NIHCM Newsletter / December 2020

COVID-19 & Staff Shortages

Staffing Shortages & Burnout

COVID-19 hospitalizations are reaching record highs and the health care system is struggling to keep up. In a recent NIHCM webinar, epidemiologist Michael Osterholm, PhD, described how the COVID-19 response is hampered by a “trifecta of shortages'' in the health care system: including staffing, PPE, and “very critical” drugs used in COVID-19 treatment.

  • According to a hospital trade association and a Stat tally, at least 25 states are experiencing shortages in nurses, doctors, and other staff. Due to these shortages, some severely ill patients have had to travel hundreds of miles for an available bed.
  • There is a record demand for travel nurses as the pandemic exposes chronic staff shortages at some hospitals. Nurses are also leaving their jobs due to burnout, for childcare and home-schooling, being infected themselves, or health concerns.
  • Additional shortages include physicians who have recently treated hospitalized patients, which may affect the quality of care. While many hotspots have enough ventilators, there are insufficient numbers of trained staff to operate them.
  • There are a record number of cases in nursing homes and more than 1 in 5 report staff shortages, which makes the upcoming monumental task of vaccinating residents and staff even more daunting.


  • A key strategy to support overstretched health care workers during the pandemic is to keep people from getting infected with COVID-19 at all.
  • The grassroots initiative, Get us PPE, is getting equipment to health care workers where the Strategic National Stockpile falls short.

Adding to the strain of the shortages, burnout is causing some health care workers to quit. Health care workers are frustrated that the public isn’t doing more to contain the virus and stop exposing them. Unfortunately, 12% of United States health care workers have been infected with COVID-19, compared to approximately 3.4% of the general population.

  • Health care workers are being burned out mentally and physically by the pandemic. In a recent survey, 40% of doctors in the United Kingdom report worsening mental health issues.
  • Even before the pandemic, 30% of nurses in nursing homes reported burnout. Now, health care workers in nursing homes and long term care facilities are struggling with grief as they brace for another surge.


  • A National Academy of Medicine report calls for immediate action in the health care system to combat clinician burnout and improve well-being.
  • The CDC has recommendations on supporting mental health in the workplace, including making mental health self-assessment tools available to all employees.
  • The term ‘burnout’ falls short in terms of encompassing health care professionals’ experiences so there is a need to clarify the language of clinicians’ distress.
  • The documentary ‘Do No Harm’ examines physician suicide and is being used in hospitals and medical schools to address burnout and the stigma attached to asking for help.

The Response: Prevention & Treatment

In addition to advising Americans to stay home during the holiday season, the CDC is sharing information and resources on the COVID-19 vaccine and the approval process.

  • On December 1st, the Advisory Committee on Immunization Practices recommended that health-care workers and nursing home residents/workers should be the first to get vaccines.
  • With promising results from vaccine clinical trials, there are logistical challenges to vaccine distribution, such as immunizing disadvantaged communities.
  • A recent survey examined reasons for vaccine hesitancy in Black and Latino communities.

Widespread testing did not become the reality that was hoped for at the pandemic’s beginning. There were not enough tests to slow the transmission of the virus.

  • Overwhelmed health departments have taken matters into their own hands and found a solution through blending technology with manual contact tracing.
  • The CDC is urging contact tracers to triage their efforts, prioritizing patients who tested positive within the last six days.


  • The CDC has gathered tips on how to talk to patients about the vaccine. Doctors are also urging the CDC to be transparent about the vaccine’s side effects.
  • This Q&A with Dr. Andrea Willis of BCBST delves into recent developments in the COVID-19 vaccine and its distribution.
  • Former FDA Commissioner Mark McClellan gives guidance on what states and people should be doing right now and addresses questions about vaccines and monoclonal antibody treatments.
  • In a recent NIHCM webinar, Dr. Dallow of BCBSMA described how payers need to help identify the individuals who should be first in line to be vaccinated and they use their resources to help educate the community.
  • Blue Cross Blue Shield of Michigan extends no-cost COVID-19 treatment through March 31, 2021 and has put more than $230 million behind COVID treatment.

Rural Challenges During the Pandemic

The spread of COVID-19 continues to accelerate in rural areas of the United States, burdening local hospitals, leading to increased efforts to slow the spread, and leaving some residents resentful toward the public health recommendations.

  • The Conversation shared the experiences of two rural doctors as COVID-19 impacts their community.
  • Under the growing strain, Kaiser Health News reports that rural areas are beginning to send their sickest patients to cities for access to more resources and comprehensive care.
  • Experts have expressed concerns over mass vaccination distribution efforts in rural areas, including combatting vaccine hesitancy and the challenges associated with refrigeration and storage.

Resources and Initiatives:

  • To support communities and rural hospitals as they weather the financial challenges associated with the pandemic, Blue Cross and Blue Shield of North Carolina is teaming with Caravan Health to bring its Blue Premier program to rural providers in the state.
  • New research from Brookings provides an in-depth, on-the-ground look at three rural communities across the U.S., and the strategies and initiatives being used to sustain them.

Food Insecurity Challenges Continue

Food insecurity has increased in the US as more individuals and families face economic instability and access barriers associated with the pandemic. We need a stronger understanding of the impact of food insecurity on children and effective strategies.

New efforts and partnerships continue to emerge to address food security challenges:

  • Blue Cross Blue Shield of Michigan’s efforts to support Michiganders facing food insecurity include funding mobile markets and food transport vans, supporting produce prescription programs, providing children with expanded nutritional programming, and making financial donations to local food banks.
  • Blue Cross NC contributed $275,000 to the Appalachian Sustainable Agriculture Project to help combat food insecurity caused by the pandemic while helping farmers in need.

Children's Health, Well-Being & Education

While they are not at high risk for the coronavirus, many children and young adults face health challenges stemming from the pandemic’s widespread impact.

  • Child vaccination rates have been in such decline that a new BCBS report estimates 9 million childhood vaccination doses could be missed nationwide by the end of 2020.
  • Some pediatricians, wary of COVID-19, are relying on urgent care sites and emergency departments to care for sick patients. In response, the American Academy of Pediatrics (AAP) came out with interim guidance on how practices can safely see patients.
  • The AAP released guidance for parents and clinicians on supporting children’s emotional and behavioral health during the COVID-19 pandemic.

Children and families continue to grapple with school closures and remote learning, leaving some children at a disadvantage.

  • A new report from Brookings looks at how the pandemic is impacting students and learning.
  • Millions of rural students lack reliable internet access to complete their schooling, relying instead on Wi-Fi buses in parking lots or visiting relatives to access the internet.

Initiatives to support children and learning:

  • The Building Healthy Communities: Step Up for School Wellness program, supported by public and private partners including Blue Cross Blue Shield of Michigan, expanded to help meet the evolving needs of Michigan schools and students this school year.
  • BlueCross BlueShield of Western New York has partnered to distribute more than 12,000 PlayPacks to Buffalo Public Schools to help keep students active while they continue to adapt to remote learning. They also awarded $100,000 to Say Yes Buffalo to provide school-based comprehensive care coordination, health promotion, patient and family support and service referrals to local students in need.

Mental Health - Nine Months into the Pandemic

Americans are facing greater mental health challenges as the pandemic continues to take its toll as we head into the winter months. In response, public and private organizations are working to make more resources and support available to people in need.

  • SAMHSA has compiled a list of resources focused on coping with COVID-19 during the holidays.
  • Mental Health America provides mental health screening tools and resources to support mental well-being.
  • NIHCM’s new infographic highlights the risk factors associated with loneliness and its impact on health and outlines key strategies to combat loneliness and social isolation.

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