Sara Karlovitch, Assistant Editor

Telehealth is severally underused in nursing homes, however the current coronavirus disease 2019 (COVID-19) pandemic can open doors for its proliferation, according to a study published in the 

Journal of the American Medical Informatics Association.

The COVID-19 pandemic has caused more than 1.84 million deaths and there have been more than 84.4 million confirmed cases worldwide, according to the World Health Organization.

 In the United States, nursing homes account for 27% of deaths from COVID-19. The virus has left many nursing home residents isolated from family and health care providers. According to the study, in response to the pandemic, Medicare relaxed its rules and regulations surrounding telehealth services in order broaden access, allowing residences to receive care without having to risk travel to a health care facility.

“Before the COVID-19 pandemic, before March 6th and the telehealth waiver, nursing homes were not reimbursed unless they were in rural areas. They were not reimbursed for their use of telehealth. So, they weren’t really reimbursed for telehealth visits. So, many homes did not use telehealth until COVID-19 happened. Then, all of the sudden, there was not only this waiver, the 1135 waiver which allows them to use telehealth but there was also a relaxation of regulations around HIPPA,” said lead study author Gregory Alexander, PhD of the Columbia School of Nursing.

The study sample was made up of 664 nursing homes randomly selected from Nursing Home Compare. In total, 13,858 residents were included. According to the study, the sample was representative of location but not bed size or ownership. The sample had a greater proportion of smaller (fewer than 60 beds) and medium (between 60 and 120 beds) sized nursing homes than large (more than 120 beds) sized nursing homes compared with the national sample. Nursing homes were given score between 0 and 42 to rate telehealth use. Higher scores correlated with a higher use of telehealth technology.

Only 5% of the nursing homes samples achieved the maximum telehealth use score while 16% had a score of 0. Investigators found that as bed size increased, so did mean telehealth use scores. Additionally, while the sample size was made up of mostly not-for-profit nursing homes, mean telehealth scores did not vary much between ownership types. However, mean telehealth scores were lower for nursing homes in rural locations compared to those in areas with a larger population size.

According to the study, the COVID-19 has further isolated nursing home patients. The study, which was published prior to the FDA’s authorization of vaccines for emergency use and subsequent rollout, says that nursing home residents who do not have an electronic connection could go months or even years without communication outside the facility’s staff and residents. In the long run, lack of outside communication may worsen patient outcomes, including higher rates of depression and mobility. Study authors suggest that the Medicare regulation relaxation on telehealth services should continue in order to reduce isolation and preserve limited resources.

“The concern, I think, going forward is what will happen to these regulations now once we get the vaccine out there and people get vaccinated…Will we go backwards?” Alexander said. “Will there be more restrictions placed on telehealth or will they continue to be expanded? And I think it will be hard for facilities who have implemented and taken on new forms of communicating and connectivity to go back to where they were before.”

Alexander, G. Powell, K. Deroche, C. An evaluation of telehealth expansion in U.S. nursing homes [Journal Article] September 2020; 

Journal of the American Medical Informatics Association

. Accessed January 6, 2021. doi: 10.1093/jamia/ocaa253

WHO Coronavirus Disease (COVID-19) Dashboard

. The World Health Organization website. Accessed January 6, 2021. 

Articles

In response to the crisis, Medicare relaxed its rules and regulations surrounding telehealth services in order broaden access, allowing residences to receive care without having to risk travel to a health care facility.

Telehealth Technology is Underused in Nursing Homes Despite Pandemic

Americans who have not yet done so should make plans to get the flu vaccine during National Influenza Vaccination Week, which is held between December 6-13, 2020, according to the California Immunization Coalition.

The recent spike of coronavirus disease 2019 (COVID-19) cases could make a severe flu season more dangerous, as simultaneous respiratory infections can overrun already burdened clinics and hospitals. Public health officials are concerned that recent stay-at-home orders have discouraged people from getting the flu vaccine, either because they are hesitant to go to a medical clinic or that they believe social distancing has made the flu vaccine unnecessary. However, lack of a flu vaccination may cause a “twindemic,” meaning people can get both COVID-19 and the flu. 

