Category: From California Healthline.org

Si existe una cita con el destino, está escrita en el calendario del doctor Taison Bell.

Al mediodía del martes 15 de diciembre, Bell, especialista en cuidados intensivos del Sistema de Salud de la Universidad de Virginia será uno de los primeros en arremangarse para recibir la vacuna que lo protegerá del coronavirus.

Bell, de 37 años, se inscribió la semana pasada a través del correo electrónico del hospital para recibir la vacuna. “La historia de esta crisis es que cada semana se siente como un año. Esta es realmente la primera vez que hay una esperanza genuina de que podemos revertir esta situación”.

Por ahora, esa esperanza se limita a unos pocos elegidos. Bell atiende a algunos de los pacientes con COVID-19 más enfermos en el hospital UVA Health en Charlottesville, Virginia.

Bell es uno de los 12,000 trabajadores del hospital “que trabajan directo con estos pacientes”, que podrían ser elegibles para unas 3,000 primeras dosis de vacunas, dijo el doctor Costi Sifri, director de epidemiología del hospital.

“Estamos tratando de encontrar las categorías de mayor riesgo, aquellas que realmente pasan una cantidad significativa de tiempo cuidando a los pacientes”, dijo Sifri. “No se tiene en cuenta a todo el mundo”.

Incluso cuando la Administración de Alimentos y Medicamentos (FDA) participaba en intensas deliberaciones antes de la autorización del viernes de la vacuna contra COVID de Pfizer y BioNTech, y días antes de que se liberaran las 6.4 millones de dosis iniciales, los hospitales de todo el país ya estaban planeando cómo distribuir la primeras, y escasas, dosis.

Un comité asesor de los Centros para el Control y Prevención de Enfermedades (CDC) recomendó que la máxima prioridad sea para los hogares de adultos mayores de atención a largo plazo y para los trabajadores de atención médica de primera línea.

Pero se sabía que la primera tanda de vacunas no iba a cubrir toda la necesidad y que se iba a tener que hacer un proceso más selectivo, incluso entre los trabajadores críticos del hospital.

En general, se aconseja a los hospitales que cubran a los miembros de su fuerza laboral con mayor riesgo, pero las instituciones deben decidir exactamente quiénes serán, dijo Colin Milligan, vocero de la Asociación Estadounidense de Hospitales, en un correo electrónico.

“Está claro que los hospitales no recibirán lo suficiente en las primeras semanas para vacunar a todos los miembros de su personal, por lo que hubo que tomar decisiones”, escribió Milligan.

En Intermountain Healthcare, en Salt Lake City, Utah, las primeras inyecciones serán para los miembros del personal “con el mayor riesgo de contacto con pacientes COVID positivos o sus desechos”, dijo la doctora Kristin Dascomb, directora médica de prevención de infecciones y salud del personal. Dentro de ese grupo, los gerentes determinarán qué cuidadores son los primeros en la fila.

En la UW Medicine, en Seattle, Washington, que incluye el Harborview Medical Center, un plan temprano requería que el personal de alto riesgo fuera seleccionado al azar para recibir las primeras dosis, dijo la doctora Shireesha Dhanireddy, directora médica de la clínica de enfermedades infecciosas.

Pero el sistema hospitalario de la Universidad de Washington espera recibir dosis suficientes para vacunar a todas las personas en ese nivel de alto riesgo dentro de dos semanas, por lo que la selección aleatoria no ha sido necesaria por ahora.

“Permitimos que las mismas personas programen la cita”, dijo Dhanireddy, y alentamos al personal a vacunarse cerca del final de sus semanas laborales en caso de que tengan reacciones a la nueva vacuna.

Los resultados de los ensayos han demostrado que las inyecciones con frecuencia producen efectos secundarios que, aunque no debilitantes, podrían causar síntomas como fiebre, dolores musculares o fatiga que podrían mantener a alguien en casa por uno o dos días.

“Queremos asegurarnos de que no todo el mundo reciba la vacuna el mismo día para que, si hay algunos efectos secundarios, no acabemos quedando cortos de personal”, dijo Sifri, de UVA Health, y señaló que las directrices exigen que no más del 25% de cualquier unidad se vacune a la vez.

En UVA Health, una vez que se distribuyan las 3,000 dosis iniciales, el hospital planea confiar en lo que Sifri describió como “un código de honor muy estricto” para permitir que los miembros del personal decidan qué lugar ocupar en la fila. Se les ha pedido que consideren factores profesionales, como el tipo de trabajo que realizan, así como riesgos personales: la edad o afecciones subyacentes como la diabetes.

“Vamos a pedirles a los miembros del equipo, utilizando el código de honor, que determinen cuál es su riesgo de COVID y si necesitan tener una cita temprana para la vacuna o una fecha posterior”, explicó.

Se elaboró este plan después que el personal de atención médica rechazara rotundamente otras opciones. Por ejemplo, pocos favorecieron una propuesta para asignar dosis a través de una lotería, como el caótico sistema basado en la fecha de cumpleaños de la película “Contagion”, sobre una horrible pandemia.

Funcionarios del hospital también enfatizaron que están tratando de diseñar planes de distribución que garanticen que las vacunas se asignen de manera equitativa entre los trabajadores de salud, incluidos los grupos sociales, raciales y étnicos que han sido perjudicados de manera desproporcionada por COVID-19. Eso requiere pensar más allá de los médicos y enfermeras de primera línea.

Por ejemplo, en UVA Health, uno de los primeros grupos invitados a vacunarse será el de 17 trabajadores cuya tarea es limpiar cuartos en la unidad de patógenos especiales donde se tratan los casos graves de COVID.

“Reconocemos que todo el mundo está en riesgo de contraer COVID, todo el mundo merece una vacuna”, dijo Sifri.

En muchos casos, quedará claro quién debe ir primero. Por ejemplo, aunque Dhanireddy es doctora especialista en enfermedades infecciosas que consulta sobre casos de COVID, está feliz de esperar. “No me pondría en el primer grupo en absoluto”, dijo. “Creo que tenemos que proteger a nuestro personal que realmente está ahí con ellos la mayor parte del día, y esa no soy yo”.

Para algunos trabajadores de salud, no ser el primero en la fila para la vacunación está bien. Debido a que la vacuna inicialmente fue autorizada solo para uso de emergencia, los hospitales no requerirán que los empleados sean vacunados como parte de esta primera ronda. Entre el 70% y el 75% del personal de atención médica de UVA Health e Intermountain Health aceptaría una vacuna COVID, mostraron encuestas internas. El resto no está seguro o no está dispuesto.

“Hay algunos que aceptarán de inmediato y otros querrán observar y esperar”, dijo Dascomb.

Aún así, autoridades del hospital dicen que confían en que aquellos que quieran la vacuna no tengan que esperar mucho. Dosis suficientes para aproximadamente 21 millones del personal de atención médica deberían estar disponibles a principios de enero, según funcionarios de los CDC.

