; Massachusetts Senior Care Association; and LeadingAge Massachusetts.
  
The recommendations outline the types of information caregiving entities can share, the importance of acute care hospitals and other entities appointing points-of-contact for sharing of information, and the need for all entities to work together and with the state’s COVID-19 Long-Term Care Command Center to identify and resolve challenges.

PICCK (Partners in Contraceptive Choice and Knowledge) is holding a webinar entitled “Contraceptive Conundrums” on Tuesday, March 16 from noon to 1 p.m. The webinar will use a series of case studies to explore how providers and patients can navigate method conundrums, conflicting values, and efficacy questions from a shared decision-making lens. Elisabeth Woodhams, M.D., and Anissa Dickerson of Boston Medical Center will present. CMEs are available. Register here. PICCK is a five-year program funded by the Executive Office of Health and Human Services and housed at Boston Medical Center/Boston University School of Medicine.