Author Interviews, Cost of Health Care, COVID -19 Coronavirus, JAMA / 26.09.2022
Covid: Safety Net Hospitals Experienced Greater Financial Losses During Pandemic
MedicalResearch.com Interview with:
Allison Witman PhD Assistant Professor of Economics Economics & Finance Cameron School of Business University of North Carolina, Wilmington
Yu Wang PhD Assistant Professor Congdon School of Supply Chain, Business Analytics, & Information Systems Cameron School of Business University of North Carolina Wilmington David Cho PhD Assistant Professor of Management California State University, Fullerton
MedicalResearch.com: What is the background for this study? Response: The COVID-19 pandemic placed tremendous financial pressure on hospitals. Beginning in March of 2020, hospitals cancelled outpatient and elective procedures to accommodate surges in demand from COVID-19 patients. As these procedures account for more than 60% of an average hospital’s revenue, cancellation posed serious challenges to the financial health of hospitals. Revenue from COVID-19 patients may have partially offset these effects, but the American Hospital Association estimated a total loss of $202.6 billion by American hospitals between March and June 2020. In response, the U.S. government created large federal assistance programs aimed to stabilize hospitals’ financial situation as their ability to maintain operations was critical to the health of the nation. Due to differences in hospital characteristics, certain hospitals such as rural hospitals and those serving a higher share of Medicaid and uninsured patients (e.g., safety net hospitals) may have been more financially susceptible to the effects of the pandemic. These hospitals that serve vulnerable patient populations historically have had lower profit margins and were candidates for targeted COVID relief funding (e.g., Safety Net Hospitals Payments, a $10 billion component of the Provider Relief Fund).
Dr. Lashaki[/caption]
Masoud Jahandar Lashaki, Ph.D.
Assistant Professor
Department of Civil, Environmental and Geomatics Engineering
Florida Atlantic University
MedicalResearch.com: What is the background for this study?
Response: Toilet flushing can generate large quantities of microbe-containing aerosols depending on the design and water pressure or flushing energy of the toilet. Based on previous reports, a variety of different pathogens which are found in stagnant water or in waste products (e.g., urine, feces, and vomit) can get dispersed widely via such aerosolization, including the legionella bacterium responsible for causing Legionnaire’s disease, the Ebola virus, the norovirus which causes severe gastroenteritis (food poisoning), and the Middle East Respiratory Syndrome coronavirus (MERS-CoV).
Based on previous reports, such airborne dispersion is suspected to have played a key role in the outbreak of viral gastroenteritis aboard a cruise ship, where infection was twice as prevalent among passengers who used shared toilets compared to those who had private bathrooms. Similarly, transmission of norovirus via aerosolized droplets was linked to the occurrence of vomiting or diarrhea within an aircraft restroom, as passengers and crew who got infected subsequently were more likely to have visited restrooms than those that were not infected. The participants in the study reported that all of the restroom surfaces appeared to be clean, which indicates that infection is likely to have occurred via bioaerosols suspended within the restroom.
Although many of these studies blamed flush-generated aerosols for disease outbreak, a limited number of them quantified the presence of such aerosols. Consequently, we decided to conduct this study to demonstrate the spike in aerosol concentrations following flushing. 
Dr. Sickbert-Bennett[/caption]
Emily Sickbert-Bennett PhD, MS, CIC, FSHEA
Director, Infection Prevention, UNC Hospitals
Administrative Director, Carolina Antimicrobial Stewardship Program, UNC Hospitals
Associate Professor of Medicine-Infectious Diseases, UNC School of Medicine
Associate Professor of Epidemiology, UNC Gillings School of Global Public Health
MedicalResearch.com: What is the background for this study?
Response: Recently public health officials have recommended doubling masks, although the 
Dr. Rettew[/caption]
David C. Rettew, MD
Child & Adolescent Psychiatrist
Associate Professor of Psychiatry and Pediatrics
University of Vermont Larner College of Medicine
MedicalResearch.com: What is the background for this study?
Response: Our group, the Wellness Environment Scientific Team at the University of Vermont, hadn’t planned to look at COVID at the outset of this study and instead were going to look at mental health and engagement in wellness activities in college students across a semester. The pandemic disrupted that plan when students were abruptly sent home but fortunately, they continued to do their daily app-based ratings of their mood, stress levels, and engagement in healthy activities. We then realized we had some interesting pre-COVID to COVID data that was worth exploring. 
