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  • Three indicators that may predict a rural hospital closure

    Three indicators that may predict a rural hospital closure


    By Clarissa Donnelly-DeRoven

    Since 2005, 181 rural hospitals across the country have shut their doors permanently — 56 of those between 2017 and 2020.

    Scholars at the North Carolina Rural Health Research Program and the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill watch the issue closely. Two researchers recently decided to investigate: did the most recent closures have anything in common financially? 

    The answer they found was a resounding yes. In the year before their closure, most of the now-closed rural hospitals nationwide had low cash on hand, negative operating margins, and negative total margins, compared to rural hospitals that stayed open. 

    George Pink, one of the authors, says the study is the first he’s seen to analyze a hospital’s finances in the immediate years before its closure.

    “We just wanted to get a handle on the hospitals that did close, compared to hospitals that did not close,” he said. “How were they different?” 

    Of the 56 hospitals that closed, 47 had less than a month’s cash on hand in the year before it closed. “Cash on hand” is a critical financial indicator that measures how many days a hospital could pay for its operating expenses with the money it has immediately available. Having little or no cash on hand indicates that an organization can’t really absorb some unexpected financial shock, in the case of a hospital that could be a surge of patients or an essential repair. 

    The other two measures — operating margin and total margin — can be a bit more complicated. 

    “When we talk sources of revenue to hospitals, we generally talk about two pots of money: operating revenue and non-operating revenue,” Pink said. “Operating revenue is revenue received for patient care — inpatient, outpatient, whatever the source. Whatever payers give you for patient care, that is called operating revenue. 

    Researchers at the Sheps Center keep the most comprehensive nationwide data on rural hospital closures. The bottom graph shows the numbers of rural hospitals that have closed each year since 2005. Credit: UNC — Cecil G. Sheps Center for Health Services Research.

    “Non-operating revenue is revenue for activities that are not related to patient care, so, for example, the largest source of non-operating revenue is typically investment income.”

    Among the hospitals that closed, 49 had negative operating margins in their final year of operation and 50 had negative total margins (which includes both operating and non-operating revenue). 

    “There’s a lot of commentary out there as to why these rural hospitals are closing,” Pink said. Many pin the blame for closures on large health systems, which buy up these smaller facilities and then close the hospitals when they consolidate services. 

    Something like that could be to blame for the closure in those facilities that are outliers in the data, the researchers didn’t look at those facilities specifically. 

    But, “By far, those are very small numbers,” Pink said. “The overwhelming percentage of the majority of them closed for financial reasons.”

    The hope is that officials from state rural health offices could make it a practice to look at these financial indicators, which would enable them to identify hospitals that are at high risk of closure and implement measures to prevent the closure. 

    This particular study didn’t examine the role Medicaid expansion might play in preventing rural hospital closures, but a 2018 Health Affairs study by Colorado researchers — which relies on data from the Sheps Center — found that the program makes a significant difference. 

    Because Medicaid expansion increases the number of people with insurance coverage — thereby decreasing the amount of uncompensated care hospitals provide — those institutions perform better financially and are less likely to close, “especially in rural markets and counties with large numbers of uninsured adults before Medicaid expansion,” the authors wrote.

    North Carolina remains one of 12 states to not expand Medicaid, though the state budget created a new 18-member committee in the general assembly to study health care access and Medicaid expansion.

    Some federal relief could be coming for rural hospitals in states such as North Carolina. In December 2020, Congress passed the Consolidated Appropriations Act of 2021. The law creates the “Rural Emergency Hospital,” a new type of facility that will not provide inpatient services but will offer 24-hour emergency care. The law passed in response to the rate of rural hospital closures, and the negative impacts the closures have had on the health of communities. 

    “During the past decade, policymakers have recognized that rural communities need options other than full-service hospitals, to ensure access to essential services,” wrote staff members from the National Advisory Committee on Rural Health and Human Services in an October 2021 policy brief on the new designation of care facility. “The [new law] created the [rural emergency hospital] provider type to give rural communities with struggling rural hospitals an option between a traditional acute-care hospital and complete closure.”

    The details of the new system are still being worked out. The federal Centers for Medicare and Medicaid Services are expected to have finalized the model by 2023, which is when hospitals can begin converting.

    Pink, who provided his expertise to the committee, argues that his study “reinforces the need for a new model of rural health care, such as the proposed rural emergency hospital.” 

    “It’s just an example of a new model that probably is long overdue,” he said.

