Category: Covid-19

A vaccination drive-thru has been set up to fast-track the countrys second phase vaccination rollout. The Gauteng Provincial Government has increased the number of vaccination sites from 28 to 63 in the provinces five regions.

This will ensure that more people over the age of 60 years and older receive the two-dose Pfizer vaccine.

Primary Healthcare worker, Sithiba Matheza, says the drive-thru vaccination site is a first of its kind.

Despite some teething problems, it was off to a good start since it went operational on Monday.

We can say the people are appreciating this project, we are still having a little bit of challenges. The first challenge is with the IT, the routers, the tablets we dont have network. We as nurses are not trained with IT issues we take care of the sick. But now you have to do the gadget thing as well and also give an injection, says Matheza.

Ekurhuleni Health District Manager, Mbangiseni Magoro, says the drive-thru vaccination site is a way of adding more sites to reach as many people as possible.

This facility that we are in is quite large, It has three entrances, and we are only using one at the moment. We will expand and open two more entrances so we can vaccinate more people. So that we can be able to reach capacity of 1 200 vaccinations per day in this facility, that is the plan, explains Magoro.

While some were happy to finally get their shots, others were frustrated by the delays caused by the technical glitches.

We sitting here for two hours already and thats a little bit long, what about all these tents standing here doing nothing. I am not very happy with it, said one elderly.

Infographic of recent COVID-19 cases in South Africa:

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Gauteng launches COVID-19 vaccination drive-thru - SABC ...

Graves being prepared at the Honingnestkrans cemetery, north of Pretoria, on 8 July 2020, during a visit by Gauteng health MEC Bandile Masuku.

Photo: Alex Mitchley/News24

Burial sites around Gauteng have started preparing graves and assessing its capacity, in order to make provisions for any outcome as Covid-19 cases in the province increase sharply.

Gauteng's Health MEC, Dr Bandile Masuku, visited the Honingnestkrans cemetery north of Pretoria on Wednesday, to assess the state of readiness should the burial site be needed.

City of Tshwane operations chief James Murphy told Masuku the Honingnestkrans cemetery has space for 24 000 single graves on the 30 hectare plot of land.

Murphy further explained that single graves were currently being marked out and dug up, but that if the need arose, mass graves would also be created.

ALSO READ |Family buries stranger after Covid-19 body mix-up

Tshwane has 14 burial sites available with a capacity of around 250 000 graves.

While Murphy was briefing Masuku on the numbers, in the background, an excavator was already at work, digging six-foot deep graves.

The MEC said, admittedly, it was an uncomfortable subject to speak about, but that the Gauteng Department of Health had to assess the state of readiness of cemeteries.

"We had to come and deal with the unfortunate and uncomfortable subject of death and also to see our preparedness as a province to see how we will be able to cater in an event that we will be having a whole lot of people who will be passing on in a short space of time," Masuku said.

"We will be going to other parts of the province to make sure that this part of the health system is ready for any eventuality."

Looking at possible mortality figures, Masuku said working on an assumption that 1% of the six million people expected to be infected in the province, that would amount to 60 000 Covid-19 related deaths in Gauteng.

"We are working around those figures and it's something we are prepared for."

But there was still a good opportunity to manage how the Covid-19 peak affected residents of the province, said the MEC.

"We are not here to pass panic, but it's also to ascertain from our side that the logistics are in place."

The preparation of cemeteries also takes into account the non-Covid-19 fatalities that would ordinarily be registered throughout the year.

Covid-19 has added a burden to these numbers, Masuku pointed out.

As of 7 July, a total of 71 488 confirmed cases have been recorded in Gauteng, with 21 414 recoveries. For three consecutive days Gauteng registered the highest number of deaths of all nine provinces.

The death toll currently stands at 478.

Of the total number of confirmed cases in the province, Johannesburg had recorded 33 750 Covid-19 cases, Ekurhuleni, 15 807 and Tshwane, 11 481.

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Grave concern: Gauteng prepares cemeteries as Covid-19 ...

Theres no sugarcoating things at this stage. Gauteng is in trouble. Premier David Makhura has suggested that the province will look to return to a harder form of lockdown in the immediate future, as GP becomes the site of the most active COVID-19 cases in South Africa. A total of 244 people have died, and over 40 000 people have been infected as more hot-spots continue to spring-up.

The grim reality of the situation was laid bare on Thursday afternoon. Makhura warned locals that they are now in the eye of the storm, as cases continue to surge in the north-east. He warned that the provincial government was worried about what lies ahead, suggesting the peak of infections may only come in September.

Prof. Bruce Mellado of Wits University was also in attendance, and he brought some very stark data to proceedings. Numbers for General ward, hospitalised and high care patients have all soared since the beginning of June and there are hot-spots cropping up all over Gauteng.

Mellados map shows the worst-affected areas within the province. Johannesburg is the only red-spot to mention, indicating the severity of the situation in this metro. Soweto, Boksburg, and Tembisa are also experiencing some concerning spikes. Meanwhile, outliers like Carletonville and Pretoria are battling to contain the virus:

The model, created by Mellado and his team at Wits, also looks at cluster outbreaks within Johannesburg. Most parts of the city have experienced hyper-local transmissions, particularly in the southern suburbs. These are truly terrifying visuals, which no doubt strengthen Makhuras calls for tighter lockdown restrictions.

