Coronavirus, Case Management, and the Vaccine

The impact of the coronavirus is being especially felt among case management professionals.

There is no topic that will define the career of those currently in healthcare more than the adaptation that has occurred due to the coronavirus pandemic.

Healthcare systems across the globe have been overwhelmed by equipment, personal protective equipment (PPE), and staffing shortages to care for the surges of patients. Currently, in the United States, there have been more than 13 million confirmed cases and more than 268,000 deaths. Now, in our third wave, cases are rolling in at over 150,000 per day, as the northern part of the U.S. braces for COVID and flu season. However, there is hope on the horizon in the form of a vaccine.

Case management has evolved with the increased number of cases in acute-care hospitals. As the numbers of COVID-19  cases have increased, hospitals have made decisions as to who is considered essential workers to remain in the hospital and which disciplines can work from home, therefore decreasing the number of individuals exposed to the hospital setting. Case management has not been exempt from these decisions, but the results have varied across organizations. Some case management programs have chosen to remove their staff from the hospital setting by completing patient assessments by phone. Other hospitals have chosen to leave their staff in the hospital setting, but removed them from the COVID units or are denying them from entering COVID rooms (or all patient rooms). The definition of who constitutes an essential worker varies by institution, and thus so does the line that the case management team falls on.

The most promising news of 2020 is the possible solution to this global crisis in the form of a very cold needle. The race to create a viable coronavirus vaccine, with hopes to end the pandemic, is taking place in laboratories around the world.

There are five phases from creation to approval of a vaccine. This process typically lasts for several years, as it is tested on both humans and animals before being approved by the Food and Drug Administration (FDA), which approves use after determining that the benefits outweigh the potential risks. The effort to create a vaccine began in January of this year, after the coronavirus was discovered in China and swiftly began to travel to all continents.

Due to the global effect, vaccinations are expected to begin to reach hospitals for distribution by the end of the year.

According to the Washington Post, the average vaccine development takes 10.7 years. As of November 2020, there are over 170 coronavirus vaccines in pre-clinical trials. Phase one has 40 vaccines in trial, when they are tested on a small number of healthy, young people to assess safety and dosages. Phase two has 17 vaccines that are tested on a larger group of individuals, including some who are at higher risk of illness. Phase three has 13 vaccines, tested on thousands of individuals to check their effectiveness and safety.

To date, there are currently no vaccines approved for distribution, although hospitals are expecting shipments within the next few weeks. The frontrunners for vaccine production in the U.S. appear to be those developed by Pfizer, BioNtech, and Moderna, topping out at an estimated effectiveness rate of 95 percent.

Challenges for hospital systems once the vaccines are available will begin with how to store them. The top three frontrunners utilize a vaccine that is based on mRNA. Pfizer’s vaccine, as currently developed, requires storage as cold as -94 degrees Fahrenheit until it is ready to be injected. This means that transportation, hospital storage, and distribution will need to ensure appropriate parameters. So far, these vaccines are also a two-part arrangement, which means that after the initial dose, coordination will need to occur on how to get the second dose three weeks later.

Organizations will also be required to report on vaccine distribution and assess effectiveness, meaning how well the vaccine protects against the virus. Guidelines will also need to be put in place to determine who will receive the vaccine first. The top vaccine companies are likely already coordinating with federal and state health officials as they determine how and to whom the vaccine will be released.

Although in the healthcare field and working in acute-care hospitals, case management teams are likely not the first line to receive the vaccine, and will need to wait as instruction trickles down through the states to hospital administration levels. Coordination will now be in two parts, obtaining the vaccine as a worker and triaging the vaccine for patients. What will be the hospital discharge implications? Do patients need to be vaccinated prior to admission to a post-acute facility, like the testing requirements experienced this year?

Top vaccine companies are hoping for an initial release before the end of the year, which means this adaptation will be coming soon, with larger-scale release estimated for spring 2021.