Bell, el médico de cuidados intensivos, dijo que está agradecido de estar entre los primeros en recibir la vacuna, especialmente después que sus padres, que viven en Boston, contrajeran COVID-19. Publicó sobre su próxima cita en Twitter y dijo que otros trabajadores de salud que se encuentran entre los primeros en la fila deberían hacer público el proceso.

“Serviremos como ejemplo de que esta es una vacuna segura y eficaz”, dijo. “La estamos dejando entrar en nuestros cuerpos. Deberías dejar que entre en el tuyo también”.

Esta historia fue producida por Kaiser Health News, un programa editorial independiente de la Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Back in early January, before COVID-19 was as familiar as the furniture, I went in for my annual physical. My doctor looked at my test results and shook his head. Virtually everything was perfect. My cholesterol was down. So was my weight. My blood pressure was that of a swimmer. A barrage of blood tests turned up zero red flags.

“What are you doing differently?” he asked, almost dumbfounded.

After all, I’m a 67-year-old balding guy who had spent much of his life as a desk-bound journalist dealing with nasty ailments like hernias (in my 30s), kidney stones (40s) and shingles (50s).

I ruminated over what had changed since my last physical. Sure, I exercise more than 90 minutes daily, but I’ve been doing that for five years. And yes, I watch what I eat, but that’s not new. Like most families with college-age kids, mine has its share of emotional and financial stresses — and there’d been no let-up there.

Only one thing in my life had registered any real change. “I’m volunteering more,” I told him.

I’d been spending less time in my basement office and more time out doing some good with like-minded people. Was this the magic elixir that seemed to steadily improve my health?

All signs pointed to “yes.” And I was feeling great about it.

Then just as I realized how important volunteering is to my health and well-being, the novel coronavirus appeared. As cases climbed, society shut down. One by one, my beloved volunteer gigs in Virginia disappeared. No more Mondays at Riverbend Park in Great Falls helping folks decide which trails to walk. Or Wednesdays serving lunch to the homeless at a community shelter in Falls Church. Or Fridays at the Arlington Food Assistance Center, which I gave up out of an abundance of caution. My modest asthma is just the sort of underlying condition that seems to make COVID-19 all the more brutal.

It used to be that missing even one day of volunteering made me feel like a sourpuss. After almost eight months without it, I’m downright dour.

Science helps explain why.

“The health benefits for older volunteers are mind-blowing,” said Paul Irving, chairman of the Center for the Future of Aging at the Milken Institute, and distinguished scholar in residence at the USC Leonard Davis School of Gerontology, whose lectures, books and podcasts on aging are turning heads.

When older folks go in for physicals, he said, “in addition to taking blood and doing all the other things that the doctor does when he or she pushes and prods and pokes, the doctor should say to you, ‘So, tell me about your volunteering.’”

A 2016 study in Psychosomatic Medicine: Journal of Behavioral Medicine that pooled data from 10 studies found that people with a higher sense of purpose in their lives — such as that received from volunteering — were less likely to die in the near term. Another study, published in Daedalus, an academic journal by MIT Press for the American Academy of Arts & Sciences, concluded that older volunteers had reduced risk of hypertension, delayed physical disability, enhanced cognition and lower mortality.

“People who are happy and engaged show better physiological functioning,” said Dr. Alan Rozanski, a cardiologist at Mount Sinai St. Luke’s Hospital, a senior author of the Psychosomatic Medicine study. People who engage in social activities such as volunteering, he said, often showed better blood pressure results and better heart rates.

That makes sense, of course, because volunteers are typically more active than, say, someone home on the couch streaming “Gilligan’s Island.”

Volunteers share a dirty little secret. We may start it to help others, but we stick with it for our own good, emotionally and physically.

At the homeless shelter, I could hit my target heart rate packing 50 sack lunches in an hour to the beat of Motown music. And at the food bank, I could feel the physical and emotional uplift of human contact while distributing hundreds of gallons of milk and dozens of cartons of eggs during my three-hour shifts. When I’m volunteering, I dare say I feel more like 37 than 67.

None of this surprises Rozanski, who looked at 10 studies over the past 15 years that included more than 130,000 participants. All of them, he said, showed that partaking in activities with purpose — such as volunteering — reduced the risk of cardiovascular events and often resulted in a longer life for older people.

Dr. David DeHart knows something about this, too. He’s a doctor of family medicine at the Mayo Clinic in Prairie du Chien, Wisconsin. He figures he has worked with thousands of patients — many of them elderly — over his career. Instead of just writing prescriptions, he recommends volunteering to his older patients primarily as a stress reducer.

“Compassionate actions that relieve someone else’s pain can help to reduce your own pain and discomfort,” he said.

At age 50, he listens to his own advice. DeHart volunteers with international medical teams in Vietnam, typically two trips a year. He often brings his wife and children to help, too. “When I come back, I feel recharged and ready to jump back into my work here,” he said. “The energy it gives me reminds me why I wanted to be a doctor in the first place.”

I think of my personal rewards from volunteering as cosmic electricity — with no “off” button. The good feeling sticks with me throughout the week — if not the month.

When will it be safe to resume my volunteering activities?

I’m considering my options. The park is offering some outdoor opportunities involving cleanup, but that lacks the interaction that lifts me. I’m tempted to go back to the food bank because even Charles Dinkens, an 85-year-old who has volunteered next to me for years, has returned after eight months away. “What else am I supposed to do?” he posed. The homeless shelter isn’t allowing volunteers in just yet. Instead, it’s asking folks to bag lunches at home and drop them off. Oh, they’re also looking for people to “call” virtual games of bingo for residents.

Virtual bingo just doesn’t float my boat.

Truth be told, there is no one-size-fits-all way to safely volunteer during the pandemic, said Dr. Kristin Englund, staff physician and infectious disease expert at the Cleveland Clinic. She suggests that volunteers — particularly those over 65 — stick with outdoor options. It’s better in a protected space where the general public isn’t moving through, she said, because “every time you interact with a person, it increases your risk of contracting the disease.”

Englund said she’d consider walking dogs outside for a local animal shelter as one safe option with some companionship. “While we do know that people can give COVID to animals,” she said, “it’s unlikely they can give it back to you.”

Meanwhile, my next annual physical is coming right up in January. It’s got me to wondering if my labs will be quite as pristine as they were the last go-round. I’ve got my doubts. Unless, of course, I’ve resumed some sort of in-person volunteering by then.

Last year, an elderly woman staying at the homeless shelter pulled me aside to thank me after I handed her lunch of tomato soup and a turkey sandwich. She set down her tray, took my hand, looked me smack in the eye and asked, “Why do you do this?”

She was probably expecting me to say I do it to help others because I care about those less fortunate than me. But that’s not what came out.

“I do it for myself,” I said. “Being here makes me whole.”

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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This story can be republished for free (details).

Vivek Kaliraman, who lives in Los Angeles, has celebrated every Christmas since 2002 with his best friend, who lives in Houston. But, this year, instead of boarding an airplane, which felt too risky during the COVID pandemic, he took a car and plans to stay with his friend for several weeks.

