With constantly shifting priorities and new COVID-related developments – mostly positive these days -- I continue to be impressed by and grateful for the commitment and professionalism I see throughout the practice. While currently stable, most of us expect to see some ups and downs in our COVID patient census – but we also believe the toughest days of the pandemic are behind us. We’re highly focused on vaccination, not only on how to handle the high volume of people who want to get the vaccine, but also on doing all we can to ensure that vulnerable populations not only have access but see its benefits. Meanwhile we’re also preparing the ambulatory practice for adjustment to life after COVID and refocusing on clinical expansion.
As you know, I’m committed to open and ongoing communication in a transparent manner. While my emails will be less frequent going forward, you can still expect to hear from me regularly with updates, progress reports and news relevant to the practice – and I always welcome your reactions, thoughts and insights as well.
As we draw near the end of a busy week, here’s a review of what you need to know today, Friday, February 26, 2021:
What’s Ahead? Reflections from the YM Board
As Chair of the YM Board, Dr. Nita Ahuja has been thinking of late about the pandemic’s impact on the practice of medicine, with an emphasis on the role academic medical centers play in shaping the future. Calling it “Our Moment to Heal Health Care,” she published an op-ed on this topic in AAMCNews, which you can read here. And, below, she shares her thoughts on what this means for us here at Yale Medicine.
“Navigating the COVID pandemic required us to work together in ways we hadn't before and revealed new synergies across the Yale Medicine clinical and research domains. We experienced -- in real time – our tremendous potential to improve patient care when we collaborate as an integrated academic medical community; and our individual responsibility to do so, as leading physicians and scientists. The pandemic also made us acutely aware of the need to optimize patient access and eradicate disparities in our health system -- both locally, and as a nation. And there are financial realities we can't ignore. These are challenges that we need to traverse, and will inform our 10 year strategic plan, as we think about what the successful growth of Yale Medicine looks like into the future.
Perhaps most of all, it's the "people" part of our work that proved most important: how do we best care for our patients — our physicians, our neighbors, our colleagues? That's really what it's all about, crisis or no crisis. A lot of the work ahead will be balancing these priorities, of rapidly increasing patient access and growing the Yale Medicine practice, while managing the demands on our frontlines, research, and administrative teams. Maintaining our new sense of community will be key. We accomplished great things in the past 12 months, and I'm optimistic the best is yet to come.”
10-Year Strategic Plan for Yale Medicine in the Works
YM Chief Strategy Officer Kim Moriarty and Dr. Rob Goodman, Chair of the Network Development and Strategy Committee, are leading a 3-month strategic planning exercise to identify effective areas for growth of the clinical practice. With representation from across the practice, and including the Health System, the group is focused on forecasting how health care may change over the next decade, with the goal of aligning trends with YM growth opportunities. Utilizing a collaborative software platform called Mural, each member of the team has contributed answers to the question of “what will healthcare look like in 2031?” and “where should YM be in 2031?” and will next address the toughest question of all: “How can we accomplish our goals?”
Click here to see a presentation of progress so far.
“Though we discuss these questions regularly, we also recognize the importance of working with a broader cross-section of people to weigh in on priorities relating to matters in which they have real expertise,” Moriarty explains.
“We are all experts in medicine and, given our insight into emerging technologies/fields thanks to being part of a world-class research environment, are uniquely positioned to define the future of healthcare,” says Dr. Goodman. “This sets us apart from many of our peers and gives us a strong competitive advantage in the region."
Vaccination Status Report
It has been an important week for our vaccine distribution program. First, we had Governor Lamont’s Monday announcement of new eligibility criteria, opening up to all age 55+ 3/1, with expansion into additional age groups every few weeks; according to the plan, by early May, vaccination will be available to all people age 16 and older. And today we expect the announcement of FDA EUA for the J&J single-dose vaccine.
Dr. Brita Roy reports that the Yale vaccination efforts continue to be notably more successful than most, with 73% acceptance rate among our healthcare workers and about 70% of those age 75 and older living in CT vaccinated so far. Supply will be dramatically improved starting next week for two reasons: The State has informed us of a 6% increase in our allotment for Moderna and Pfizer vaccines, and we’ve been told that the state expects to receive 10,000 additional doses of the J&J vaccine if available.
Thus far the Health System has delivered about 105,000 doses overall (including both first and second doses) to healthcare workers and CT residents over 65 years of age. We now have mass vaccination sites at the University of Bridgeport and Mohegan Sun, as those were two under-served geographies, bringing the total number of sites throughout the state to 8.
With the rollout to the general population proceeding smoothly, the committee is now turning its attention to special populations. Initiatives include in-home vaccination for people who are unable to travel to a vaccination site and special programs for those living in congregate settings, including designated hours at public vaccination sites as well as on-site clinics in large facilities. Additionally, pop-up vaccination clinics will begin next week in local churches in the New Haven area.
Dr. Roy says that there have been “minimal serious adverse events” experienced by people receiving vaccines thus far. Vaccine side effects typically range from none to mild to flu-like symptoms that generally subside within 24-48 hours. The Health System has had reports of 30+ allergic reactions (currently being studied by allergists) and 18 delayed skin reactions, with rashes or swelling at the injection site arising up to a week later. “With all the doses given, so far, we’ve had to submit only 11 required serious adverse event reports (.00011%) to the CDC for true life-threatening reactions or issues related to improper administration of the vaccine,” she noted.
Why Are COVID Cases Declining? Dr. Martinello Shares Insights
Dr. Rick Martinello offered insights into why COVID cases have declined so dramatically in the past several months. Five commonly cited hypotheses (see these here) play a role, he believes, but to understand what’s happening and why, we should also look to the natural history of pandemics, which tend to occur in 12- to 16-week waves along the line of what we’ve experienced this winter. “Though we know a great deal about why cases rise during an upswing, the other side is not so well understood,” Dr. Martinello said. “But we do know that in this time period, cases tend to go down despite having a large percentage of the population that remains susceptible.”
Dr. Martinello said that it’s hard to tell how the growing prevalence of the UK, SA, Brazil, and other variants will play out, calling that a “wild card.” He also noted that, remarkably and despite ongoing proactive surveillance, the System has not seen a single case of influenza this winter.
Paul Taheri, MD, MBA
Deputy Dean for Clinical Affairs, YSM
CEO, Yale Medicine