A survey of US hospitals' criteria for the allocation of remdesivir to treat COVID-19

Evaluating private hospital performance before and during COVID-19 in China

The coronavirus disease 2019 (COVID-19) pandemic had a tremendous impact on the global medical system. The development of private hospitals is an important measure to deepen the reform of China's medical and health system, and an important driving force to improve the effective supply of medical services. This study aims to compare the performance of China's private hospitals before and during COVID-19 and determine the factors that affect hospital profitability between the 2 periods. Data are collected from 10 private listed hospitals from 2017 to 2022, and ratio analysis is used to measure hospital performance in 5 aspects, namely profitability, liquidity, leverage, activity (efficiency), and cost coverage. Multiple regression analysis is used to determine the influencing factors of hospital profitability. The results show a negative impact of COVID-19 on private hospital performance. Specifically, regardless of region, hospital profitability, liquidity, and cost coverage were reduced due to COVID-19, while hospital leverage was increased. COVID-19 had also an impact on hospital efficiency. In addition, before COVID-19, current ratio and cost coverage ratio were the determinants of hospital profitability, while only cost coverage ratio affected hospital profitability during the COVID-19 outbreak. We provide evidence that COVID-19 had an impact on China private hospitals, and the findings will aid private hospitals in improving their performance in the post-COVID-19 era.

Essential services: Quantifying the contributions of America's pharmacists in COVID-19 clinical interventions

BACKGROUND

As the COVID-19 pandemic spread across the United States, America's pharmacists and their teammates expanded their clinical services to help their communities from every practice setting: community and ambulatory care, inpatient, long-term care, academia, public health, and many others.

OBJECTIVES

The objective of the study is to begin to quantify contributions of U.S. pharmacists in providing clinical interventions that mitigate and control the pandemic. These interventions span the gamut of diagnosis, prevention, treatment, and support, intervening patient by patient with vaccines, diagnostic tests, convalescent plasma, monoclonal antibodies, antiviral medications, and supportive therapies.

METHODS

Review of published literature, relevant web pages, and queries to national and state professional pharmacy associations and government agencies.

RESULTS

From February 2020 through September 2022, pharmacists and their teammates conducted >42 million COVID-19 tests, provided >270 million vaccinations (including 8.1 million COVID-19 vaccinations for long-term care residents) within community pharmacy programs alone, and provided >50 million influenza and other vaccinations per year. Pharmacists plausibly accounted for >50% of COVID-19 vaccinations in the United States. Pharmacists prescribed, dispensed, and administered an uncounted number of antibody products and antiviral medications, including care for 5.4 million inpatients and innumerable outpatients. Using conservative estimates, pandemic interventions by pharmacists and teammates averted >1 million deaths, >8 million hospitalizations, and $450 billion in health care costs.

CONCLUSIONS

Pharmacists and their teammates contributed to America's health and recovery during the COVID-19 pandemic by providing >350 million clinical interventions to >150 million people in the form of testing, parenteral antibodies, vaccinations, antiviral therapies, and inpatient care. The number of lives touched and people cared for by pharmacists continues to rise.

Transparency, health equity, and strategies in state-based protocols for remdesivir allocation and use

Background

The Emergency Use Authorization (EUA) of remdesivir for coronavirus disease 2019 raised questions on transparency of applied strategy, and how to equitably allocate and prioritize eligible patients given limited supply of the medication. The absence of federal oversight highlighted the critical role by states in health policymaking during a pandemic.

Objective

To identify public state-based protocols for remdesivir allocation and clinical guidance for prioritizing remdesivir use and assess approaches and inclusion of language promoting equitable access or mitigating health disparities.

Methods

We identified remdesivir allocation strategies and clinical use guidelines for all 50 states in the U.S. and the District of Columbia accessible on state health department websites or via internet searches. Public protocols dated between May 1, 2020 and September 30, 2020 were included in the study. We reviewed strategies for allocation and clinical use, including whether protocols contained explicit language on equitable access to remdesivir or mitigating health disparities.

Results

A total of 38 states had a remdesivir allocation strategy, with 33 states (87%) making these public. States used diverse allocation strategies, and only 10 (30%) of the 33 states included language on equitable allocation. A total of 30 states had remdesivir clinical use guidelines, where all were publicly accessible. All guidelines referenced recommendations by federal agencies but varied in their presentation format. Of the 30 states, 12 (40%) had guidelines that included language on equitable use. Neither an allocation strategy or clinical use guideline were identified (public or non-public) for 10 states and the District of Columbia during the study period.

Conclusions

The experience with the remdesivir EUA presents an opportunity for federal and state governments to develop transparent protocols promoting fair and equal access to treatments for future pandemics.