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    by Clarissa Donnelly-DeRoven, North Carolina Health News
    January 24, 2022

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  • A combination of luck and risk-taking quickly propel small medical clinic to forefront of Covid testing

    A combination of luck and risk-taking quickly propel small medical clinic to forefront of Covid testing


    By Tony Mecia, The Charlotte Ledger

    To see the lines of cars weaving through parking lots of StarMed testing centers all over Charlotte, it might be tempting to think that the company running the show is drawing on a deep reservoir of healthcare experience.

    In fact, it’s a relative newcomer, an unlikely overnight sensation that has successfully waded into the heavily regulated healthcare industry and become a household name, with more than a dozen testing centers in Mecklenburg County. It’s doing 40,000 Covid tests a week and employs nearly 2,000 people, up from just 100 two years ago.

    StarMed’s voyage from obscurity to Charlotte Covid testing colossus comes from a combination of fortunate timing, acting on hunches and embracing a risk-taking startup mentality — much of it emanating from its fast-moving CEO, Michael Estramonte, a chiropractor who moved here from New York a little more than 20 years ago.

    There have been rough patches along the way. His first medical clinic, in a converted Chinese restaurant off Freedom Drive in west Charlotte, was barely breaking even when Covid hit. As recently as a year ago, he had to take out a $1.5M loan to make payroll. And lately, he’s been feeling the pains of a growing business, with some customers complaining about long waits for test results.

    In an interview Tuesday morning in his office off Tuckaseegee Road in west Charlotte, Estramonte marveled at the run his company has had, recalling a meeting with staff two years ago, as Covid was spreading in China.

    “I remember saying, ‘If this comes over here, we need to find a way to be relevant to the community,” he said. “I had no idea at the time that it would wind up being what it became.”

    A new venture’s rocky start: Estramonte, 46, went to college in Upstate New York, at SUNY-Oswego. He moved to Charlotte in 2000 to join the Keith Clinic of Fletcher Keith, a well-known chiropractor who started in Charlotte in 1960. Keith became Estramonte’s mentor, and Estramonte took over the Keith Clinics on Tuckaseegee and Central Avenue after Keith died in 2010, in addition to the one he owned in Sugar Creek.

    The chiropractic business was successful, and Estramonte saw a need to expand into medicine in underserved areas. In 2018, he took some of the profits from the chiropractic office, spent $3M on upfitting an old Chinese restaurant and hired two doctors and three physician assistants to open a clinic offering primary and urgent care.

    It was expensive, and his projections were off.

    “I lost a lot of money in getting this up and going,” he said. “I remember saying to my [chief operating officer] a few times, ‘Maybe we should just get out of this and open up a bunch of Supercuts and manage those.’”

    StarMed stuck with it, and by 2019, the medical clinic had a new director — Dr. Arin Piramzadian, or “Dr. P.” — and it was financially close to breaking even.

    A gamble on testing: Still, it became clear to Estramonte that the company would need to look somewhere else to make money. In October 2019, he decided to open a lab sophisticated enough to run toxicology tests, instead of shipping them off to big testing companies like Labcorp or Quest Diagnostics. “It was a lot of STD testing,” he said, with a chuckle. “I was like, ‘If somebody is going to get paid for it, we might as well do it.’”

    North Carolina approved the lab in January 2020. At the time, awareness of the coronavirus was starting to increase, though it was mostly isolated to China and, later, Italy. Estramonte needed to order equipment for his new lab and asked his staff what was needed for coronavirus testing, in case it came to the U.S. They ordered the needed equipment, from a company called Thermo Fisher Scientific.

    “I had no idea if it was coming over here,” he said. “I had no idea if we could derive profit from testing. I just knew that, all right, let’s go and get it, and if it works out — I’ve done a lot of that type of stuff over the years. A lot of it fails.”

    In hindsight, it was a smart move. The equipment arrived in May, and by then, everyone wanted one — but they were hard to get.

    Covid testing wound up being financially beneficial for StarMed, which receives reimbursements from insurance companies and the government for tests that are free to patients. The amount of reimbursement varies, but Estramonte says it’s enough to cover StarMed’s costs — which are also ballooning as it quickly hires and trains staff. He said he didn’t want to discuss specifics of the company’s finances.

    The company hit a financial rough patch about a year ago, Estramonte says. Insurance companies were slow to pay, and his company wasn’t billing them fast enough because it lacked workers. He took out a $1.5M loan to make payroll. He says it has since been paid off, after the anticipated payments arrived.

    “I love the complexity and the urgency of stuff as much as I hate it,” he said. “I was told by an old business life coach, ‘The reason you put out fires is because usually you’re the one that creates them.’”

    StarMed made another prophetic move as the Delta variant spread in the middle of last year. It ramped up hiring for an anticipated surge in testing. Its human resources department has increased in size from three people to 25. When Delta took off, followed by Omicron, StarMed had the infrastructure in place to handle increases in testing volume.

