New Tribal Area Health Education Center in the Works

Last session the state legislature passed a bill authorizing a sixth Arizona Regional Center Area Health Education Center (AHEC) that will focus on the American Indian health system and workforce. Its creation was the culmination of the hard work of many organizations and individuals, none more so than Kim Russell, Human Services Coordinator at the Inter-tribal Council of Arizona.

In concert with the other five regional AHECs, the Arizona American Indian AHEC will support the overall mission to enhance access to quality health care, particularly primary and preventive care, by improving the supply and distribution of health care professionals through academic/community educational partnerships in rural and urban medically underserved areas. 

The Arizona AHECs major funded activities include: 

  • Youth (Grades K-16 Health Career Pipeline Programs) introduces Arizona’s youth to health careers 
  • Health Professions Trainee Education includes clinical rotations, also called field experiences 
  • AHEC Scholars Community Interprofessional Community Immersion 
  • Continuing Education for working health professionals 
  • Community Health Promotion for health education activities and events for community members

Tribal partners are currently meeting to prepare a request for proposal for the creation of the new Tribal AHEC Regional Center in early 2022. To learn more about the Arizona American Indian AHEC, please visit: https://azahec.uahs.arizona.edu/

Now that Arizona Is In Crisis Standards of Care (for the Most Critically Ill COVID Patients), How Will Doctors Allocate Treatment?

Now that each and every extracorporeal membrane oxygenation (ECMO) machine in Arizona is being used, we are essentially in Crisis Standards of Care, at least for the most critically ill COVID patients (ECMO machines are the last resort for COVID patients in severe respiratory failure).

“Crisis Standards of Care” is basically a protocol for making healthcare decisions when the system can’t provide all of the care that everybody needs because the needs outstrip the resources. It’s a protocol to help healthcare providers objectively decide who gets care when resources don’t allow everyone to get treatment.

Arizona has two documents that outline how doctors are supposed to make life and death decisions because there aren’t enough resources to treat all patients.

Arizona Crisis Standards of Care – Full Document

Arizona Crisis Standards of Care Addendum April 2021

The reports specify statewide triage protocols to use when demand outstrips supply. It has a section on “Stabilization of Patients Awaiting Triage” and “Triage Protocols for Scarce Resource Allocation”.  From a big picture point of view, all patients who can potentially benefit from therapies are offered treatment when resources are sufficient, but when resources aren’t (as is the case right now for patients in respiratory failure), patients get assessed to determine how best to allocate care. The documents outline objective triage protocols to make those decisions (called tertiary triage).

The Crisis Standards of Care protocol uses a stepwise scoring system process to determine how to prioritize patients. People with lower scores would be a higher priority for treatment because they’re more likely to survive.

Patients with lower scores would be given priority for care (see the reports for details). But sometimes, several people might have the same score (color coding).  If that happens, the protocol says that additional factors may be considered as priorities. Those priorities include:

  1. Pediatric patients < 18 years of age;

  2. First responders or front-line healthcare workers;

  3. Single caretakers for minors or dependent adults;

  4. Pregnant patients; and

  5. Short-term survival to hospital discharge based on clinical judgement, provided this judgement is made
    without regard to basis of race, ethnicity, color, national origin, religion, sex, disability, veteran status,
    age, genetic information, sexual orientation, gender identity, perceived quality of life, resource intensity/duration, perceived social worth, or any other ethically irrelevant criteria.

This is our new reality folks, again. Sadly, it didn’t have to be this way if only Governor Ducey had used evidence-based policies to incentivize vaccination (e.g. vaccination mandates) and other tools like universal masking requirements in public indoor environments.

