A "trifecta of shortages" is hampering the U.S. healthcare system's ability to treat current and future COVID-19 patients, a member of President-elect Joe Biden's COVID-19 Advisory Board said Wednesday.
Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, said during a webinar hosted by the National Institute for Health Care Management that care for hospitalized coronavirus patients could be compromised due to a lack of staffing rather than a lack of beds. Providers will again run out of personal protective equipment in light of the current surge in cases, especially since Europe is experiencing similar increases, he said. Finally, critical drugs used to treat COVID patients are in increasingly short supply, a problem also exacerbated by Europe's surge.
"I anticipate in the coming days with the shortages of healthcare workers, the shortages of PPE and the shortages of drugs, the challenges will only become more acute," Osterholm said. "That's hard to hear, but we have to plan for it. We have to be there."
Osterholm said 29 of the 40 "very critical" drugs used in COVID treatment are in shortage status, and both the number of drugs in shortage and the severity of those shortages are growing. Such drugs include antibiotics for secondary bacterial infections and Propofol, an anesthetic used during intubation. Many of those drugs come from India, a country that's been hit hard with COVID itself and has limited production and shipment of the drugs as a result, he said.
Emergency use authorization for a leading vaccine contender is expected in December. When that happens, doses will be distributed within 48 hours, Hemi Tewarson, a visiting senior policy fellow with the Duke-Margolis Center for Health Policy, said during the webinar. That will be an "unprecedented" undertaking for states and communities that will dwarf typical flu campaigns of the past.
Under the National Academy of Medicine's phased approach, the first phase, 1a, would cover up to 20 million healthcare personnel and first responders. Phase 1b includes people at high clinical risk, including those with cancer, chronic kidney disease and chronic obstructive pulmonary disease. It also includes older adults in congregate settings like nursing homes. Phase 1b could cover more than 100 million people, Tewarson said.
The second phase covers teachers, essential workers, people with moderate clinical risk, homeless shelter and group home staff, prisoners and all other older adults. That population is estimated at greater than 38 million, but could be up to 100 million, she said.
The third phase, believed to cover 152 million people, includes young adults, children and essential workers with moderate risk of exposure. The fourth and final phase extends to everyone else.
Distributing the vaccine will extend across the coming year, Tewarson said.
"I think it illustrates the challenge we have in front of us as a country of getting people vaccinated at the numbers that we're really thinking about," she said. "I think it is a part of the critical solution to really ending the pandemic, but this is going to be over a long period of time."
States will face "hard decisions" about who gets the vaccine first depending on how many doses they receive, Tewarson said. Nontraditional providers like emergency medical technicians and paramedics will likely be enlisted to help with distribution, which could take place in places like mobile units, churches and harm reduction centers, she said.
States will have to figure out how to effectively track the vaccine, including potential adverse events, and ensure people get second doses if necessary and identify adverse events, Tewarson said.
Another hurdle will be the high rate of skepticism about the new vaccines.
For its part, Blue Cross and Blue Shield of Massachusetts will use every platform it has to distribute factual information about the COVID-19 vaccine, Dr. Katherine Dallow, the insurer's vice president of clinical programs and strategy, said during Wednesday's webinar. Once the vaccine is out, insurers and other organizations need to band with the Biden administration to ensure the public hears consistent, credible information, she said.
Osterholm said unless citizens make major behavior changes, it's only a matter of time before the U.S. hits 200,000 cases per day. But even if the country were to completely shut down COVID-19 transmission right now, he said the pandemic would unfold unchanged for at least the next three weeks.
"Today, unfortunately, I believe we are at the greatest single public health crisis in the world since the 1918 pandemic," Osterholm said.
Osterholm encouraged the audience to talk to their friends, neighbors and families about why prevention efforts are so important. He said going to bars, weddings, funerals, athletic events put not only puts that individual at risk, but their loved ones and healthcare workers as well.
"The bottom line is, stop swapping air," Osterholm said. "Stop swapping air. However you do that, by distancing, masking can help. The bottom line is that's what we have to do."