    Guerrilla marketing: StarMed has also been breaking the norms of healthcare marketing, which in Charlotte typically consists of conservative approaches intended to be reassuring. StarMed, though, has a chatty and edgy Twitter account, and the company participated with ad agency BooneOakley in a risky marketing stunt in September: painting a black truck with a fictional funeral home name and the message “Don’t Get Vaccinated.” The fake funeral home’s website linked to StarMed — which reported a 22{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} increase in vaccine appointments the following week. It made national news. StarMed later said on Twitter: “We had to resuscitate our Marketing Director with one of our defibrillators and explain that this was all @oakleydavid and his team @booneoakley.”

    Estramonte sounds clearly pained when talking about some of the criticism StarMed has received on social media, like recent frustration about delays in receiving testing results. He released a letter Monday saying the trouble was linked to a technology and communications breakdown with an outside lab the company uses for overflow testing. He says he wishes everyone could receive five-star service, but the company’s quick growth makes it hard. Maybe that’s inevitable when you go from a small business to a larger one. He says he’s unaccustomed to the spotlight, like the long profile Axios Charlotte published of him on Tuesday.

    He says he’s looking forward to Covid settling down, and when it does, he says he envisions using some of the money to open more clinics in underserved areas.

    As Estramonte talks, you can almost feel his mind moving forward to the next topic, the next tangent. Asked how his brain works, he says, “It’s obviously ADHD.” He said he held off taking medication for it until a couple years ago. “I thought I would lose my creativity and my imagination. If anything, it just got enhanced,” he said.

    Matt Hanis, a Charlotte-based business of healthcare expert, says StarMed happened to be “in the right place at the right time.” He says it’s harder for large organizations, like the major hospital systems, to move quickly to change their workflows and information technology.

    Estramonte says he works well with the local hospitals and the health department, and he’s happy to have found a niche.

    “If StarMed’s role in a short period of time is to take the stress off the hospital systems, and we were able to figure that out in Mecklenburg County, that’s probably a service that a lot of other major cities in the country didn’t get,” he says. “That does feel good.”

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    by Tony Mecia, North Carolina Health News
    January 22, 2022

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  • No break from Covid: Metro Atlanta medical officials urge vaccinations

    No break from Covid: Metro Atlanta medical officials urge vaccinations

    A 70-yr-outdated gentleman recently entered a metro Atlanta healthcare facility soon after a slide. He subsequently tested optimistic for Covid.

    So did his daughter, who drove him to the medical center. Eight other family members associates also tested beneficial.

    Branstetter

    3 of the 10 died, reported Dr. Danny Branstetter, health-related director of infection avoidance for Marietta-centered Wellstar Overall health Process, addressing the media Thursday about the Covid disaster in the Atlanta space.

    None of the 10 was vaccinated, claimed Branstetter, who did not provide personalized aspects.

    Branstetter joined clinical officers of five other metro Atlanta wellness care techniques in the media briefing to supply a stark description of the recent Covid surge’s impact on hospitals and their staffs.

    These officials’ information: Georgians must do what they can to lower and prevent bacterial infections.

    That starts with vaccinations. A significant bulk of people hospitalized with Covid have not been vaccinated, the officers said.

    At Children’s Healthcare of Atlanta, more than 95 per cent of small children who are hospitalized with Covid and are suitable for vaccination have not received the shots, said Dr. Andi Shane, division chief of pediatric infectious disorders at the pediatric well being technique. (Here’s a modern GHN tale on kids’ vaccination fees.)

    Youngsters not qualified for vaccines – those people below age 5 – “are fully dependent upon individuals all-around them’’ to safeguard them from the virus, Shane included.

    The briefing continued the unparalleled coordination between these Atlanta region well being techniques in alerting the media and community about the hazards and avoidance strategies linked to Covid unfold.

    Georgia not too long ago has established information in numbers of infections documented every day. The recent surge, ignited by the Omicron variant, has created an amazing spread of the disorder, Dr. Kathleen Toomey, Georgia’s Public Overall health commissioner, explained to condition lawmakers earlier Thursday. Late in the day, Congressman Hank Johnson, a Georgia Democrat, introduced that he has analyzed constructive for Covid.

    Grady Memorial Medical center

     

    Atlanta’s Grady Memorial Hospital is running at 110 per cent capability, Dr. Robert Jansen, chief healthcare officer and main of personnel of Grady Well being System, told reporters.

    The hospital’s unexpected emergency space “is wall-to-wall stretchers,’’ he reported. “We have no potential remaining at the medical center.’’ It is the busiest Grady has been because the pandemic started. The healthcare facility has been pressured to divert ambulances not long ago to other amenities.