The trip — a 24-hour drive — was too much for one day, though, so Kaliraman called seven hotels in Las Cruces, New Mexico — which is about halfway — to ask how many rooms they were filling and what their cleaning and food-delivery protocols were.

“I would call at nighttime and talk to one front desk person and then call again at daytime,” said Kaliraman, 51, a digital health entrepreneur. “I would make sure the two different front desk people I talked to gave the same answer.”

Once he arrived at the hotel he’d chosen, he asked for a room that had been unoccupied the night before. And even though it got cold that night, he left the window open.

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Scary Statistics Trigger Strict Precautions

Many Americans, like Kaliraman, who did ultimately make it to Houston, are still planning to travel for the December holidays, despite the nation’s worsening coronavirus numbers.

Last week, the Centers for Disease Control and Prevention reported that the weekly COVID hospitalization rate was at its highest point since the beginning of the pandemic. More than 283,000 Americans have died of COVID-19. Public health officials are bracing for an additional surge in cases resulting from the millions who, despite CDC advice, traveled home for Thanksgiving, including the 9 million who passed through airports Nov. 20-29. Hospital wards are quickly reaching capacity. In light of all this, health experts are again urging Americans to stay home for the holidays.

For many, though, travel comes down to a risk-benefit analysis.

According to David Ropeik, author of the book “How Risky Is It, Really?” and an expert in risk perception psychology, it’s important to remember that what’s at stake in this type of situation cannot be exactly quantified.

Our brains perceive risk by looking at the facts of the threat — in this case, contracting or transmitting COVID-19 — and then at the context of our own lives, which often involves emotions, he said. If you personally know someone who died of COVID-19, that’s an added emotional context. If you want to attend a wedding of loved family members, that’s another kind of context.

“Think about it like a seesaw. On one side are all the facts about COVID-19, like the number of deaths,” said Ropeik. “And then on the other side are all the emotional factors. Holidays are a huge weight on the emotional side of that seesaw.”

The people we interviewed for this story said they understand the risk involved. And their reasons for going home differed. Kaliraman likened his journey to see his friend as an important ritual — he hasn’t missed this visit in 19 years.

What’s clear is that many aren’t making the decision to travel lightly.

For Annette Olson, 56, the risk of flying from Washington, D.C., to Tyler, Texas, felt worth it because she needed to help take care of her elderly parents over the holidays.

“In my calculations, I would be less of a risk to them than for them to get a rotating nurse that comes to the house, who has probably worked somewhere else as well and is repeatedly coming and going,” said Olson. “Once I’m here, I’m quarantined.”

Now that she’s with her parents, she’s wearing a mask in common areas of the house until she gets her COVID test results back.

Others plan on quarantining for several weeks before seeing family members — even if, as in Chelsea Toledo’s situation, the family she hopes to see is only an hour’s drive away.

Toledo, 35, lives in Clarkston, Georgia, and works from home. She pulled her 6-year-old daughter out of her in-person learning program after Thanksgiving, in hopes of seeing her mom and stepdad over Christmas. They plan to quarantine for several weeks and get groceries delivered so they won’t be exposed to others before the trip. But whether Toledo goes through with it is still up in the air, and may change based on COVID case rates in their area.

“We’re taking things week by week, or really day by day,” said Toledo. “There is not a plan to see my mom; there is a hope to see my mom.”

And for young adults without families of their own, seeing parents at the holidays feels like a needed mood booster after a difficult year. Rebecca, a 27-year-old who lives in Washington, D.C., drove up with a roommate to New York City to see her parents and grandfather for Hanukkah. (Rebecca asked KHN not to publish her last name because she feared that publicity could negatively affect her job, which is in public health.)

“I’m doing fine, but I think having something to look forward to is really useful. I didn’t want to cancel my trip completely,” said Rebecca. “I’m the only child and grandchild who doesn’t have children. I can control my actions and exposures more than anyone else can.”

She and her two roommates quarantined for two weeks before the drive and also got tested for COVID-19 twice during that time. Now that Rebecca is in New York, she’s also quarantining alone for 10 days and getting tested again before she sees her family.

“I think, based on what I’ve done, it does feel safe,” said Rebecca. “I know the safest thing to do is not to see them, so I do feel a little bit nervous about that.”

But the best-laid plan can still go awry. Tests can return false-negative results and relatives may overlook possible exposure or not buy into the seriousness of the situation. To better understand the potential consequences of the risk you’re taking, Ropeik advises coming up with “personal, visceral” thoughts of the worst thing that could happen.

“Envision Grandma getting sick and dying” or “Grandma in bed and in the hospital and not being able to visit her,” said Ropeik. That will balance the positive emotional pull of the holidays and help you to make a more grounded decision.

Harm Reduction?

All of those interviewed for this story acknowledged that many of the precautions they’re taking are possible only because they enjoy certain privileges, including the ability to work from home, isolate or get groceries delivered — options that may not be available to many, including essential workers and those with low incomes.

Still, Americans are bound to travel over the December holidays. And much like teaching safe-sex practices in schools rather than an abstinence-only approach, it’s important to give out risk mitigation strategies so that “if you’re going to do it, you think about how to do it safely,” said Dr. Iahn Gonsenhauser, chief quality and patient safety officer at the Ohio State University Wexner Medical Center.

First, Gonsenhauser advises that you look at the COVID case numbers in your area, consider whether you are traveling from a higher-risk community to a lower-risk community, and talk to family members about the risks. Also, check whether the state you’re traveling to has quarantine or testing requirements you need to adhere to when you arrive.

Also, make sure you quarantine before your trip — recommendations range from seven to 14 days.

Another thing to remember, Gonsenhauser said, is that a negative COVID test before traveling is not a free pass, and it works only if done in combination with the quarantine period.

Consider your mode of transportation as well — driving is safer than flying.

Finally, once you’ve arrived at your destination, prepare for what might be the most difficult part: to continue physical distancing, wearing masks and washing your hands. “It’s easy to let our guard down during the holidays, but you need to stay vigilant,” said Gonsenhauser.

KHN senior correspondent JoNel Aleccia discussed the demand for COVID-19 vaccines with Newsy’s “Morning Rush” on Thursday.

• Click here to watch Aleccia on Newsy
• Read Aleccia’s “Demand for COVID Vaccines Expected to Get Heated — And Fast”

KHN Editor-in-Chief Elisabeth Rosenthal discussed COVID vaccine distribution and its potential hiccups with RNN TV’s “Richard French Live” on Tuesday. The exchange starts at about the three-minute mark.

• Click here to watch Rosenthal on RNN TV

California Gov. Gavin Newsom called out the health care reporting chops of California Healthline correspondent Angela Hart during a press conference on Monday.

• Click here to watch the mention in Newsom’s press conference

KHN Colorado correspondent Rae Ellen Bichell discussed the shortage of nurses that has turned hospital staffing into a sort of national bidding war with KUNC’s “Colorado Edition” on Dec. 3.