Dr. Saha[/caption]
Abhishek Saha, PhD
Assistant Professor
Department of Mechanical and Aerospace Engineering
University of California San Diego
MedicalResearch.com: What is the background for this study?
Response: At a very early stage of COVID 19 pandemic, the scientific community identified that respiratory droplet is the primary mode of transmission of the SARS-CoV2 virus. Naturally, the health agencies have encouraged facemasks to restrict these droplets from spreading during respiratory events, like coughing, sneezing, talking, etc. While WHO recommended using either N95 masks or other types of three-layer masks, due to a sharp increase in demand and scarcity in supplies, a variety of either home-made or locally purchased masks became popular. Naturally, one wonders if these single- and double-layer masks provide enough protection. To provide some insight into this critical question, our team, which also includes Professor Swetaprovo Chaudhuri from the University of Toronto, and Professor Saptarshi Basu of the Indian Institute of Science, experimentally analyzed what happens to the respiratory droplets when they impact single- and multi-layer masks. 
Dr. Lee[/caption]
Brian P. Lee, MD, MAS
Assistant Professor Clinical Medicine
University of Southern Californi
Keck School of Medicine
Los Angeles, California
MedicalResearch.com: What is the background for this study?
Response: The COVID-19 pandemic has been associated with mental health stressors, including anxiety, loneliness, and social instability. We hypothesized the pandemic may have led to increased alcohol and tobacco use as a coping mechanism for these stressors. National retrospective questionnaires had suggested higher reports of substance use, but these are limited by selection and recall biases, in addition to subjective report – we sought to address this knowledge gap by using a nationally-representative longitudinal cohort (Nielsen National Consumer Panel) tracking real-time purchases of households across the US. 
Dr. Zimmerman[/caption]
Frederick Zimmerman, PhD
Professor, Department of Health Policy and Management
Fielding School of Public Health
UCLA
MedicalResearch.com: What is the background for this study?
Response: The science on school transmissions of COVID is becoming clearer all the time in its conclusion that there is little to no transmission in school environments as long as reasonable precautions are taken. Yet one recent study got a lot of attention for claiming that states that allowed their schools to remain open in the early days of the pandemic saw more cases. That study did not control for several important factors that might explain this association, so our study aimed to correct that work.
Rahul Subramanian[/caption]
Rahul Subramanian PhD candidate
Department of Ecology and Evolution
Biological Sciences Division
University of Chicago
Chicago, IL 60637
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Understanding the proportion of COVID-19 cases that become symptomatic, as well as the extent to which people without symptoms contribute to COVID-19 transmission, has important public health implications.
However, changes in PCR testing capacity over time have made these quantities hard to estimate precisely.
We used a model that incorporates daily changes in PCR testing capacity, cases, and serology to precisely estimate the proportion of cases that were symptomatic in New York City during the initial wave of the outbreak.
Only 1 in 7 to 1 in 5 cases were symptomatic.
Furthermore, non-symptomatic cases of the virus (this includes people who are either pre-symptomatic or asymptomatic) substantially contribute to community transmission, making up at least 50% of the driving force of SARS-CoV-2 infection. 
Asimanshu Das[/caption]
Asimanshu Das, Ph.D. student
Brown University School of Engineering
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Driving in a car with ride-share or car-pool is a widely prevalent social interaction. The study aimed to address the airflows inside cars in various window open/closed configurations using computer simulations, and also looking into the possibility of movement of aerosol-type of particles from one occupant to other.
The main findings are that opening windows provides a likely benefit to reduce the potentially pathogenic aerosols inside the cabin. Generally, more windows the better, but at the least it would be advisable to have one rear side window and one frontside window open.
Sitara Weerakoon[/caption]
Sitara Weerakoon, MPH (she/her)
PhD Candidate | Epidemiology & Biostatistics
Graduate Research Assistant
Center for Pediatric Population Health
UTHealth
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Measures to control the spread of COVID-19 included stay-at-home mandates and business lockdown policies which resulted in many facing a loss of income or employment and more time spent isolated at home. Life stressors (like job loss and social isolation) have been shown to be associated with increased drinking at unhealthy levels. Those with a history of mental health problems may be even more at risk.