    Nurses and other workers are emotion exhaustion and stress all through this fifth surge, reported Sharon Pappas, main nurse executive at Emory Healthcare. Staff have been terribly resourceful and resilient in fighting the condition, she mentioned.

    Inventory photo

    Nevertheless, Pappas stated, “we are observing a lot of nurses and clinicians go away the job or pause their occupations due to the fact of the worry the pandemic has triggered, both of those personally and skillfully.’’

    Dr. Jayne Morgan, government director of Piedmont Healthcare’s Covid-19 Undertaking Pressure, mentioned that the normal length of a medical center continue to be is decrease during this Omicron-driven surge than all through the preceding 4 Covid waves.

    But Morgan warned that persons really should just take the recent wave pretty severely. The sentiment that some folks have about deliberately getting Covid so they can set it at the rear of them is “an certainly terrible strategy,’’ she said.

    Therapeutic solutions are in short offer, she observed, with Piedmont and other programs possessing to triage who will get this treatment.

    There is also the probable for a particular person to get “long-haul’’ Covid or other lingering indications. And Morgan said small children need to have to be guarded from the ailment.

    Like other programs, Northeast Ga Wellbeing System, dependent in Gainesville, has seen record quantities of workforce out sick with Covid. If you have signs or symptoms, don’t go to do the job or vacation, claimed Dr. Supriya Mannepalli, the system’s healthcare director for infectious diseases. “Isolate immediately and get analyzed.”

  • Keep it real when explaining Omicron to older people

    Keep it real when explaining Omicron to older people


    By Thomas Goldsmith

    Given the near constant emergence of new permutations of COVID and the rise of the Omicron variant of the virus, a Duke clinician says he sticks to verifiable, often common-sense paths during conversations with people such as his own grandparents, who are in their 90s and living in long-term care. 

    As with almost every factor since the pandemic started, the best guidance and information can be – and has been – transformed as new science and variants arise. Thomas Holland, a specialist in infectious disease at Duke University Medical Center, says that means it can be difficult to settle on hard and fast rules that people might prefer. 

    “If you think back, about 18 months ago we were [communicating] about, ‘Is it six feet you need to be away from someone else or is it seven feet?’” Holland said over the phone. 

    “We all want to know exactly what we can and can’t do; and this has sort of defied our ability to do that.”

    Part of the path forward will involve following recommendations that have been in place since the beginning of the pandemic, say additional experts involved with public health.

    “In some ways, we’re going back in time to some of the recommendations at the beginning of the outbreak,” Jennifer Wolff, a professor of health policy and management at the Johns Hopkins University Bloomberg School of Public Health, told The 19th, an independent nonprofit newsroom. 

    Growing opinion on the importance of wearing well-fitting N95 or even KN95 masks also applies to older people, especially those who are likely to encounter larger groups of people.

    “If the older person is wearing a tightly fitted mask like an N95, it might be fine for them to go grocery shopping,” Nina Blachman, director of the geriatrics fellowship program at NYU Langone Health, told The 19th. 

    ‘Good idea to be masked’

    In another shift of the guideline, family gatherings or outings that seemed for a short while to fall within acceptable places for older people to go are now out. For the moment, those activities should be considered for delays or cancellations given the rise of Omicron. 

    Even given the pandemic’s shifting landscape, Holland said, it’s possible to share usable guidelines on more specific topics with people like his mentally sharp grandparents.

    “I told them that this variant is more transmissible and that I think it’s a good idea to be masked when they’re around other folks, except when they’re eating,” Holland said. 

    People of any age must deal with risks and benefits when making choices, and it’s not possible to deal with zero risk, he said.

    “My grandparents are 96 years old and they are not going to wait it out for two more years without socializing or seeing anybody,” Holland said, referring to a potential endpoint for the pandemic. “So I don’t tell them that they need to stay confined to their rooms if they are not under sort of an outbreak situation.

    “I tell them to enjoy socializing with other folks, but to be safe about it, meaning masking. I tell them to enjoy their meals as it’s a really important social time or part of the day for them. Hopefully, that’s the right balance.” 

    96 percent of 75-plus are vaccinated 

    Meanwhile, specific information about how the ultra-infectious, ultra-transmissible COVID variant Omicron is affecting older people in North Carolina is emerging amid the flood of sometimes contradictory COVID-19 info.

    Even though it’s been a major factor for only about a month, the Omicron strain also seems less likely to bring death and hospitalization, according to the Centers for Disease Control and Prevention. It might not be as harmful to older people if they’ve been vaccinated and boosted.

    There are exceptions in the risk to people with existing conditions like underlying respiratory diseases, such as COPD. That means clinicians must pass on to COPD patients the additional risks they face from the more easily transmissible COVID.