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COVID-19: New maps expose Gauteng's worst hot-spots [photo]

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Of the 8,787 people who have died in Texas due to COVID-19 since early February, at least 43 were fully vaccinated, the Texas Department of State Health Services said.

That means 99.5% of people who died due to COVID-19 in Texas from Feb. 8 to July 14 were unvaccinated, while 0.5% were the result of breakthrough infections, which DSHS defines as people who contracted the virus two weeks after being fully vaccinated.

All people 12 and older are eligible for the COVID-19 vaccine in Texas. Children ages 12-17 can get the Pfizer vaccine, but COVID-19 vaccines are not mandatory for Texas students.

State and local health officials say that vaccine supply is healthy enough to meet demand across much of Texas. Most chain pharmacies and many independent ones have a ready supply of the vaccine, which is administered free and mainly on a walk-in basis. Many private doctors' offices also have it. And you can check current lists of large vaccine hubs that are still operating here.Public health departments also have vaccines. You can register with the Texas Public Health Vaccine Scheduler either And businesses or civic organizations can set up their vaccine clinics to offer it to employers, visitors, customers or members.

Yes. Medical experts recommend that people who have had COVID-19 should still get the vaccine. If someones treatment included monoclonal antibodies or convalescent plasma, they should talk to their doctor before scheduling a vaccine appointment. The CDC recommends that people who received those treatments should wait 90 days before getting the vaccine.

Yes. Health experts and public officials widely agree that the vaccine is safe. The three currently approved vaccine manufacturers Pfizer, Moderna and Johnson & Johnson reported their vaccines are 95%, 94% and 72% effective, respectively, at protecting people from serious illness. While no vaccine is without side effects, clinical trials for Pfizer, Moderna and Johnson & Johnson show serious reactions are rare.

The agency did not release details about the 43 deaths and noted that these are preliminary numbers, which could change because each case must be confirmed through public health investigations. Statewide, more than 50,000 people have died of COVID-19 since March 2020, but the rate of deaths has slowed dramatically since vaccines became widely available in April.

Dr. David Lakey, the chief medical officer of the University of Texas System, said people succumbing to the coronavirus despite being vaccinated was not unexpected.

No vaccine is 100%, said Lakey, who is also a member of the Texas Medical Associations COVID-19 task force. And weve known for a long while that the vaccines arent 100%, but theyre really really good at preventing severe disease and hospitalizations. There will always be some individuals that will succumb to the illness in the absence of full herd immunity.

He added that 0.5% is a very low number of individuals in a state of 30 million. In the grand perspective of everything, thats not a large number that would call into question at all the use of this vaccine.

COVID-19 cases have been surging in Texas and nationally mostly among unvaccinated people as the highly contagious delta variant has become dominant. The Pfizer-BioNTech vaccine is 88% effective against symptomatic cases of the delta variant and 96% effective against hospitalizations, according to Yale Medicine. Researchers are still studying the efficacy of the Moderna vaccine against the delta variant but believe it may work similarly to Pfizer.

As of Monday, 42.8% of Texans have been fully vaccinated; the state continues to lag behind the national vaccination rate of 48.8%, according to the Mayo Clinic.

DSHS doesnt track the number of COVID-19 hospitalizations among vaccinated people statewide because hospitals are not required to report that information to the state. Travis Countys health authority, Dr. Desmar Walkes, told county commissioners and Austin City Council members in a Tuesday meeting that almost all new COVID-19 cases and hospitalizations in the area have been among unvaccinated people.

Its not surprising that we have [increasing COVID-19] cases, Lakey said. This delta variant spreads very rapidly among individuals, and theres only some of these individuals who have been vaccinated, and a small number of those will have severe disease. But the vast majority of the people that have severe disease will be the unvaccinated individuals.

Disclosure: The Texas Medical Association and the University of Texas System have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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Texas has seen nearly 9000 COVID-19 deaths since February. All but 43 were unvaccinated people. - The Texas Tribune

SINGAPORE England has removed nearly all coronavirus restrictions. Germany is allowing vaccinated people to travel without quarantines. Outdoor mask mandates are mostly gone in Italy. Shopping malls remain open in Singapore.

Eighteen months after the coronavirus first emerged, governments in Asia, Europe and the Americas are encouraging people to return to their daily rhythms and transition to a new normal in which subways, offices, restaurants and airports are once again full. Increasingly, the mantra is the same: We have to learn to live with the virus.

Yet scientists warn that the pandemic exit strategies may be premature. The emergence of more transmissible variants means that even wealthy nations with abundant vaccines, including the United States, remain vulnerable. Places like Australia, which shut down its border, are learning that they cannot keep the virus out.

So rather than abandon their road maps, officials are beginning to accept that rolling lockdowns and restrictions are a necessary part of recovery. People are being encouraged to shift their pandemic perspective and focus on avoiding severe illness and death instead of infections, which are harder to avoid. And countries with zero-Covid ambitions are rethinking those policies.

You need to tell people: Were going to get a lot of cases, said Dale Fisher, a professor of medicine at the National University of Singapore who heads the National Infection Prevention and Control Committee of Singapores Health Ministry. And thats part of the plan we have to let it go.

