COVID-19 FAQs to help you answer client questions

Let me take a quick look to see how things look across the United States and then we’ll drill into some of those individual topics. As you can see here, as you’ve probably been seeing in the headlines, this is a view of the United States and what’s happened since basically during 2021, so what’s happened since January has basically been the steep decline during the January and February months. But since then our last five, six seven weeks or so, you can call it what you want but it basically looks like a plateau to me for that extended period of time, with some upswings and some downswings during that time, especially over the last couple of weeks. As we have seen, that’s driven by some select pieces in parts of the country but definitely starting to tail up a little bit. What I would say is that hasn’t so far resulted in any significant increase in mortality. You can see the black line here continues to trail down, maybe starting to level off a little bit. We know that mortality is a lagging indicator to cases so we’ll continue to track this. Hopefully you see that doesn’t start to spike up but good to see that still staying flat, if not declining.

On the next slide we thought everyone’s really interested, myself included, on where we are from a herd immunity perspective and so I put together this visual just to kind of show how things have tracked over the past eight or nine weeks here. You can see in orange are those folks that have had some sort of vaccination. That doesn’t imply that they’re all completely vaccinated, but at least had some sort of vaccination. And the blue bar, quick portion of the bar, are those people that had a known case of COVID. As a country, on the far right, we’re up to over 9% of the population has had COVID, at least a known case of COVID, and 36% of the population having some sort of vaccine delivered to them. Now, case in point, speaking from personal experience, you do need to have both vaccinations to be fully protected, but we know that there’s at least some protection from partial vaccination as well. So we’re up to when you combine those two bars together on the right hand side, over 45% of the population has some sort of protection at this point. And that’s increasing at about 4% every week. Next page.

If you break that out by state you can see there’s a wide range of I’ll call success rates here, where we have states on the far right that didn’t have much COVID to begin with and aren’t doing a great job around vaccination rates, where you get into the 40% range. But you have some states in the Dakotas and New Mexico and so on, that are approaching 60% of their population again, either having a known case of COVID or having some sort of vaccination so far.

The next page is where I take that math and up it a little bit and take into perspective the known cases of COVID is likely the tip of the iceberg. No one knows for sure what the actual COVID rate is in the community but we know that it’s some multiple of the known COVID population. And there’s lots of different studies that are out there. The study that I reference here notes that it’s likely three times the known cases, the actual cases of COVID. So if you do that math, now as a country on the far right hand side, we’re up to 28% of the population probably had some form of COVID in the past and we again, have the 36% that had a vaccine, gets us to over 60% of the population. And again, increasing by four to five points every week. We’re getting into some big numbers and we’re getting those percentages up into the upper 60s. Gets us into at least the neighborhood of starting to talk about when does herd immunity start to make an impact here.

And the next slide shows that broken out by state and again, wide variability but can see there are some states on the far left who are above 70%, even above 80%. So again, we don’t know for sure what that assumed COVID number is. Probably somewhere in the middle. But we’re getting into some significant percentages on here as we start to talk about and look forward to herd immunity. Next page.

Don’t forget, as part of your UCH reporting package, we have obviously, been keeping everyone up to date with all the COVID experienced, the number of cases, the number of tests, and now the number of vaccines. So you will see that in your report that’s being delivered to you on a regular basis. Just note, there is gaps in our reporting. Not every vaccine that’s being delivered is being administered or submitted in a claim to us so there will be some gaps until we get some of those state and federal registry data flowing through. But until then, just know it’s as wide and an expansive look at vaccination rates as we potentially could deliver to you.

And then the next slide, I thought it would be good to talk about Michigan. It is the headline. Michigan has had more case, COVID cases in the past week than they’ve had during any point in the pandemic so really rising. A very different chart. Instead of a decline during the spring, we’re seeing an increase, a significant increase in the last few weeks here. Obviously, a focus in the country. We still see mortality has stayed down consistently, but the last couple of weeks it’s starting to creep up in Michigan as well so we’re potentially starting to see some of that lagging indicator.

And then finally, we know that COVID is not just about screening and testing and vaccination rates. The ripple effect that this has had on the US healthcare system is going to be felt for a long time and especially when it comes to mental health. And so as we look at our [PH 00:05:14] book of business and see the change, the upswings in some of these conditions and the prevalence of these conditions, such as anxiety disorders and specifically in kids, we’re seeing this is likely something we’re going to be talking about for a long time. During the pandemic and as we get out of the pandemic, these types of issues are going to be near and dear in the core chronic disease for us to keep tabs on.