    “When people have flare-ups of their COPD there’s often some kind of trigger, including respiratory viruses,” Holland said. “Pre-COVID, you knew that other viruses, whether it was flu or common cold viruses, might trigger COPD flare and now COVID gets you like that.”

    The huge number of new cases — in the six figures daily — means that the overall triggering of COPD cases will also increase. 

    That means people with that and other underlying conditions, such as heart disease, diabetes, asthma and immune problems still need to be careful, perhaps more careful than they were this fall after the surge of Delta cases had subsided. 

    “We are seeing hundreds of thousands a day in this country and so, even if it’s a really small percentage that gets severely ill, that’s still a big number,” Holland said. “It’s a bit of a paradox because it’s simultaneously true that Omicron is associated with less severe illness and also true that our hospitals are overflowing and that we’re really swamped.”

    The new waves of Omicron infections are affecting older people in North Carolina even though more than 90 percent of people over 65 have had at least one dose of vaccine. For 65-74s, it’s 89 percent and for those older than 75, it’s a whopping 96 percent.

    But the nuances and variants matter here, too. That’s another bit of revised news that health care workers must tell the ranks of older vaccinated people: Omicron could still affect them. 

    “It certainly is the case that that Omicron variant is causing infections in people that are vaccinated,” Holland said.

    In addition, there are indications that vaccines can lower the risk of the vexing long COVID syndrome as well as the chances for the potentially devastating multisystem inflammatory syndrome in adults or MIS-A.

    “Getting a booster dose  really helps protect against Omicron and then most importantly it really protects against bad outcomes from  infections,” Holland said.

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    by Thomas Goldsmith, North Carolina Health News
    January 20, 2022

    1

  • Effort to Vaccinate Kids Stalls as Omicron Surges | Healthiest Communities Health News

    Effort to Vaccinate Kids Stalls as Omicron Surges | Healthiest Communities Health News

    By Rachana Pradhan and Hannah Recht

    The national effort to vaccinate children has stalled even as the omicron variant upends schooling for millions of children and their families amid staffing shortages, shutdowns and heated battles over how to safely operate. Vaccination rates vary substantially across the country, a KHN analysis of the federal data shows. Nearly half of Vermont’s 5- to 11-year-olds are fully vaccinated, while fewer than 10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} have gotten both shots in nine mostly Southern states.

    Pediatricians say the slow pace and geographic disparities are alarming, especially against the backdrop of record numbers of cases and pediatric hospitalizations. School-based vaccine mandates for students, which some pediatricians say are needed to boost rates substantially, remain virtually nonexistent.

    “You have these large swaths of vulnerable children who are going to school,” said Dr. Samir Shah, a director at Cincinnati Children’s Hospital Medical Center. Compounding the problem is that states with low vaccination rates “are less likely to require masking or distancing or other nonpartisan public health precautions,” he said.

    In Louisiana, where 5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of kids ages 5 to 11 have been fully vaccinated, Gov. John Bel Edwards, a Democrat, added the shot to the list of required school immunizations for the fall, over the objections of state legislators, who are mostly Republicans. The District of Columbia and California, where about 1 in 5 elementary school kids are fully vaccinated, have added similar requirements. But those places are exceptions — 15 states have banned COVID vaccine mandates in K-12 schools, according to the National Academy for State Health Policy.

    Mandates are one of multiple “scientifically valid public health strategies,” Shah said. “I do think that what would be ideal; I don’t think that we as a society have a will to do that.”

    Vaccine demand surged in November, with an initial wave of enthusiasm after the shot was approved for younger children. But parents have vaccinated younger kids at a slower pace than 12- to 15-year-olds, who became eligible in May. It took nearly six weeks for 1 in 5 younger kids to get their first shot, while adolescents reached that milestone in two weeks.

    Experts cite several factors slowing the effort: Because kids are less likely than adults to be hospitalized or die from the virus, some parents are less inclined to vaccinate their children. Misinformation campaigns have fueled concerns about immediate and long-term health risks of the vaccine. And finding appointments at pharmacies or with pediatricians has been a bear.

    “One of the problems we’ve had is this perception that kids aren’t at risk for serious illness from this virus,” said Dr. Yvonne Maldonado, chair of the American Academy of Pediatrics Committee on Infectious Diseases. “That’s obviously not true.”

    Parents are left to weigh which is more of a threat to their children: the COVID virus or the vaccine to prevent the virus. Overwhelmingly, research shows, the virus itself presents a greater danger.

    Kids can develop debilitating long-COVID symptoms or a potentially fatal post-COVID inflammatory condition. And new research from the CDC found that children are at significantly higher risk of developing diabetes in the months after a COVID infection. Other respiratory infections, like the flu, don’t carry similar risks.