For months, many residents in Singapore, the small Southeast Asian city-state, pored over the details of each new Covid case. There was a palpable sense of dread when infections reached double digits for the first time. And with borders closed, there was also a feeling of defeat, since even the most diligent measures were not enough to prevent infection.

Our people are battle weary, a group of Singapore ministers wrote in an opinion essay in the Straits Times newspaper in June. All are asking: When and how will the pandemic end?

Officials in Singapore announced plans to gradually ease restrictions and chart a path to the other side of the pandemic. The plans included switching to monitoring the number of people who fall very ill, how many require intensive care and how many need to be intubated, instead of infections.

Those measures are already being put to the test.

Outbreaks have spread through several karaoke lounges and a large fishery port, and on Tuesday Singapore announced a tightening of measures, including banning all dine-in service. The trade minister, Gan Kim Yong, said the country was still on the right track, comparing the latest restrictions to roadblocks toward the final goal.

Singapore has fully vaccinated 49 percent of its population and has cited Israel, which is further ahead at 58 percent, as a model. Israel has pivoted to focusing on severe illness, a tactic that officials have called soft suppression. It is also facing its own sharp rise in cases, up from single digits a month ago to hundreds of new cases a day. The country recently reimposed an indoor mask mandate.

Its important, but its quite annoying, said Danny Levy, 56, an Israeli civil servant who was waiting to see a movie at a cinema complex in Jerusalem last week. Mr. Levy said that he would wear his mask inside the theater, but that he found it frustrating that restrictions were being reimposed while new virus variants were entering the country because of weak testing and supervision of incoming travelers.

Michael Baker, an epidemiologist at the University of Otago in New Zealand, said that countries taking shortcuts on their way to reopening were putting unvaccinated people at risk and gambling with lives.

At this point in time, I actually find it quite surprising that governments would necessarily decide they know enough about how this virus will behave in populations to choose, Yes, we are going to live with it, said Mr. Baker, who helped devise New Zealands Covid elimination strategy.

New Zealanders seem to have accepted the possibility of longer-term restrictions. In a recent government-commissioned survey of more than 1,800 people, 90 percent of respondents said they did not expect life to return to normal after they were vaccinated, partly because of the lingering questions about the virus.

Scientists still do not fully understand long Covid the long-term symptoms that hundreds of thousands of previously infected patients are still grappling with. They say that Covid-19 should not be treated like the flu, because it is far more dangerous. They are also uncertain about the duration of immunity provided by vaccines and how well they protect against the variants.

Much of the developing world is also still facing rising infections, giving the virus a greater opportunity to rapidly replicate, which then increases the risks of more mutations and spread. Only 1 percent of people in low-income countries have received a vaccine dose, according to the Our World in Data project.

In the United States, where the state and local governments do much of the decision-making, conditions vary widely from place to place. States like California and New York have high vaccination rates but require unvaccinated people to wear masks indoors, while others, like Alabama and Idaho, have low vaccination rates but no mask mandates. Some schools and universities plan to require on-campus students to be vaccinated, but several states have prohibited public institutions from imposing such restrictions.

In Australia, several state lawmakers suggested this month that the country had reached a fork in the road at which it needed to decide between persistent restrictions and learning to live with infections. They said that Australia might need to follow much of the world and give up on its Covid-zero approach.

Gladys Berejiklian, the leader of the Australian state of New South Wales, immediately knocked the proposal down. No state or nation or any country on the planet can live with the Delta variant when our vaccination rates are so low, she said. Only about 11 percent of Australians over age 16 are fully vaccinated against Covid-19.

Prime Minister Scott Morrison also backed away from calls for a shift in the countrys Covid protocols. After announcing a four-phase plan for returning to regular life on July 2, he has insisted that the strength of the Delta variant requires an indefinite postponement.

In places where vaccine shots have been widely available for months, such as Europe, countries have bet big on their inoculation programs as a ticket out of the pandemic and the key to keeping hospitalizations and deaths low.

Germans who have been fully immunized in the past six months can dine indoors in restaurants without showing proof of a negative rapid test. They are allowed to meet up in private without any limits and to travel without a 14-day quarantine.

In Italy, masks are required only when entering stores or crowded spaces, but many people continue to wear them, even if only as a chin guard. My daughters chide me they say Ive been vaccinated and dont need to wear a mask, but I got used to it, said Marina Castro, who lives in Rome.

England, which has vaccinated nearly all of its most vulnerable residents, has taken the most drastic approach. On Monday, the country eliminated virtually all Covid-19 restrictions despite the rise of Delta-variant infections, particularly among young people.

On Freedom Day, as the tabloids called it, pubs, restaurants and nightclubs flung their doors wide open. Curbs on gatherings and mask requirements were also lifted. People were seen dining al fresco and sunbathing, cheek to jowl.

In the absence of most rules, the government is urging people to use personal responsibility to maintain safety. Sajid Javid, Britains health secretary who tested positive for the coronavirus last week said last month that the country needed to learn to live with the virus. That is despite polls suggesting that the English public prefers a more gradual approach to reopening.

Officials in Singapore, which reported a year-high 182 locally transmitted infections on Tuesday, say the number of cases is likely to rise in the coming days. The outbreak appears to have delayed but not scuttled plans for a phased reopening.

You give people a sense of progression, Ong Ye Kung, Singapores health minister, said this month, rather than waiting for that big day when everything opens and then you go crazy.

