Will Humble Disease Control, Wills Blog

Healthcare Worker Personal Protective Equipment Still a Challenge

Arizona has now received 75% of our allocation of personal protective equipment (gloves, masks, gowns, hoods) from the Strategic National Stockpile.  The goods come in to the ADHS warehouse from the SNS and are shipped to the county/tribal health departments, who then prioritize where the PPE will go.  Most are continuing to prioritize inpatient facilities.

In the mean-time, individual hospitals, community health centers, skilled nursing facilities and healthcare providers of all sizes are continuing to pursue PPE from their usual wholesalers.  I presume that the state of Arizona is doing the same.

The bottom line is that there is only so much PPE in the world and it is in super high demand everywhere.  The primary manufacturers are in China, which is now just in the process of getting their manufacturing industries up and running.

It’s unfortunate- but for the duration of the pandemic healthcare providers of all types won’t have the personal protective equipment that they have been accustomed to having their entire career. 

The CDC has a website with some practical guidance to help healthcare providers conserve their PPE  – they call it strategies to optimize the use of PPE. The site has separate guidance for masks, gloves, gowns, respirators, and ventilators.  There’s also a PPE Burn Rate Calculator to help facilities calculate the use as they go.

Most facilities are probably already using Contingency Level conservation methods- and there is a good chance that’ll progress to the Crisis Level at some point in the next few weeks.  Here’s a link to the state’s Contingency PPE Guidance.

Will Humble Disease Control, Wills Blog

Updated Case and Infection Fatality Ratios for COVID-19

Last week The Lancet published a new study examining the case and infection fatality ratios for the pandemic.  The case fatality ratio is an estimate of the fraction of people that have been confirmed to have the disease that end up passing away.  The infection fatality ratio on the other hand is the fraction of people that pass away that have been infected with the virus (the infection fatality ratio includes asymptomatic cases).

The author’s best estimate of the case fatality ratio is 1.38%. Of course, there’s a big difference in the case fatality ratio by age. The ratio was a lot bigger in older age groups, with a CFR of 13% among people aged 80 years or older.  Their estimated overall infection fatality ratio is 0.66%, also with an increasing profile with age.

Will Humble Disease Control, State Legislature, Wills Blog

State Allocates Some of the $100M in Rainy Day Money

On Friday state agencies told the legislature what they intend spend some of the $100M in rainy day funds on. So far, they’ve allocated $35M from the $50M medical fund and $6.7M from the other $50M contingency fund.

They’re planning to spend $10M on ventilators, and $8.5M for medical masks, $5.8 million to help county health departments, and $1.2 million to tribes for local preparedness and response.  Another $1.1M is going to the Boys & Girls Clubs & $2.4M to the YMCA to expand childcare options for essential workers.  $3M will go toward buying lab equipment and other supplies for testing.  $1.8M is headed to DEMA & $750K for a “hospital build-out”.

You can see the spending plan for both of the $50M funds here.

Will Humble Affordable Care Act, Disease Control, Social Determinants, Wills Blog

What Health Insurance Options Are Out There for Folks that Have Been Laid Off?

Beyond the public health impact of the virus itself, the social distancing interventions are causing their own public health impacts by adversely impacting the social determinants of health. When people lose their ability to make a living it can cause a cascade of harmful outcomes. It’s a good thing that the recent $2.2T fiscal stimulus is on the way (especially the increase in unemployment insurance benefits) – but that’s just a patch.

Among things that folks that have been laid off are worrying about is health insurance.  Some people that have been laid off may be OK for now if their employer is temporarily carrying their group insurance (at least for April).  Most people that have been laid off will probably be losing their employer-based health insurance at the end of the month in which they were laid off.  Those folks have a few different options.

Medicaid

Medicaid may be an option for some folks recently laid off.  AHCCCS is recommending that people apply for AHCCCS health insurance as soon as they’re laid off.  To apply online, folks can visit the Health-e-Arizona PLUS online application portal.  Here’s AHCCCS’ Enrollment Information Webpage with a summary of the qualifying criteria including  income eligibility requirements. 

In most instances for initial eligibility determinations, the actual (or anticipated) income to be received in the application month is considered. The application form allows you to indicate that you’ve lost your income. AHCCCS has stated that additional unemployment insurance payments and the upcoming stimulus checks won’t be counted as income when determining medical eligibility, so that’s good. 

