As the state vaccination plan moves past long-term care facilities and on to the next group, deploying mobile units will help prevent eligible people in small facilities from being left behind.
This article was published on Tuesday, February 16, 2021 in Kaiser Health News.
ANTIOCH, Calif. — A mobile "strike team" is bringing vaccines to some of Northern California's most vulnerable residents along with a message: This is how you avoid dying from covid-19.
So far, that message has been met with both nervous acceptance and outbursts of joy from a population that has been ravaged by the disease. One 68-year-old pastor, who lives in a racially diverse, low-income senior housing complex, rolled down his sleeve after his shot and said he wants to live to see 70 — just to spite the government.
The team of county nurses and nonprofit workers is targeting Contra Costa County residents who are eligible for covid vaccines but have been left out: residents of small assisted-living facilities that haven't yet been visited by CVS or Walgreens, and occasionally people who live in low-income senior housing. The retail pharmacy giants have a federal government contract to administer vaccines in most long-term care facilities.
Launched a few weeks ago, the strike team moves through each vaccination clinic with practiced choreography. At a small group home in Antioch recently, a nurse filled syringes while another person readied vaccine cards and laid them on a table. An administrative assistant — hired specifically for these clinics — checked everyone's paperwork and screened them for symptoms and allergies before their shots, logging them into the state's database afterward. After the shots, a strike team member told each person when their 15 minutes of observation was up.
In a little over an hour, 14 people had a shot in their arm, a card in their hand and their data in the system. Nurses wiped down the chairs and tables and packed up supplies.
As the state vaccination plan moves past long-term care facilities and on to the next group, deploying mobile units will help prevent eligible people in small facilities from being left behind, said Dr. Mike Wasserman, past president of the California Association of Long Term Care Medicine.
"The assisted living side has been our greatest tragedy," Wasserman said. "It's February. We're vaccinating others already and we haven't finished vaccinating those who need it most."
California is in the midst of transferring primary control of vaccine distribution from local public health departments to Blue Shield of California. The agreement between the state and the insurance company includes incentives for vaccinating underserved and minority populations, and like Contra Costa, Los Angeles, Kern and other counties are creating mobile clinics to reach vulnerable residents.
But as efficiently as these clinics can run, it's still slow going to vaccinate a few people at a time in a state that has lost more than 44,500 people to covid.
Small long-term care facilities, usually with no more than six beds, are the strike team's main target. These "six-beds" are a major source of residential care for older Californians, as well as others who need care and supervision but don't want to live in nursing homes. Of almost 310,000 long-term care beds in California, about one-third are in nursing homes, according to Nicole Howell, executive director for Ombudsman Services of Contra Costa, Solano and Alameda counties. Two-thirds are in some form of assisted living, mostly six-beds.
These homes are typically in residential areas, with little to distinguish them from other houses on a suburban block. They're small businesses, often owned by families, that offer a "social" model of care, not a medical one. There is no doctor or director of nursing on staff.
Long-term care residents were in line to be vaccinated right after front-line health workers, starting in nursing homes. Theoretically, residents of small facilities like six-beds should get their shots from the same federal program vaccinating most nursing homes, which is administered through CVS and Walgreens.
But it's difficult to coordinate with these homes because there are so many, Howell explained, and they often have fewer resources and minimal IT infrastructure. Because these aren't large corporate chains or 500-bed facilities with everyone's medical records on hand, it takes time and local knowledge to reach them all, she said.
Catherine Harris, 72, gets her first dose of covid vaccine in the community room of a low-income senior housing complex in Richmond, California. She got her shot from a mobile vaccine team that visits Contra Costa County's vulnerable residents. (Rachel Bluth/KHN)
CVS and Walgreens said they have administered first and second doses to nearly all nursing home residents in the state and have started on assisted living communities. They said they do not have breakdowns of which kinds of assisted living facilities they have visited, but CVS Health spokesperson Joe Goode noted that the pharmacy has completed the first round of doses at nearly 80% of participating assisted living facilities, with hundreds more clinics scheduled.
The state has largely left it up to facilities to call the pharmacies to schedule clinics, though many did not know it was their responsibility until late January, according to Mike Dark, a lawyer with California Advocates for Nursing Home Reform. He had been fielding calls for weeks from families who were told that, if they wanted to get their loved ones in six-bed homes vaccinated, they needed to figure it out themselves, he said.
"Smaller assisted living facilities, the ones least equipped to deal with this virus, still house people with significant impairment and needs," Dark said. "It's been a scandal, really, how poorly this process has been going."
The residents at Above All Care, a six-bed in Orange County, finally got their first shots on Feb. 4, according to owner Nicolas Oudinot. But that came after weeks of confusion and silence.
"From November to mid-January, I had no information," Oudinot said. "I went from nothing to getting a call every day. They tried to schedule the same facility two or three times."
In late December, when it became clear that many long-term care facilities wouldn't get clinics scheduled for months, Contra Costa County decided the federal program needed to be supplemented with local resources, said Dr. Chris Farnitano, the county health officer.
"This is where we're seeing the most dying happening," Farnitano said. "These are the most vulnerable people. We've got to protect them sooner."
The mobile vaccine strike team emerged from a collaboration among the county, local home health agencies, advocates for long-term care residents and nonprofit groups. It was created without additional public funding when Choice in Aging, a local nonprofit that provides community-based support to older residents, paid its own administrative workers to staff the clinics alongside county public health nurses.
The team of five or six people heads out several days a week, hauling rolling carts packed with syringes, bandages and a special vaccine cooler. The team might spend one day vaccinating 100 people in six-bed and other small facilities for older people or those with disabilities. The next, it might visit 50 seniors and their caregivers gathered from a few low-income apartments.
The vaccines are treated like a precious resource. Nothing goes to waste and there's a list of caregivers on standby if the team finds itself with extra shots. Nurses say they can almost always squeeze a sixth dose of what they call "liquid gold" out of the vials, intended to contain five.
When defrosted vials aren't in the cooler, they're carried gingerly, sandwiched between two egg cartons so they don't tip or break. Often, the team's biggest problem is running too far ahead of schedule.
Its efforts seem to be working: 810 people in 50 facilities had been vaccinated as of Tuesday.