I’m Dr. Rhonda Randall. I’m the Chief Medical Officer of UnitedHealthcare’s Employer Individual Business. As Craig’s data showed us, today we have nearly 560,000 deaths reached from COVID-19 in the United States. And that has touched every one of us. Today is the anniversary of the death of my aunt. She died in a nursing home in Pennsylvania and she died alone and no one was able to attend her funeral. Now that I’m vaccinated, I’m looking forward to traveling to visit her grave site. So it’s something I’m glad Allison brought pieces around grief, the pieces around adolescence, the high school students, elementary school students have had, college age students have had a long, prolonged loss of milestones over the last year. I think it’s important to reflect on all of that.

I’m going to start with some of the trends that we’re seeing in return to care. There’s some good news, some facts I want to share with you, and some things that we still need to do a lot of work on as a healthcare system. I’ll start with the good news. Childhood immunizations and medication refills for chronic conditions like diabetes and cholesterol are up the first quarter of 2021 versus the first quarter of 2020, even pre-pandemic. There’s some encouraging trends with return to care that are showing us that we are with some measures improving, even over pre-pandemic rates from the prior year. One of the things that concerns me is related to the data that was just shared with you in behavioral health. We’ve seen a four-fold increase in children and adolescents who have prescriptions for anti-psychotics. The good news is that they’re getting care. The bad news is that those diagnoses are on the increase. And we still need to see improvements in cancer screening. We’re seeing cancer screenings pick up but there’s still a ways to go for things like breast cancer, colon cancer, cervical cancer, and other required cancer screening.

Let me move next to talk a little bit about an update on the variant. The variant labeled B.1.1.7. This is the variant that was first identified in the UK. It now represents more than 40% of the strains circulating in the United States. The strain B.1.351, which was first identified in South Africa, and the strain P.1, which was first identified in Brazil. Each of those represent less than or right around 1% of the strain circulating in the United States. There seems to be a significant increase in the transmissibility with particularly the B.1.1.7, which was first identified in the UK, compared to the original circulating variant. Newer studies are showing that there does not seem to be an increase in mortality that was first thought to be under investigation. More transmissible, similar severity. Important to note. From a natural immunity perspective, studies are just starting to emerge now that show that our T cell responses are effective on most of the circulating variant and most of the circulating mutations. So that’s good news as well. Studies are undergoing with those variants with the various vaccines that have been developed and approved in the US and in some other nations as well.

Let’s move next to do a little bit of a deep dive on vaccines. So here’s good news. Nearly 250 million doses of vaccine have been delivered in the United States and about four out of five of each of those doses have been put into arms and administered. As of yesterday, almost one-fourth, just under 23% of the US adult population has been fully vaccinated and more than a third, nearly 37% of the US adult population has received at least one dose. That percentage is much higher when you look at those at highest risk for severe illness and death. For those over the age of 65, nearly 63% of them are fully vaccinated and 80% have had at least one dose. That’s great news in protecting the most vulnerable.

Let’s talk next about the news of yesterday, a pause on J&J. As of April 13th, the FDA and CDC recommended a pause in the use of the J&J Janssen COVID-19 vaccine due to a rare and severe blood clot in some individuals who received it. This represents six individuals out of the nearly seven million individuals who have been vaccinated worldwide. There is not yet an established cause and effect relationship but safety being a top priority and the use of this vaccine has been asked to be put on hold out of an abundance of caution so that they can do further review and analysis in the coming weeks. So for those who’ve received their Johnson & Johnson vaccine, the potential concern doesn’t seem to have any impact on the effectiveness and if you have questions, think you might be experiencing an adverse reaction, we recommend that you call your primary care provider or other healthcare professional. We’re also seeing with this process with safety protocols are in action. As I said earlier, no cause and effect has been established. The pause is to study that in detail and see if there is a difference between those who have received the vaccine and the general population.

Some other pertinent vaccine updates. Moderna is now in phase 1 trials for a version of their vaccine that only requires standard refrigeration. So it’ll be a little longer before we have news on that. Children and adolescents, I get a lot of questions on these. Pfizer, their current emergency authorization is for ages 16 and up. They are right now in a phase 3 trial of 2,200 volunteers between the ages of 12 and 15. They published that data just a couple weeks ago on March 31st and last week they asked the FDA to expand their existing emergency use authorization to include ages 12 to 15. There is no date yet and when the FDA will make that decision.