During the 2019-2020 flu season, vaccinations prevented an estimated 7.52 million illnesses, 3.69 million medical visits, 105

000 hospitalization and 6300 deaths. Flu shots are especially important for those at a higher risk of developing serious flu complications, including people 65 and older, pregnant woman, and people with chronic medical conditions such as heart disease, asthma, and diabetes. 

"The flu can be a very serious virus, particularly for the elderly and immune compromised, and even mild cases can result in hospitalizations," said Randy Bergen, MD in a prepared statement. "Because we don't know yet how bad the flu virus will be, and because it peaks at a time when we are seeing COVID-19 cases rise, it is critical for everyone to get a flu vaccination so we do not see a massive and perilous spike of both viruses."

According to Bergen, patients should contact their physicians to see what safety measures are in place to protect patients from COVID-19 during flu vaccination.

Health Officials Stress Importance of Flu Vaccinations Amid the Rise in COVID-19 Cases During National Influenza Vaccination Week (December 6-13) [News Release]. Sacramento, CA; December 9, 2020: California Immunization Coalition.

A flu vaccine is especially important this year, as it can prevent a “twindemic” with COVID-19.

Health Experts Urge Americans to Vaccinate Against Flu During National Influenza Week

Randall A. Oyer, MD, president of the Association of Community Cancer Centers, and medical director at Penn Medicine’s Ann B. Barshinger Cancer Institute in Lancaster, Pennsylvania talks to 

® on the necessity of cancer screenings in the effort to reduce cancer mortality. The coronavirus disease 2019 (COVID-19) pandemic is projected to cause a spike in cancer deaths, which, according to Oyer, is due to the decline in screening since the pandemic began.

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Cancer deaths are expected to spike due to COVID-19. 

Cancer Screenings Crucial for Mortality Reduction

Favipiravir may be a beneficial treatment for mild-to-moderate coronavirus disease 2019 (COVID-19), according to a study published in the 

International Journal of Infectious Diseases

The COVID-19 pandemic has caused over 1.39 million deaths and there have been more than 59.2 million confirmed cases worldwide, according to the World Health Organization.

 Favipiravir is an RNA-dependent RNA polymerase (RdRp) inhibitor that is approved in Japan and China for the treatment of novel influenza virus.

Currently, 2 other trials have demonstrated that favipiravir has an advantage over other antivirals in treating COVID-19. Additionally, it is estimated that over 80% of patients with COVID-19 experience mild-to-moderate illness. However, very little antiviral research has investigated therapeutic interventions in this patient group.

The randomized, open-label phase 3 study took place across 7 sites in India. Study participation had a maximum treatment period of 28 days. Care was provided past the 14-day mark based on investigator judgement. The control arm received standard of care alone while the study group received standard of care plus favipiravir. Drugs with suspected antiviral activity against SARS CoV-2, including hydroxychloroquine, were prohibited.

Patients treated with favipiravir met the primary end point of median time to RT-PCR negativity 28.7% sooner than those treated with standard of care alone. However, according to the study, the median time to viral clearance was shorter in the control group (7 days) than in the study group (11 days). The statistically significant endpoint was not achieved.

“Faster viral clearance would be expected to reduce the duration of infectivity during the early course of disease, which would yield critical reductions in the secondary attack rate, duration of quarantine, and burden on health care providers and facilities,” study authors write.

Favipiravir was found to be well tolerated, and no adverse events led to drug discontinuation. One patient in the control group died of acute respiratory distress syndrome.

1. Udwadia, Zarir, et al. Efficacy and Safety of Favipiravir, an Oral RNA-Dependent RNA Polymerase Inhibitor, in Mild-to-Moderate COVID-19: A Randomized, Comparative, Open-Label, Multicenter, Phase 3 Clinical Trial. November 8, 2020. 

https://doi.org/10.1016/j.ijid.2020.11.142

2. WHO Coronavirus Disease (COVID-19) Dashboard

. The World Health Organization. Accessed November 25, 2020. 

The drug, which is approved for use in Japan and China, may help those with mild-to-moderate COVID-19. 

Favipiravir May be an Effective COVID-19 Treatment

The FDA has approved sodium sulfate, magnesium sulfate, and potassium chloride tablets (Sutab; Sebela Pharmaceuticals) for colonoscopy preparation.

A colonoscopy is the most common method of colorectal cancer detection. Prior to a colonoscopy, patients need to complete a liquid bowel preparation.

