WILKES-BARRE — Recent research on the healthcare system’s response and challenges in the face of COVID-19 detailed in the 2020 Indicators Report compiled by The Institute for Public Policy and Economic Development at Wilkes University, revealed a number of important findings.
According to Teri Ooms, executive director of The Institute, and Andrew Chew, senior research and policy analyst, the research showed:
• Inadequate stockpiles of personal protective equipment, shortages of COVID-19 testing supplies, and a lack of coordination in allocating available resources hampered the healthcare system’s ability to respond.
• Shortages in stockpiles of supplies have been intensified by a decline in public health funding and the current fee for service model of the healthcare system.
• Limitations in the health IT infrastructure made it difficult to collect and consolidate data on COVID-19 cases and testing results and develop a coordinated response.
• Communications from federal and state authorities, including changing guidelines and sometimes contradictory messaging, led to confusion among healthcare providers and the general public.
• There is an increased need for testing and contact tracing which will be managed at the state level.
• The surge in unemployment is likely to increase the uninsured rate and expand the need for public health insurance as workers lose employer-sponsored health coverage.
• The use of telemedicine and other methods for remote access and patient monitoring increased due to limitations on in-person care.
• All health care providers, including hospitals, community health centers, and long-term care centers, have faced significant clinical and financial challenges in responding to the pandemic.
“As we all know, the COVID-19 pandemic has been perhaps the most immediate public health concern this year,” Ooms said. “Our region has been significantly impacted.”
The report shows that Luzerne County saw a significant growth of cases in early April, which were largely centered around the Hazleton area.
However, the rate of growth in new cases in Luzerne County leveled off and has been gradually flattening since.
Lackawanna County saw a steady growth in cases through May, and the rate of new cases didn’t significantly slow there until late May. Lackawanna County has had a particularly large proportion of its cases in long-term care facilities.
Both counties have a higher rate of total COVID-19 cases than the state as a whole.
Ooms said the Health and Health Care section of the 2020 Indicators Report identifies important health indicators in Pennsylvania and Lackawanna and Luzerne counties.
These indicators include death from health conditions such as cancer and heart disease, death by suicide, infant and child mortality, childhood lead exposure, teen pregnancy, unhealthy behaviors such as cigarette smoking and excessive drinking, health insurance status, obesity, and the availability of health care facilities such as hospitals and nursing homes.
The report shows the rate of death from cancer is an indicator affected by behavior (such as smoking, which is known to cause various types of cancer) and by health care (cancer death rates decline as access to the latest treatments improve).
“Demographics also complicate these statistics; cancer is more prevalent among older individuals, for instance,” Ooms said. “The cancer death rate in Lackawanna and Luzerne counties is significantly higher than for the Commonwealth as a whole.”
According to Chew, the age-adjusted rate of death by heart disease – another leading cause of death in the U.S. – is similarly impacted by health-related behaviors and access to health care.
“Although the rate of death by heart disease was lower in 2017 than it was in 2009 (for both counties and Pennsylvania), it increased in Lackawanna and Luzerne counties following a decline in the previous year,” Chew said. “The rate of death by heart disease is significantly higher in both Lackawanna and Luzerne counties than in the Commonwealth as a whole.”
The reports also shows that positive test results for elevated childhood lead levels, as identified in screenings of children younger than 72 months, is more common in Lackawanna County than in Pennsylvania as a whole. Screening for childhood lead exposure is not mandated; nonetheless, there was a noticeable increase in the percentage of children tested statewide and in Luzerne County in 2018, while the percentage tested in Lackawanna declined slightly.
Effects of persona behavior
Ooms said personal behavior impacts many health conditions, including, but not limited to, heart disease and cancer. Making healthy lifestyle choices is extremely important.
“However, eating healthy can be costly and access to healthy food can be limited,” Ooms said. “At a time when many area residents are living with low or moderate incomes, healthy choices are not always top priorities.”
Ooms went on to say that issues of social determinants and the existence of food deserts in the region also complicate efforts to improve population health. She said the adult obesity rate has stood at around 30 percent regionally and statewide in recent years.
“In two key health-related behaviors, this area has performed worse in recent years than the state as a whole,” Chew said. “Cigarette smoking has been more prevalent in Lackawanna and Luzerne counties than in Pennsylvania, and excessive drinking has been at least as frequent regionally as it is statewide.”
Chew also said drug overdose deaths have risen in both counties compared with several years ago, despite drops in the opioid prescribing rate. He said fentanyl is a major factor in persistent deaths from drug overdoses.
“The prevalence of these high-risk behaviors is a significant public health concern,” Chew said.
Health insurance coverage
The report shows that health insurance coverage of area residents has improved between 2010 and 2018. A considerably larger proportion of individuals had coverage in 2018 than in 2010, largely due to an increase in people covered by public health insurance.
“There has indeed been a strong increase in public health insurance regionally, while the percent of the population covered by private health coverage has been slowly declining regionally and statewide,” Ooms said. “Enrollment in federal marketplace plans has been dropping in both counties and in Pennsylvania overall.”
Finally, Ooms said the cost of health care is an important concern. Though Lackawanna and Luzerne counties are homes to multiple health care resources and the number of beds available in hospitals has not declined significantly, cost could impede access for those who are under-insured or uninsured.
The report shows that between 2013 and 2018, for example, the daily private hospital room rate has increased by 29 percent in Lackawanna County and by 58 percent in Luzerne County. The semi-private daily room rate for nursing home facilities has also grown since 2012.
Furthermore, nursing home beds per 1,000 seniors have declined compared with 2012 rates, despite a recent uptick.
”This is a concern because the region’s growing senior population and increasing life expectancy will likely drive demand for long-term care,” Ooms said.