Moderna began testing phase 2/3 in 3,000 adolescents in December of 2020 and they recently began a trial in infants and children aged 6 months to 11 years, in the middle of March. Similarly, J&J announced on April 2nd that they began phase 2A trial in adolescents age 12 to 17. So it is likely that we will see in the next coming weeks the ability for Pfizer to go to younger ages and Moderna and J&J possibly fast following later this summer, making things look good for next school year. Thirteen vaccines have been approved by regulating bodies worldwide and I anticipate that we will see two additional manufacturers apply for review by the FDA Vaccine and Related Biological Products Advisory Committee in the coming month. That would be AstraZeneca and Novavax.

I get questions often. I’ll cover a couple of them now and then we’ll see if there’s more that come in Q&A. Will we need to get an annual vaccine like the flu shot or will we need to get a booster beyond the single dose or the double dose shot? Well, the science isn’t definitive on that yet. What we know now is that the current vaccines that have emergency use authorization have demonstrated immunity from the virus for up to six months and we’ll hopefully find that that’s longer. It would be great if we found out it’s for a lifetime, but it’s too soon to say that. And Phil will comment later on how our business is ready for this, in his section.

Other questions that I get often are, should we make the vaccine mandatory for our staff? There is a lot that you need to consider in making that decision. The first is, right now, the vaccines have emergency use authorization, not full FDA approval so you may decide that you want to use that as a marker for when you make a decision. The supply and access to vaccine may be another consideration that you take. What exceptions you would take and the industry you work in. So if you have ER physicians or long-term care workers in your plan, your decision may be different than other industries. So lots of considerations to take into account. I think one of the best things to do right now is make sure that access is easy, provide good education, have a good leadership shadow and support vaccination generally.

Next time we get together, I hope to talk to you a little bit more about what we refer to as COVID long-haulers. That’s not just a single disease. It’s actually a host of different symptoms that we see several weeks to months after recovery from COVID. And we can talk about that in greater depth.

I’m Allison Davenport from Optum Behavioral Health. We’ll spend a little time talking about the trends that we’re seeing, as Craig said, and we’ll talk about just a couple of examples of how we can respond. So I want us to reflect for just a minute on what Craig was just saying, through the lens of the lens of the whole person. As Craig noticed, we are seeing increases in these presentations of psychological distress. One of the things our team is watching very, very closely, if you’ll just flip to the data slide if we’re not there already – thank you – is the substance abuse trend that you see increasing. I want to draw out here – and you can see it on the slide but I’m going to go a little bit deeper – I want to draw out the health disparities and the inequities that you’re seeing here. And you can see them very plainly but it’s important for us all to know that the percentages of people who were reporting these symptoms have increased between August and January of this year. It's a very short amount of time but we see disparities even in how these symptoms are increasing. And this really underscores a need to ensure that our members are able to access high quality, culturally competent, and equitable healthcare. We can move on.

I would guess that many of us think and maybe dream about the conclusion of this public health crisis as an end point and as Craig said, the reality is that for our individual and collective mental health, this will be with us for a while. We’ve experienced financial stress, loneliness, isolation. We’ve been away from families. Grandparents have not been able to hug their grandchildren. All of this has a profound effect that isn’t short-term. While many of us have spent a year at home, we have to remember and at Optum Behavior Health we especially have to pay attention to the fact that home is not a place of safety and refuge for everyone. We remain concerned about domestic violence, interested in promoting awareness aware that issue, which we’re doing a little bit right here. And also providing access to trauma informed care. We can keep going.

We’ve talked about a lot of the impacts of the crisis here. I think the one that we haven’t touched on just yet is grief. So many people have lost so much and I think that the inability of us to mourn those losses in ways that are organic for us or customary for us, just compound that. So all of these factors have an impact. Let’s shift to talking about how we can respond. I would offer that what we’re creating right now and what’s essential for us is not just a series of solutions but really an ecosystem that addresses our employees, our people as the dynamic human beings that they are with needs that vary, with needs that change, and who have choices that we must honor. This visual shows just a range of assets but really just a small sample of the range of assets that we’re deploying now to create that experience for people. You can see here, we’ll talk about education and awareness in just a second. But we’re talking about coaching. Some people may prefer a self-guided coaching experience. Some people need more support to address a short-term emotional concern. And some people need support and treatment for a series and diagnosed behavioral health condition. We need an ecosystem that addresses all of that.