We aimed to see if binge drinking (5 or more drinks [male] or 4 or more drinks [female] in one session) and levels of alcohol consumption among binge drinkers were impacted by these pandemic-related factors. We found that increased time spent at home (in weeks) was associated with a 19% increase in the odds of binge drinking and binge drinkers with a previous diagnosis of depression and current depression symptoms (during the early months of the pandemic) had a 237% greater odds of drinking more alcohol (vs drinking the same amount) compared to those with no history and current symptoms of depression.
Dr. Barrett[/caption]
Emily Barrett, PhD
Associate Professor
Department of Biostatistics and Epidemiology
Rutgers School of Public Health
MedicalResearch.com: What is the background for this study?
Response: We started this study in the very early stages of the pandemic to look at SARS-CoV-2 viral transmission and disease severity in health care workers as compared to non-health care workers. There was a tremendous amount of fear and uncertainty about the virus and the early anecdotal reports coming out of China and Italy highlighted the plight of many frontline health care workers who had been infected on the job. We knew that our U.S. health care workers would soon be facing this tremendous challenge. We started this study to examine risks of infection in our vulnerable frontline health care workers and a comparison group of non-health care workers. Our results are from the early stages of the U.S. pandemic in March-April 2020.
Dr. Glicksberg[/caption]
Benjamin Glicksberg, PhD
Assistant Professor of Genetics and Genomic Sciences
Member of the Mount Sinai COVID Informatics Center
Member of the Hasso Plattner Institute for Digital Healt
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study?
Response: Reports from health systems that detailed the clinical characteristics and outcomes of their COVID-19 patients were instrumental in helping other health systems rapidly adapt and know what to expect. There are few studies, however, that assess what happens to these patients after they were discharged from the hospital.
In our work, we address this gap by determining both how many individuals re-present to the hospital within 14 days, and what clinical characteristics of these patients differ from those who do not. Such information is critical in order to continue to refine optimal treatment plans and discharge decisions for patients of all backgrounds and clinical profiles. To provide more context to the question, we also determined if and how these factors changed between initial presentation and readmission to the hospital.
Dr. Yonker[/caption]
Lael Yonker, MD
Pediatric Pulmonology
Director, MGH Cystic Fibrosis Center
Principal Investigator, Pediatric COVID biorepository
Mucosal Immunology and Biology Research Center
Massachusetts General Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Children were initially felt to be spared from the COVID-19 pandemic. Here, we show that children can become sick from SARS-CoV-2 infection, and even if the initial illness is mild, some go on to develop a severe inflammatory illness after the initial illness. We also show that children can carry very high levels of virus early in the course of infection, suggesting they may play a larger role in spreading the virus than previously thought.
Dr. Heald-Sargent[/caption]
Taylor Heald-Sargent, M.D., Ph.D.
Ann & Robert H. Lurie Children’s Hospital
Chicago
MedicalResearch.com: What is the background for this study?
Response: Given the ongoing debate around the ability of children to transmit SARS-CoV-2, we noticed that our clinical data could address one of the prevalent assumptions. Some people postulated that the reason children have less severe infections with SARS-CoV-2 is because they are not able to replicate virus as much as adults and therefore may not transmit as readily. 
Dr. Sinha[/caption]
Pranay Sinha, MD
Research Fellow
Section of Infectious Diseases
Boston University School of Medicine
MedicalResearch.com: What is the background for this study?
Response: In the early days of the COVID-19 pandemic there were no evidence-based treatments for severely ill patients infected with this virus. We formed an interdisciplinary group of physicians from departments of adult and pediatric infectious diseases, rheumatology, and pulmonary/critical care as well as clinical pharmacy specialists. Given some promising data from China, we instituted treatment with off-label IL-6 receptor inhibitors (tocilizumab and sarilumab). The rationale was to mitigate the exuberant immune response observed in some patients infected with SARS-CoV-2 (also called cytokine storm or cytokine release syndrome).
Quite quickly, we started noticing that giving the drug to our sickest patients wasn’t eliciting dramatic improvement. We reasoned that by the time patients were severely ill and requiring ventilators, the damage to their lungs from the cytokine storm had already taken place. It was like closing the barn door after the horse had already bolted.
