Editor’s note: This commentary is by Meg Hansen, a former executive director of Vermonters for Health Care Freedom and current TV host and political commentator. She is running for lieutenant governor in 2020.
Life has come to an unprecedented halt, as we brace ourselves against the coronavirus disease 2019 (COVID-19) pandemic. Health officials originally advised the public to stay home for the next 15 days, practice social distancing, and maintain rigorous hygiene. These steps will slow the contagion (“flatten the epidemic curve”), preventing thousands from falling ill simultaneously and overwhelming our hospitals.
Our political leaders, for their part, must balance regulatory flexibility and public safety. Now is the time for clear and reasoned discourse, and targeted deregulation to prevent Italy-like rationing of ventilators and hospital beds in Vermont.
COVID-19 originated in China last December and is caused by a new human strain of coronavirus called SARS-CoV-2. Scientists believe that the DNA spillover event occurred from an infected bat to a pangolin (scaly ant-eater) to humans in a Wuhan “wet market,” where livestock and wild animals are freshly slaughtered for meat.
Pandemic coverage has eclipsed all other news, as the media assiduously reports the growing number of COVID-19 cases. But meaningful details are hard to come by. As of this writing, Vermont has 22 cases and two elderly patients have died. How many of these patents have flu-like symptoms as opposed to severe respiratory distress? How many are using ventilators and how many are in the ICU? Absent this information, it would be natural for the public to conflate a coronavirus infection with respiratory failure and death. This is a recipe for mass panic.
A February study conducted by the Chinese Center for Disease Control and Protection showed that 80.9 percent (of 72,314 COVID-19 confirmed, suspected, and asymptomatic cases in China) experience mild, flu-like symptoms and patients fully recover at home. This applies to the vast majority of those under the age of 60 and without pre-existing conditions, as confirmed by other studies. Clarifying the infection pattern does not minimize the risks at hand. We need dispassionate discussion to counter the sensationalized reports blurring the contours of this crisis.
We also need swift and decisive action from the government – a tall order given that agility eludes bureaucracy. So it is encouraging that the Food and Drug Administration (FDA) will soon conduct clinical trials to test anti-malarial drug chloroquine for the treatment of COVID-19. Chloroquine has biochemical properties that prevent the replication of coronaviruses, and Chinese studies demonstrated the drug’s apparent efficacy and acceptable safety against SARS-CoV-2. Researchers abroad (including at my alma mater where I graduated with an MBBS/ British medical degree) are also testing anti-viral drugs remdesivir and lopinavir–ritonavir.
Balancing Regulatory Flexibility and Public Safety
Following the federal government’s declaration of the coronavirus outbreak as a public health emergency on January 31, the FDA prioritized the test kit developed by the Centers for Disease Control and Prevention (CDC). But the test was faulty. Laboratories across the nation could have developed their own tests to fill the void caused by CDC’s error. However, federal regulations thwarted these attempts, resulting in the initial lack of widespread testing.
Since then, in a welcome turnabout, the FDA has authorized states to develop diagnostic tests in laboratories within their borders, and private companies to provide coronavirus test kits to the public. The Department of Health and Human Services has allowed doctors to practice across state lines. But now, Vermont’s bureaucratic leviathan threatens public health. The following three steps will mitigate the spread of COVID-19 and increase community preparedness.
1. Suspend Vermont’s CON laws
Vermont enacts Certificate of Need (CON) laws that are designed to curtail costs by artificially limiting the supply of health resources. Providers must receive approval from the State to create or expand healthcare facilities in a given area, and permission is only granted when sufficient need for new services has been demonstrated. In practice, CON laws lead to healthcare rationing. The government often denies requests for new facilities to suppress economic competition and protect the University of Vermont Health Network’s monopoly. These restrictive, crony laws will jeopardize public safety by reducing our capacity to take care of all Vermonters who may need medical attention during this crisis.
2. Remove the plastic bag ban
COVID-19 is highly contagious and spreads via droplets and fomites. Several studies have shown that reusable shopping bags (unlike plastic bags) turn into germ reservoirs. Beginning this July, Vermont retailers will be prohibited from giving plastic bags to customers at the checkout.
3. Use OneCare Vermont data for preemptive care
A population health approach creates partnerships between primary care and public health sectors to address local health needs and improve community health outcomes. OneCare Vermont’s ACO All-Payer model has invested millions in establishing this new system (see table).
|Informatics Infrastructure Support||$1,500,000||$3,500,000||$4,250,000||$3,500,000||$12,750,000|
|Complex Care Coordination Program||$977,616||$5,618,419.87||$9,181,362.14||$10,223,589.68||$26,000,987.69|
|Community Health Team Payments||$2,245,852||$2,411,679.13||$2,379,711.25||$7,037,242.38|
|Support and Services at Home (SASH)||$13,857||$3,704,400||$3,815,532||$3,968,245.89||$11,502,034.89|
Because the elderly and people with chronic medical conditions (e.g. hypertension, diabetes, and COPD) are at a high risk for serious COVID-19 illness and death, the following metrics will help identify at-risk persons and allow healthcare providers to target preemptive care. By Hospital Service Area (HSA) and age group, for the first quarter of 2020 (Q1) –
(a) Number and results of A1C (diabetes blood test) scores recorded
(b) Number and results of hypertension cases under control
(c) Number of COPD cases by severity
Further, how many Vermonters tested positive/ negative for the influenza virus in each HSA in Q1 2020? This data could predict the potential impact of COVID-19 and guide resource allocation. If OneCare fails to deliver this critical information now, then our politicians must hold the billion-dollar experiment accountable.
Rudyard Kipling (another India-born Southern Vermonter) wrote, “Of all the liars in the world, the worst are our own fears.” Advanced medicine, Internet knowledge sharing, and our powerful survival instinct will win the day.