Choice in Aging CEO Debbie Toth said she originally got into this line of work to give people a choice of where to spend their last years. But the pandemic has given her work new urgency: saving lives.
"These are people who would die" if they got covid, she said. "We have an opportunity to make sure they don't. That's our north star."
California Healthline correspondent Angela Hart contributed to this report.
Internal Revenue Service filings from thousands of nonprofit hospitals show they sent $2.7 billion in bills over a year to patients who probably qualified for free or discounted care.
This article was published on Monday, February 15, 2021 in Kaiser Health News.
Jared Walker, who runs a nonprofit that helps people pay medical bills, posted a TikTok video explaining the recipe to “crush” hospital bills via charity care policies.
“What that means is that if you make under a certain amount of money, the hospital legally has to forgive your medical bills,” Walker said in the video.
The video has been viewed more than 10 million times. Walker’s organization, Dollar For, had already helped wipe out millions in medical bills before he posted that video.
Internal Revenue Service filings from thousands of nonprofit hospitals show they sent $2.7 billion in bills over a year to patients who probably qualified for free or discounted care.
That number is more likely a floor than a ceiling, experts said.
The strategy Walker espouses won’t work for all bills, but it could help address some of those billions — and is a good place to start.
A tweet circulating on social media claims vaccine shortages wouldn't exist if Pfizer and Moderna shared "their vaccine design with dozens of other pharma companies who stand ready to produce their vaccines and end the pandemic."
This article was published on Monday, February 15, 2021 in Kaiser Health News. This story was produced in partnership with PolitiFact.
Vaccine makers Pfizer and Moderna earned praise for creating highly effective covid-19 vaccines in record time. But are they inadvertently hurting the public by not sharing their technology with other pharmaceutical companies to help speed up vaccine manufacturing and distribution?
That’s what one post circulating on social media claims.
“The vaccine shortage doesn’t need to exist,” reads an image of a tweet shared thousands of times on Facebook. “Pfizer and Moderna could share their design with dozens of other pharma companies who stand ready to produce their vaccines and end the pandemic.”
In short, the situation is not that simple. The post was flagged as part of Facebook’s efforts to combat false news and misinformation on its News Feed. (Read more about PolitiFact’s partnership with Facebook.)
The tweet doesn’t mention that the two drugmakers are already partnering with other companies to produce the vaccine. It also makes it appear as if dozens of companies are regulated to make vaccines and have a ready supply of the raw materials, equipment and storage needed to efficiently and effectively produce them. Experts say that’s not the case.
When PolitiFact reached out to the tweet’s author, Dr. James Hamblin, a public health policy lecturer at Yale University and writer at The Atlantic, he acknowledged that using the words “stand ready” in the tweet inaccurately implied the process could begin immediately.
“It takes time and investment to begin making mRNA vaccines,” Hamblin told PolitiFact. “The companies would need the assurance that they not lose money by getting into that space, possibly in some way similar to the assurances given during the research phase of warp speed.”
Vaccine Technology Narrows the Field
Both Pfizer and Moderna’s vaccines rely on newer messenger RNA technology. (It has been studied for some time but hasn’t been used in a vaccine until now.) The mRNA is fragile and needs to be handled carefully, with specific temperatures and humidity levels to keep it from breaking down.
It’s highly unlikely, experts say, that “dozens” of manufacturing plants have the capability to get this type of production off the ground immediately. Even if Pfizer-BioNTech and Moderna made their vaccine designs open source today, pharmaceutical researchers estimate, it would still take several months for other companies to produce the shots, and by then mass distribution and inoculation will be well underway.
PolitiFact reached out to both companies for comment but did not hear back.
Dr. Rajeev Venkayya, president of the Global Vaccine Business Unit at Takeda Pharmaceuticals and former director of vaccine delivery at the Bill & Melinda Gates Foundation’s Global Health Program, wrote a Twitter thread addressing the complexity and risk of vaccine manufacturing.
Among many other issues, Venyakka said, vaccines are complex biologics and it’s hard to predict whether changes to the manufacturing process will affect the vaccines’ effectiveness or safety.
“Many vaccines are made by growing viruses in cells, and when that doesn’t happen as expected, it can lead to losses in production and delayed timelines. This is an area where cell- and virus-free mRNA vaccine production has a major advantage,” Venkayya wrote.
“For these reasons, every aspect of vaccine manufacturing is tightly controlled: raw materials, equipment, production processes, training, operating procedures etc. All of it happens under GMP [good manufacturing practice] regulations, and facilities are regularly inspected.”
According to the Food and Drug Administration, manufacturers may share any information or data about their products they choose, as they are the owners of the information. But the company is responsible for ensuring that any contract manufacturer is in compliance with the FDA’s good manufacturing practice regulations.
These rules establish minimum requirements for the methods, facilities and controls used in making and packing pharmaceuticals. They aim to ensure that a product is safe for use and that it has the ingredients and strength it claims to have.
Existing Partnerships Are Already Speeding Production
John Grabenstein, associate director for scientific communications at the Immunization Action Coalition, a vaccine information organization that works in partnership with the Centers for Disease Control and Prevention, told PolitiFact the tweet wrongly presumes that the companies aren’t already outsourcing production. Grabenstein tracks partnerships between pharmaceutical companies and contract manufacturers.
He said Pfizer-BioNTech is working with biopharmaceutical companies Rentschler and Polymun, while Moderna has partnered with Rovi, Recipharm and Lonza. Some of the companies are located exclusively overseas, while others have plants in the U.S.
Typically, the contractors are doing one of the major portions of production, Grabenstein said, such as manufacturing the bulk product, formulation of the bulk into the final preparation, filling the drug product into vials, or finishing the final packaging, which could include labeling vials, inserting them and paperwork into boxes, and assembling boxes for a carton.
For example, Rovi, one of the companies working with Moderna, signed a contract in July to start filling and packaging 100 million doses of the vaccine in early 2021.
In fewer cases, a full-fledged manufacturer is commissioned to make a mirror image of the original product, from start to finish.
One example of this is the Serum Institute of India — the world’s largest vaccine manufacturer — which is already producing a parallel version of the Oxford-AstraZeneca vaccine that the institute will market with the trade name CoviShield. The institute launched the construction of new facilities in June to make that happen. The organization recently announced a similar partnership with Novavax.