    Katharine Lehmann said she had concerns about myocarditis — a rare but serious side effect that causes inflammation of the heart muscle and is more likely to occur in boys than girls — and considered not vaccinating her two sons because of that risk. But after reading up on the side effects, she realized the condition is more likely to occur from the virus than the vaccine. “I felt safe giving it to my kids,” said Lehmann, a physical therapist in Missouri, where 20{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of younger kids have gotten at least one dose.

    Recent data from scientific advisers to the CDC found that myocarditis was extremely rare among vaccinated 5- to 11-year-olds, identifying 12 reported cases as of Dec. 19 out of 8.7 million administered doses.

    The huge variations in where children are getting vaccinated reflect what has occurred with other age groups: Children have been much less likely to get shots in the Deep South, where hesitancy, political views and misinformation have blunted adult vaccination rates as well. Alabama has the lowest vaccination rate for 5- to 11-year-olds, with 5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} fully vaccinated. States with high adult vaccine rates such as Vermont, Massachusetts, Connecticut and Maine have inoculated the greatest shares of their children.

    Even within states, rates vary dramatically by county based on political leanings, density and access to the shot. More than a quarter of kids in Illinois’ populous counties around Chicago and Urbana are fully vaccinated, with rates as high as 38{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} in DuPage County. But rates are still below 10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} in many of the state’s rural and Republican-leaning counties. In Maryland, where 1 in 4 kids are fully vaccinated, rates range from more than 40{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} in Howard and Montgomery counties, wealthy suburban counties, to fewer than 10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} along parts of the more rural Eastern Shore.

    Nationally, a November KFF poll found that 29{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of parents of 5- to 11-year-olds definitely won’t vaccinate their children and that an additional 7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} would do so only if required. Though rates were similar for Black, white and Hispanic parents, political differences and location divided families. Only 22{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of urban parents wouldn’t vaccinate their kids, while 49{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of rural parents were opposed. Half of Republican parents said they definitely wouldn’t vaccinate their kids, compared with just 7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of Democrats.

    The White House said officials continue to work with trusted groups to build vaccine confidence and ensure access to shots. “As we’ve seen with adult vaccinations, we expect confidence to grow and more and more kids to be vaccinated across time,” spokesperson Kevin Munoz said in a statement.

    The Hunt for Shots

    Just before her younger son’s 5th birthday, Lehmann was eager to book COVID vaccine appointments for her two boys. But their pediatrician wasn’t offering them. Attempts to book time slots at CVS and Walgreens before her son turned 5 were unsuccessful, even if the appointment occurred after his late-November birthday.

    “It was not easy,” she said. Wanting to avoid separate trips for her 10-year-old and 5-year-old, she nabbed appointments at a hospital a half-hour away.

    “Both of my kids have gotten all their vaccines at the pediatrician, so I was kind of shocked. That would have certainly been easier,” Lehmann said. “And the kids know those nurses and doctors, so I think it would have helped to not have a stranger doing it.”

    The Biden administration has pointed parents to retail pharmacies and 122 children’s hospitals with vaccine clinics. Nationwide, more than 35,000 sites, including pediatricians, federally qualified health centers and children’s hospitals have been set up to vaccinate young kids, according to the administration. Yet administering the COVID vaccine to children presents obstacles that haven’t been as prominent for other inoculations.

    Enrolling pediatricians in the COVID-19 vaccine program is a challenge because of the application process, reporting requirements for administered doses, and staffing, said Claire Hannan, executive director of the Association of Immunization Managers.

    “Many of them are short-staffed right now and don’t necessarily have huge capacity to serve,” she said. Plus, “it’s not as easy to engage the schools in school-based clinics in certain areas just due to the political environment.” Health centers, government officials and other groups have set up more than 9,000 school vaccination sites for 5- to 11-year-olds nationwide.

    The CDC’s long-standing program, Vaccines for Children, provides free shots for influenza, measles, chickenpox and polio, among others. Roughly 44,000 doctors are enrolled in the program, which is designed to immunize children who are eligible for Medicaid, are uninsured or underinsured, or are from Native or Indigenous communities. More than half of the program’s providers offer COVID shots, although the rates vary by state.

    Pharmacies have been heavily used in Illinois, where 25{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of 5- to 11-year-olds are fully vaccinated.

    Dr. Ngozi Ezike, a pediatrician and the director of the Illinois Department of Public Health, said 53{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of shots administered to younger children as of Jan. 5 were done at pharmacies. Twenty percent occurred at private clinics, 7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} at local health departments, 6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} at federally qualified health centers and 5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} at hospitals.