• Click here to hear Bichell on KUNC
• Read “Need a COVID-19 Nurse? That’ll Be $8,000 a Week” by KHN senior Colorado correspondent Markian Hawryluk and Bichell

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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This story can be republished for free (details).

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High stakes and big challenges await as the U.S. prepares to roll out vaccines against COVID-19, with front-line health care workers and vulnerable nursing home residents recommended as the top priority.

Doses could be on their way very soon. An independent advisory committee to the Food and Drug Administration on Thursday gave a green light to the first vaccine candidate, made by Pfizer in conjunction with the German company BioNTech — a recommendation expected to be approved by the agency within days. The committee is scheduled to consider a second candidate, made by Moderna, Dec. 17.

On tap is an initial stockpile of vaccines made during the approval process, with federal officials hoping to distribute at least 20 million doses by year’s end.

While that will go a long way toward reaching the top-priority groups — the nation’s 21 million health care workers and 3 million long-term care residents — there won’t be enough to inoculate everyone on Day One, or even the first week.

In Ohio, for example, the governor expects an initial delivery of 98,000 doses, with the state allocating 88,000 of those to long-term care facilities, said Pete Van Runkle, executive director of the Ohio Health Care Association, which represents long-term care facilities.

“It’s more than a drop in the bucket, but it’s not all that’s needed,” said Van Runkle, who estimated there are between 150,000 and 175,000 residents and staff members in long-term care centers in the state.

Consequently, the doses will be distributed in waves, with the centers and hospitals not chosen for the first wave getting them in the coming weeks, he said.

Facilities will have to divvy up the supplies to best address the needs of patients and employees.

For hospitals, first up are likely to be “workers with the greatest exposure” to the virus, said Anna Legreid Dopp, a senior director at the American Society of Health-System Pharmacists, a trade group representing more than 55,000 pharmacists who work for hospitals and health systems.

Then who? Perhaps those with personal medical conditions putting them at higher risk. And there may be other considerations specific to individual hospitals. What if, for example, only two people are trained to run a specialized treatment system in the ICU needed to care for patients seriously ill with COVID-19?

“Are they at the top of the list?” asked Dopp.

Nursing homes have a slightly different calculation because they have fewer employees than hospitals, said Van Runkle.

“It’s more a question of choosing which facilities” will get the initial doses, he said. “Once those are chosen, they’ll vaccinate everyone there [who consents], not pick and choose among people.”

Even so, there may be some selectivity because most nursing home employees are women and many are of child-bearing age. Because the vaccines have not yet been tested on pregnant women, those who are pregnant or breastfeeding may not be eligible in the initial rollout.

Which long-term care facilities get the vaccine first may come down to where they are located in relation to two large pharmacy chains: CVS and Walgreens.

In October, the federal government signed an agreement with CVS and Walgreens to store and administer the vaccines. Most long-term care facilities opted to join the partnership.

Under the agreement, the pharmacist teams will make at least three trips to each nursing home over a couple of months to administer the vaccines, which must be given in two doses, set several weeks apart.

One big hurdle in distributing the two vaccines seeking FDA approval is keeping them cold. The Pfizer vaccine is stored at around 94 degrees below zero, while the Moderna option is kept at minus 4 degrees. CVS expects to keep the vaccine at 1,100 locations around the country that have the required refrigeration technology, said Mike DeAngelis, senior director of corporate communications at CVS Health. From those hubs, teams of pharmacists and pharmacy technicians will take thawed doses of the vaccines to the long-term care facilities and administer them to staff and residents. About 30,000 homes have signed on with CVS for the clinics.

Walgreens expects to administer the vaccinations in more than 23,000 long-term care locations, according to a written statement.

While there’s no charge to the nursing homes or residents, Medicare will pay an administrative fee to CVS and Walgreens of $16.94 for the first shot and $28.39 for the second.

Yet there’s a flip side to the supply equation: What if no one wants to go first?

“That’s what keeps me up at night,” said Dr. Michael Wasserman, the immediate past president of the California Association of Long Term Care Medicine, a group of physicians, nurses, social workers and others who provide care to seniors.

That’s key because a good portion of America must be vaccinated to get to the much-sought-after “herd immunity,” in which most people are protected and the virus finds it difficult to spread.

“What if government and pharmacies do a great job in getting vaccine to the front door, then no one takes it?” Wasserman worries.

Nursing home residents are particularly vulnerable to COVID-19 and account for 40% of all reported deaths.

With COVID-positive test results on the rise in almost every state, vaccinating nursing home workers is crucial to protecting not only themselves, but also their patients.

That reality meets a reluctance among many front-line nursing home workers to take the vaccine, said Lori Porter, co-founder and CEO of the National Association of Health Care Assistants, which represents certified nursing assistants who work in long-term care.

Their distrust stems from many things, she said, including politicization around the vaccines, fueled by misinformation on social media.

Educational campaigns and personal endorsements from trusted organizations could help counter the falsehoods, she said. A nationwide event planned for next week by her organization will allow certified nursing assistants to ask questions directly of physician experts and hear from a panel of their peers.

“I’m asked 100 times a day if I’m going to be taking it,” said Porter, who definitely will, hoping to do so in a live webcast, to further convince her members it’s safe.

Despite the need to vaccinate staff to protect residents, Wasserman, a former regulator and nursing home executive, does not think mandates are appropriate for workers, many of whom are low-paid and people of color. “As a society, are we prepared to force this group of folks to get a brand-new vaccine?” he asked.

A better approach, he said, is the type of educational programs that Porter mentioned, so that workers can weigh the evidence and decide whether they want to get vaccinated.

Although employers may have the authority to mandate vaccination, many experts don’t think that policy will be widespread in the nursing home industry, given a shortage of workers and a fear of losing staffers who choose not to comply.

“I can tell you our members are not going to do that,” said Van Runkle, with the Ohio trade group. “If they were to try a mandate, some number of workers would say, ‘Sorry, this is the last straw. I’m leaving.’”

Instead of a mandate, Porter said, a few nursing homes are offering prizes or financial incentives — with at least one talking about offering a drawing for a new car among those who participate. Others, however, may take the opposite approach: ending supplemental hazard pay for workers who refuse.

As for residents, there is no debate. They will not get the vaccine unless they agree, often in writing, said Van Runkle.

For those with dementia or other health problems that prevent making such a decision, family members or others with legal authority must sign, which could slow down the vaccination process considerably.

“During a pandemic, it may be difficult to get hold of them or get their handwritten signature on a document,” said Van Runkle. “We’ve got to sort all this out in the next couple of weeks.”

With front-line health workers and nursing home residents and staff expected to get the initial doses of COVID vaccines, the thornier question is figuring out who goes next.

The answer will likely depend on where you live.

While an influential federal advisory board is expected to make its recommendations later this month, state health departments and governors will make the call on who gets access to a limited number of vaccines this winter.