“This is incredibly intricate and the number of facilities and trained personnel is really, really small,” Grabenstein said. “It’s not like you’re just giving a recipe to another restaurant. That ‘recipe’ is thousands and thousands of pages long, and then you have to validate and show that you meet all the really tight performance specifications and prove consistency of process before any of the regulators will let you distribute any of the vaccine.”
Hamblin, the author of the Twitter post, said it’s unlikely the companies would share their vaccine designs, given the current system of intellectual property and funding, though he noted exceptions, like Sanofi.
Sanofi, a French multinational pharmaceutical company, announced in January that it had entered into a partnership with BioNTech, the company that co-developed the vaccine with Pfizer. Sanofi said it will provide the company access to its “established infrastructure and expertise to produce over 125 million doses of COVID-19 vaccine in Europe.” Initial supplies will originate from Sanofi’s production facilities in Frankfurt, Germany, this summer.
Hamblin noted that if vaccine makers open the intellectual property in a permanent, unconditional way — rather than on a small scale for a finite period — it could help get more companies and governments into the production “in a more permanent, cost-effective way.”
“If we have to manufacture boosters in specific areas for new strains, for example, or for the next coronavirus, we could be on it right away,” Hamblin said. “Again, speaking hypothetically about that — not implying it will happen or would be quick or easy or anything else.”
Defense Production Act Allows Greater Collaboration But Takes Time
With President Joe Biden invoking the Defense Production Act, couldn’t that serve to help speed things up? Yes, but the law is not as sweeping as some think.
The Defense Production Act of 1950 gives presidential authority to promote national defense by expediting and expanding the supply of materials and services from the U.S. industrial base.
Dr. George Siber, a vaccine expert on the advisory board of CureVac, a German mRNA vaccine company, told KHN that invoking the act would allow the government to commandeer an appropriate plant to expand production, but that it would still take about a year to get going.
Companies would first have to undertake a thorough cleaning of their equipment and facilities to prevent cross-contamination and would need to set up, calibrate and test equipment, and train scientists and engineers to run it, Siber told KHN.
“Do you want glass? Aluminum? Filter resins? What is the thing that you need?” Grabenstein said. “For example, vaccine manufacturers say, ‘If only I had more glass vials, I could increase my weekly production.’ OK, the government gets you more glass vials. Then it reveals the next bottleneck.”
He added: “Is there production that could be stopped or delayed, and let those machines be used for this goal? Sure, but you still have to clean it, and quality-control that it’s really clean, and then the transfer and validation of process. It’s months or years of commitment. This is not turn-on-a-dime kind of stuff.”
According to the CDC, nearly 66 million doses of the Moderna and Pfizer-BioNTech vaccines had been distributed and roughly 45 million administered by the second week in February.
A post claims the covid-19 vaccine shortage doesn’t need to exist because Pfizer and Moderna can share their vaccine designs with “dozens” of other pharmaceutical companies that are ready to produce the vaccines and end the pandemic.
This premise oversimplifies the vaccine manufacturing process.
First, the post doesn’t mention that Pfizer-BioNTech and Moderna already have partnerships with various contract manufacturers to help speed up vaccine production. Second, industry experts say it’s highly unlikely “dozens” of pharmaceutical companies that aren’t already producing the vaccines stand ready to do so. Supplies, personnel training and facility compliance are just a few aspects that make the process complex and lengthy.
So, while such partnerships are clearly an asset to rapid vaccine production, they are not entirely practical in the grand sense that this tweet implies.
The statement contains an element of truth but ignores critical facts that would give a different impression. We rate it Mostly False.
Tweeters lit up KHN's timeline in recent days with valentine messages about topics ranging from covid-19 vaccines and mask-wearing to the price of healthcare.
This article was published on Friday, February 12, 2021 in Kaiser Health News.
Nothing warms our hearts like a few good Health Policy Valentines ― especially those that are sweet on KHN. Tweeters lit up our timeline in recent days with valentine messages about topics ranging from covid-19 vaccines and mask-wearing to the price of health care. Here are some of our favorites.
In honor of Valentine’s Day, the panelists on the latest episode of KHN’s “What the Health?” chose their favorite #healthpolicyvalentines from Twitter.
❤
Just like Medicaid I won't terminate your eligibility with me until the end of the PHE. #HealthPolicyValentines
Some savvy readers report no problem getting in line for the vaccine, but others say that balky application processes and lack of information have stymied their efforts.
This article was published on Friday, February 12, 2021 in Kaiser Health News.
Too little covid vaccine and too great a demand: That’s what KHN readers from around the country detail in their often exasperating quest to snag a shot, although they are often clearly eligible under their local guidelines and priority system. Public health officials say the supply is growing and will meet demand in several months, but, for now, readers’ experiences show how access is limited. Some savvy readers report no problem getting in line for the vaccine, but others say that balky application processes and lack of information have stymied their efforts. Their unedited reports are a good snapshot of the mixed situation around the country.
