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New Study Tracks US Response, Hospital Inequities

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Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today.

New Study Tracks Public Health Efforts

As governors across the country struggle with the question of how and when to safely reopen parts of the US economy, researchers have launched a study to determine which public health efforts are actually working.

Researchers at the City University of New York Institute for Implementation Science in Population Health (ISPH) kicked off the Communities, Households, and SARS/COV-2 Epidemiology (CHASING) COVID study to examine the use and effectiveness of public health measures including masks, stay-at-home orders, avoiding gatherings, and handwashing, WebMD reports.

The research team recruited more than 7000 people from across the country to participate in the study, at least a quarter of whom are frontline workers in healthcare or other essential areas. Participants will be contacted monthly for at least 6 months to assess what actions they are taking to control the spread of the virus. They will also be asked about COVID-19 symptoms, testing, and diagnosis, as well as their healthcare access. Researchers will collect and store dried blood-spot specimens from participants until a proven antibody test is available.

“Our study focuses on a wide range of things that aim to provide a more holistic view of the impact of the public health response beyond its direct impact on SARS/COV-2,” said Denis Nash, PhD, executive director of ISPH and principal investigator of the study.

Pandemic Exposes Hospital Inequities

The cancellation of all elective procedures combined with preparation for a flood of costly COVID-19 patients has put hospitals across the United States in a tough financial position. But the COVID-19 pandemic is also shining a spotlight on the haves and have-nots of the hospital world.

Consider Inova Health System, with campuses in the wealthy suburbs of Washington, DC. The system entered the COVID-19 crisis with enough money in reserve to operate for at least 21 months. Before the stock market drop in 2020, Inova had a reported $3.1 billion in investments that could be rapidly liquidated and a $238 million line of credit that it drew down for pandemic preparedness. In contrast, Truman Medical Centers, a safety-net hospital in downtown Kansas City, Missouri, has less than a month of cash reserves.

“At the end of the day, not all hospitals are created equal,” Charlie Shields, Truman’s president and CEO, told Kaiser Health News. “If you were sitting on a year of…cash on hand, that would not be as challenging, but most safety-net hospitals are south of 25 days, and we’re probably around 10. How do you manage through that?”

Now the federal government is coming to the aid of hospitals with a bailout package of $175 billion. But experts say there’s no mechanism to account for which hospitals entered the pandemic with more resources, ultimately leaving safety-net facilities disadvantaged again. The US Department of Health & Human Services (HHS) will distribute the first $30 billion in funding based on Medicare payments made in the previous year. Distribution of the remaining funds will be based on the prevalence of coronavirus infections in a hospital or region, as well as the number of low-income and uninsured patients.

Expect Excess Cancer Deaths

More people will die from cancer because of the COVID-19 pandemic, according to new research focused on the United States and the United Kingdom.

Researchers estimate that there will be 6270 excess deaths among cancer patients in England 1 year from now and 33,890 excess deaths among cancer patients over age 40 in the United States.

The reason for this uptick in mortality is that most patients who have cancer or suspected cancer are not using healthcare services during the COVID-19 pandemic. For instance, at eight hospitals in England and Northern Ireland, researchers discovered a 60% average decrease in chemotherapy attendance from prepandemic levels. Meanwhile, urgent cancer referrals dropped by an average of 76% compared with before the pandemic in those same regions.

“The recorded underlying cause of these excess deaths may be cancer, COVID-19, or comorbidity (such as myocardial infarction),” Alvina Lai, PhD, University College London, England, and colleagues observed.

The report, which was published on ResearchGate as a preprint, is the first of its kind. The paper has not undergone peer review.

Don’t Overlook Elastomeric Masks

As the shortage of personal protective equipment (PPE) continues, New York cardiologist Eldad Einav, MD, is urging healthcare professionals to consider an alternative: the reusable elastomeric respirator.

These respirators are often used by industrial workers and have tight-fitting facepieces held by straps. The Centers for Disease Control and Prevention advises that they provide equal or superior protection to disposable N95 respirators, can last for years, and are able to withstand repeated cleaning.

Reusable respirators certainly have disadvantages, but the benefits may be greater, Einav noted. “They are cumbersome, interfere with speech and vision, and require disinfection and storage between shifts. On the upside, they protect against respiratory virus transmission and are cost-effective.”

Former FDA Chief Warns of “New Epidemic”

Scott Gottlieb, MD, former commissioner of the Food and Drug Administration, is warning of a “new epidemic” or “large outbreak” if states begin opening schools and workplaces, Politico reports.

During a May 3 appearance on CBS’s “Face the Nation,” Gottlieb also said that mitigation efforts so far have fallen short.

“While mitigation didn’t fail, I think it’s fair to say that it didn’t work as well as we expected. We expected that we would start seeing more significant declines in new cases and deaths around the nation at this point, and we’re just not seeing that,” Gottlieb said.

So what’s next? Gottlieb predicted that the diagnosis of 20,000 to 30,000 new COVID-19 cases per day could become the “new normal.”

Trump Replaces HHS IG

President Trump has nominated a new inspector general for HHS, replacing the agency official who had spearheaded a report showing severe shortages of testing supplies and PPE during the pandemic, the New York Times reports.

Trump had publicly criticized HHS Principal Deputy Inspector General Christi A. Grimm, who has been a career employee with HHS, following the release of the COVID-19 report in April. On May 1, Trump announced his intention to nominate Jason C. Weida to take over the IG post. Weida is an assistant US attorney in Boston.

The IG report looked at hospital experiences in responding to COVID-19 in late March. Government investigators found that there were inadequate testing supplies, extended waits for test results, and widespread shortages of PPE that put staff and patients at risk.

Mary Ellen Schneider is executive editor at MDedge, part of the Medscape Professional Network. She has more than 15 years of experience reporting on healthcare.

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