Reporting was contributed by Damien Cave from Sydney, Isabel Kershner from Jerusalem, Melissa Eddy from Berlin, Natasha Frost from Auckland, New Zealand, Benjamin Mueller from London and Richard Prez-Pea from New York.

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How Nations Are Learning to Live With Covid-19 Pandemic - The New York Times

A Pfizer COVID-19 vaccine is administered at a mobile clinic in Los Angeles county, which has pockets of vaccine hesitancy.

By Rachel FrittsJul. 21, 2021 , 11:00 AM

In many U.S. regions, the Delta variant of SARS-CoV-2 has caused the COVID-19 pandemic to surge once again. Last weeks 7-day average of daily new cases increased by nearly 70%, to more than 26,000; hospitalizations have jumped by more than one-third, according to the Centers for Disease Control and Prevention.

Part of the reason is that less than half of the U.S. population is fully vaccinated. Some scientists and physicians worry vaccine hesitancy is fueled by the fact that shots available in the United Statesmade by Pfizer and BioNTech, Moderna, and Johnson & Johnson (J&J)have been authorized on an emergency basis but have yet to be fully approved. Antivaccine activists, talk show hosts, and far-right politicians have made the vaccines experimental nature a talking point.

Full approval from the Food and Drug Administration (FDA) could help win over skeptics, says Monica Gandhi, an infectious disease physician at the University of California, San Diego. It means something to people for it to be approved, she says. It just seems like the simplest, easiest thing we could be doing right now.

Pfizer and Moderna have both applied for full FDA approval for their jabs, but it could be months away. Heres where things stand.

All three vaccines have been given an emergency use authorization (EUA), which FDA offers during crises as a quick way to give people access to potentially lifesaving medicines. In the past, EUAs have typically been used for drugs during very catastrophic, immediate circumstances, like an anthrax attack, says Jesse Goodman, a former chief scientist at FDA whos now at Georgetown University. The COVID-19 pandemic marks the first time EUAs have been granted for new vaccines.

To receive an EUA, vaccine manufacturers had to follow a special set of guidelines that asked for safety and efficacy data from clinical trials involving tens of thousands of participants, as well as information on vaccines quality and consistency. Pfizer and Moderna both received an EUA in December 2020; J&Js came in February. Based on the real-world data they have collected since then, Pfizer applied to FDA for full approval in early May, and Moderna on 1 June. J&J is expected to follow soon.

Its one of scale. FDA will review much more data, covering a longer period of time, before granting full approval. Its not a huge difference, but it is a real difference, Goodman says. The agency will analyze additional clinical trial data and consider real-world data on effectiveness and safety. It will inspect manufacturing facilities and make sure quality control is very strict. Its an exhaustive review, Goodman says.

FDA is already familiar with much of the data, however, for instance on the very rare side effects caused by the J&J and Pfizer vaccines that didnt show up in clinical trials.

On 16 July, FDA accepted Pfizers application under priority reviewmeaning it will move faster than during standard reviews, which typically take at least 10 months; the agency now has until January 2022 to review the materials. That seems like a long time, but last week an FDA official told CNN that the decision is likely to come within 2 months. The review has been ongoing, is among the highest priorities of the agency, and the agency intends to complete the review far in advance of the [January] Date, an FDA press officer confirmed to Science in a statement.

FDA has not formally accepted Modernas application, possibly because the company has not yet submitted all the required materials.

Full approval could help overcome vaccine hesitancy, Eric Topol, director of the Scripps Research Translational Institute, wrote in a recent op-ed in The New York Times. Some people who understand that the E in EUA stands for emergency are waiting for full FDA approval before they receive a shot, he wrote.

I think its fair to say that any number of us who are clinical infectious disease doctors and in public health are frankly a little surprised at how long the process is taking, says William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center.

I want [FDA] to be careful. I also want them to move it along, Schaffner says. Frankly, Id like them to work on the weekends. The people who are vaccinating are working on the weekends. The virus is working on the weekends.

About 30% of unvaccinated people say they were waiting for vaccines to receive full approval, according to a survey of 1888 adults conducted in June by the Kaiser Family Foundation. But the report cautions that for many people, FDA approval is likely a proxy for general safety concerns. Not everyone now focused on approval may actually get a vaccine, especially if they perceive the approval process as rushed or politically motivated.

For the people who are really dead set against getting the vaccine at this point, I dont know that the FDA giving it full approval is going to make a huge difference, says Krutika Kuppalli, an infectious disease doctor at the Medical University of South Carolina who says many of her patients are wary of COVID-19 shots.

But full approval may sway some people. For example, for members of groups that have been treated poorly by the health care system, signing a consent form to get vaccinateda requirement for vaccines with an EUAmay be a psychological barrier, Gandhi says: Signing a consent that says experimental and the phrase experimental brings up issues of experimentation on Black and brown communities.

More than 500 U.S. universities and some high-profile hospitals have already issued vaccine mandates, meaning staff and students must be vaccinated.

But many schools and hospitals are hesitant to ask their employees to take what is technically still an experimental product and are holding out for full approval; so is the U.S. military. Some states, including those with some of the lowest vaccination rates in the country, such as Alabama, Arkansas, and Tennessee, have gone so far as to ban mandates in schools and colleges until vaccines are fully approved. (Conversely, a judge this week upheld Indiana Universitys vaccine mandate after it was challenged by a group of eight students.) Once a vaccine is approved, I think it will be on firmer foundation for organizations and businesses to mandate it, Goodman says.

