Catholic Health World - February 15, 2021 by Catholic Health Association

Collaborating with diocesan bishops 2 Executive changes 7 COVID and dementia 8 PERIODICAL RATE PUBLICATION

FEBRUARY 15, 2021 VOLUME 37, NUMBER 3

Doctor who treated first U.S. COVID patient reflects By LISA EISENHAUER

Looking back on the year that has passed since he treated the first U.S. patient confirmed to have COVID-19, Dr. George Diaz finds reasons to be encouraged even as the pandemic continues to rage. Diaz is an infectious disease specialist with Providence St. Joseph Health based at Providence Regional Medical Center Everett in Washington state. He has been among the leaders guiding the system’s response to the pandemic. At 49, he has been practicing in his specialty field since 2005. He and his colleagues in Everett not only successfully treated that first patient, including making use of the antiviral remdesivir for COVID treatment for the first time in the world, they helped develop the system’s protocols for COVID treatment. They have taken part in clinical studies for other promising drugs and been part of a Continued on 6

Thoracic surgeon Dr. Kumari Adams of Saint Joseph Mercy Health System of Canton, Michigan, mugs for the camera after receiving a COVID inoculation.

Dr. George Diaz and other members of the infection control team at Providence Regional Medical Center Everett in Washington state take part in a moment of silence on Jan. 19. The event marked the one-year anniversary of when the first patient confirmed to have COVID-19 in the nation came to a Providence clinic for care.

As COVID symptoms linger, doctors search for causes, treatments Care providers say the experience of long haulers underscores the importance of masking and other infection precautions

Ministry facilities aim to increase vaccine acceptance among people of color

By LISA EISENHAUER

Trust building, authenticity are essential People of color have had higher rates of infection, more severe illness and higher rates of death from COVID-19 than white people. Many in the health system in the U.S. are aiming to ensure people in minority populations get equitable access to vaccination. Vaccine hesitancy is an early hurdle they are working to surmount. In a survey conducted by the Pew Research Center in late November before regulators gave emergency approval to the first vaccines, 42% of Black and 63% of Hispanic adult respondents said they would definitely or probably get immunized as compared with 61% of white adults. About 18% of the total survey group said that although they didn’t want to be among the first groups to be vaccinated, they hadn’t ruled out being vaccinated. A sampling of Catholic health leaders said their systems and facilities are committed to addressing racial disparities as part of the national COVID vaccination effort. They are being intentional about listening to the concerns of members of the public who are worried about vaccination and then addressing those concerns. The systems are focusing outreach efforts on minority and other vulnerable populations, including Black and Hispanic people and immigrants. Dr. Loren Robinson, vice president of medical affairs at CHRISTUS Health, said Continued on 4

Lisa Eisenhauer/© CHA

By JULIE MINDA

A care provider treats a patient with a history of COVID-19 in an intensive care unit at SSM Health DePaul Hospital in suburban St. Louis. Early studies show that about 10% of people who are infected with the virus suffer long-term symptoms, such as fatigue, headaches and sleep disturbances.

In January, Loyola Medicine opened a specialty neurology clinic that amounts to a stake in the ground on what could be the next frontier of the COVID-19 pandemic. It treats patients struggling with debilitating and unrelenting symptoms weeks or months after the acute stage of the infection. The condition known as long-haul COVID or long COVID is thought to occur in about 10% of people infected. It may reflect persistent immune activation and/or lingering inflammation, and may be independent of the severity of the initial COVID infection. Dr. José Biller, professor and chair of the department of neurology at Loyola University Medical Center in suburban Chicago and Loyola University Chicago Stritch School of Medicine, heads the clinic with two neurology colleagues. While the clinic’s Continued on 5

Health care improvement expert extols transformation based on morality By LISA EISENHAUER

Dr. Donald M. Berwick acknowledged that the call he put out to those attending CHA’s Sponsorship Institute to pursue “the moral determinants of health” was a big ask. He has mounted a campaign to urge the nation to refocus its efforts to improve health away from Berwick clinical care and toward addressing underlying causes of poor health such as underperforming schools,

low-paying jobs, inadequate housing and the social isolation of older citizens. He laid out his proposal in “The Moral Determinants of Health,” an opinion piece that appeared in the JAMA Network on June 12. “No scientific doubt exists that, mostly, circumstances outside health care nurture or impair health,” he wrote. Berwick expanded upon his thoughts when he spoke at the Sponsorship Institute on Jan. 19. The event, which continued on Jan. 21, drew about 100 people from Catholic health ministries. Its topic was “Charting a Path Forward for the Post-COVID-19 World and Church Relations.”

