5 Things Washington: Heat and health, Charissa Fotinos, Federal action

Thanks to our amazing team of reporters, led by our Managing Editor Emily Boerger, for holding down the fort here at State of Reform while I was out on a break. You will see bylines from 8 folks not named DJ on our site right now as we continue to build our footprint and our reporting. We’re over 1500 stories so far this year covering 15 states, though Washington State is, of course, our home.

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1. Quick data: Delta variant and breakthroughs

The Delta variant has arrived in Washington State. It now makes up 57% of all COVID cases in the state, the first time it has become the majority variant, according to DOH.

From January 17 to July 17, there have been 3,446 documented breakthrough cases of COVID among vaccinated Washingtonians. Of the DOH cases, 83% reported symptoms. However, studies showing that 80% of COVID infections are asymptomatic suggest additional breakthrough cases that are not reported, due to a lack of symptoms, could push the total to 12,000.

Of the 48 cases of death among these breakthrough cases, the median age was 84 years old. 29 cases were among long-term care facility patients.


2. Fotinos appointed Interim Medicaid Director

Charissa Fotinos, MD, has been appointed the Interim Medicaid Director at the HCA. She will hold the position until it’s filled following a national search. Fotinos currently serves as the Deputy Medical Director at the HCA.

While it’s always a good idea to see which candidates appear in a national search, Fotinos would be a solid pick for very big shoes left emptied by MaryAnne Lindeblad’s departure. Fotinos brings significant institutional knowledge to a position that will be tasked with renewal of the 1115 wavier, providing oversight to Medicaid programs outside of the HCA, and preparing for a possible re-procurement in the next 12-24 months. There is a lot on Medicaid’s plate. Having an internal candidate here is probably the right move given the timing and context surrounding the agency.


3. Heat wave, wildfires, and health

With another heat dome coming this week, expect temperatures to top 100 °F in Eastern Washington. In the last heat wave, estimates count approximately 100 heat-related deaths in the state, all of which were preventable, says Kristie Elbi in this Q&A with reporter Matt Beuschlein. Elbi is a Professor of Global Health at UW.

The Bootleg Fire in Oregon is at about 420,000 acres, or about 60% of the acreage of Rhode Island. The 85,000-acre Lick Creek Fire in SE Washington is currently the largest in the state.

Air quality has remained good in the state, though smoke from the NW wildfires has spread across the country. The heat dome may allow the smoke to sit here in the state for some time, however, deteriorating air quality significantly.

4. Federal action on health care

Current management of the $1T bi-partisan infrastructure package, and the subsequent $3.5T package Democrats hope to push through, is something of a master class in policy making in a divided Congress. Murray and Senate Democrats hope to start debate on a $1T package as soon as this week, with much of that package paid for. Sen. Bernie Sanders is shaping the second, larger package, that includes subsidies for the individual market and allowing Medicare to negotiate pharma pricing. In a presentation to members of Congress, the White House says the provisions are immensely popular and that Democrats should run on the issues.

In the administration, Biden’s recent Executive Order focuses, in part, on hospital consolidation. It even calls for the FTC to review past mergers to see if those have brought harm to patients. The White House says, “Thanks to unchecked mergers, the ten largest healthcare systems now control a quarter of the market… Research shows that hospitals in consolidated markets charge far higher prices than hospitals in markets with several competitors.” Biden is making market competition and anti-trust regulation a central focus of his administration, and apparently hospitals are getting wrapped up in that review.

5. A fall COVID spike and the reality of 100% seroprevalence

UW’s Institute for Health Metrics and Evaluation shows a doubling of daily deaths in the state through the fall, to about 14. But the science and the data are increasingly clear: getting vaccinated overwhelmingly protects recipients from severe symptoms.

However, contrary to the more prominent public messaging about the importance of vaccinations, disease modelers will tell you this disease has become endemic. It’s not going anywhere, and will continue to have a presence in our lives for years to come. Like the flu, it will continue to mutate and have a seasonal spike as we move indoors. So, like the flu, at some point in our lives, we will all get COVID. It’s not a question of if, they tell me, but when. That is a seroprevalence of 100%. And, like the flu, if you get it for the first time in your life when you are old, and you haven’t been vaccinated, it could be deadly.

The takeaway from these conversations is two-fold. First, get vaccinated. Two, learn how to live with accepting some level of risk for COVID, just as you do with the flu, though a level likely much greater than many have been willing to accept over the last year