The tablets offer patients an alternative, especially for those who have trouble completing the liquid bowel preparation. Colorectal cancer is one of the leading causes of cancer-related deaths, and screening is crucial for effective management. Every year, 19 million colonoscopies are performed in the United States.

The approval was based on 2 trials in which 92% of patients achieved successful bowel cleansing by using the tablet. Cleansing in all segments of the colon, including the proximal colon, was achieved in 92% to 95% of patients.

In one of the trials, the tablets were deemed easy and tolerable to consume in 91% of participants. A significant majority of participants, 78%, said they would use the tablets again for a future colonoscopy.

“Successful bowel prep is critical for gastroenterologists to clearly see any polyps or abnormalities, yet the immense volume of liquid prep solutions can prevent patients from adequately completing their regimens. Tablets provide a welcome alternative for successful prep completion and visualization of the colon,” said Douglas K. Rex, MD, director of Endoscopy at Indiana University Hospital and Professor, Department of Medicine, Division of Gastroenterology and Hepatology, University of Indiana School of Medicine, in a press release.

Compared with the competitor, more patients taking the tablets reported nausea and vomiting, according to the press release. More than half of patients, 52%, reported at least 1 selected gastrointestinal adverse reaction.

Sebela Pharmaceuticals Receives FDA Approval for SUTAB® Tablets for Colonoscopy Preparation [News Release] November 10, 2020; Braintree, MA. Accessed November 11, 2020.

Sutab tablets provide an alternative to traditional liquid bowel preparation, which is hard to complete for some patients.

FDA Approves Alternative to Traditional Colonoscopy Preparation

A new scoring model can help predict hospitalization, critical illness, or death for coronavirus disease 2019 (COVID-19) presenting patients at urgent care centers, according to a study published in

The COVID-19 pandemic has caused over 1.2 million deaths and there have been more than 46.8 million confirmed cases worldwide, according to the World Health Organization.

 The virus has had a dramatic effect on the health care system, including urgent care facilities.

In order to help limit the spread of COVID-19, Massachusetts General Hospital closed most outpatient facilities and set up new Respiratory Illness Clinics, according to the study. The clinics were staffed by reassigned nurses and clinicians, and many had little urgent care experience. Investigators developed a COVID-19 Acuity Score (Cova) in order to better determine a patient’s risk for hospital admission, ICU admission, or death within 7 days.

The score uses demographic, medical history, clinical, and radiographic variables to determine risk. Data was collected between March 7, 2020 and May 14, 2020. All patients were assigned to a developmental cohort or a prospective cohort, and were admitted through the emergency department or the respiratory clinics.

Investigators found that in the developmental cohort, which was made up of 9381 people, 35.6% of patients had adverse events within 7 days of presentation, 27.3% were hospitalized, 7.2% received treatment in an intensive care unit (ICU) or mechanical ventilation, and 1.1% had died. In the prospective cohort, which was made up of 2205 people, 32.9% of patients had adverse events, 26.1% were hospitalized, 6.3% received ICU treatment or mechanical ventilation, and 0.5% died, according to the study.

"While several other groups have developed risk scores for complications of COVID-19, ours is unique in being based on such a large patient sample, being prospectively validated, and in being specifically designed for use in the outpatient setting, rather than for patients who are already hospitalized," Shivani Mukerji, MD, PhD said in a prepared statement. "Cova is designed so that automated scoring could be incorporated into electronic medical record systems. We hope that it will be useful in case of future COVID-19 surges, when rapid clinical assessments may be critical."

Haoqi S, Aayushee J, Leone M, et al. Cova: An Acuity Score for Outpatient Screening that Predicts COVID-19 Prognosis. 

. Published October 24, 2020. Accessed October 30, 2020. https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiaa663/5938525

. The World Health Organization. Updated November 3, 2020. Accessed November 3, 2020. 

Risk score predicts prognosis of outpatients with COVID-19 [News Release] October 26, 2020; Boston, MA: Massachusetts General Hospital . Accessed October 30, 2020. https://www.massgeneral.org/news/press-release/Risk-score-predicts-prognosis-of-outpatients-with-covid-19

A new scoring model is helping to determine the risk of hospitalization and death for patients being treated for COVID-19 in outpatient clinics such as urgent care centers.