July 22, 2020

Editorial

By: Elizabeth Wood
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Healthcare facilities in recent months have been catching up on case backlogs caused by the COVID-19 pandemic. But new infection surges in several states have overwhelmed some hospitals, leading to renewed bans on elective procedures in Texas and Florida as of early July.

The higher rates of infection are attributable partly to the increased amount of testing and partly to lack of compliance with recommended social distancing practices in some areas of the country. The numbers are constantly changing, but downward trends in infections seem to reverse themselves soon after restrictions are lifted.

Forecasters as of mid-June were figuring there would be an additional 56,000 to 90,000 deaths from the coronavirus by October 1, based on “reproduction number” modeling of how many people will be infected by a given individual in a given community. In late June, the University of Washington’s Institute for Health Metrics and Evaluation projected more than 175,000 total deaths by October. In early July, with total US cases topping 3 million, Chris Murray, MD, DPhil, director of the institute, warned that without greater use of masks and social distancing, deaths could exceed 200,000 by November.


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Second wave

A second wave later this year was the biggest concern of respondents to a survey conducted by Deloitte in early May. Among the 50 clinical leaders at health systems, hospitals, and ambulatory surgery centers who responded, 82% cited a second wave, followed by worries about low patient demand (54%) and having an adequate supply of materials, medications, equipment, or testing (50%).

Respondents said they expect elective procedure volumes to return to pre-COVID-19 levels within 2 to 6 months. Doing so involves the following steps:

• additional cleaning and disinfecting measures (cited by 88% of respondents)

• training or retraining staff on infection control procedures (80%)

• acquisition of personal protective equipment (PPE) (94%)

• developing internal (92%) and external (70%) communications strategies.

As of late June, however, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, cautioned that in light of the new cases being reported daily, it’s premature to discuss a second wave. The first wave is not over yet.

 

Financial recovery

In a mid-June poll conducted by healthcare consultancy Advis, recouping lost patient volume and revenue was the chief concern of more than 70% of respondents. Advis surveyed more than 100 healthcare executives and found that a majority (62%) did not favor cancelling non-urgent procedures if a second wave occurs.

Facilities nationwide are cutting costs, but 56% of Advis survey respondents said they expected to do so without significant staff furloughs or layoffs vs 25% planning to take those steps. A majority also expect to see more mergers and acquisitions.

That’s in line with actions typically taken after an economic downturn, says H. Mallory Caldwell, transaction advisory services principal at Ernst & Young LLP. Given the additional time needed for coronavirus testing, safe distancing measures, and enhanced cleaning and sterilization protocols—along with the reluctance of many patients to go to a hospital—surgical volumes will be slow to ramp up.

“In talking with providers, the general sense is those who are reopening [are doing so] at 20% of their capacity. [Hospitals] think that’s going to last for a while until we’ve got a vaccine, a good therapeutic, or proven herd immunity,” Caldwell told HealthLeaders Media.

Although nearly 52% of the Advis survey respondents cited concern about a dramatic rise in infections later in 2020, nearly 65% said they believe the healthcare industry will be prepared for a second surge.

“The one thing we have to do is to understand that there is not one thing. We need a comprehensive battle strategy, meticulously implemented,” Thomas R. Frieden, MD, former director of the Centers for Disease Control and Prevention, told The Washington Post. Other experts noted that until a vaccine becomes available, sophisticated testing strategies are needed to detect surges in the virus. And already there are concerns that not everyone will want to be vaccinated.

Still, a vaccine remains our best hope for the future. Multiple companies are fast-tracking research and development. Moderna, Inc, has a Phase 3 study slated for late July that will include 30,000 participants and will be conducted in collaboration with the National Institute of Allergy and Infectious Diseases.

The primary endpoint will be prevention of symptomatic COVID-19 disease, and secondary endpoints will be prevention of severe COVID-19 disease (requiring hospitalization) and prevention of infection by SARS-CoV-2, the virus that causes COVID-19. Moderna expects it may be able to deliver 500 million doses per year and possibly up to 1 billion doses per year starting in 2021.

“We may be able to at least know whether we are dealing with a safe and effective vaccine by the early winter, late winter, (or) beginning of 2021,” Dr Fauci said in a JAMA Network interview. ✥

 

References

Aizenman N. Coronavirus 2nd wave? Nope, the US is still stuck in the first one. NPR. June 12, 2020.

 

Associated Press. 2nd wave of virus cases? Experts say we’re still in the first. Modern Healthcare. June 21, 2020.

 

https://covid19.healthdata.org/united-states-of-america.

 

https://investors.modernatx.com/news-releases/news-release-details/moderna-advances-late-stage-development-its-vaccine-mrna-1273.

 

https://www.prnewswire.com/news-releases/resuming-deferred-procedures-will-be-complex-as-health-systems-work-to-mitigate-concerns-deloitte-survey-finds-301066103.html.

 

https://www.reuters.com/article/us-health-coronavirus-usa/covid-19-vaccines-to-enter-late-stage-trial-by-end-of-july-fauci-says-idUSKBN243346.

 

O’Brien J. Following the COVID-19 surge: 5 hospital impacts. HealthLeaders Media. June 5, 2020. https://www.healthleadersmedia.com/finance/following-covid-19-surge-5-hospital-impacts.

 

Wan W, Johnson C Y. Coronavirus may never go away, even with a vaccine. Washington Post. May 27, 2020. https://www.washingtonpost.com/health/2020/05/27/coronavirus-endemic/.

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