I mentioned education awareness and these materials invite us to think about that I think in a little bit of a new way. It’s probably really hard for you to read the words on here. It’s really hard for me without my glasses. So I’ll read you some of the words on this slide that I think are pretty powerful. Choose empowerment over shame. Adults are pictured here but that’s a really important message as we start to think about our and that’s where we’re going to go next. I know that these are concerning statistics but it’s really, really important that we talk about it because our kids are impacted too. One of the things that we can do, we must do right now and we are doing, is to simply the care for kids and for the parents who care for them. What I’ve heard from parents who are caring for children with a health concern, whether it’s medical, physical, behavioral, is that caring for them requires the parent to do a lot of navigation and a lot of work. Our family support program offers a specialized care advocate on our clinical team who’s that family’s expert guide to speed access to treatment and to eliminate dead ends for that family. If you can see on Craig’s slide, eating disorders were a condition there and we know that this often impacts people in their youth. On the next slide we’re showing a tool that clinicians, patients, families, can use to navigate all the points of care in one single recovery record. Very recently in a couple of states and a couple of products we’re offering access to virtual care for eating disorders that treats patients in their own homes through the provider Equip. And we can keep going.

I’d say finally, to conclude, if you have EAP, leveraging the digital infrastructure of EAP as your entry point to care is a great way to get there. But I want to thank you so much for allowing me to spend some time with you and I hope that you’re safe and well until we meet again.

Allison, I’m going to start with you. Could you talk a little bit about more on the behavioral health side, what we’ve been doing around tele-behavioral and some of the trends we’ve been seeing there and the access that we’ve really been working hard to create there?

Yup, happy to. Optum Behavioral Health has and has had one of the largest virtual networks, I think in the industry, and certainly in COVID a majority of our outpatient visits were conducted through telehealth. And the questions I get a lot are, is it clinically effective and is it efficient? And we’re reviewing this all the time and what our studies indicate right now is that this is a clinically effective modality for certain conditions. And is it efficient? What I hear from providers and the studies that we see show that we have higher appointment compliance so people keep their appointments. They don’t miss them, they don’t cancel them. They tend to stick with treatment, so better treatment adherence. And we see this across technologies and actually across disorders and population. So that’s some perspective for you, Phil.

Great. Thank, you Allison. I’m going to keep going with you with one more and just talk about adolescent challenges and specifically leaning in there and what we’re thinking about. I can just tell you. I know for those of you who are listening to us today, you’ve talked to so many families and what our kids have had to go through, particularly kids 14 to 20, and the challenges are just immense. Can you talk a little bit about what we’re really focusing on there and what we’re trying to do and how you think about that?

I can and I agree with the challenge. Many of us are parents, we see it. And if we just step back a second and look at the data, the CDC shows that the second and third quarters of 2019 versus 2020, we see a marked difference in kids coming to the ER, presenting at the ER for behavioral health concerns. Ages 5 to 11 increased 24%, 12 to 17, 31% increase in presenting at the emergency room for a mental health concern. We think about the response in kind of three ways. First, identify. So particularly for children who have come to that higher level of care as a first step, identifying them through our data, intervening. Ensuring that we’re getting care advocacy matched up with that family is critical. Engaging them. So how are we engaging the caregivers of those children, either through a digital experience, through care advocacy, the family support program I talked about. Helping them navigate the system and then to really ensure that we’re helping to guide people too as they go through that journey. And a special concern I think, particularly on many people’s minds right now, LGBTQ and youth of color. How are we ensuring culturally competent care for them? We actually have a partnership with the TrevorProject right now to focus more on those disparities that we see and use. So broad brush but that’s sort of some of the things we’re thinking about.

That’s great, Allison. Thanks. And I just want to pull something out that you said there for our clients here today, which is increasingly what we’re trying to do is we’re using our data sets and we’re not waiting for someone to present at the emergency room. We’re trying to look at other situations and try to be proactive in trying to engage those populations. And there’s obviously very different needs across the behavioral spectrum but we’re not waiting and we’re trying to get much more proactive.