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As a result, it’s been a free-for-all in recent weeks as manufacturers, grocers, bank tellers, dentists and drive-share companies all jostle to get a spot near the front of the line.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) voted 13 to 1 this month to give first vaccination priority to health care workers and residents of long-term care facilities once the Food and Drug Administration approves one or more COVID-19 vaccines for emergency use. The advisory committee is expected to provide further details of its list of prioritized recipients before year’s end.

Its next recommendations are likely to focus on prioritizing people who keep society functioning, like workers in food and agriculture, public safety and education. Older people and those with chronic diseases are also considered high on the list.

But because early supplies of vaccine are limited, tough choices lie ahead, such as: Is it more important to prioritize teachers who come into contact with many people each day, or farmworkers, who can’t work remotely and provide the country’s food?

“We have to be mindful of equity issues, comorbidities and the likelihood of death versus survival, even within these essential workers,” said Mitch Steiger, a legislative advocate for the California Labor Federation. There will be “a lot of really tough conversations and a lot of different competing principles.”

Initially, states won’t get enough vaccine doses to cover even their top-ranked groups.

In California, a state of 40 million residents, the initial shipments of around 1 million doses won’t come close to covering everyone at the front of the line. More than 2 million people fall into the Phase 1a category of vaccine distribution, which covers only those at risk of getting sick at a health care or long-term care setting.

Even within that health worker category, there’s jockeying to get to the front of the line, with pharmacists and dentists arguing for priority.

Dr. Laurie Forlano, deputy commissioner for population health at the Virginia Department of Health, said the state has been hearing from numerous parties via letters, phone calls and virtual meetings as it decides which “critical workers” will follow the initial bunch in getting vaccinated. “It is complex,” she said of the undertaking. “But it is not new for public health to make these decisions.”

States have already signaled different priorities.

Florida Gov. Ron DeSantis said that after nursing home residents and front line health workers are inoculated, the state will try to vaccinate people 65 and over and residents with significant illnesses.

Kentucky Gov. Andy Beshear said grade school teachers should be next in line after health care workers and nursing home residents, along with first responders and adults with significant illnesses.

Pennsylvania will include “critical workers” and people with high-risk conditions at the top of its priority list, along with health workers, nursing home residents and staff and first responders, according to state health department spokesperson Rachel Kostelac.

Nationally, disease advocacy groups point out that people with some preexisting conditions are at a greater risk of death if they become infected with the coronavirus. The American Diabetes Association published an opinion piece advocating for its patients; the National Renal Administrators Association wrote to federal regulators saying kidney patients should be prioritized.

Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials, said he expects states to largely follow the committee’s priority list. But it’s unclear how much detail the CDC committee will provide in its next round of recommendations — such as which “high-risk individuals” and critical workers to include.

Leaving some flexibility for states is good, Plescia said, because they may differ on ways to vaccinate people efficiently. For example, some states may be home to large factories where people are at higher risk and could get vaccinated on-site.

That’s also where lobbying comes into play.

“Priority 1a for us is getting our employees into that ‘priority 1b’ priority group,” said Bryan Zumwalt, executive vice president of public affairs for the Consumer Brands Association, which represents companies that make thousands of household products, from toilet paper to soda. Of the membership’s 2.3 million employees, 1.7 million are considered essential, he said.

“Workers at our companies are making life-sustaining products,” Zumwalt said. The association is reaching out with letters to state health departments, but Zumwalt said the process would be easier if there were a uniform national priority order for the vaccine, instead of letting states have final say.

These companies are dealing with absenteeism rates averaging 10%, he said, which could cause delays in producing food and other key products.

“When one worker tests positive, an additional five to 10 workers have to be taken off the production lines,” he said.

In Idaho, a COVID-19 advisory board decided this month that after health workers and nursing home residents and staff, first responders such as police and firefighters, and grade school teachers and staff should get the shots, followed by correctional facility staff, then food-processing workers, grocery workers and the Idaho National Guard.

Dr. Elizabeth Wakeman, an associate professor of philosophy at the College of Idaho, and a member of the board, had told her colleagues that it made more sense to vaccinate with the aim of slowing virus transmission rather than ranking groups on their value to society.

That would put food-processing workers ahead of grocery clerks, because there’s more room to maintain distance and better ventilation in a grocery store, Wakeman said.

There’s also pressure to quickly protect food service and farmworkers. Diana Tellefson Torres, executive director of the United Farm Workers Foundation, said farmworkers are both essential and deeply at risk. They may work outdoors where transmission risk is lower, but they often live and ride to work with many people outside their immediate families, she said.

Most farmworkers are undocumented immigrants who lack health insurance and “might not even know they have underlying health conditions,” said Tellefson Torres, who sits on California’s Community Vaccine Advisory Committee. “There’s a lot of vulnerability.”

It’s almost time for the winter citrus crops to be harvested in California, and the lettuce needs to be picked in Arizona.

“It’s important to ensure that the community of individuals who provide food for this country, the food at each one of our tables, is also taken into consideration as a top priority,” said Tellefson Torres.

In the opening week of California’s legislative session, one of the first pieces of legislation to be introduced argued that the food-supply workforce should be first in line for vaccines and rapid tests.

The International Association of Fire Fighters, a union representing 322,000 firefighters and emergency medical personnel, is pushing to include its members as among the first to get access to the vaccine, arguing that firefighters provide emergency medical services that bring them into people’s homes and other closed spaces.

Airline employees also want to be quickly vaccinated.

Pharmacists, too, have also been making their case. While the ACIP included pharmacists in its Phase 1a health worker category, each state interprets the recommendations differently based on its vaccine supply, noted Mitchel Rothholz, chief of governance and state affiliates for the American Pharmacists Association, which is urging states to keep its members atop the list. “It’s a race for who gets the vaccine first,” he said. “Everybody wishes there was enough supply for everyone right out of the gate, but that’s not the situation.”

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Vivek Kaliraman, que vive en Los Angeles, ha celebrado todas las navidades desde 2002 con su mejor amigo, que vive en Houston. Pero, este año, por el riesgo de COVID, en lugar de ir en avión, manejó y piensa quedarse varias semanas.

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El viaje, que le llevaría 24 horas, era demasiado largo para hacerlo en un día, así que Kaliraman llamó a siete hoteles en Las Cruces, Nuevo México —que está a medio camino— para preguntar cuántas habitaciones ofrecían y cuáles eran sus protocolos de limpieza y entrega de alimentos.

“Llamaba por la noche y hablaba con una persona de la recepción y luego volvía a llamar durante el día”, dijo Kaliraman, de 51 años, que es empresario en el sector de la salud digital. “Quería estar seguro de que las dos personas me dieran la misma respuesta”.

Cuando llegó al hotel elegido, pidió una habitación que hubiera estado desocupada la noche anterior. Y aunque esa noche hacía frío, dejó la ventana abierta.

