At the very moment the United States needed its public health infrastructure the most, many local health departments had all but crumbled, proving ill-equipped to carry out basic functions let alone serve as the last line of defense against COVID-19. Epidemiologists, academics and local health officials across the country say the nation’s public health system is one of many weaknesses that continue to leave the U.S. poorly prepared to handle the pandemic. Read more.

The U.S. Department of Health and Human Services (HHS), through the Assistant Secretary for Health, issued guidance under the Public Readiness and Emergency Preparedness Act (PREP Act) to expand access to safe and effective COVID-19 vaccines when they are made available. This guidance authorizes state-licensed pharmacists to order and administer, and state-licensed or registered pharmacy interns acting under the supervision of the qualified pharmacist to administer, COVID-19 vaccinations to persons ages 3 or older, subject to certain requirements. The authorization preempts any state and local laws that prohibit or effectively prohibit those who satisfy these requirements from ordering or administering COVID-19 vaccines as set forth above. The authorization does not preempt state and local laws that permit additional individuals to administer COVID-19 vaccines to additional persons. Access a copy of the guidance – PDF, information on Operation Warp Speed and clinical resources on vaccines, including continuing education training on best practices.

As many as 12 million people have lost access to employer-sponsored coverage because of COVID-19, according to the Economic Policy Institute. Analysts estimate that 6.4 million workers have lost access to insurance through their employer amid job losses during the pandemic. The 12 million comes from including spouses and dependents in those plans. It takes into consideration that not every worker who loses employer coverage will become uninsured. Read more.

When the COVID-19 emergency declaration eventually ends, many regulatory waivers and administrative flexibilities that consumers and health care providers have come to rely upon during this pandemic will abruptly end. This raises two significant concerns: the ability of the health care community to respond effectively to new threats will be diminished and consumers will have become accustomed to and expect these flexibilities–especially relating to telehealth–to continue. Rep. Christopher Quinn (R-Delaware) introduced HB 2779 to a set a clear timeline for the termination of waivers and administrative flexibilities afforded to health care providers and practitioners for one year after the end of the COVID-19 emergency declaration.

The week of September 8, 2020, the Medicare Payment Advisory Committee (MedPAC) produced a summary on the impact of federal funds provided to hospitals in response to the COVID-19 pandemic. Notably, MedPAC reported that the negative impact on hospital operating profits was significantly less than the American Hospital Association (AHA) estimated. According to Healthcare Dive, “[AHA] estimated the pandemic would reduce U.S. hospital operating profits by almost $51 billion in April, the month with the sharpest decline in patient volume. But MedPAC researchers estimate hospitals only lost about half that: between $20 billion and $30 billion that month.” Additionally, they note that while some facilities reported an extraordinarily high income because of increased federal aid, many cash-strapped rural facilities are continuing to plead for aid as the COVID-19 pandemic rages on in rural America.

For the second week in a row, the rates of COVID-19 infections in rural and urban areas are trending in opposite directions. According to the Daily Yonder, “The proportion of new cases generated in rural counties continued to increase as the number of new cases in metropolitan counties fell for the sixth straight week.” This disturbing trend is placing a strain on patients and providers in rural areas, and as Alan Morgan, NRHA CEO, noted in May 2020, “Unfortunately, we are now entering a phase where rural America is going to be front and center of these discussions as we go forward. The challenge is: we are moving into an area where those most in need of health care services and those that are most at risk of COVID-19 are going to be in these small towns where they have limited access to health care.”

Senate Majority Leader Mitch McConnell (R-KY) and his Republican colleagues introduced a new COVID-19 relief package. This package was even more narrow than previous GOP proposals. Notably, this package included very few health care provisions and no additional funding for the Provider Relief Fund. Leader McConnell filed cloture on this bill. The vote, which required a 60-vote threshold for passage, failed on a nearly party-line vote 52-47, with Senator Rand Paul (R-KY) being the only Republican to vote against the proposal.

As part of NIOSH’s efforts to keep stakeholders up to date on the CDC and NIOSH coronavirus disease 2019 (COVID-19) response, below is a summary of new information posted this week.

General Resources

Two New NIOSH Science Blogs are Now Available on Respiratory Protection

• The Blog, Respiratory Protection vs. Source Control – What’s the Difference?, helps readers understand the difference between respiratory protection, which protects the wearer, and source control, which protects others.
• The Blog, Supplementing the Supply of N95s With Reusable Elastomeric Half Mask Respirators, discusses the use of reusable elastomeric half mask respirators (EHMRs) as a substitute for N95 respirators. This comes as organizations rely on other types of respiratory protection due to the high demand and limited supply of N95 respirators during the COVID-19 pandemic.

Industry-Specific Resources

Update to Wildland Firefighter FAQs   

Updates to the Wildland Firefighter FAQs webpage address new concerns, clarify that testing recommendations are relevant to prevent infection and the spread of COVID-19 regardless of test result or exposures, and update the screening terminology to be consistent across the CDC website.

Limiting Workplace Violence Infographic Translated

The webpage Limiting Workplace Violence Associated With COVID-19 Prevention Policies in Retail and Services Businesses has a newly translated infographic. “Basic dos and don’ts for EMPLOYEES to prevent workplace violence” has been translated into eight languages: Chinese, Korean, Vietnamese, French, Haitian-Creole, Portuguese, Spanish, and Russian.

New Fact Sheets

CDC recently published fact sheets for two additional groups that provide suggestions for preventing the spread of COVID-19

• Hotel, resort, and lodge employees and employers
• Paratransit operator employees and employers

The Advisory Committee on Immunization Practices updated its recommendations for prevention and control of seasonal flu with vaccines for the 2020-2021 flu season. Influenza vaccination of persons aged ≥6 months to reduce prevalence of illness caused by influenza will reduce symptoms that might be confused with those of COVID-19. See CDC’s interim guidance for immunization services during the COVID-19 pandemic.