Berwick is a clinical pediatrician who has a long list of accomplishments. They include running the Centers for Medicare and Medicaid Services under President Barack Obama and being president emeritus and a senior fellow at the Institute for Healthcare Improvement, a nonprofit focused on motivating and building the will for change. He also was a co-author of two seminal reports on how to improve health care: To Err is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century. The reports were products of the Continued on 3

CATHOLIC HEALTH WORLD February 15, 2021

Updated guide illuminates relationship between bishops and health care ministries By JULIE MINDA

The scope, makeup and sponsorship of most Catholic health care ministries have changed dramatically over the last twoplus decades. In light of this, the bishops’ conference has updated a document originally published in 1997 on the relationship between diocesan bishops and these ministries in their dioceses. The intent is to continue to encourage mutual cooperation and communication. CHA is producing an accompanying study guide. The document and study guide will be published on the CHA website, likely in early March. Published by the United States Conference of Catholic Bishops in mid-January, the second edition of “The Pastoral Role of the Diocesan Bishop in Catholic Health Care Ministry” explains the role and theological grounding of health care in the Catholic Church. The USCCB document explains that bishops have authority over the health care organizations within their dioceses. They are responsible for safeguarding the integrity of Catholic health care in their respective dioceses, promoting the celebration of sacraments, and ensuring that pastoral care is provided in those facilities. Fr. Charles Bouchard, OP, CHA senior director of theology and sponsorship, said the document suggests bishops interpret and promulgate the EthiFr. Bouchard cal and Religious Directives for Catholic Health Care Services in their dioceses with consistency. “Because the USCCB has no juridic authority over individual bishops, the bishops issue the ERDs as directives and not legislation. The new document suggests that a bishop can strengthen the legal authority of the directives by promulgating them as ‘particular law’ in his diocese,” said Fr. Bouchard. “Making them law does not affect the bishop’s right to interpret them, but it does help assure a consistent standard from one diocese to another.” The document calls for ongoing dialogue and collaboration between bishops and the leaders of the Catholic facilities within their dioceses, as well with other

At a CHA virtual Sponsorship Institute webinar last month, Bishop Kevin Vann, bishop of Orange, California, displays a memento he keeps in his office as a reminder of his long history in Catholic health care. He worked as a medical technologist at what is now HSHS St. John’s Hospital in Springfield, Illinois, before leaving to join the priesthood.

Catholic ministries, such as Catholic social services. The document also calls for partnership between bishops and ministry leadership around Catholic health care formation programming, palliative care services and community benefit. It emphasizes the importance of ministry leaders keeping bishops abreast of activity, such as mergers and acquisitions, that affects the composition of the ministry. Bishops should be informed as early as possible of such negotiations, according to the USCCB. The document lays out some top challenges and opportunities the ministry is facing now. Sr. Mary Haddad, RSM, CHA president and chief executive officer, said, “As the complexities of health care in the United States continue to evolve and as Sr. Haddad we strive to care for those who are poor and vulnerable, it is vitally important to ensure collaboration between the diocesan bishop and Catholic health leaders.” She said the CHA study guide will be a valuable resource for bishops and health care leaders alike to reflect on their mutual responsibility for Catholic health ministries and explore ways to foster greater collaboration. “The strength and viability of our health ministries depend on it,” Sr. Mary said.

Different environment Fr. Bouchard said that when the bishops’ conference published the first edition of the “The Pastoral Role of the Diocesan Bishop in Catholic Health Care Ministry,” the vast majority of Catholic health care organizations looked very different than they do now. Ministry systems generally were smaller, less complex in composition and more geographically contained than today’s systems, and almost all were sponsored directly by a religious congregation, diocese or other type of religious institute. In 1996, the year prior to the publication of that first edition, Catholic Health Initiatives established the Catholic Church’s first pontifical public juridic person. The creation of the Catholic Health Care Federation PJP allowed for the congregations that had came together to form CHI to be represented on that sponsor board. The model also allowed for greater lay representation on that board. That sponsorship model since has become the norm for Catholic health systems. Also, it is now typical for Catholic health systems to span multiple states and encompass a much greater variety of clinical and non-clinical business lines. Some have for-profit and non-Catholic subsidiaries. The complexity and other factors have changed the environment in which bishops oversee the health care facilities within their dioceses, and how they interact with those

