August 19, 2020

Every day, hospital executives must sift through data they’ve received from governmental and clinical leaders, and attempt to make wise choices based on such data.  The problem is not just that there is an overload of information out there, but that it is often conflicting information.  This group of doctors doesn’t agree with that group of doctors regarding treatment, or that leading official said one thing about mask effectiveness a few months ago and is saying something different today.  There are recurring claims of over-inflated COVID numbers and counter-claims of suppressed COVID numbers.  What is one to do?  Where does the truth lie?

It should come as no surprise to mindful adults that some people have an agenda and will do anything to push that agenda, even if it means playing fast and loose with the truth.  If you live long enough you will see evidence of such propaganda, and it can be quite persuasive or repellant, depending on your point of view.  All we can do is give all sides in the debate an honest hearing, search out the most non-biased, fact-based evidence, and allow our common sense to do the rest.  We should also be acutely aware of our own predispositions and biases—including political biases—and not allow them to interfere with sensible reasoning and sound judgment.

With that in mind, we are providing below an assortment of COVID-related news that has recently been released from multiple outlets and that may be impactful for hospital decision-makers.  It will be up to the reader to determine the level of reliability of the source and the story.

A Question of Immunity

According to The New York Times, multiple studies are pointing to “lasting immunity” relative to the novel coronavirus, even in individuals who only experienced a mild infection.  The studies, which have yet to be peer reviewed, indicate that “certain antibodies and immune cells appear to persist months after infections have resolved,” according to one hospital industry analyst’s review of the Times article.  The problem is that, for months, we have seen story after story assuring us that several people who had clearly recovered from COVID-19 ultimately came down with it a second time.  This would seem to raise questions about any new “lasting immunity” findings.

Indeed, a recent communication from the Centers for Disease Control (CDC) in Atlanta looks as if it contradicts the studies referenced in the Times.  The CDC has provided an update to its isolation guidance, which originally held that those who test positive for COVID do not need to quarantine or get tested again for up to three months, as long as they do not develop symptoms again.  On Aug. 16, the agency clarified that its guidance doesn’t imply immunity.  According to one healthcare reporter, “the CDC is uncertain if someone can be re-infected with COVID-19, but cited data suggesting low levels of the virus may exist up to three months after recovering from the initial infection.”

Dueling Vaccines

The New York Times is also reporting that the CDC is working with certain states on a COVID vaccine distribution plan.  The plan may be in response to the announcement made last week by federal officials concerning the Trump administration’s desire to deliver tens of millions of vaccine doses by early 2021.  This, of course, presupposes that there will be a vaccine by that time.

According to the most recent issue of Newsweek, there are several potential vaccination solutions undergoing current testing, some of which may be ready by early next year; but, then again, they may not.  Then, of course, there is the claim made last week by President Vladimir Putin that Russia has successfully developed the world’s first COVID vaccine.  (Well, after all, they were the first to put a man in space.)  Naturally, non-Russians are somewhat skeptical of this medical breakthrough claim.

The fact of the matter is there is no guarantee that a vaccine that specifically addresses and safely prevents every variant of what is called COVID-19 will be developed.  After all, we have yet to develop a fully successful immunization against the seasonal flu, not to mention the common cold.  Nevertheless, some vaccines have historically been shown to be extremely effective in nearly eradicating certain maladies.  We can only hope that doctors and hospitals will have increasingly better access to treatments that prevent or ease this particular virus in the weeks and months ahead.

The Tale of the Tests

On August 15, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization for a COVID-19 saliva test that was developed by the Yale School of Public Health. The SalivaDirect test reportedly offers a “cheaper, less invasive testing method that does not rely on chemical reagents that have caused shortages of other tests.”

At first glance, this would seem to be exciting news.  However, we’ve all heard of various announcements and studies that have thrown COVID testing, generally, into question.  Tainted CDC test kits (per Washington Post), false positives, false negatives, positive one day and negative the next—it all works together to undermine citizens’ confidence in the entire testing process.

Bringing It Home

So, what are hospital administrators and clinicians to do with this information?  Do they plan for a better, more “normal” 2021 because more Americans will have an immunity against coronavirus (or not), and because a vaccine is on its way (assuming it is), and because COVID testing is becoming faster and cheaper (if it’s reliable)?  All hospitals can do is have contingency plans in place that include the possibility of a continuation of high numbers of COVID cases into 2021, recognizing that some models predict a spike in such cases this coming fall and winter.  Government mandates may also play a role in hospital operations, with federal, state and local officials issuing potential orders that may affect elective surgeries, for example.  Hopefully, we are on our way to better times, but the times are often defined by those presenting the “facts.”