| health_care_vaccine_mandate_new_practice_resources | Health Care Vaccine Mandate: New Practice Resources | COVID-19 Vaccine | Shared_Content/News/Membership_Memo/2021/September_24/health_care_vaccine_mandate_new_practice_resources | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2021/September/covid-vax-vials-645x425px.jpg" class="pull-right" alt="Vials of COVID-19 vaccine" /></div>
<h5>September 24, 2021</h5>
<h2>Health Care Vaccine Mandate: New Practice Resources</h2>
<p>Practices, clinics, and other health care settings across Washington have a little under a month left to ensure clinicians, staff, and other workers in private health care and long-term care settings are fully vaccinated by the state deadline of Oct. 18. Here's what's new since <a href="[@]Shared_Content/News/Membership_Memo/2021/September_10/department_of_health_updates_faqs_for_health_care_vaccine_mandate">our last update</a>:</p>
<h3>Sample FAQ from The Everett Clinic</h3>
<p>The Everett Clinic has shared its frequently asked questions document that addresses concerns about the mandatory vaccine requirement. The document represents one practice's interpretation of the proclamation, is provided for informational purposes only, and should not be construed as legal advice on any specific facts. We encourage you to consult with legal counsel before implementing any policy or practice or taking any employment-related action. </p>
<p><a href="[@]WSMA/Resources/COVID-19/Implementing_the_COVID_19_Vaccine_Mandate_at_Your_Practice/Implementing_the_COVID_19_Vaccine_Mandate_at_Your_Practice.aspx?WebsiteKey=c182ff6d-1438-4899-abc5-614681b54927">Access The Everett Clinic COVID-19 Vaccination FAQ</a> (sign-in required).</p>
<h3>Sample contractor attestation form</h3>
<p>Working with the employment attorneys from Montgomery Purdue PLLC, the WSMA offers a sample contractor attestation form, which your practice may adapt for use.</p>
<p> <a href="[@]WSMA/Resources/COVID-19/Implementing_the_COVID_19_Vaccine_Mandate_at_Your_Practice/Implementing_the_COVID_19_Vaccine_Mandate_at_Your_Practice.aspx?WebsiteKey=c182ff6d-1438-4899-abc5-614681b54927">Access the sample contractor attestation form</a> (sign-in required).</p>
<p>More resources, including an on-demand webinar and other sample clinic policy and exemption forms are available on the WSMA website. Visit <a href="http://www.wsma.org/WSMA/Resources/COVID-19/Implementing_the_COVID_19_Vaccine_Mandate_at_Your_Practice/Implementing_the_COVID_19_Vaccine_Mandate_at_Your_Practice.aspx">Implementing the COVID-19 Vaccine Mandate at Your Practice</a> (sign-in required) for these resources.</p>
</div> | 9/24/2021 12:00:00 AM | 1/1/0001 12:00:00 AM |
| wsma_launches_covid_19_vaccination_confidence_campaign | WSMA Launches COVID-19 Vaccination Confidence Campaign | COVID-19 Vaccine | Shared_Content/News/Membership_Memo/2021/September_24/wsma_launches_covid_19_vaccination_confidence_campaign | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2021/September/talk-to-your-doctor-stevensco-645x425px.png" class="pull-right" alt="Talk to your doctor screen image" /></div>
<h5>September 24, 2021</h5>
<h2>WSMA Launches COVID-19 Vaccination Confidence Campaign</h2>
<p>The WSMA this week launched its "Talk to Your Doctor" COVID-19 vaccine confidence campaign to encourage vaccine uptake in rural and disadvantaged communities in our state.</p>
<p>This three-month, multiplatform, data-driven marketing campaign features videos with local doctors promoted across popular web platforms, including Facebook and YouTube, and supplemented with traditional media outreach and print resources. Supported through a grant from the Washington State Department of Health, the first phase of the campaign launched this week in the Tri Counties, with potential additional funding available for a second phase in Southeast Washington later this year or in early 2022.</p>
<h3>Watch the Tri County "Talk to Your Doctor" videos</h3>
<p>For the Tri County campaign, the WSMA produced eight 15-second spots and three 30-second spots, designed to run across Facebook and before and during videos on YouTube and on Google-approved websites. The videos feature familiar local physicians from communities in Pend Oreille, Ferry, and Stevens counties and focus on different key messages to encourage vaccination, each including the tag line to "talk to your doctor about getting the COVID-19 shot." <a href="https://vimeo.com/user/6809798/folder/5498609">Watch the videos</a>.</p>