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facilities’ leadership, said Fr. Bouchard. The updated document addresses those shifts. CHA’s study guide contains commentary from CHA sponsorship and formation experts. Fr. Bouchard and Bishop Kevin Vann, bishop of Orange, California, introduced the USCCB document and the CHA study guide at CHA’s virtual Sponsorship Institute last month. Bishop Vann and Fr. Michael Fuller headed the USCCB committee that updated the document. Fr. Fuller was recently appointed associate general secretary of the USCCB. Fr. Bouchard is encouraging Catholic health systems and facilities to Fr. Fuller become familiar with the updated document and perhaps have a dialogue with the bishops who oversee their ministries about the content of the USCCB document and the implications for their facilities. CHA will host a series of educational sessions in the coming months to acquaint ministry leaders and others with these resources. Fr. Bouchard said he thinks the document and commentary “could be an opportunity for our Bishop Vann ministry leaders and their bishops to sit down together and discuss how they can improve their collaborative relationship.” Bishop Vann told Sponsorship Institute participants that he’s had a career-long affinity for Catholic health care. Before entering the priesthood, he had been a medical technologist at a Catholic facility. He said that in his 15 years as a diocesan bishop, he has experienced firsthand the benefits of being integrally involved with the facilities he oversees. Bishop Vann said he has regular meetings, phone calls and visits with the leaders of the health care facilities in his diocese. He makes pastoral visits to patients and staff, taking time to socialize in hospital cafeterias. He recommends this level of immersion by church ordinaries. jminda@chausa.org

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February 15, 2021 CATHOLIC HEALTH WORLD

Berwick on transformation From page 1

Institute of Medicine’s Committee on Quality of Health Care in America. The institute is now the National Academy of Medicine. He noted in his talk that the nation’s social ills have been brought to the fore in recent months by the COVID-19 pandemic’s harsher toll on communities of color and the systemic racism spotlighted by the police killing of George Floyd. However, he said the United States long has known that such inequities exist. He pointed out that studies have shown for decades that health conditions and shorter life spans correlate with poverty, hunger, crime and other societal menaces. “It’s no news at all and yet here is a country which is spending 18% of our gross domestic product on health care that is, I would guess, in policy terms, turning its back on cause,” Berwick said.

Committing to equity Berwick made several references to The Health Gap: The Challenge of an Unequal World, a book by British epidemiologist Michael Marmot. He described it as the most efficient and disciplined summary of the state of knowledge about the global causes of illness and health that he has ever read. The book points to five determinants of health — early childhood experiences,

education, work and the workplace, experi- social ills because of the pandemic and the ences of elders and community resilience. renewed cries for social justice, he said, Those five factors are the keys to a sixth now is the time to address them. determinant of health, which Marmot calls His campaign offers seven broad solufairness and Berwick calls solidarity, as in tions that he said will take political might to a sense that people in a society care about bring about: Ratifying major United Nations and for each other. “Marmot’s read back is when communi- human rights treaties that the U.S. is nearly ties and societies have a sense of commit- alone among democracies in snubbing. Making health care a human right. ment to equity they invest in the conditions Reversing climate change. of daily life, those five social determinant Reforming the criminal justice system. arenas, which make them healthier soci Reforming the immigration system. eties,” Berwick said. “Societies that toler Ending hunger ate high degrees of “No scientific doubt inequity, by the same and homelessness. Restoring dignity cascade, experience exists that, mostly, higher inequities in to democratic instituhealth.” tions and integrity to circumstances outside How those ineqthe voting process. health care nurture or uities play out in the “This is a weird list United States is obvito be showing a group impair health.” ous, in Berwick’s view. of health care leaders, He pointed to cities but that is in some ways — Dr. Donald M. Berwick such as New York and my point,” Berwick Chicago where life expectancies can be said. “I think health care needs to embrace predicted based on neighborhood, with morality in the pursuit of health and, thereresidents of those with the highest average fore, this agenda in the pursuit of health. I household incomes far outliving the resi- think this is our work.” dents of poor neighborhoods. He noted that those low-income neighborhoods tend to ‘A very big ask’ have high concentrations of Black and HisTo do that work will require more than panic residents. shifting the focus of the nation’s health policies, Berwick pointed out. It will Time is right require shifting resources, including some With the nation’s attention focused on of the $3.5 trillion that now goes to the

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health care system. “That is a very big ask. It means becoming party to, I guess, a transformation,” he said. “It means a new way to think about our work, new investments, new business models and the willingness to give up our hints of avarice — our political ability to confiscate resources — and to give it back to society for other uses.” In addition to advocating for broader change, Berwick said health systems and leaders can take direct action on their own. They can devise ways to reduce the per capita cost of care, change practices to reduce their own carbon footprints, set up programs to hire the recently incarcerated and boost the communities around their facilities by including local industries in supply chains. Berwick ended by acknowledging that his solutions for improving the nation’s health aren’t simple or perhaps even palatable for some health care leaders. “I apologize if I’ve offended anyone with this talk because I’m asking for more change than most have considered,” he said. “But I don’t see another route to well-being.” leisenhauer@chausa.org

