David Hutton

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The Department of Health and Human Services (HHS) recently extended the national public health emergency declared for the COVID-19 pandemic, thereby extending COVID-19 payment and regulatory flexibilities granted during the period.

HHS Secretary Alex Azar renewed the COVID-19 national public health emergency declaration, which came as good news for physicians who were concerned that the loosening of regulations on telehealth would end leaving them unable to properly treat their patients while keeping both parties safe from the risk of infection.

The new declaration will extend the national public health emergency for another 90 days, according to the Public Health Service Act.

According to a news release, HHS has implemented key telehealth payment and coverage flexibilities during the pandemic, including expanded coverage of telehealth services delivered to Medicare beneficiaries in a wider range of locations.

In a statement, Rick Pollack, president and CEO of the American Hospital Association (AHA), said the action “will allow us to continue our efforts to ensure that hospitals and health systems are using every tool available to respond to COVID-19.”

The AHA last month called on Azar to extend the public health emergency.

“The declaration of a public health emergency has given hospitals and health systems and our caregivers the ability to respond in an innovative, timely and decisive manner to the virus,” Pollack said in the statement. “It has been an invaluable tool in the battle against COVID-19 by providing the necessary resources to care for patients and communities, such as expanded use of telemedicine and the ability to provide care in alternative care sites.”

The AHA was a part of a group of 340 organizations that sent a letter to Congressional leaders asking for telehealth flexibilities introduced during the COVID-19 pandemic be made permanent.

Amid the COVID-19 pandemic, physicians across most specialties, including ophthalmology, experienced a marked drop in patient visits as nonessential visits and procedures were curtailed, and patients worried that a medical appointment could lead to a coronavirus infection.

As the pandemic took hold, ophthalmology was hit hard, with some physicians experiencing a drop of about 80 percent in patient visits, according to a survey by The Commonwealth Fund.

In another survey by Strata Decision of more than 200 hospitals in 40 states, patient encounters for cataracts were down 97 percent in March and April, while encounters for glaucoma were down 88 percent.

Even as cases of coronavirus surges in the South and West, ophthalmologists are prepared, having developed methods to safely practice amid COVID-19.

Specialists have led the charge. The American Society of Retina Specialists (ASRS) COVID-19 Survey Series noted what most retina specialists already surmised: The pandemic was wreaking havoc on clinical practices and perhaps patients’ ocular well-being.

“Retina practices throughout the nation began to implement strategies to protect patients, staff, and doctors through enhanced sanitation, office decongestion, and social distancing,” said David Williams, MD, MBA, a past president of ASRS and in private practice in Minneapolis.

Articles

The Department of Health and Human Services recently extended the national public health emergency declared for the COVID-19 pandemic, thereby extending payment and regulatory flexibilities. Amid the pandemic, ophthalmologists continue to adapt to practicing in the era of COVID-19. 

COVID-19: HHS extends public health emergency declaration 

In a report released this month, the Robert Wood Johnson Foundation found that about 10.1 million people could lose employer-based insurance coverage this year as a result of the Covid-19 pandemic.

The report, which was prepared by researchers at the Urban Institute, estimated that 48 million non-elderly people will be part of a household where someone loses their job due to Covid-19. Of these, only about 21% will lose their insurance as a result.

A portion of them would have already had insurance coverage through another family member’s job (34%), through Medicaid (27%), or might have already been uninsured (10%), leaving roughly 21% that would lose their coverage as a result of the pandemic.

The study wasn’t all doom and gloom though, as projections show that an estimated 3.3 million of those will regain their employer-sponsored insurance by being added to another family member’s policy. Another 2.8 million people will expected to enroll in Medicaid and 600,000 are expected to enroll in the individual market, mainly through the Affordable Care Act’s marketplace.

But still, 3.5 million are expected to remain uninsured.

The study uses a statistical model informed by Department of U.S. Department of Labor data on job losses to make its projections.

“The findings imply the COVID-19 recession is disproportionately affecting workers paid low wages, many of whom did not have employer-sponsored coverage even when they were working. Higher percentages of people losing their employer insurance will become uninsured in states that did not expand eligibility,” the study’s authors concluded.

About 10.1 million people could lose employer-based insurance coverage this year as a result of the Covid-19 pandemic, according to a report released by the Robert Wood Johnson Foundation.

Study finds millions of Americans to lose health insurance by end of 2020 due to COVID-19 pandemic

A potential coronavirus vaccine developed by Oxford University with AstraZeneca has produced a promising immune response in a large, early-stage human trial.