Precauciones por estadísticas aterradoras

Muchos estadounidenses, como Kaliraman, que finalmente llegó a Houston, todavía piensan viajar en diciembre, a pesar de que las cifras de coronavirus en el país empeoran día a día.

La primera semana de diciembre, los Centros para el Control y Prevención de Enfermedades (CDC) informaron que la tasa de hospitalización semanal por COVID estaba en su punto más alto desde el comienzo de la pandemia.

Más de 283,000 estadounidenses han muerto a causa de COVID-19. Los funcionarios de salud pública se preparan para un aumento de casos como resultado de los millones de personas que, desoyendo el consejo de los CDC, viajaron para celebrar el Día de Acción de Gracias, incluyendo los 9 millones que pasaron por los aeropuertos del 20 al 29 de noviembre.

Los hospitales están colmados. Por eso, de nuevo, expertos en salud recomiendan a los estadounidenses que se queden en casa durante las fiestas.

Para muchos, sin embargo, los viajes se reducen a una cuestión de riesgo-beneficio.

Según David Ropeik, autor del libro “How Risky Is It, Really?” y experto en psicología de la percepción de riesgos, es importante recordar que lo que está en juego en este tipo de situaciones no puede ser cuantificado con exactitud.

Nuestro cerebro percibe el riesgo al observar primero la amenaza —en este caso, contraer o transmitir COVID-19— y luego el contexto de nuestra propia vida, que a menudo involucra emociones, explicó.

Si conoces personalmente a alguien que murió por COVID-19, eso es un contexto emocional agregado. Si quieres asistir a una boda, es escenario.

“Piensa en ello como una balanza. A un lado están todos los datos sobre COVID-19, como el número de muertes”, dijo Ropeik. “Y del otro lado están todos los factores emocionales. Las vacaciones son un gran peso en el lado emocional”.

Las personas que entrevistamos para esta historia dijeron que entienden el riesgo que implica. Y sus razones para viajar difieren. Kaliraman comparó su viaje para ver a su amigo con un ritual importante: no se ha perdido esta visita en 19 años.

Lo que está claro es que muchos no se toman la decisión de viajar a la ligera.

Para Annette Olson, de 56 años, el riesgo de volar desde Washington, D.C., a Tyler, Texas, valía la pena porque necesitaba ayudar a cuidar de sus padres, ya muy mayores, durante las vacaciones.

“Desde mi punto de vista, yo represento un riesgo menor para ellos que el que supondría tener a una enfermera viniendo a la casa, que entra y sale, y va a otras casas”, comentó Olson. “En cuanto llego yo, estoy en cuarentena”.

Ahora que está con sus padres, lleva una máscara facial en las zonas comunes de la casa hasta que reciba los resultados de la prueba de COVID.

Otros piensan ponerse en cuarentena semanas antes de ver a sus familiares; aunque, como en el caso de Chelsea Toledo, la familia que va a visitar esté a sólo una hora en auto.

Toledo, de 35 años, vive en Clarkston, Georgia, y trabaja desde su casa. Sacó a su hija, de 6 años, de la escuela en persona después del Día de Acción de Gracias, con la esperanza de ver a su mamá y a su padrastro en Navidad.

Madre e hija harán cuarentena durante varias semanas y pedirá que les envíen las compras del mercado para no entrar en contacto con nadie antes del viaje. Toledo no sabe si seguirá con este plan. Todo puede cambiar basado en base a los casos de COVID en su área.

“Estamos tomando las cosas semana a semana, o realmente día a día”, contó Toledo. “No hay un plan para ver a mi madre; está la esperanza de verla”.

Para los jóvenes adultos que viven solos, ver a los padres en las fiestas es una recarga de energía en este año difícil. Rebecca, de 27 años, vive en Washington, D.C., y condujo con una amiga con la que vive, a Nueva York para ver a sus padres y a su abuelo en Hanukkah. (Rebecca le pidió a KHN que no publicara su apellido porque temía que la publicidad pudiera afectar negativamente su trabajo, que es en la salud pública).

“Estoy bien, pero creo que tener una ilusión ayuda. No quería cancelar mi viaje”, dijo Rebecca. “Soy la única hija y nieta que no tiene hijos. Puedo controlar, más que nadie, lo que hago y con quién entro en contacto”.

Ella, y las dos amigas con las que vive, estuvieron en cuarentena durante dos semanas antes del viaje y se hicieron la prueba de COVID-19 dos veces durante ese tiempo. Ahora que Rebecca está en Nueva York, se ha puesto en auto cuarentena durante 10 días y se hará la prueba de nuevo antes de ver a su familia.

“Creo que, con lo que he hecho, voy segura”, comentó Rebecca. “Aunque sé que lo más seguro es no verlos, así que me siento un poco nerviosa”.

Porque el mejor plan siempre puede fallar. Las pruebas pueden dar falsos negativos y los familiares pueden pasar por alto la posible exposición o no creer en la gravedad de la situación.

Para entender mejor las consecuencias potenciales del riesgo que se está corriendo, Ropeik aconseja tener pensamientos “personales y viscerales” sobre lo peor que podría pasar.

“Imagina que la abuela se enferma y muere” o “que la abuela está en la cama del hospital y no puedes visitarla”, dijo Ropeik. Eso equilibrará la atracción emocional positiva de las fiestas y te ayudará a tomar una decisión más fundamentada.

¿Reducción de daños?

Todos los entrevistados para esta historia reconocieron que muchas de las precauciones que están tomando son posibles sólo porque disfrutan de ciertos privilegios, incluyendo la posibilidad de trabajar desde casa, poder aislarse o hacer que les envíen los comestibles; opciones que pueden no estar al alcance de todos, incluyendo los trabajadores esenciales y aquellos con bajos ingresos.

Aun así, los estadounidenses viajarán durante las vacaciones de diciembre.

Y al igual que con la enseñanza de prácticas sexuales seguras en las escuelas, en lugar de un enfoque basado únicamente en la abstinencia, es importante dar estrategias de mitigación de riesgos para que “si se va a hacer, se piense en cómo hacerlo de forma segura”, recomendó el doctor Iahn Gonsenhauser, del Centro Médico Wexner de la Universidad Estatal de Ohio.

En primer lugar, Gonsenhauser aconseja observar los números de casos de COVID en tu área, considerar si viajas de una comunidad de alto riesgo a una de bajo riesgo y hablar con tus familiares sobre los riesgos. Además, comprueba si el estado al que viajas tiene requisitos de cuarentena o de pruebas que debes hacerte al llegar.

Y ponte en cuarentena antes del viaje, las recomendaciones van de siete a 14 días.

Otra cosa que hay que recordar, dijo Gonsenhauser, es que una prueba de COVID negativa antes de viajar no es una garantía, y sólo funciona si se hace en combinación con el período de cuarentena.

También se debe considerar el medio de transporte: conducir es más seguro que volar.

Por último, una vez que hayas llegado a tu destino, prepárate para lo que podría ser la parte más difícil: continuar el distanciamiento físico, usar máscara y lavarte las manos. “Es fácil bajar la guardia durante las vacaciones, pero hay que mantenerse alerta”, concluyó Gonsenhauser.