In Francewhere vaccine hesitancy is also running highmore than 1 million people signed up for a vaccine after President Emmanuel Macron announced on 12 July that vaccination would become mandatory for health care workers and health passes would be required to enter malls, bars, restaurants, and other public places. But those measures proved controversial as well: Tens of thousands took to French streets on Saturday in protest.

Perhaps, but the agency does not want to rush. Any vaccine approval without completion of the high-quality review and evaluation that Americans expect the agency to perform would undermine the F.D.A.s statutory responsibilities, affect public trust in the agency and do little to help combat vaccine hesitancy, FDAs Peter Marks wrote in The New York Times in response to Topols plea for speed.

Any claims that this is taking a long time [are] almost like saying you dont want FDA to do the normal, complete job that it does, Goodman says. Regulatory rigor is especially important for messenger RNA vaccines, which use an entirely new technology, he adds.

Every expert Science talked to had the same message: The data amassed so far show the vaccines given an EUA in the United States are very safe and very effective. It was really incredible to see how well these vaccines worked in the clinical trials, Gandhi says.

The vaccines are such a gift, says Cody Meissner, a pediatrician at Tufts Childrens Hospital specializing in infectious diseases and a member of FDAs vaccine advisory committee. Every adult should get this vaccine.

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When will COVID-19 vaccines be fully approvedand does it matter whether they are? - Science Magazine

Louisiana has recorded the third-highest day of new COVID-19 cases since the start of the pandemic.

A total of 5,388 cases were reported to the Louisiana Department of Health between July 20 and July 21. The total number of cases in the state is now 506,882.

Nearly all, 99 percent, were collected between July 13 and July 20, meaning the cases represent the current surge of COVID-19 sweeping the state, driven at least in part by the more contagious Delta variant.

The majority of cases were among people 18 to 39 years old.

Hospitalizations also jumped in the state to 844, up 65 in a day. Another 9 people with COVID-19 are on ventilators, bringing that total to 64. Through April, May and June, hospitalizations had hovered at around 300, before rising sharply since the beginning of July.

The figures are only the latest in a near-daily barrage of bad news from the health department as it tracks this fourth wave of the pandemic in Louisiana.

Baton Rouge General Hospital reported its own worrying figures today. The hospital now has 54 COVID patients, up 21 from Monday. It said 40 percent are under 50 years old, and the average stay in hospital for patients in their 20s is nine days.

Of those patients, 95 percent were unvaccinated.

Louisiana remains one of the lowest-vaccinated states in the country, with only about 50 percent of adults at least partially vaccinated against COVID-19.

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Louisiana Hits Third-Highest Number Of COVID-19 Cases Reported In A Day - WWNO

The City and Borough of Juneau Emergency Operations Center reports 29 new residents identified with COVID-19 in Juneau for July 20 and July 21. Public Health attributes seven to community spread, 12 to secondary transmission, two to out-of-state travel, and eight are under investigation. The cluster associated with the American Cruise Line ship Constellation remains at 16 12 have recovered, and four active are isolating in Juneau.

Cumulatively, Juneau has had1,458 residents test positive for COVID-19 and 186 nonresidents. There are 67 active cases in Juneau and 1,572 individuals have recovered. All individuals with active cases of COVID-19 are in isolation.

Statewide, the Alaska Department of Health and Social Services reports472 new people identified with COVID-19 in the past two days 435 are residents and 37 are nonresidents. The state also reports one death a female resident of Prince of Wales-Hyder Census Area in her 70s bringing the total number of resident deaths to 375. Alaska has had 70,328 cumulative resident cases of COVID-19 and a total of 3,046 nonresidents.

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CBJ reports 29 new COVID-19 cases in Juneau July 20 & 21 City and Borough of Juneau - City and Borough of Juneau

This article is the third in a series on COVID-19 and the Districts health care workforce which will discuss the ecosystem of care providers relevant to COVID-19 and primary care outcomes, evaluate patients access to clinicians, and measure health care capacity. Read the other articles in the series:

Since March 2020, over 33 million people have contracted COVID-19 in the United States.[1] Compared to the national average and many other large metropolitan areas, D.C. fared relatively well, with a case rate of 6,996 per 100,000 people, compared to the national average of 10,140 per 100,000 people.[2],[3] While many elements contributed to D.C. s relatively low case rate during COVID, one factor is the existing health infrastructure, including the quantity of healthcare workers.

In previous articles in this series, we have focused specifically on health care workforce and health care demand within the District of Columbia. However, modest distances are frequently traveled by individuals seeking health care. Additionally, health care providers are relatively mobile in terms of employment and may relocate to a different city while staying within the broader region (e.g., in order to retain within-state licensure). Therefore, this article focuses on the ecosystem of health care providers in the metropolitan statistical area (MSA) in addition to looking within city boundaries (see the previous piece in this series on the number of healthcare workers within D.C.), and compares the size and composition of the D.C. regions health care workforce to areas with similar demographics.