President Outlines Updated Federal COVID Interventions

Last week the President outlined a number of new interventions designed to mitigate COVID spread this winter. Here’s an outline of what was announced last week. The intervention plan includes the following categories:

  1. Boosters for All Adults
  2. Vaccinations to Protect Our Kids and Keep Our Schools Open
  3. Expanding Free At-Home Testing for Americans
  4. Stronger Public Health Protocols for Safe International Travel
  5. Protections in Workplaces to Keep Our Economy Open
  6. Rapid Response Teams to Help Battle Rising Cases
  7. Supplying Treatment Pills to Help Prevent Hospitalizations and Death
  8. Continued Commitment to Global Vaccination Efforts
  9. Steps to Ensure We Are Prepared for All Scenarios 

I won’t go into the particulars here (you can review for yourself) but among the most significant are that private health insurance plans will be required to reimburse for buying home test kits. Test kits will be free at community health centers, and there will be more outreach/access points of adult boosters and childhood vaccines.

The requirement that in-bound jet passengers test negative 24 hours before departure (regardless of vaccination status) makes sense but the complete ban on inbound travel from 8 African countries makes no sense, particularly in light of the requirement for a negative test 24 hours before departure.

Arizona Hospitals Under Contingency Standards of Care as Nearly 40% of Arizona ICU Beds Are Now COVID Patients

View Dr. Joe Gerald’s Weekly COVID Epidemiology & Hospital Occupancy Analysis
From Dr. Gerald this week:
“In brief, who knows what the hell is going on in the fog of Thanksgiving. Case counts took a precipitous fall, but hospital COVID-19 occupancy continues to creep up. Given what we saw this time last year, testing/case data are unreliable due to major disruptions in access to testing and willingness to get it. Even though hospital occupancy is a lagging indicator, it’s the best we have in the moment. Yesterday and today saw the ADHS Dashboard post some big case numbers so don’t be surprised if we experience a bit of catch up then settle into a more regular pattern of increasing rates until Christmas week.”
“Unfortunately, the Omicron variant seems just as concerning this week as it did last week. I’ve posted a couple of links to reports out of Europe and South Africa, but no one really knows what the real-world impact is going to be yet. Even so, it is better to act now than wait. So, predictably, that is the last thing we’ll do.”
“For those on Twitter, I’ve been following @trishgreenhalgh for updates on COVID-19 and Omicron in particular. As long as you ignore the comments, I’ve been pleased with her information.”
“Anyway, we’ve got our hands full in Arizona with the Delta variant. What’s needed hasn’t changed: get vaccinated, get tested, wear a mask, and avoid high risk exposures (e.g., prolonged indoor exposure where others aren’t masked). I’ve upgraded from cloth to KN-95’s myself and got my third shot booster! Hopefully, others will do the same.”

How Big of a Deal is the Omicron Variant?

There’s been no shortage of doomsayers when it comes the discovery of the Omicron.  The truth is that we don’t know enough yet to assess what the public health impact of Omicron will be compared with Delta. Yet.

The keys to making that determination depend on:

  1. How transmissible Omicron is;
  2. What the clinical presentation is for persons with an Omicron infection (compared to Delta); and
  3. Whether immunity people have built from vaccinations or previous infections provide substantial protection from being infected with or having a bad outcome from Omicron.

The main way that Omicron could displace Delta is if it’s more transmissible than Delta (currently 99% of global infections are Delta). If Omicron is less transmissible (regardless of the clinical symptoms Omicron presents) then Omicron will likely die out. If Omicron is slightly less transmissible than Delta, but substantially evades immunity people have previously acquired, then Omicron might be able to compete with Delta. If Omicron is more transmissible than Delta (regardless of clinical presentation and immunity escape) it will take over (like Delta displaced Alpha).

Another key piece of information we’ve yet to discover is just how dangerous Omicron is compared with Delta. Is an Omicron infection worse than outcome that Delta (and if so- in what populations)?

Is Omicron Worse than Delta? There Are 3 Possibilities

Omicron could be less dangerous to public health than Delta if it’s more transmissible, has a milder clinical presentation, and if previously acquired immunity still provides protection from infection and bad clinical outcomes.