Esta historia fue producida por Kaiser Health News, un programa editorial independiente de la Kaiser Family Foundation.

Can’t see the audio player? Click here to listen on SoundCloud.

The first vaccine to protect against COVID-19 could be approved in the U.S. within days, but legislation to help fund its distribution remains mired in Congress.

And President-elect Joe Biden has tapped California Attorney General Xavier Becerra as his secretary of Health and Human Services. The choice of Becerra, who served 12 terms in the House of Representatives, is being criticized by Republicans for his support of single-payer health care.

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Kimberly Leonard of Business Insider and Mary Ellen McIntire of CQ Roll Call.

Among the takeaways from this week’s podcast:

• Despite indications that both Republican and Democratic lawmakers are eager to push out a new COVID relief bill, they are having trouble finding common ground on the issue of liability protections for employers whose workers or customers may get sick. And the party leaders, notably Senate Majority Leader Mitch McConnell, have not tipped their hands on whether they will go along with the effort.
• Complicating the COVID relief bill talks is Congress’ inability thus far to come to terms on a spending bill for the government for the fiscal year that began Oct. 1.
• Some of the delay in getting deals on spending and COVID relief is linked to the uncertainty over which party will control the Senate after the January special elections in Georgia, which will determine two Senate seats. Although many observers expect the Republicans to win at least one, if not both, of those races, McConnell can’t be sure. He likely aims to use what political muscle he has now with the majority and an ally in the White House to get deals favorable to his causes.
• Despite the grumbling by some Republican senators over Becerra’s nomination, it is still too early to suggest that he won’t win approval. The outcome may also depend on whether McConnell remains majority leader and whether Republicans determine that this is a nomination they want to take a stand on — or whether they save the gunpowder for another nominee.
• Dr. Vivek Murthy, chosen by Biden to be the next surgeon general, is likely to have a broader portfolio than that office typically has because of his strong relationship with Biden.
• An advisory committee for the Food and Drug Administration is meeting to consider an application for Pfizer’s COVID vaccine. If the request is approved, consumers should still anticipate there could be glitches in distribution and some unforeseen issues with the vaccine, such as the side effects noted in Britain this week in people with strong allergies. Nevertheless, this vaccine and others can be expected to make significant progress in the battle against the coronavirus. 
• The clinical trials for the COVID vaccine have shown it reduces the severity of the disease, but it’s not clear whether the vaccine will stop disease transmission.

Also this week, Rovner interviews Michael Mackert, director of the Center for Health Communication at the University of Texas-Austin and a professor both at the Dell Medical School and the Stan Richards School of Advertising and Public Relations.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: Politico’s “How Biden Aims to Covid-Proof His Administration,” by Alice Miranda Ollstein and Daniel Lippman

Kimberly Leonard: Business Insider’s “Here’s How the GSA Plans to Disinfect the White House Between Trump’s Departure and Biden’s Arrival,” by Robin Bravender and Kimberly Leonard

Mary Ellen McIntire: The Atlantic’s “The Danger of Assuming That Family Time Is Dispensable,” by Julia Marcus

Joanne Kenen: The New Yorker’s “How Will We Tell the Story of the Coronavirus?” by Andrew Dickson

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunes, Stitcher, Google Play, Spotify, or Pocket Casts.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

The Trump administration wants to require the Department of Health and Human Services to review most of its regulations by 2023 — and automatically void those not assessed in time.

A proposed rule would require HHS to analyze within 24 months about 2,400 regulations — rules that affect tens of millions of Americans on everything from Medicare benefits to prescription drug approvals.

The move has met a fierce backlash from health providers and consumer advocates who fear it would hamstring federal health officials while they seek to control the COVID-19 pandemic, which has killed more than 250,000 Americans.

The HHS proposal appears designed to tie up the incoming Biden administration, say critics. They note the timing of the proposal, which was issued Nov. 4 — the day after Election Day, when it appeared President Donald Trump would likely lose his bid for a second term.

“The cynical part of me thinks this is a perfectly designed way to bring the department to a standstill in the next administration,” said Mary Nelle Trefz, health policy associate at Common Good Iowa, a consumer advocacy group.

She said HHS does not have the bandwidth to review all these regulations during the next two years while running its many programs, including Medicaid and Medicare.

If the proposal is finalized before Jan. 20, it is likely to be undone by the incoming Biden administration. But the chore would add to duties of HHS officials trying to attack the pandemic, she said.

HHS officials deny their proposal was aimed at the Biden administration. Brian Harrison, chief of staff at the department, said he first sought legal review of the proposal in April. “Our lawyers moved as fast as they could,” he said, and the rule was written with the expectation it would be implemented during Trump’s second term.

“The outcome of the election had nothing to do with it,” he said.

Democrats and Republicans for the past 40 years have failed to review existing regulations, leaving unnecessary and irrelevant rules on the books, Harrison said.

But Andy Schneider, a research professor at the Center for Children and Families at Georgetown University who has written about the proposal, said he fears the sunset provision will be one of many actions the Trump team will take to distract the incoming administration.

“It speaks volumes that they waited until the end of the fourth year of the administration to decide that the regulatory process needs to be improved,” he said.

Incoming administrations have typically frozen new rules that were pending but have not taken effect before Inauguration Day. That gives new administrations time to unwind them.

Efforts to enact reviews of funding bills and other legislation, known as sunset clauses, have been popular among conservatives for years. The federal government has occasionally used sunset provisions in legislation, such as the tax cuts enacted during the George W. Bush administration, but it is rare to make department regulations subject to these types of mandatory deadlines.

The option is more popular among states, which have adopted varying procedures for measures passed by the legislatures or regulatory boards. Those efforts run the gamut from requiring most initiatives to be reviewed to identifying specific agencies or legislation that must be reconsidered on a regular timetable.

HHS accepted public comments on the proposal though Dec. 4, except on part of the rule affecting Medicare regulations, which has a Jan. 4 deadline. A final rule is expected before Biden becomes president on Jan. 20.

HHS officials don’t point to any specific regulations they say are outdated. However, in their supporting material for the proposal, they note in part:

“An artificial-intelligence-driven data analysis of HHS regulations found that 85 percent of department regulations created before 1990 have not been edited; the Department has nearly 300 broken citation references in the Code of Federal Regulations, meaning CFR sections that reference other CFR sections that no longer exist.”

Harrison said the scarcity of reviews is due to “inertia” and “lack of an incentive mechanism.”

“Many presidents have formally ordered their agencies to review existing regulations, and it has been existing law for 40 years, so simply asking the divisions to review these regulations has been tried for decades and proven to be ineffective,” Harrison said.

“We need to incentivize their behaviors,” he said.

With more than 80,000 employees, the department should be able to complete the review of 2,400 rules in 24 months, he added.