The Districts health care workforce has high numbers of clinicians, as there are seven private hospitals in D.C., as well as a Veterans Affairs hospital, childrens hospital, and six specialty hospitals, in addition to more than 50 primary care facilities and urgent care facilities. D.C. also has three medical schools, as well as many other universities offering programs to become nurses, physician assistants, medical assistants, and respiratory therapists. The D.C. clinical environment offers ample opportunity to recent graduates in the healthcare field and also attracts health care workers from other areas because of its density, the quality of healthcare facilities, and competitive salaries. For instance, the average annual nursing salary with a bachelors degree in D.C. is almost $94k, compared to the national average of $79k.[4]

Due to the relative ease of travel and providers ability to move between areas in the metro region, focusing on the District alone will conceal whether people in the metropolitan area have adequate access to health care. In contrast to the Districts high concentration of medical schools and facilities, and population of approximately 700,000 people, the Washington, D.C. metropolitan statistical area (alternatively the Washington MSA) has a population of 6.3 million people and sprawls from Spotsylvania, VA in the southwest to Calvert and Prince Georges counties in the east, and Frederick, MD in the north. Given that providers can move around the region and that people often travel for medical care, we wondered: How does the Washington D.C. metropolitan areas healthcare capacity compare to other similar jurisdictions within the United States?

To see how the D.C. area compares to other MSAs, we chose the following six jurisdictions, which, like the Washington MSA, have medical schools and other health care teaching institutions producing a pipeline of health care clinicians (HCCs), are racially and ethnically diverse, and are hubs for travel and business:

Within the Washington MSA, registered nurses (682 per 100,000 people) far outnumber all other types of healthcare providers. Home health aides (561 per 100,000 people) make up the second largest share of the workforce, while doctors (254 per 100,000 people) are the third most abundant HCC group. The allied health workforce includes medical assistants and home health aides, the latter of whom have provided in-home care during the pandemic even at great personal risk.[5] Physician assistants, respiratory therapists, and occupational therapists have also been vital front-line workers during the pandemic, although there are fewer per capita than other clinicians.

While the Washington MSA has the second-highest rate of physicians and surgeons among the comparative cohorttrailing just New Yorkit trails the bulk of the cohort for its supply of other HCCs. For all other providers besides respiratory and occupational therapists, the Washington MSA is sixth among the seven-member cohort. Its population-adjusted count of respiratory therapists (20 per 100,000 population) is just more than half that of the cohort-wide average (37 per 100,000 population). Accordingly, the Washington MSA trails the cohort-wide average for every HCC type besides physicians and surgeons.

During the COVID-19 pandemic, physicians and surgeons handled a variety of interventions ranging from intensive care unit (ICU) ventilation treatment and blood filtration on the invasive end, to more straightforward practices such as the administration of antiviral drugs. Importantly, they also make critical decisions about which treatments to administer, and especially during the early days of the pandemic, were making decisions about elective surgeries and other procedures.

With a physician workforce of 254 per 100,000 population, the Washington MSA is near the top of its comparative cohort but falls far short of leaders such as Massachusetts, which has the highest per capita physician supply of any state (449.5 per 100,000 population). The Washington regions physician supply is similar to, but less than, the nationwide average in 2018 (277.8 active physicians per 100,000 population).[6]

On a global scale, according to a 2018 Kaiser Family Foundation survey of physicians per-capita worldwide, the U.S. physician density, and the similar Washington MSA physician density, fall short of those of peer countries, such as Austria (520 per 100,000 population), Switzerland (430 per 100,000 population), and France (320 per 100,000 population).[7]

As the U.S. scrambled to mount a workforce response to the COVID-19 pandemic, several jurisdictions relaxed or removed supervision requirements and made it easier for physician assistants (PAs) to cross state borders, which in some cases meant going from more-restrictive to less-restrictive environments.[8] The Washington regions relatively strong per-capita count of physicians and surgeons is offset somewhat by a relatively low count of PAs per-capita (32 per 100,000 population), which is considerably less than the cohort average (47 per 100,000 population) and nearly half that of the neighboring Baltimore MSA (61 per 100,000 population).

Registered nurses (RNs), the largest single HCC group of the providers in this analysis, had a direct impact on COVID-19 diagnosis and treatment during the pandemic. One of the chief tools in health policymakers toolkits was the expansion of the RN workforce, whether through accelerated graduation of nursing students or reintroduction of previously retired nurses. Nurses played pivotal roles across nearly every COVID-19 treatment, including in the most life-threatening ICU situations. Policymakers expanded nurses ability to provide COVID-19 treatment through similar methods used for increasing the available supply of PAs (e.g., making it easier to practice across multiple states).[9]

There are almost 4 million actively licensed RNs in the U.S. Of all actively licensed RNs, 3.3 million are employed in the nursing field, 2.7 million of whom are involved in patient care. The density of RNs and advanced practice RNs (APRNs) per 100,000 population varies across states. In 2018, the South Atlantic region of the U.S., which contains the Washington MSA, had 682 nurses with patient care responsibilities per 100,000 population. The Washington MSA (682 RNs per 100,000 population) falls well short of the cohort average (882 per 100,000 population). In fact, the Washington MSA trails each MSA in the cohort except Atlanta (646 per 100,000 population). Nearby Baltimore (1,135 RNs per 100,000 population) and Philadelphia (1,153 per 100,000 population) have nearly double the population-adjusted supply of nurses relative to the Washington MSA.

