NIHCM Newsletter / October 2021
Boosters, Health Equity & Mental Health
COVID-19 Vaccines: Children, Boosters, Mandates
As of October 1st, the U.S. surpassed the estimated deaths that occurred during the 1918 influenza pandemic with 700,000 COVID-19 related deaths. Recent studies have shown that newer variants, such as Alpha, Delta, and Mu have evolved to spread more efficiently through the air, infecting more people than the original virus. As the national vaccination rate slows, the focus has shifted towards children’s vaccines, booster shots, and vaccine mandates.
- Children: Pfizer has submitted their application for authorization of the vaccine for children 5-11 years old and the FDA has scheduled a review of the data for October 26th. Vaccinating children is critical to ending the pandemic, however, 42% of parents say they are unlikely to get their children vaccinated.
- Boosters: COVID-19 vaccine booster doses are currently only available to eligible Pfizer recipients. The FDA is meeting on October 14th and 15th to discuss boosters for the Moderna and Johnson & Johnson vaccines. According to a CDC study, the side effects of the booster shots are similar to those of the second dose.
- Mandates: The Biden Administration ordered the Occupational Safety and Health Administration (OSHA) to draft a new rule mandating that all companies with more than 100 workers require vaccination or weekly testing. A recent poll found that support for requiring public school students 12+ to be vaccinated against Covid stood at 54%.
Initiatives and Resources
- BlueCross BlueShield of Tennessee will cover the costs for the COVID-19 booster for immunocompromised members.
- A new survey from Blue Cross and Blue Shield of Minnesota shows not all vaccinated seniors are returning to their pre-pandemic activities at the same rate, with 1 in 5 yet to visit with any family or friends.
Health Equity: AI & Taking Action
The pandemic illuminated vast disparities in health and well-being across racial and ethnic groups. To create a more equitable health care system, it is critical to understand the impact of artificial intelligence on health care, the social determinants of health, and other reasons for disparities in care.
- Artificial Intelligence: NIHCM’s recent webinar and infographic explored diagnostic algorithms used in health care. Organizations are changing the race-related AI information they use, examples include a new diagnostic formula to improve Black patients’ access to kidney care. See MedPage Today coverage of NIHCM's webinar.
- Disparities in Care: A recent study shows that revised guidelines for lung cancer screening perpetuate racial and ethnic disparities. A study on Black women’s high rate of premature births found racism to be a strong factor in explaining racial disparities.
- Action & Advocacy: The latest research aimed at reducing disparities includes a growing body of research on implementation science for providers, health systems, and policymakers, such as this framework developed to address cancer care disparities.
Initiatives & Resources:
- A study by NIHCM grantee Ziad Obermeyer and colleagues found significant racial bias in an algorithm that uses health care costs to identify patients with high health needs.
- BlueCross BlueShield of Massachusetts becomes the first health plan in MA to incorporate equity measures into its payment models and will begin paying doctors more money if they close longstanding gaps in care for Black, Latino or Asian patients.
- Horizon Blue Cross Blue Shield of New Jersey announces a new dental school scholarship to help Black and Latino students pursue dentistry.
- The Equitable Food Access in Indianapolis Neighborhoods initiative, funded by the Anthem Foundation, aims to improve nutritious food access and help build a more equitable food system.
Mental Health: Social Media & the Workplace
The COVID-19 pandemic and its resulting changes in daily life have negatively impacted Americans’ mental health while also creating new barriers for seeking help. Between 2019 and 2021, addressing mental health challenges at work underwent a normalization process. There is also increasing awareness of the mental health impact of social media on youth.
- Teens: 1 in 5 teens states that Instagram makes them feel negative about themselves. Amid the recent reports that Facebook was aware of the toxic effects for teenage girls, the company has decided to pause the development of Instagram Kids for those under 13.
- The Workplace: A survey found 91% of respondents believe that workplace culture should support mental health. 51% of health care workers reported their mental health declined during the pandemic. Despite the rise in utilization of mental health support services, many employers plan to reduce mental health coverage post-pandemic.
Initiatives & Resources:
- Horizon Blue Cross Blue Shield of New Jersey launched a virtual program that provides evidence-based treatment for eating disorders, the second deadliest mental health condition.
- NIHCM Grantee, WBUR, released Pandemic Generation, exploring COVID-19’s impact on the mental health of children and young adults.
Since the start of the pandemic, nearly 1 in 5 health care workers have quit.
Health Care Workers & Caregivers
Nationally, the demand for health care workers has often outweighed the supply; this trend has been exacerbated by COVID-19. Since the start of the pandemic, nearly two years ago, 18% of health care workers have quit, citing COVID-19, poor pay, burnout, and vaccination mandates and 12% have been laid off.
- Shortages: In health care, 79% of workers reported that the shortage has impacted them and their workplace. Staffing shortages may force 78% of nursing homes to close and the disability community is facing staffing challenges, due mainly to low wages and burnout.
- Mandates: As vaccine mandates begin to roll out nationwide, employers fear they could make staffing even more difficult. With the CDC’s recent guidance that pregnant women should receive the COVID-19 vaccine, it is unclear whether or not pregnant health care workers will be exempt.
Initiatives & Resources:
- NIHCM Grantee, Vox, published a series about the impact of COVID-19 on communities around the U.S., including support for physician mental health and unpaid caregivers.
- NIHCM hosted a webinar series, with accompanying infographics on the health care workforce, topics include physician burnout, nurses, community health workers, and pharmacists.
Rural Health: COVID-19 & Telehealth
There are more than 57 million Americans currently residing in rural areas. These settings often have unique characteristics that put residents at higher risk of death, including reduced access to health care, distance to specialty and emergency care, and higher rates of poverty. Studies have shown that even before the pandemic, the rural health safety net was becoming increasingly unstable.
- Impact of COVID-19: Residents in rural areas are dying of COVID-19 at more than double the rate of urban residents. The Delta variant has been especially detrimental to these communities, yet, vaccination rates have slowed in rural counties.
- Telehealth: Telemedicine expansion into rural areas has been relatively slow due to questions over interstate licensing, broadband access, and reimbursement rates. Recently, the Department of Health and Human Services announced $20 million in funding for the expansion and strengthening of telehealth services.
- Hospital Closures: Since 2010, 138 rural hospitals have closed and 453 more are vulnerable to closure; overall, 46% of rural hospitals have a negative operating margin.
Initiatives & Resources:
- In collaboration with the University of North Carolina at Chapel Hill, Blue Cross Blue Shield of North Carolina invested $3.2 million to conduct a clinical study on sustainable practices to improve food security and overall health.
- Anthem Blue Cross and Blue Shield teamed up with Eastern Kentucky University to launch a health care scholarship for students who will serve in rural communities.
- Through mobile units, Blue Cross Blue Shield of Arkansas helped to bring COVID-19 vaccines and health care to the state’s rural and underserved communities.
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