<p>Many thanks to our participating physicians: Curtis Gill, DO, Newport; Geoff Jones, MD, Newport; Lisa Matelich, MD, Newport; Shannon Radke, MD, Newport; Kal Kelley, MD, Republic; Ramon Canto, MD, Colville; Caleb Holtzer, MD, Chewelah; and Edward Johnson, MD, Kettle Falls. And a special thanks to Sam Artzis, MD, health officer for the Northeast Tri County Health District, for his guidance and support.</p>
<h3>"Talk to Your Doctor" brochure</h3>
<p>A print brochure will be developed for the campaign this fall and will be available to all WSMA members across the state.</p>
<p>If you have questions about the campaign, email Graham Short at <a href="mailto:gfs@wsma.org">gfs@wsma.org</a>.</p>
</div> | 9/24/2021 12:00:00 AM | 1/1/0001 12:00:00 AM |
| covid_long_haulers | COVID Long-Haulers | COVID-19 Vaccine | Shared_Content/News/Latest_News/2021/covid_long_haulers | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2021/sept-oct-2021-reports-cover-645x425px.jpg" class="pull-right" alt="WSMA September-October 2001 cover image" /></div>
<h5>September 1, 2021</h5>
<h2>COVID Long-Haulers</h2>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<p>By John Gallagher</p>
<p>
When the coronavirus pandemic first hit, Jason Goldman, MD, MPH, recognized the importance of researching the impact of the virus. An infectious disease physician with Swedish Medical Center in Seattle, Dr. Goldman, who's also a clinical researcher, instituted a study on immune response in COVID-19 patients.
</p>
<p>
"We enrolled the first patients in March 2020," he says. "At the time, we were thinking about COVID as an acute viral infection." So, it was a bit of a shock when patients returned after a few months for follow-up testing and were still exhibiting problems.
</p>
<p>
"It was surprising to find that the immune system had not calmed down in study participants that we tested at one to two months after their acute infection," Dr. Goldman recalls. "The manifestations after COVID persisted a long time and affected many organ systems."
</p>
<p>
What the study was finding were the early signs of what is now known as post-acute COVID-19 syndrome (PACS), or what is commonly called long-haul COVID. More than a year and a half into the pandemic, PACS remains a perplexing problem, frustrating patients and doctors alike, while adding stress to an already overburdened health care system.
</p>
<p>
Sequelae from infectious diseases are hardly surprising; chronic fatigue syndrome, Epstein-Barr virus, and Lyme disease can cause a confusing array of problems. What's different is the sheer volume of PACS patients. Although precise incidence rates don't exist, the number of people who experience significant sequelae for several months after an acute COVID-19 infection has been estimated to be about 10% to 30%.
</p>
<p>
"We have millions of persons in this country now who have had COVID, and even though it's a small percentage with long-haul symptoms, that number is still very large," says Leslie Linares-Hengen, MD, an infectious disease specialist at St. Joseph's Medical Center in Tacoma. "It's much greater than with other post- infectious syndromes."
</p>
<p>
Moreover, because COVID-19 was such a new disease, at the outset, no one had any idea what the long-term effects might be. "We had to live through the epidemic and the care of the patients to understand what was going to happen," says Dr. Linares-Hengen.
</p>
<h3>A tricky diagnosis</h3>
<p>
One major challenge for physicians is that PACS doesn't present as a clear-cut syndrome. "Patients' symptoms seem to be all over the board," says Peter Barkett, MD, an internal medicine physician at Kaiser Permanente Silverdale Medical Center. "It's such a new thing with such variety in presentation that it's really difficult to pin down."
</p>
<p>
Patients with PACS can suffer from pulmonary and cardiovascular problems. They may report brain fog or less ability to taste and smell. They may have intermittent fevers or severe post-exercise fatigue. They may feel anxious or have trouble sleeping. Or they may have some combination of all of these problems. While PACS seems more prevalent in people with severe acute infection from COVID-19, plenty of PACS patients had mild or even asymptomatic infections.