    “You need all pieces of the pie” to get more kids vaccinated, Ezike said.

    Kids Respond to ‘the Greater Good’

    The Levite Jewish Community Center in Birmingham, Alabama, tried to boost vaccinations with a party, offering games and treats, even a photo booth and a DJ, along with shots given by a well-known local pharmacy. Brooke Bowles, the center’s director of marketing and fund development, estimated that about half a dozen of the 42 people who got a dose that mid-December day were kids.

    Bowles was struck that children were more likely to roll up their sleeves when their parents emphasized the greater good in getting vaccinated. “Those children were just fantastic,” she said. In parts of the Deep South like this one, pro-vaccine groups face a tough climb — as of Jan. 12, only 7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of Jefferson County’s children had gotten both shots.

    The greater good is what pediatricians have emphasized to parents who are on the fence.

    “Children are vectors for infectious disease,” said Dr. Eileen Costello, chief of ambulatory pediatrics at Boston Medical Center. “They’re extremely generous with their microbes,” spreading infections to vulnerable relatives and community members who may be more likely to end up in the hospital.

    Seventy-eight percent of the hospital’s adult patients have received at least one dose. For children 5 and up, the figure is 39{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}, with younger children having lower rates than adolescents, Costello said. Particularly amid an onslaught of misinformation, “it has been exhausting to have these long conversations with families who are so hesitant and reluctant,” she said.

    Still, she can point to successes: A mother who lost a grandparent to COVID was nonetheless reluctant to vaccinate her son with obesity and asthma whom Costello was seeing for a physical. The mother ultimately vaccinated all four of her children after Costello told her that her son’s weight put him at higher risk for severe illness.

    “That felt like a triumph to me,” Costello said. “I think her thinking was, ‘Well, he’s a kid — he’s going to be fine.’ And I said, ‘Well, he might be fine, but he might not.’”

    This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues and one of the three major operating programs at KFF (Kaiser Family Foundation). It has been republished with permission.

    Methodology

    Vaccination numbers are from the Centers for Disease Control and Prevention as of Jan. 12.

    National vaccination rates are calculated by the CDC and include vaccinations provided by federal programs such as the Indian Health Service and the Department of Defense, as well as U.S. territories. To compare the vaccination rollout for kids and adolescents, we counted day 0 as the day the CDC approved the vaccine for each age group: May 12, 2021, for 12- to 15-year-olds and Nov. 2, 2021, for 5- to 11-year-olds.

    The CDC provides vaccination numbers at the state and county level. These numbers do not include the small fraction of children who were vaccinated by federal programs. To calculate rates for 5- to 11-year-olds, we divided by the total number of kids ages 5 to 11 in each state or county.

    To calculate the number of children ages 5 to 11 in each state, we used the U.S. Census Bureau’s 2019 Population Estimates Program “single year of age” dataset, the latest release available. For county-level data, we used the National Center for Health Statistics’ Bridged Race Population Estimates, which contain single-year-of-age county-level estimates. We selected the 2019 estimates from the 2020 vintage release so the data would reflect the same year as the state-level estimates.

    Vaccination data by age is unavailable for Idaho, counties in Hawaii and several California counties. For county-level vaccination data, we excluded states in which the county was unknown for at least 10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the kids vaccinated in that state.

  • COVID Fatigue: Are You Among the ‘Vaxxed & Done’? | Health News

    COVID Fatigue: Are You Among the ‘Vaxxed & Done’? | Health News

    By Dennis Thompson HealthDay Reporter

    (HealthDay)

    MONDAY, Jan. 17, 2022 (HealthDay Information) — You’ve gotten vaccinated. You’ve gotten boosted. You have on your mask, preserve social distancing, wash your palms — you do almost everything you’ve got been asked to do to guard oneself and other individuals.

    And you are totally fed up.

    If that description sounds like you, you may well be section of a contingent of people who consider by themselves “vaxxed and performed” with the COVID-19 pandemic.

    The time period was coined by Atlantic author Derek Thompson, in an essay describing a increasing rift among the people today who’ve taken COVID critically through the pandemic.

    The “vaxxed and carried out” bunch are inclined to retain getting boosted, but they want to experience the benefits of their good behavior relatively than manage masking and other actions that largely secure the unvaccinated, Thompson wrote.

    “COVID is turning out to be something like the seasonal flu for most people today who retain up with their pictures, so I’m organized to handle this like I have handled the flu: by generally not worrying about it and residing my daily life commonly,” Thompson wrote in describing the “vaxxed and performed” state of mind.

    General public well being and psychological health and fitness officers agree that “vaxxed and accomplished” is a true phenomenon, in that some vaccinated People are turning into exasperated with COVID-19 basic safety mandates that numerous worry will under no circumstances carry.