TALE OF THE DAY — Feb. 12 —
I’m 65 and eligible for the vaccine. But I belong to an independent medical group, and many of the big vaccinators here are big medical groups. When I call my doctor, he tells me that they are waiting for a clinic, that he has no vaccine. The touted “mass vaccination site” at Cal Expo is barely used. When I hear there’s vaccine available at various hospitals, pharmacies and clinics, when I log on there are no appointments available. It’s vaccine for the privileged and members of the big medical groups. Everyone else loses out.— 65-year-oldSacramento, California
— Feb. 12 —
I am trying to get my 86-year-old mother vaccinated in Manhattan, NYC. Aside from the shortage, I am very angry at the hospitals and other vaccination sites for their horrible, inconsiderate websites, which are making the anxiety worse. Very simple things could be done to make them kinder. At present, you end up going in circles. For example: NorthwellHealth’s facilities are near her apartment. After going to the NYC covid page, I select one of their hospitals and click to their site. When they do not have any vaccine, they have no information on their covid page about 1st vaccine appointments. None. There is a button for making appointments, which leads you to making regular appointments with doctors. There should be a big button on the page you land on from the NYS listing that says MAKE A VACCINATION APPOINTMENT, even if there are no appointments. Some of the other sites make you fill out the forms before telling you that there are no vaccines. And you can’t just do it once. You have to do it over and over again. My sister and I are trying to do this for her. The fact that you MUST go thru the internet is pushing the elderly, those who need the vaccine the most, to periphery. But, at least, they could make the websites friendly and helpful. We’re a country where we spend more money and time making sure people know how to drink coke than they do helping people understand healthcare. This is a systematic problem that should be improved. There are marketing people out there who know how to interact with the public, but the healthcare system chooses not to use them.— New York
Yesterday I experienced the good and the bad of the vaccine rollout. My 95-year-old mother endured a one hour, twenty minute ordeal mostly standing outside 380 W MacArthur Kaiser in Oakland, thankfully a wheelchair was offered and very much appreciated.We were there 15 minutes early for the 10:15 appt. and finished at 11:20. The whole operation seemed clunky and bureaucratic, think of standing in a long line at a rental car company.Now to my almost dreamlike experience gliding through the Moscone Center in SF, arriving about 25 minutes early for my 5:45 appt. I was immediately checked in and escorted to the vaccination booth, the nurse checked me out on her screen asked me the routine questions jabbed my arm gave me my 5:45 sticker and sent me to observation area. After my morning in Oakland I’d love to take my mom to Moscone for her second shot but as far as I can tell Kaiser doesn’t seem to allow that.— Oakland, California
I’m a stage 4 cancer survivor and may have long-term heart and lung effects from the treatments I went through. I’m 44 and live in Denver. It’s unclear which vaccine group I fall into. Some states, such as New York, prioritize any cancer survivor, but Colorado only considers people who have been in treatment for the past month. Also, they want you to have two high-risk conditions — how are those defined? Do I qualify? Do my doctors have any input on that?My oncologist and my primary care doctor have no word on when I might get vaccinated. My health system’s website says if you have an online account, you’re already in their system and they will inform you when you’re eligible. I do not know if that takes into account my medical history.I’ve been to four pharmacies so far in my area; only one has had vaccines, and they did have a list on paper to call if they wound up with extras. I also signed up online with a couple of health care systems (Centura, National Jewish) for notifications; only one asked about medical conditions upon sign-up.So, at this rate, I’m guessing: spring? Summer? Will I be treated as a healthy adult and be the last vaccinated?— 44-year-oldDenver
Checked the Sacramento County website on Feb. 3. Found a link to a vaccination clinic at our neighborhood Safeway. Made an appointment for Feb. 6, at which time I received my first dose. Within minutes of being vaccinated, I received an email confirming an appointment for the second dose in 28 days.— Sacramento, California
We heard the local center would allow people to sign up at 3 p.m. on a Sunday. My husband and I were refreshing our respective computers every five seconds waiting for the portal to open. We snagged appointments via EventBrite on the same day, same hour. When my husband and I went for our first shot, we stood in line for roughly 1½ hours outside, in the sun and heat, before we got inside the county health office, which administered the shot. Most of the other people in line were older and/or frail, with walkers and in wheelchairs. The county staff did their best to make them comfortable, which wasn’t much due to the logistics of the operation. The second shot was a breeze — in and out in about 25 minutes, including the mandatory 15-minute wait after the inoculation. I have a friend who is 80 years old, a three-time cancer survivor, and still can’t get an appointment and has tried numerous times.— Lakewood Ranch, Florida
I signed up with the Kalamazoo County Health Department in Michigan. It was just a couple of weeks, I think, before they sent the application to sign up for the appointment. I had a choice of two days and three time spans with first, second and third choice and was asked if I needed any assistance. I then was emailed an appointment. When I got there, a policeman was directing traffic and giving instructions to stay in the car until five minutes before my appointment. It seemed less. I went through several stops very fast. The parking lot had so many cars and I had to wait 30 minutes after my injection. And, still, in 45 minutes I was driving down the street and also had my second appointment made. They reminded me days before my appointment, the day before my appointment and the morning of my appointment. So fast, so efficient and so many people there that there was no time to do anything but get done what had to be done. AMAZING planning and amazing workers and volunteers.— 77-year-oldKalamazoo, Michigan
Maryland covid distribution is a true mess. There is no central registration site. The state has a site that lists many providers, most of which do not have the vaccine. One of the large statewide vaccine sites, Six Flags America, does not allow you to sign up for the vaccine. Almost all the sites listed on the state’s website indicated they do not have the vaccine.— 68-year-oldEllicott City, Maryland
It’s terrible here in the county for Tier 2. That includes all the educators and everyone over 70. The appointment software company they chose to use did nothing to change their program to account for thousands daily and hourly trying to get an appointment.I eventually was able to get my first shot. I still was not able to use the information that the Carson City Health and Human Services was putting in the news. I noodled around on the internet and discovered a notice that a drugstore (Walgreens) and a drugstore within a supermarket (Smith’s Food and Drug) were being sent the Moderna vaccine and were taking appointments starting the next day. I tried Walgreens but I don’t shop there and could not enter its system. I tried Smith’s, and it was so simple anyone could get on it. I made an appointment so easily for the next morning. Four days ago, I received an email from Kroger, the parent company of Smith’s, telling me the day and time for my second dose. Each city, county and state seem to have surprisingly different ways of putting out information, where and how the vaccine is delivered and administered. I do think it is still a logistics issue that was not anticipated by our former government officials.— 78-year-oldCarson City, Nevada
I signed up for a vaccine several weeks ago with the county health department. I’m 78, living in Albuquerque. My registration was acknowledged but nothing further. The county program appears to be in chaos.— 78-year-oldAlbuquerque, New Mexico
Kristi Noem says that while her state sought to protect high-risk populations and keep hospitals from overflowing with patients, it was done in a way that still allowed residents to earn a living.
This article was published on Friday, February 12, 2021 in Kaiser Health News. This story was produced in partnership with PolitiFact.