</p>
<p>
"These are complex, multidimensional presentations that are hitting patients," says Aaron Bunnell, MD, a physical medicine and rehabilitation physician with UW Medicine. UW opened a post- COVID clinic in April 2020 at Seattle's Harborview Medical Center, initially targeting those recovering from critical illness, but soon expanded it as the need grew. At present, patients are waiting three months for an appointment.
</p>
<p>
Some patients are putting off treatment in the belief that their symptoms will fade. When they finally do present to a physician, they "are at their wits' end," says Dr. Barkett. "There are a lot of patients who are suffering in silence with long COVID symptoms." Dr. Barkett now makes a point of asking every patient who has had COVID-19 about lingering symptoms and if there are things that they are no longer able to do.
</p>
<p>
Because some patients never tested positive for COVID-19, it's not always clear that their symptoms are related to the disease. Diagnosis can be difficult, particularly for patients who may have been infected early in the pandemic when testing was scarce. Antibody tests are helpful, but not foolproof.
</p>
<p>
Once they do seek help, patients frequently have faced a battery of tests to figure out what's wrong with them. "Because the symptoms are so broad, a lot of these patients are getting a lot of very expensive workups, with largely negative results," says Dr. Bunnell.
</p>
<h3>Time frame for recovery a moving target</h3>
<p>
Treatment is focused on lessening the severity of symptoms. "We don't have any approved therapies for PACS," notes Dr. Goldman. "Mostly it's symptomatic management."
</p>
<p>
Supporting patients and being transparent with them is also important. "When I talk to patients, I tell them we're not going to be able to fix this in one stroke," says Dr. Barkett. "We're going to try some things, check them, and adjust. We will be working on this over the long term."
</p>
<p>
The good news is that for most patients, symptoms seem to resolve over time.
</p>
<p>
"It's comforting for patients to hear that they will get better eventually," Dr. Goldman says.
</p>
<p>
Still, even with that positive news, there are caveats. For some patients, says Dr. Linares-Hengen, "it's a picket-fence recovery: good days and bad days."
</p>
<p>
There is also a subset of patients who don't get better. "For some patients, six months along, they are still having debilitating symptoms," says Dr. Barkett.
</p>
<p>
Moreover, the very definition of "long-haul" keeps moving further out as time goes on. "The longer the studies go post-COVID, the more we see symptoms lingering because of the nature of real- time research," says Dr. Linares-Hengen. "First it was a few months, then six, then eight, and now reports of a year out."
</p>
<p>
Multiple research studies are underway to better understand PACS. One nationwide master cohort study is seeking to enroll 10,000 patients. "If we knew what causes the different manifestations of PACS, we could treat people better," says Dr. Goldman.
</p>
<p>
Meanwhile, the medical system will be faced with how to handle the influx of PACS patients. A lot of the burden may fall on primary care physicians and providers.
</p>
<p>
"It's going to be very taxing to our medical system, probably in a way we haven't seen before," says Dr. Linares-Hengen. "Most of these patients will present in primary care settings. There is not going to be the infrastructure to be managed only by some specialists."
</p>
<p>
Still, says Dr. Barkett, the primary care physician may have a unique advantage in treating PACS patients. "One of the things we can do in reassuring patients is leveraging our existing relationship with them," he notes. "With a lot of things in medicine, the trust and comfort with the clinician making a recommendation makes a big difference. We can be a support system for them."
</p>
<p>
Dr. Linares-Hengen agrees.
</p>
<p>
"Many of these patients are looking for some relief in a world of uncertainty," he says. "We need to be able to listen to them with compassion when it's hard to pinpoint the exact physiological derangement, as well as to help through the uncertainty of treatments. Even though we don't have great answers, they still need our ear."
</p>
<p>
<em>John Gallagher is a freelance writer who specializes in covering health care. He is a regular contributor to WSMA Reports.</em>
</p>
<p>
<em>This article was featured in the September/October 2021 issue of WSMA Reports, WSMA's print newsletter.</em>
</p>
</div> | 9/1/2021 12:00:00 AM | 1/1/0001 12:00:00 AM |