The bottom line is that a lot of things are in flux right now and there’s nothing to lose by applying right away.  People can schedule a free phone appointment with a certified assister to learn more. Call 1-800-377-3536 or by visiting www.coveraz.org/connector.

Marketplace Insurance

People recently laid off can also buy health insurance through the federal marketplace under the Affordable Care Act.  Enrolling in Marketplace plans is usually limited to the open enrollment period, but when a person is laid off and loses their employer based health insurance it’s called a “qualifying event” and they can buy Marketplace insurance even though it’s not open enrollment.  So that’s another option.  And remember, Marketplace plans come with subsidies for folks that financially qualify.

COBRA

For decades there’s been a law in place called COBRA – which allows people to maintain their employer-related group health insurance- except that they need to pay both the employer and employee side of the premium (which can be expensive). So, folks that have been laid off can ask their employer for a COBRA application and get coverage that way.

Other Help

There are other programs out there that can help people with resources in times of need like this.  A good place to explore the potential benefits is a website called Arizona Self Help.  It’s a free and easy way to find out if your family can get help from 40 different health and human services programs. The website provides Program list/descriptions, Contact information, List of items you may need to bring to an eligibility interview, and Program applications.

Will Humble Disease Control, Wills Blog

Does Your Blood Type Influence Whether You’ll Get COVID-19?

Maybe.

Researchers in China have discovered some interesting evidence suggesting that persons with Type A blood have a higher risk of getting COVID-19 when compared to non-A blood type people.  The researchers in China compared the blood group distribution in 2,173 patients with COVID-19 from three hospitals in China with that in normal people from the corresponding regions near those hospitals.

Their Meta-analysis on the pooled data (which has not been peer-reviewed) found that blood group A had a statistically significantly higher risk for COVID-19 (odds ratio 1.20) compared with non-A blood groups.  Blood group O had a statistically significant lower risk for the disease (odds ratio 0.67) compared with non-O blood groups.

Their report concluded that “People with blood group A have a significantly higher risk for acquiring COVID-19 compared with non-A blood groups, whereas blood group O has a significantly lower risk for the infection compared with non-O blood groups.” 

However, always remember to check the odds ratio on studies like this. In this case you’ll see that the odds ratio for the blood group A is 1.2 which basically means that folks with Type A blood are 20% more likely to get the illness.  The odds ratio for the Group O folks suggests that they are roughly 30% less likely to be confirmed as a case. Not exactly a huge difference, but it was statistically significant.

Also, the study hasn’t been peer-reviewed which means that it hasn’t been examined for its accuracy and shouldn’t be used to guide clinical practice.

Will Humble Disease Control, State Legislature, Wills Blog

State Legislature Adjourned – for Now

Last Monday, the state legislature completed its work to pass the budget for the fiscal year and adjourned until April 13.

With a few exceptions, the “skinny” budget strips out one-time funding and increases spending in areas that require annual adjustments such as K-12 education and AHCCCS. The budget also continues to phase in the 20% teacher pay increases and the restoration of district and charter additional assistance in K-12 education.  

Using Federal Child Care Block Grant Funds, the budget funds childcare subsidies for 3,000 additional children and increases rates for childcare providers with quality ratings of 3 to 5 stars.

The bare bones budget leaves out several of our priorities like:  

  • Providing comprehensive dental care for pregnant moms participating in Medicaid/AHCCCS

  • Restoring supports to grandparents and other kinship caregivers who step in when parents are unable to care for their children.

  • Raising the childcare subsidy reimbursement rates for all childcare providers to help working parents with high out-of-pocket costs

In response to the evolving issues surrounding COVID-19, the legislature authorized $50 million for deposit into a new “Contingency and Safety Net Fund”. These funds may be spent only after the governor declares a state of emergency. It’s separate and apart from the $55M that the ADHS received from the rainy day fund two weeks ago.

These new funds are restricted to housing assistance, including eviction and foreclosure prevention; services for persons experiencing homelessness, including shelter, clothing, food and transportation; food bank operations; and assistance to businesses with fewer than 50 employees, health care providers and nonprofit organizations.

That’s good because these social distancing interventions are having a profound impact on the social determinants of health and the safety net programs mentioned in the new Contingency and Safety Net Fund are very important.

1 2 3 4