- US case count tops 1M
The number of confirmed Covid-19 cases in the United States now exceeds 1,000,000 as of April 29, with more than 50,000 deaths attributed to the virus.
- US may have plateaued—but it's not a decline
There continue to be signs that the pandemic has plateaued domestically. While this is certainly good news, any enthusiasm should be tempered by two reality checks. First, the United States is a huge country; statistics to date have been disproportionately weighted by the experience of New York City, and there are many parts of the country that are still likely in the early stages of seeing the full effects of the virus. Second, the experience of several countries in Western Europe suggest that the decline of the pandemic will likely be lengthy and uneven.
- Rural spread raises new concerns
As the impact of the disease begins to hit rural America, there are a number of new causes for concern. Rural communities face at least four distinct and difficult challenges in combating the disease: a greater percentage of the population is elderly and has one or more chronic illnesses; significantly lower percentages of physicians per capita; hospitals that were already on shaky ground financially and may not be able to withstand the economic burden of the disease; and less community infrastructure such as transportation, high-speed communication, and public health resources.
- Legislation will likely ease short-term cash flow challenges—but long-term impact still unclear
In addition to the CARES Act, the Paycheck Protection Program and Health Care Enhancement Act allocates almost $500 billion in funding to support health care providers and small businesses. These two pieces of legislation, along with CMS' Accelerated and Advanced Payment Programs, will likely significantly ease the short-term cash flow challenges facing many health systems and physician groups. Longer-term financial prognosis will continue to depend on how quickly these provider organizations can return to normal operations—and how much foregone care they can provide in the months ahead.
- Regulators will likely face pressure to ease repayments of Accelerated and Advanced payments
Because so many providers have been accessing not only CARES Act grants, but also Accelerated and Advanced Payment programs, CMS has halted the Advanced Payments (for Part B, which it started using its regulatory authority), and slowed down applications for the Accelerated Payments (used for Part A) to help preserve the Medicare trust fund. Regulators and legislators will likely face enormous pressure to ease repayments of Accelerated and Advanced payments going forward.
- States—and hospitals—look to reopen for regular business
In spite of the uncertainty around what the coming months will bring, several states are reopening businesses, and many health systems are preparing to restart scheduled procedures. Enormous variability exists from state to state in terms of testing capacity, guidelines for businesses and health systems, ability to implement contact tracing, and level of preparedness for subsequent surges of Ccovid-19 cases.
- Antibody testing sparks interest—but there are reasons to be cautious
Recent weeks have seen increasing interest in the potential of antibody testing to help implement safe reopening of the economy, but there are a number of reasons for caution. First, antibody tests are an epidemiological tool intended to measure community spread; they are not a substitute for diagnostic testing for Covid-19 itself. Second, there are open questions as to whether the presence of antibodies indicate immunity from coronavirus; the possibility of repeat infections would mean that even a positive antibody test is not a guaranteed safe condition for returning to work or reducing social distancing. Lastly, Covid-19 antibody tests may carry a high rate of false positives.
- Health systems must prepare carefully to resume full operations
Health systems considering resuming normal operations will need to navigate all of this uncertainty carefully. One example is pre-admission screening protocols; health systems across the globe are implementing a range of testing and visitation policies intended to provide a safe environment for patients and caregivers. Robust testing—and the capacity to support them at 100% compliance—will be a critical success factor for systems choosing to reopen in the coming weeks.
- Health systems must reassess supply chain to ensure sufficient PPE
Health systems will also need to reevaluate supply chain and procurement practices to ensure adequate supplies of PPE. Long-term trends toward single source contracts, lean inventory management, and global manufacturing have created a supply chain that is excellent at delivering quality products at low cost, but less able to respond flexibly in the face of disruption or unanticipated demand surges. Future emergency preparedness will require supply chain leaders to build more slack and transparency into their processes; this will have the likely ripple effect of fueling additional standardization and price pressures on historically more "protected" preference item categories.
- Supply chain analytics will become the new currency
Supply chain analytics will become the new currency among vendors, distributors, and provider organizations. Supply chain leaders need to find, make, or invest in tools that can help them gain greater visibility into their needs and recent purchases—as well as into product approvals or recalls and potential new suppliers. Suppliers, distributors, and technology firms able to provide greater supply chain transparency will likely find ample opportunities to engage health system purchasing leaders in more collaborative, strategic conversations.
Slide deck: Your 45-minute Covid-19 update
Stay up to date on the Covid-19 epidemic with this on-demand webinar and downloadable slides from yesterday, April 30, 2020.