Covid-19 has pushed states to adopt unique approaches to protect their residents, but few have garnered as much scrutiny as South Dakota. Its governor, Kristi Noem, refused to enact a mask mandate or close any businesses. She argued these precautions were a matter of personal choice, even at large gatherings, such as a July 3 political event at Mount Rushmore and the annual motorcycle rally in Sturgis that was connected to covid cases in Minnesota and other nearby states.
She sees success in the approach.
In a recent television interview, Fox News personality Laura Ingraham asked Noem, a Republican, why she believes news outlets criticize her handling of the pandemic. Her response: While her state sought to protect high-risk populations and keep hospitals from overflowing with patients, she said, it was done in a way that still allowed residents to earn a living.
"That was a unique approach that, for our people, really worked well," she said in the segment. "We did have tragedies and we did have losses. But we also got through it better than virtually every other state."
That got us wondering. Are we really "through" the pandemic? And on what measures is this statement based?
We first reached out to Noem’s office to ask these questions.
In an email, communications director Ian Fury didn’t address the first question. On the second, Fury cited South Dakota’s standing in these categories: vaccine distribution, unemployment, the number of people moving to the state and the state’s budget surplus.
Fury dismissed using an "apples-to-apples" comparison between South Dakota and other states on measures such as deaths and case counts, saying such assessments are flawed because the timing of surges and the metrics used can vary by state.
Expanding the Lens on How South Dakota’s Doing
Several measures can offer clues as to how a state is managing the pandemic, experts said.
In the health category, the number of deaths per capita is one way to track the most severe covid cases, said Kumi Smith, assistant professor of epidemiology at the University of Minnesota.
This metric is not a real-time snapshot of how quickly the virus is spreading in a community, given the lag in reporting deaths. But, Smith said, it can provide “a much fuller picture of what’s going on with the pandemic” than case counts alone. That’s because case counts can wax and wane depending on other factors, such as the availability of coronavirus tests and which populations a state prioritizes for testing, she said.
In South Dakota, 1,815 lives have been lost to the pandemic, making its per capita death rate 205 deaths for every 100,000 residents as of Wednesday, according to data from the Centers for Disease Control and Prevention. The state’s death rate ranks among the top 10 in the nation.
Another key metric is positivity rates — or the percentage of people tested who have the virus. It can indicate whether a state is regularly testing enough residents, said Dr. Amesh Adalja, an infectious diseases physician and senior scholar at the Center for Health Security at Johns Hopkins University.
Positivity rates vary by how they are calculated. Data from the South Dakota Department of Health and the CDC shows the average weekly positivity rate peaked in the spring. Few tests were being done at the time, which means every positive result would have had a greater impact on the rate. Johns Hopkins’ covid tracker, which uses a different method, shows the state’s rate peaked in November.
High positivity rates can indicate a lack of adequate testing that allowed the virus to spread unchecked, said Adalja. “Their death count may be even higher,” he added, because some of those cases may not have been properly tested and identified as caused by covid.
Last week, the positivity rate hovered slightly under 7%, as reported by the state. Johns Hopkins researchers placed the figure closer to 20% as of Feb. 3. Both are above the 5% maximum rate recommended by the World Health Organization to reopen a community.
Hospitalization data — specifically, the number of intensive care unit beds occupied — can also help gauge how a state is handling the pandemic, public health experts said. By comparing the number of beds occupied in intensive care units during the pandemic with the year before, said Smith, the metric can show whether hospitals could keep up with the demand caused by the virus.
Newsreportsindicate some South Dakota hospitals struggled to keep up with demand in the fall when the state’s outbreak peaked. As of Wednesday, state data shows, about half of adult and pediatric ICU beds in the state were available.
Public health experts noted South Dakota has emerged as a national leader in distributing covid vaccines, ranking among the 10 states with the most residents vaccinated per capita. While the vaccines do offer a way out of the pandemic, “I do think that we are still at the very, very beginning of a very long end,” said Smith.
And the Economy?
Most of the metrics Noem’s office highlighted related to South Dakota’s economy. And, indeed, the state has the lowest unemployment rate in the country and ended the budget year with a $19 million surplus.
How did the state manage to pull that off during a pandemic?
Evert Van der Sluis, a professor of economics at South Dakota State University, said several factors helped. The state experienced less of an economic decline than initially projected at the start of the pandemic because of federal aid, conservative revenue projections and a multibillion-dollar investment in wind energy, he said.
South Dakota — where agriculture is the top industry — also benefited from billions of dollars in direct federal government payments to farmers, said Van der Sluis. While some of these payments were connected to the pandemic, others helped offset the financial losses caused by fallout from a U.S. trade dispute with China.
However, Van der Sluis said, these indicators don’t capture the depth of the damage caused by the pandemic.
They also don’t necessarily highlight how a state has done better than others because they don’t take into account that variations in population density, tax revenue and industries all influence how a state manages an outbreak.
"We can talk about economic well-being," he said, "but some of the enormous harm done by covid is not reflected, at least in the short run, by economic measures." It may become apparent in long-term measures like health care spending and lost productivity, he added.
While the lack of lockdowns also may have played a role in keeping South Dakota’s economy afloat, said Lucy Dadayan, a senior research associate at the Urban Institute, there are other states that raked in cash while implementing strong public health measures. Case in point: California.
As reported by Politico, California defied expectations of an economic downturn because of tax revenue from its wealthiest residents and their stock market gains. Ultimately, Dadayan said, a state’s ability to stay financially afloat is dependent on a variety of factors — which makes it more difficult to draw comparisons between states and their economic performance during the pandemic.
"It all matters," she said.
Our Ruling
Both public health measures and fiscal stability represent important pieces to forming a full picture of how the state is handling the pandemic, experts said.
As Van der Sluis noted, these metrics are blunt instruments when measuring the damage done by the death of a loved one.
In addition, comparing states wholesale is difficult, given their differences and the dynamic nature of the pandemic, as various sources noted. And, though South Dakota is experiencing a decline in case counts, with 109,580 cases to date and growing concern nationwide about the virus’s emerging variants, it’s hard to say the state has “come through” the pandemic.
Noem’s statement on South Dakota’s performance cherry-picked the data, emphasizing the state’s economy while giving less weight to the lives lost and the burden of disease its residents suffered. We rate it Mostly False.
Seniors of color are lagging in covid vaccinations, and the Biden administration plans to redirect doses to community clinics as soon as next week to help make up for the emerging disparity.