Harrison said the proposal is authorized by a law signed by President Jimmy Carter in the late 1970s requiring federal agencies to review existing rules. But that law has no provision that calls for cutting regulations that are not reviewed within a certain time frame, Schneider said.

The proposal says the HHS secretary would have flexibility to stop some regulations from being eliminated “on a case by case basis.”

HHS estimates the reviews would cost up to $19 million over two years. Regulations would have to be reviewed every 10 years under the proposal.

When he took office in 2017, Trump vowed that for every regulation his administration issued, it would remove two. In July, he said his administration had more than exceeded that goal.

“For every one new regulation added, nearly eight federal regulations have been terminated,” he said in a Rose Garden speech. The Washington Post Fact Checker said that claim was based on “dubious math and values each regulation as having equal weight.”

One of the few groups to endorse the HHS proposal is the National Federation of Independent Business. The group said the proposal would alleviate regulatory burdens on small businesses.

But other groups, such as the American Academy of Neurology, suggest the proposed rule would limit input from interest groups on changes to existing regulations, because it would not follow the usual process of seeking public comments when altering rules. “The AAN is highly supportive of the current process to modify and rescind regulations through the notice and comment period, as it affords stakeholders the necessary opportunity to provide feedback on proposed regulations prior to changes being implemented,” the group told HHS.

The Medicaid and CHIP Payment and Access Commission, which advises Congress, opposes the proposal. “MACPAC questions the need for a proposed rule that creates a duplicative and administratively burdensome new process that is likely to create confusion for beneficiaries, states, providers, and managed care plans,” the group said in a letter to HHS. “The new requirements will create additional unnecessary work that will distract the department and CMS from the critical roles they play in our health care system, Medicaid and CHIP amid the pandemic and its resulting economic challenges.”

It’s unclear how the proposed rule would affect long-standing regulations for product safety and standards, said Betsy Booren, senior vice president of the food lobbying group Consumer Brands Association. “The idea that these regulations would be sunset because a regulations timer went too long is not acceptable,” she wrote in comments on the proposed rule.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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As hospitals across the country weather a surge of COVID-19 patients, in Seattle — an early epicenter of the outbreak — nurses, respiratory therapists and physicians are staring down a startling resurgence of the coronavirus that’s expected to test even one of the best-prepared hospitals on the pandemic’s front lines.

After nine months, the staff at Harborview Medical Center, the large public hospital run by the University of Washington, has the benefit of experience.

In March, the Harborview staff was already encountering the realities of COVID-19 that are now familiar to so many communities: patients dying alone, fears of getting infected at work and upheaval inside the hospital.

This forced the hospital to adapt quickly to the pressures of the coronavirus and how to manage a surge, but all these months later it has left staff members exhausted.

“This is a crisis that’s been going on for almost a year — that’s not the way humans are built to work,” said Dr. John Lynch, an associate medical director at Harborview and associate professor of medicine at the University of Washington.

“Our health workers are definitely feeling that strain in a way that we’ve never experienced before,” he said.

Until the late fall, the Seattle area had mostly kept the virus in check. But now cases are rising faster than ever, and Washington Gov. Jay Inslee has warned a “catastrophic loss of medical care” could be on the horizon.

“This is the very beginning, to be honest, so thinking about what that looks like in December and January has got me very concerned,” Lynch said.

Lessons Learned From Spring Surge

When the outbreak first swept through western Washington, hospitals were in the dark on many fronts. It was unclear how contagious the virus was, how widely it had spread and how many intensive care beds would be needed.

Intensive care unit nurse Whisty Taylor remembers the moment she learned one of her colleagues — a young, active nurse — was hospitalized on their floor and intubated.

“That’s really when it hit — that could be any of us,” Taylor said.

Concerns over infection control and conserving personal protective equipment meant nurses were delegated all sorts of unusual tasks.

“The nurses were the phlebotomists and physical therapists,” said nurse Stacy Van Essen. “We mopped the floors and we took the laundry out and made the beds, plus taking care of people who are extremely, extremely sick.”

A lot has changed since those early days.

Staff members besides just nurses are now trained to go into COVID rooms and be near patients, and the hospital has ironed out the thorny logistics of caring for these highly contagious patients, said Vanessa Makarewicz, Harborview’s manager of infection control and prevention.

How to clean the rooms? Who’s going to draw the blood? What’s the safest way to move people around?

“We’ve grown our entire operation around it,” Makarewicz said.

The physical layout of the hospital has changed to accommodate COVID patients, too.

“It’s still busy and chaotic, but it’s a lot more controlled,” said Roseate Scott, a respiratory therapist in the ICU.

Harborview has also learned how to stretch its supplies of PPE safely. And as cases started to rise significantly last month, the hospital quickly reimposed visitor restrictions.

“In the past, we’ve had visitors who then call us two days later and say, ‘Oh, my gosh, I just came up positive,’” said nurse Mindy Boyle.

Boyle said months of caring for COVID patients — and all the steps the hospital has taken, including having health care workers observed as they don and doff their PPE — has tamped down the fears of catching the virus at work.

“It still scares me somewhat, but I do feel safe, and I would rather be here than out in the community, where we don’t know what’s going on,” said Boyle.

‘We’re All Tired of This’

Preparation can go only so far, though. The hospital still runs the risk of running low on PPE and staff, just like so much of the country.

During the spring, the hospital cleared out beds and recruited nurses from all over the nation, but that is unlikely to happen this time, with so many hospitals under pressure at once.

“All things point to what could be an onslaught of patients on top of a very tired workforce and less staff to go around,” said Nate Rozeboom, a nurse manager on one of the COVID units. “We’re all tired of this, tired of taking care of COVID patients, tired of the uncertainty.”

Already, COVID’s footprint at Harborview is expanding and bringing the hospital close to where it was at its previous peak.

“The fear I have personally is overwhelming the resources, using up all the staff — and the numbers are still going to go up,” said Scott.

And she said the realities of caring for these desperately ill patients have not changed.

“When they’re on their belly, laying down with all the tubes and drains and all these extra lines hanging off of them, it takes about four to five people to manually flip them over,” Scott said. “It feels intense every time. It doesn’t matter how many times you’ve done it.”

Hospitalized patients are faring better than in the spring, but there are still no major breakthroughs, said Dr. Randall Curtis, an attending physician in the COVID ICU and a professor of medicine at the University of Washington.

“The biggest difference is that we have a better sense of what to expect,” Curtis said.

The few treatments that have shown promise, including the steroid dexamethasone and the antiviral remdesivir, have “important but marginal effects,” he said.

“They’re not magic bullets. … People are not jumping out of bed and saying, ‘I feel great. I’d like to go home now,’” Curtis said.

Taylor said nursing has never quite felt the same since she started in the COVID ICU.

“These people are in the rooms for months. Their families can only see them through Zoom. The only interaction they have is with us through our mask, eyewear, plastic,” Taylor said. “We’re just giving their body a runaround trying to keep them alive.”

This story is from a reporting partnership that includes NPR and KHN. 

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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