This disparity underscores the importance of evaluating larger regions such as MSAs or commute zones rather than just looking at Washington. According to 2018 Bureau of Health Workforce data, the Districts supply of nurses (1,841 per 1,000 population) is considerably larger than the nationwide average (1,206 per 1,000 population). State-level data showing high rates for MD and VA masks the fact that parts of MD and VA have much higher RN counts than the cities just outside of the Washington MSA. Washington, D.C. itself enjoys a high supply of health care training programs and provides ample incentives to retain HCCs, but the events of the last 15 months show the importance of regional health care resilience.

Occupational and respiratory therapists play more specific roles within the continuum of care than many of the other HCCs discussed. Occupational therapists enable patients suffering from physical or mental health issues to perform in everyday activities, like how to communicate following a brain injury or preparation to return to work after an accident. They work in a variety of settings, including hospitals, homes, and rehab facilities. During the pandemic specifically, occupational therapists work with COVID-19 patients whose health was severely impacted by the virus as well as people adapting to a different level of mobility, resource access, and well-being due to pandemic-related changes. Respiratory therapists conduct clinical interventions to improve patients breathing when they suffer from chronic obstructive pulmonary disease, chest trauma, pneumonia, asthma, and other diseases that impact a persons ability to consume oxygen. During the pandemic, they often worked with the most severely sick COVID-19 patients, helping them to breathe.

The Washington MSA falls short of its comparative cohort for population-adjusted supply of both occupational and respiratory therapists, though the range of estimates is similar across all MSAs.

As those infected with COVID-19 are increasingly treated from home (at least relative to the pandemic peak that saw ICUs at capacity), home health providers become ever-more central to adequate healthcare delivery. Coupled with medical assistants, who provide valuable COVID-19 care such as vaccine administration, home health aides and other allied health professionals show how an adequate workforce depends on strength of the care continuum.

Research specifically looking at the adequacy of the Washington regions allied health workforce is scarce. Still, national and state-level studies of health professional shortage areas (HPSAs) show that the Washington MSAs primary care settings where allied health professionals are an integral part of care delivery are vulnerable to an undersupply of providers. Averaging across Washington, D.C., Maryland, and Virginia, less than half of health care need is met; the District itself is in the weakest position of the three with just more than one quarter of its need met according to June 2021 data.[10]

Allied health workforce experts have indicated that Americans will be returning to their health care providers offices, which will undeniably lead to a huge spike in demand for [allied] health care workers who help keep the health care system running.[11] A chief concern cited is the contraction of non-essential health care jobs during the pandemic coupled with the relatively low pay seen in some allied health occupations.[12] This scarcity could be exacerbated by the potential that allied health professionals may depart for higher-paying occupations, both within and outside of the healthcare field, or leave the workforce altogether.

Scarcity will impact a variety of health care settings, as allied care professionals work in a multitude of environments. For example, while respiratory therapists work mostly in hospital settings (82% of RTs according to Bureau of Labor Statistics data), medical assistants are much more varied (just 15% work in hospitals, with 57% working in physicians offices). Data on home health aides is more scarce, but a shortage would make it increasingly difficult for those in need of at-home care to find it.

The Washington metro area falls short of its peers for supply of both allied health professional types. While comparable to neighboring region Baltimore and two southern geographies, Atlanta and Dallas, the Washington MSA trails each Northeastern MSA by at least three-fold. The overall cohort average (1,114 per 100,000 population) has double the home health aides that the Washington MSA reported in 2020 (561 per 100,000 population), and 128% of the Washington regions supply of medical assistants (882 per 100,000 population compared to 682).

Certification, and thus quantification, of allied health professionals varies considerably by state, and even by locale. It is hard to precisely estimate the number of allied health professionals given issues of self-reporting (i.e. individuals employed in other professions choosing to self-report as home health aides, or conversely home health aides identifying with another occupation).[13] However, assuming that all estimates have similar biases in the identification of allied health professionals, the data still yields a significant gap between the D.C. region and neighboring jurisdictions.

The COVID-19 pandemic has shown how important an adequate workforce is to the delivery of high-quality health outcomes. Indeed, ensuring an effective supply of health care clinicians is critical beyond current pandemic conditions as the ongoing effects of the coronavirus and pre-existing health needs (primary care and beyond) remain. The analysis in this article underscores the difference between looking at the roughly 700,000-person District of Columbia and the roughly 6.3 million Washington metropolitan area residents. Washingtons myriad physician, nursing, therapist, and allied health training programs all-but-ensure that the District will have a large pipeline of providers. The broader region, meanwhile, falls short in a number of critical provider types, many of whom have been integral to COVID-19 response. Further analysis could yield the dynamics underlying these descriptive facts and illuminate how to go about shrinking the gap.

In the next article in this series, using an original dataset created collected from the D.C. Department of Health and other stakeholders, we will zoom in on the healthcare workforce within the District specifically, how it has fluctuated over time, and specifically the composition of the healthcare workforce during the spring of 2020.

Feature photo by Ted Eytan (Source).

[1] https://coronavirus.jhu.edu/region/united-states

[2] ibid.