This article was published on Thursday, February 11, 2021 in Kaiser Health News.
Mary Barnett is one of about a dozen seniors who got a covid-19 vaccine on a recent morning at Neighborhood Health, a clinic tucked in a sprawling public housing development on the south side of downtown Nashville, Tennessee.
"Is my time up, baby?" Barnett, 74, asked a nurse, after she'd waited 15 minutes to make sure she didn't have an allergic reaction. Barnett, who uses a wheelchair, wasn't in any particular rush. But her nephew was waiting outside, and he needed to get to work.
"Uber, I'm ready," she joked, calling him on the phone. "Come on."
Seniors of color like Barnett are lagging in covid vaccinations, and the Biden administration plans to redirect doses to community clinics as soon as next week to help make up for the emerging disparity. Tennessee is one of a few states allocating vaccines to the network of clinics known as FQHCs, or federally qualified health centers.
In most of the states reporting racial and ethnic data, a KHN analysis found that white residents are getting vaccinated at more than twice the rate of Black residents. The gap is even larger in Pennsylvania, New Jersey and Mississippi.
"Equity is our north star here," Dr. Marcella Nunez-Smith said at a briefing Tuesday, announcing vaccine shipments to the federally funded clinics. "This effort that focuses on direct allocation to community health centers really is about connecting with those hard-to-reach populations across the country."
Nunez-Smith, who leads the administration's health equity task force, said federally funded clinics — at least one in every state — will divvy up a million doses to start with, enough for 500,000 patients to get both doses. Eventually, 250 sites will participate.
The administration said roughly two-thirds of those served by FQHCs live at or below the poverty line, and more than half are racial or ethnic minorities.
Seeking People Out
In Nashville, more than a third of eligible white residents have gotten their first shot, compared with a quarter of Hispanic residents and fewer than one-fifth of Black Nashvillians.
Unlike many local health departments, Neighborhood Health is not fending off crowds. They're seeking people out. And it's slow work compared with the mass vaccination campaigns by many public health workers and health systems.
Barnett lives in a public housing complex that gathered names of people interested in getting the vaccine. She was lucky to have her nephew's help to get to her appointment; transportation is a challenge for many seniors. Some patients cancel at the last minute because a ride falls through. Often, the clinic offers to pick up patients.
Aside from logistical challenges, Barnett said, many of her neighbors are in no rush to get their dose anyway. "I tell them about taking it, they say, 'Oh, no, I'm not going to take it.' I say, 'What's the reasoning?'"
Usually, Barnett said, they don't offer much of a reason. Her own motivation is a sister with kidney disease who died of covid in July.
"You either die with it or die without it," her brother told her in support of getting the vaccine. "So if the shot helps, take the shot."
Same Story, Next Chapter
People of color have made up an outsize share of the cases and deaths from covid nationwide. And, predictably, the same factors at play driving those trends are also complicating the vaccine rollout.
Rose Marie Becerra received an invitation to get the vaccine through Conexión Américas, a Tennessee immigrant advocacy nonprofit. A U.S. citizen originally from Colombia, she's concerned about those without legal immigration status.
"The people who don't have documents here are nervous about what could happen," she said, adding they worry that providing personal information could result in immigration authorities tracking them down.
And unauthorized immigrants are among those at the highest risk of covid complications.
Even with 1,300 total community health centers around the country, Neighborhood Health CEO Brian Haile said his 11 clinics in the Nashville area can't balance out a massive health system that tends to favor white patients with means.
Haile said everyone giving vaccines — from hospitals to health departments — must focus more on equity.
"We know what's required in terms of the labor-intensive effort to focus on the populations and vaccinate the populations at the highest risk," Haile said. "What we have to do as a community is say, 'We're all going to make this happen.'"
Democratic legislators in three states introduced bills that would slap an 80% tax on the drug price increases that ICER determines are not supported by evidence of improved clinical value.
This article was published on Friday, February 12, 2021 in Kaiser Health News.
Fed up with a lack of federal action to lower prescription drug costs, state legislators around the country are pushing bills to penalize drugmakers for unjustified price hikes and to cap payment at much-lower Canadian levels.
These bills, sponsored by both Republicans and Democrats in a half-dozen states, are a response to consumers' intensified demand for action on drug prices as prospects for solutions from Congress remain highly uncertain.
Eighty-seven percent of Americans favor federal action to lower drug prices, making it the public's second-highest policy priority, according to a survey released by Politico and Harvard University last month. That concern is propelled by the toll of out-of-pocket costs on Medicare beneficiaries, many of whom pay thousands of dollars a year. Studies show many patients don't take needed drugs because of the cost.
"States will keep a careful eye on Congress, but they can't wait," said Trish Riley, executive director of the National Academy for State Health Policy (NASHP), which has drafted two model bills on curbing prices that some state lawmakers are using.
Several reports released last month heightened the pressure for action. The Rand Corp. said average list prices in the U.S. for prescription drugs in 2018 were 2.56 times higher than the prices in 32 other developed countries, while brand-name drug prices averaged 3.44 times higher.
The Institute for Clinical and Economic Review found that drugmakers raised the list prices for seven widely used, expensive drugs in 2019 despite the lack of evidence of substantial clinical improvements. ICER, an independent drug research group, estimated that just those price increases cost U.S. consumers $1.2 billion a year more.
Democratic legislators in Hawaii, Maine and Washington recently introduced bills, based on one of NASHP's models, that would impose an 80% tax on the drug price increases that ICER determines in its annual report are not supported by evidence of improved clinical value.
Under this model, after getting the list of drugs from ICER, states would require the manufacturers of those medicines to report total in-state sales of their drugs and the price difference since the previous year. Then the state would assess the tax on the manufacturer. The revenue generated by the tax would be used to fund programs that help consumers afford their medications.
"I'm not looking to gather more tax dollars," said Democratic Sen. Ned Claxton, the sponsor of the bill in Maine and a retired family physician. "The best outcome would be to have drug companies just sell at a lower price."
Similarly, Massachusetts Gov. Charlie Baker, a Republican, proposed a penalty on price hikes for a broader range of drugs as part of his new budget proposal, projecting it would haul in $70 million in its first year.