The researchers are calling their experimental vaccine ChAdOx1 nCoV-19 (AZD1222). It combines genetic material from the coronavirus with a modified adenovirus that is known to cause infections in chimpanzees.

The phase one trial had more than 1,000 participants in people ages 18 to 55.

ChAdOx1 nCoV-19 produced a strong immune response with predominantly mild and moderate unsolicited adverse events in the 28 days after the injection.

The immune spike peaked 28 days after injection among the about 1,000 test subjects. The subjects median age was 35 years old, there was a nearly equal split between men and women, and the vast majority, 90.9 percent, were white, according to the study.

According to investigators, the vaccine produced antibodies and killer T-cells to combat the infection that lasted at least 2 months. Neutralizing antibodies, which scientists believe is important to gain protection against the virus, were detected in participants. The T-cell response did not increase with a second dose of the vaccine, they said, which is consistent with other vaccines of this kind.

“The immune system has two ways of finding and attacking pathogens — antibody and T cell responses,” Oxford professor Andrew Pollard said in a news release. “This vaccine is intended to induce both, so it can attack the virus when it’s circulating in the body, as well as attacking infected cells. We hope this means the immune system will remember the virus, so that our vaccine will protect people for an extended period.”

The vaccine was found to be well-tolerated and there were no serious adverse events, according to the researchers. Fatigue and headache were the most commonly reported, they said. Other common side effects included pain at the injection site, muscle ache, chills and a fever.

AstraZeneca received $1 billion from the U.S. Health Department’s Biomedical Advanced Research and Development Authority (BARDA) to develop, produce, and deliver the possible vaccine starting this fall. As part of that deal, AstraZeneca has concluded the first agreement for at least 400 million doses and has secured capacity for one billion doses. The first deliveries will begin in September. The program includes a phase III clinical trial with 30,000 participants and a pediatric trial.

Anthony Fauci, MD, the top U.S. infectious disease expert, has repeatedly said he’s “cautiously optimistic” scientists will be able to create at least one safe and effective vaccine by the end of the year or early 2021.

A potential coronavirus vaccine has produced a promising immune response in a large, early-stage human trial.

COVID-19: Vaccine shows positive response in early trial


The American Academy of Ophthalmology (AAO) is taking its annual meeting virtual amid the COVID-19 pandemic.

“In light of epidemiological projections, government regulations and public health mandates to prevent the spread of disease—including social distancing, limited crowd sizes and face coverings—the Academy has been forced to cancel its in-person annual meeting this year,” said the AAO in a statement on its website.

The academy will present a virtual-only event to engage and connect members and to deliver the critical scientific and clinical information that you expect from the most important ophthalmology meeting of the year.

David W. Parke II, MD, chief executive officer of the AAO, in a video posted on the academy’s website, noted that the decision was based on the ability to “realistically and safely” put on a high-quality show.

“Now the data are much clearer,” said Parke in the video. “The epidemiological predictions, the government mandates, the requirements for social distancing, and for maximum crowd size make it absolutely impossible for us to put on the type of quality meeting that you expect and that we expect.”

As a result, Parke said in the video statement that the AAO would be converting this year’s event, planned for the weekend of Nov. 14 in Las Vegas, to a purely virtual meeting.

“This is the first time since 1945, at the height of World War II, that the academy has had to cancel the event,” he said.

Parke noted that the AAO has been hosting virtual meetings for 7 years and will spend the months leading up to the event ensuring everything is in place to deliver a quality educational experience.

“We will do our best to provide virtual networking and social activities in this context,” he said. “We were absolutely forced to take the step that we did take, compelled by the data. That is what we all should do as scientists.”

The website now includes information for anyone who is registered and for presenters. Additional details will be released over the coming weeks.

For anyone who has already registered for the meeting, the academy will send information by Aug. 12 about the options available, including receiving a refund, applying payments made to the AAO 2020 virtual meeting, or transferring the registration to AAO 2021 in New Orleans.

The American Academy of Ophthalmology (AAO) is taking its annual meeting virtual amid the COVID-19 pandemic. 

Author | David Hutton

Articles

COVID-19: HHS extends public health emergency declaration

Study finds millions of Americans to lose health insurance by end of 2020 due to COVID-19 pandemic

COVID-19: Vaccine shows positive response in early trial

AAO 2020 going virtual