[3] https://www.census.gov/quickfacts/DC

[4] https://www.ziprecruiter.com/Salaries/BSN-Nurse-Salary-in-Washington,DC

[5] https://khn.org/news/mostly-poor-minority-home-health-aides-lacking-ppe-share-plight-of-vulnerable-covid-patients/

[6] Estimates in the main text are based on data from the Bureau of Labor Statistics (BLS) Occupational Employment Statistics (OES), which is a survey of employers. As such, it undercounts physicians and other HCCs that are in private practice rather than employed for an organization that would be surveyed through BLS OES.

[7] https://www.healthsystemtracker.org/chart-collection/u-s-health-care-resources-compare-countries/#item-nurses-licensed-to-practice-density-per-1000-population-2000-2018

[8] https://www.fsmb.org/siteassets/advocacy/pdf/state-emergency-declarations-licensures-requirementscovid-19.pdf

[9] https://www.ncsbn.org/State_COVID-19_Response.pdf

[10] https://data.hrsa.gov/Default/GenerateHPSAQuarterlyReport

[11] https://www.statnews.com/2021/07/02/the-health-care-workforce-is-understaffed-for-life-after-covid-19/

[12] While occupational therapy assistants and aides made an average of $60,950 in 2020, the average across professions classified as similar to medical assistants by the Bureau of Labor Statistics is just $46,257.

[13] Self-report is less of an issue in data sources like the BLS OES, which is a survey of employers. Still, employers might apply different definitions for various types of allied health professional.

D.C. Policy Center Fellows are independent writers, and we gladly encourage the expression of a variety of perspectives. The views of our Fellows, published here or elsewhere, do not reflect the views of the D.C. Policy Center.

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Who is providing COVID-19 care in the Washington Metropolitan Area? - The D.C. Policy Center

Confirmed cases of COVID-19 have passed 191.4 million globally, according to Johns Hopkins University. The number of confirmed deaths stands at more than 4.11 million. More than 3.7 billion vaccination doses have been administered globally, according to Our World in Data.

The vast majority of new COVID-19 cases in Spain over the past five weeks have been in unvaccinated people, Health Minister Carolina Darias said on Monday.

Peru has signed a deal to buy 20 million doses of the Sputnik V vaccine, its Health Ministry announced yesterday.

Daily new confirmed COVID-19 cases in Turkey have risen to 8,780 - double a low point reached earlier in July.

New COVID-19 cases in Britain have risen by nearly 41% in the last seven days, with 46,558 new cases reported yesterday.

Zimbabwe has ordered all its workers should receive a COVID-19 vaccine and asked all but 10% of civil servants to work from home, in an effort to curb the spread of the disease.

Australia's two largest states have reported increases in new COVID-19 cases, hitting hopes that restrictions could be eased. New South Wales registered 110 new cases - up from 78 the day before - nearly four weeks into a lockdown of its largest city, Sydney. Victoria reported 22 new cases - up from nine.

South Korea has reported a daily record of 1,784 new COVID-19 cases, breaking a mark set last week.

The Delta variant of COVID-19 is behind more than 80% of new U.S. cases, but authorized vaccines remain more than 90% effective in preventing hospitalizations and deaths, said top U.S. infectious disease expert Anthony Fauci yesterday.

It comes as the U.S. Centers for Disease Control and Prevention announced that life expectancy in the U.S. fell by a year and a half in 2020 to 77.3 years - primarily as a result of deaths caused by the pandemic. It's the biggest one-year decline since World War Two.

As part of work identifying promising technology use cases to combat COVID, The Boston Consulting Group recently used contextual AI to analyze more than 150 million English language media articles from 30 countries published between December 2019 to May 2020.

The result is a compendium of hundreds of technology use cases. It more than triples the number of solutions, providing better visibility into the diverse uses of technology for the COVID-19 response.

To see a full list of 200+ exciting technology use cases during COVID please follow this link.

Indonesia has extended its COVID-19 restrictions to 25 July, with case numbers still high. The country is aiming for a gradual easing of restrictions next week if infections drop, President Joko Widodo said yesterday.

"If the trend of cases continue to decline, from July 26 the government will initiate gradual easing," he said in a virtual address.

Infections have repeated been around 50,000 per days in the last week, with the number of COVID-19-related deaths above 1,000 for the fifth consecutive day on Tuesday.

Restrictions that were first introduced on 3 July will remain in place on the island of Java and Bali and other cities across the archipelago. They include having workers at non-essential businesses working from home, limited on travel and the closure of shopping malls.

Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, has said the Tokyo Olympic Games should go ahead to demonstrate what is possible with the right plan and measures amid the COVID-19 pandemic.

Speaking to the International Olympic Committee members at their session in the Japanese capital, Tedros said the world needed the Olympics now "as a celebration of hope".

"The Olympics have the power to bring the world together, to inspire, to show what's possible," he said.

Dr Tedros criticised the vaccine discrepancies between countries though, saying the pandemic could be ended if there was a fairer distribution of vaccines.

COVID-19 vaccine doses administered by continent.

Image: Our World in Data

"Instead of being deployed widely, vaccines have been concentrated in the hands and arms of a lucky few," he said.

"The pandemic will end when the world chooses to end it. It is in our hands," he said. "We have all the tools we need. We can prevent this disease, we can test for it and we can treat it."

Written by

Joe Myers, Writer, Formative Content

The views expressed in this article are those of the author alone and not the World Economic Forum.

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COVID-19: What you need to know about the pandemic on 21 July - World Economic Forum