Meanwhile, Republican and Democratic lawmakers in Hawaii, Maine, North Dakota, Oklahoma and Rhode Island have filed bills that would set the rates paid by state-run and commercial health plans — excluding Medicaid — for up to 250 of the costliest drugs to rates paid by the four most populous Canadian provinces. That could reduce prices by an average of 75%, according to NASHP.
Legislators in other states plan to file similar bills, Riley said.
Drugmakers, which have formidable lobbying power in Washington, D.C., and the states, fiercely oppose these efforts. "The outcomes of these policies would only make it harder for people to get the medicines they need and would threaten the crucial innovation necessary to get us out of a global pandemic," the Pharmaceutical Research and Manufacturers of America, the industry's trade group, said in a written statement.
Colorado, Florida and several New England states previously passed laws allowing importation of cheaper drugs from Canada, an effort strongly promoted by former President Donald Trump. But those programs are still being developed and each would need a federal green light.
Bipartisan bills in Congress that would have penalized drugmakers for raising prices above inflation rates and capped out-of-pocket drug costs for enrollees in Medicare Part D drug plans died last year.
"If we waited for Congress, we'd have moss on our backs," said Washington state Sen. Karen Keiser, a Democrat who sponsored the state's bill to tax drug price hikes.
Based on ICER data, two of the drugs that could be targeted for tax penalties under the legislation are Enbrel and Humira — blockbuster products used to treat rheumatoid arthritis and other autoimmune conditions.
Since acquiring Enbrel in 2002, Amgen has raised the price 457% to $72,240 for a year's treatment, according to a report last fall from the House Committee on Oversight and Reform.
In a written statement, Amgen denied that Enbrel's list price increase is unsupported by clinical evidence and said the company ensures that every patient who needs its medicines has "meaningful access" to them.
The price for Humira, the world's best-selling drug, with $20 billion in global sales in 2019, has gone up 470% since it was introduced to the market in 2003, according to AnalySource, a drug price database.
In contrast, AbbVie slashed Humira's price in Europe by 80% in 2018 to match the price of biosimilar products available there. AbbVie patents block those biosimilar drugs in the U.S.
AbbVie did not respond to requests for comment for this article.
Manufacturers say the list price of a drug is irrelevant because insurers and patients pay a significantly lower net price, after getting rebates and other discounts.
But many people, especially those who are uninsured, are on Medicare or have high-deductible plans, pay some or all the cost based on the list price.
Katherine Pepper of Bellingham, Washington, has felt the bite of Humira's list price. Several years ago, she retired from her job as a management analyst to go on Social Security disability and Medicare because of her psoriatic arthritis, diabetes and gastrointestinal issues.
When she enrolled in a Medicare Part D drug plan, she was shocked by her share of the cost. Since Pepper pays 5% of the Humira list price after reaching Medicare's catastrophic cost threshold, she spent roughly $15,000 for the drug last year.
Medicare doesn't allow drugmakers to cover beneficiaries' copay costs because of concerns that it could prompt more beneficiaries and their doctors to choose high-cost drugs and increase federal spending.
Many patients with rheumatoid and other forms of arthritis are forced to switch from Enbrel or Humira, which they can inject at home themselves, to different drugs that are infused in a doctor's office when they go on Medicare. Infusion drugs are covered almost entirely by the Medicare Part B program for outpatient care. But switching can complicate a patient's care.
"Very few Part D patients can afford the [injectable drugs] because the copay can be so steep," said Dr. Marcus Snow, an Omaha, Nebraska, rheumatologist and spokesperson for the American College of Rheumatology. "The math gets very ugly very quickly."
To continue taking Humira, Pepper racked up large credit card bills, burning through most of her savings. In 2019, she and her husband, who's retired and on Medicare, sold their house and moved into a rental apartment. She skimps on her diabetes medications to save money, which has taken a toll on her health, causing skin and vision problems, she said.
She's also cut back on food spending, with her and her husband often eating only one meal a day.
"I'm now in a situation where I have to do Russian roulette, spin the wheel and figure out what I can do without this month," said Pepper.
A key U.S. senator is calling on the Federal Trade Commission to investigate N95 mask fraud and federal agents announced the seizure of 1.7 million more counterfeit 3M masks in the New York borough of Queens as the breadth of a major scam concerning front-line health workers continues to grow.
Early Thursday, Sen. Maria Cantwell (D-Wash.), on her first day as chair of the Senate Commerce Committee, said she would ask the Federal Trade Commission to look into 1.9 million counterfeits shipped to hospitals in Washington state. The state hospital association announced earlier in the week that law enforcement had notified them that they'd been sold fake N95s branded as 3M products.
"We are looking to our FTC to make sure that there are no fraudulent products and materials out here, like masks, that my state is facing," Cantwell said in a statement.
KHN reported Thursday that hospitals in Ohio, Minnesota and New Jersey also were sold thousands of fake masks. Later in the day, nurses on a covid-19 unit at Jersey Shore University Medical Center discovered yet another highly suspicious aspect to their 3M-branded respirators: The lot numbers printed on the masks did not match the lot numbers on the boxes they were shipped in.
"Lives are literally at risk because these workers are not protected," said Debbie White, president of the Health Professionals & Allied Employees union.
KHN also reported that independent tests on masks given to New Jersey nurses — which matched the very lot numbers 3M had warned customers about in a fraud alert — actually showed filtration levels at 95% or above, as would be expected of a genuine N95.
Yet the 3M company said other critical aspects of the devices, such as how consistently and well they fit the face, could not be guaranteed. The Cleveland Clinic, which took purported 3M N95s off the shelves after discovering they were fake in January, said in a statement that their tests revealed "these masks were not effective."
Federal law enforcement authorities have been tracking down these counterfeits for months. Homeland Security Investigations and its Global Trade Investigations unit have been coordinating with Border Patrol officials to seize more than 14.5 million counterfeit masks, nearly all falsely branded as 3M.
One of their cases made headlines Thursday, when Homeland Security Investigations and Queens District Attorney Melinda Katz announced an arrest and the seizure of nearly 1.8 million fake 3M masks in a warehouse.