    “You will find definitely a stage of disappointment I assume that people have at folks who have produced alternatives to not get vaccinated, and how that has continued to increase the crisis,” said Vaile Wright, a accredited psychologist and senior director of wellbeing care innovation for the American Psychological Affiliation.

    “But I feel persons are also pissed off with the system, and the way in which the system has really enable down men and women who have for the most element attempted to do the best that they can to keep themselves and many others harmless,” Wright additional.

    Pandemic exhaustion environment in

    The way that the COVID-19 pandemic has unfolded feeds straight into the sensation of “vaxxed and completed,” described Dr. Georges Benjamin, executive director of the American Public Health Association.

    “It truly is pretty, very hard to maintain persons constrained on an unexpected emergency basis, no subject what you do,” Benjamin stated. “We have experienced at the very least three scenarios where we believed this point was going to go absent.”

    Us residents have emerged from lockdowns relevant to just one variant, only to be instructed to mask up for the subsequent. They have gotten completely vaccinated so they could resume typical life, only to be informed that they essential to keep protection steps to shield the unvaccinated and the medically susceptible. They have gotten boosted due to waning immunity, only to obtain that Omicron is so infectious they will likely get it anyway.

    “We’re swiftly approaching the three-yr mark of this pandemic, and people’s lives have improved so considerably in that time,” claimed Dr. Vivian Pender, president of the American Psychiatric Association.

    “You can find this sort of new regular, but the new usual retains shifting. Just when it began to come to feel like items were being likely to go again to the way it made use of to be, along will come Omicron,” Pender said.

    Benjamin included that “individuals are just drained of it. They’re all seeking to determine out what individually they’re heading to do. I imagine most persons have reconciled that I am not likely to get definitely ill and die, but I may perhaps get the Omicron variant, and I am hoping if I get the Omicron variant I will never get serious unwell. I think there is a resignation that, Alright, if that comes about, fantastic. I am going to even now do stuff to be watchful, but if it happens I’m not heading to worry above it.”

    Wright won’t consider persons experience “vaxxed and performed” have abandoned security techniques and masking wholesale, but it has led them to very seriously re-consider how they are going to expend the relaxation of their lives with a virus that exhibits no indications of ever heading away.

    The dilemma is that drawing a really hard line and declaring yourself “vaxxed and completed” carries similar psychological charges to all those paid by the unvaccinated, Wright stated.

    “To the degree that individuals can be adaptable in their contemplating and admit that uncertainty will continue and you are just seeking to make the greatest decisions for you and your family, and focusing on what is actually inside of your handle, I believe that will lend alone to far better psychological well-staying,” Wright mentioned.

    “For people today who want to continue to struggle the situation by both not complying with protective steps or partaking in what I see as a large amount of judgment against others as to how they are doing, I imagine all those persons are going to continue to seriously battle,” Wright continued.

    Preparing for the future ‘new normal’

    Considerate and dependable men and women who’ve reached their “vaxxed and performed” limit should think about that putting on a mask and preserving social distancing will aid health and fitness treatment workers who are staying slammed by the Omicron surge, Pender mentioned.

    “It can be vital to carry down the hospitalization prices. The hospitals are overwhelmed, and typical wellbeing care is having a strike,” Pender stated, since persons usually are not in a position to get treatment for non-COVID emergencies thanks to the hurry of Omicron hospitalizations.

    Masking also allows secure individuals who are at elevated threat through no fault of their individual, Pender extra.

    “There are people in our life who are susceptible from COVID. Even people who have been vaccinated and boosted may perhaps have an fundamental affliction that they you should not know about,” Pender said.

    “Crystal ball” predictions primarily based on the outbreaks in South Africa and Britain lead Benjamin to believe that in just a month or so the Omicron surge will start off to wane, and condition officers will facial area the option of lifting mask mandates and other safety steps.

    Now is the time to get started planning for how to offer with the easy to understand frustrations of the “vaxxed and done” at the time this pandemic enters nonetheless one more new usual, Benjamin said.

    “As a modern society, we now require to figure out how we live with this article-Omicron,” Benjamin stated. “We nevertheless have to have to deal with this. It is really even now undesirable. It really is however clogging up our hospitals. But we want to determine out where we go from this, when this point nadirs.”

    The Mayo Clinic has extra about the psychological wellbeing results of the pandemic.

    Sources: Vaile Wright, PhD, accredited psychologist and senior director of health and fitness care innovation, American Psychological Affiliation Georges Benjamin, MD, government director, American Public Overall health Affiliation Vivian Pender, MD, president, American Psychiatric Association

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