Omicron could be a wash if it’s less transmissible than Delta and previously acquired immunity still provides protection. In that case, Omicron will die out too. Omicron could end up being about as transmissible as Delta, have a similar clinical presentation to Delta, and be substantially covered by acquired immunity – in which case Delta and Omicron could replicate side by side without a substantial change in public health impact.

Omicron could be more dangerous if it’s more transmissible and has the same or worse clinical presentation compared to Delta and/or escapes previously acquired immunity. If Omicron has a substantially worse clinical presentation and is more transmissible than Delta- that would be really bad.

The point is that we don’t have enough information from the ongoing epidemiological investigation in the Republic of South Africa to determine whether Omicron poses the same, more, or less threat compared to Delta. The Republic of South Africa has impressive research institutions and a competent national health department- so before December is over, we should have the answers to those 3 key aspects:

  • Transmissibility;
  • Clinical Presentation; and
  • Immunity escape.

Those pieces of information will tell us whether Omicron is a bad thing, a good thing, or a wash.

Build Back Better Act Is a Boon For A Transition to Clean Energy

If signed into law, the Build Back Better Act would set the United States on a path to a 50-52% reduction in carbon pollution by 2030. That’s the same goal scientists say is necessary to prevent the worst impacts of climate change.

Here what’s included in this historic legislation that will put the U.S. on the path to cutting our climate pollution in half by 2030, invest directly in communities of color too often left behind, and create good-paying jobs.

  • Electric Vehicles: Includes tax credits for consumers who purchase EVs of up to $12,500 per vehicle. These incentives would have a critical impact on climate and air pollution by inducing rapid market transformation, and improve air quality in high traffic areas.
  • Electric Vehicle Charging: Builds a 500,000 electric vehicle charging stations in communities nationwide. Along with a clean grid, rapid electrification of passenger vehicles and medium- and heavy-duty trucks would prevent 150,000 pollution-related deaths and save consumers $2.7 trillion by 2050.
  • Home Energy Efficiency: Enables working & middle-class families to save up to $8,000 while weatherizing their homes to reduce utility bills and pollution.
  • Lower Energy Bills: Helps the average family save about $500 each year in utility bills.
  • Clean Air: Converts more than 60,000 diesel school buses to clean electric buses so schoolchildren can breathe clean air, and convert 70% of U.S.P.S. mail trucks to electric vehicles to reduce air and climate pollution in your neighborhood
  • Clean Water: Helps replace over 5 million lead service lines to deliver clean water to neighborhoods nationwide
  • Job Training: BBB Act training programs will prepare Arizona’s workers for high-quality jobs in fast-growing sectors like public health, childcare, manufacturing, IT, and clean energy. Nineteen Arizona community colleges will have the opportunity to benefit from grants to develop and deliver innovative training programs and expand proven ones.

2022 National Health Service Corps Loan Repayment Programs Accepting Applications

The Health Resources & Services Administration’s National Health Service Corps (NHSC) is accepting applications for its loan repayment programs for its fall cycle. There has been a substantial increase in funding available this year… so there are more opportunities than ever in this important public health workforce program! 

To apply, click here.

Public Health Workforce Federal Loan Forgiveness Program

Last week the U.S Department of Education announced a program that provides temporary relief to current and future Public Service Loan Forgiveness program participants as a result of the COVID-19 pandemic.

Public health workers that borrowed money for school under the PSLF program can get credit for past ‘non-qualifying payments’. Under the new rules, “any prior payment made will count as a qualifying payment, regardless of loan type, repayment plan, or whether the payment was made in full or on time”. The change applies to student loan borrowers with Direct Loans, those who have already consolidated into the Direct Loan Program, and those who will consolidate into the Direct Loan Program.

The Department of Education will credit borrowers for prior payments made while working for a qualifying employer like a county or state health department regardless of loan type or repayment plan. To participate, borrowers need to submit this form by Oct. 31, 2022.

Temporary Loan Forgiveness Highlights