Katz's office got a tip that counterfeit masks were being offered for sale from a warehouse in the Long Island City section of Queens. Investigators posed as undercover buyers and purchased masks on several days to verify their authenticity.
The investigators determined that a healthcare system in the southern U.S. bought 200,000 of them, at prices that were more than twice what an authorized vendor is advised to charge, which is $1.27 each. Officials arrested the warehouse manager, a 33-year-old from Brooklyn, and said the investigation is ongoing.
Peter Prater's family wasn't thinking about covid-19 when the call came that he had been taken to the hospital with a fever.
It was April, and the Tallahassee Developmental Center, where Prater lives, hadn't yet had any covid diagnoses. Prater, 55, who has Down syndrome and diabetes, became the Florida center's first known case, his family said. Within two weeks, more than half of the roughly 60 residents and a third of the staff had tested positive for the virus, according to local news reports.
"We thought we were going to lose him," said Jim DeBeaugrine, Prater's brother-in-law, who also works as an advocate for people with disabilities. "We weren't aware of a correlation to Down syndrome and bad outcomes with covid yet. He's just a frail person, period."
Prater survived after roughly seven weeks in the hospital. But five others from the center — three residents and two staffers — died. The center is working to follow federal and state pandemic guidelines, said Camille Lukow, regional director of the Mentor Network, which began operating the facility in December.
Early studies have shown that people with intellectual and developmental disabilities have a higher likelihood of dying from the virus than those without disabilities, likely because of a higher prevalence of preexisting conditions. While some high-profile outbreaks made the news, a lack of federal tracking means the population remains largely overlooked amid the pandemic.
No one knows how many of the estimated 300,000 people who live in such facilities nationwide have caught covid or died as a result. That creates a blind spot in understanding the impact of the virus. And because data drives access to scarce covid vaccines, those with disabilities could be at a disadvantage for getting prioritized for the shots to keep them safe.
While facilities ranging from state institutions that serve hundreds to small group homes with a few people have been locked down throughout the pandemic, workers still rotate through every day. Residents live in close quarters. Some don't understand the dangers of the virus. Those who need help eating or changing can't keep their distance from others. Many facilities also have struggled to keep enough masks and staffers on hand.
The Consortium for Citizens with Disabilities has repeatedly asked federal agencies to hold facilities where people with disabilities live to the same pandemic rules as nursing homes, which must report covid cases directly to national agencies.
Nicole Jorwic, senior director of public policy with The Arc of the United States, a nonprofit that serves people with disabilities, said a spotlight on nursing homes makes sense. Those homes have seen more than 121,000 deaths due to the pandemic. But it's unclear what the toll is at the facilities focused on those with disabilities.
"How do we know how big the problem is if we're not capturing it?" she asked.
Greg Myers, a Centers for Medicare & Medicaid Services press officer, said in an email that states, not federal officials, manage Medicaid-funded intermediate care facilities and group homes for people with developmental disabilities. He said many of those facilities serve fewer than eight residents and don't "pose the same concerns as larger congregate settings."
Some states are tracking the caseloads, though Jorwic said the type of information they collect varies. New York state data revealed disability group home residents there are dying at higher rates than the general population. In Illinois — which called on the National Guard to respond to outbreaks in two of the state's largest developmental centers in April — more than half of the 1,648 residents in state-run developmental facilities have had the virus.
Still, cases are flying under the radar. When The Associated Press did a national survey in June of how many people in such housing have fallen sick or died of covid, about a dozen states didn't respond or release comprehensive data.
"The delay or complete lack of access to this data comes with a body count," Jorwic said. "You're not acknowledging that these settings are just as dangerous as other settings, like nursing homes."
Centers for Disease Control and Prevention guidelines recommend that states prioritize long-term care facilities early in the vaccine rollout, but few states specified that people with disabilities who live in group homes should be candidates for that initial vaccine distribution.
New York is one of the few that did specifically include certified-group facilities, and this month opened access to all people with intellectual or developmental disabilities.
"New York state has the actual data to help show the horrors of covid," said Dr. Vincent Siasoco, a primary care physician in New York City who focuses on patients with developmental disabilities.
Siasoco, a board member of the American Academy of Developmental Medicine and Dentistry, said that likely misses people with medical risks not yet reflected in data, like someone living in a group home with cerebral palsy who gets food through a tube and can't speak.
"More studies have to be done. Data has to be shared," Siasoco said.
In the meantime, the academy has said intellectual and developmental disability diagnoses should be explicitly included on the list of high-risk conditions used to determine vaccine priority, and facilities housing those with disabilities should have access at the same time as nursing homes — though, Siasoco acknowledged, there's a long line of people advocating to be prioritized and not enough vaccine to go around.
In Montana, people in group living settings including disability housing were in the phase initially right behind healthcare workers and nursing home residents on the list for vaccines. But the new governor, Republican Greg Gianforte, instead prioritized anyone 70 and older and those with underlying health conditions, with the goal of protecting the most vulnerable. The change nearly tripled how many people qualify for that phase of the vaccine rollout.
Group home administrators have said many of their clients may still qualify for a vaccine under the governor's new rule because of their medical risks. The new plan also allows health providers to include people with medical conditions on a case-by-case basis.
Dee Metrick, the executive director of Reach Inc., which offers group housing in Bozeman, said the local health department is working to get shots to Reach's residents. However, she said, the change creates more uncertainty for some people with disabilities across the state, as each county does things differently.
"We're hoping this will unfold in their favor, but we just don't know," said Metrick, who added that people with developmental disabilities have historically not received proper medical care or fair treatment.
In Florida, the state's covid vaccine plan included group living settings for those with disabilities in its early vaccine rollout to long-term care facilities.
"But there have been instances where local authorities have not gotten the memo," said Jim DeBeaugrine, Prater's brother-in-law, who is also the interim CEO of The Arc of Florida.
The state has faced criticism for being slower with its vaccine rollout than some expected and after some camped out in lines overnight to get a dose — something group home residents can't do. DeBeaugrine said that how and when group homes can get vaccines to their residents varies, but all should be able to start by March 1.
By February, Prater's family had heard he would have the option to receive a dose, but a bacterial infection has delayed him from being able to get the shot.