CHI Franciscan, Virginia Mason health systems combine The CHI Franciscan and Virginia Mason health systems united in January to form Virginia Mason Franciscan Health. The joint operating company has a market concentrated in the Seattle-Tacoma area and in south central Washington. It is a subsidiary of Chicago-based CommonSpirit Health. The new system encompasses 11 hospitals — all but one of which were from CHI Franciscan — and nearly 300 sites of care, including primary and specialty care clinics, same-day surgery centers, and Benaroya Research Institute and Virginia Mason Institute, two medical research centers in Seattle, according to a press release from CommonSpirit Health. The new system employs more than 18,000 team members and staff and has nearly 1,500 hospital beds. Virginia Mason Franciscan Health is a Catholic health system. Virginia Mason facilities will remain non-Catholic. The legacy organizations, CHI Franciscan and Virginia Mason, have an equal number of seats on the board of the new system. Marvin O’Quinn, president and chief operating officer of CommonSpirit Health, is one of the board members. Virginia Mason Franciscan Health will focus on expanding patient access points and developing innovative models of care delivery that enhance quality and the patient experience, the press release said. CHI Franciscan and Virginia Mason had created several partnerships in recent years including a birth center and women’s health clinic in Seattle and oncology programs at St. Anne Hospital in Burien, Washington, and St. Francis Hospital in Federal Way, Washington. Dr. Gary S. Kaplan, the former chairman and Kaplan chief executive of Virginia Mason, and Ketul J. Patel, who is president of the Pacific Northwest Division of CommonSpirit and was the chief executive of CHI Franciscan, share the chief executive post at Virginia Mason Franciscan Patel Health.

CATHOLIC HEALTH WORLD February 15, 2021

Vaccine acceptance From page 1

it is central to the ministry’s mission to “keep people in the communities we serve healthy and out of the hospital so they can live their best and healthiest lives.” Robinson said to do this, the ministry “must address the long and storied history” between people of color and the Robinson health system. “We need to be transparent and accurate — we’re here as a resource. That is our duty,” said Tiffany Capeles, CHRISTUS system director, health equity, diversity and inclusion. Capeles

‘Tragic impact’ Dr. Rhonda Medows is president of population health management for Providence St. Joseph Health and chair-elect of CHA’s board. She said for many, vaccine hesitancy is Medows rooted in “the disproportionate and tragic impact of health disparities on people of color — including Black, Latino, Native and indigenous peoples.” She said many of these populations have a long history of suffering immoral and inhumane treatment at the hands of medical professionals, including being the unwitting subjects of cruel and dehumanizing medical experimentation. Mike Slubowski, president and chief executive of Trinity Health, said that while the most egregious cruelties are in the past, data shows that disparity continues today, including conscious and implicit bias in the care that is delivered to people Slubowski of color. Shivonne Laird, Bon Secours Mercy Health’s director of community health impact, added that compounding such inequities is the fact that, as a group, people of color can be at higher risk of conLaird tracting COVID and fare worse under COVID in part because of social determinants. For instance, a recent study found that

Dr. Norvell Coots, president and chief executive of Holy Cross Health in Silver Spring, Maryland, and chief executive of Trinity Health’s Maryland region, celebrates with colleagues after receiving his COVID vaccination. Coots, who is Black, has been encouraging people of color to get vaccinated.

many Black and Hispanic families are more vaccination selfies on their social media likely to live in multigenerational house- accounts. Many facilities have stood up holds and hold essential jobs that can’t be “selfie stations” for this purpose. done from home, increasing their COVID Employees can play a powerful role in risk. encouraging others to get the COVID vacMedows said, “We need to acknowledge cine, especially in vulnerable populations, what has happened CommonSpirit said in the past and what in a press release. “We need to acknowledge is happening now Employee survey re– what has happened in the sults released in late and respect people’s realities. But we are past and what is happening January showed 69% saying to not let past of Black respondents history stop us from and 77% of Hispanic now and respect people’s doing what we can respondents said they realities. But we are saying have been or intend to to get us beyond this pandemic.” to not let past history stop be vaccinated.

Role models Community us from doing what we Slubowski said connections can to get us beyond this Trinity Health is Trinity Health and using the system’s Providence St. Joseph pandemic.” 123,000 colleagues Health are tapping — Dr. Rhonda Medows across 22 states as a into the informal and type of microcosm formal networks of for the population at large. The perceptions community health workers that they had they’ve shared are consistent with national been establishing well before the pandemic polling conducted by others: employees began. These individuals promote the health who are people of color have expressed of their neighbors and improve health care more concern than their Caucasian col- access for medically underserved people. leagues about vaccination. Part of how Their close ties to the community are provTrinity Health has been addressing such ing vital now. hesitancy is by engaging its clinical and The community health workers are lisadministrative leaders who are minorities in tening posts for the health systems, meettalking to employees about their confidence ing with community and church groups in the COVID vaccines. and their own clients to get unfiltered CommonSpirit Health says it is encour- information about the reasons behind vacaging employees to get vaccinated through cine hesitancy or barriers to vaccine access outreach that includes debunking myths and reporting back to their health systems. about vaccine danger. To spread the word They’re also engaging with other commuabout vaccine safety to hard-to-reach com- nity influencers to spread their pro-vaccine munities, employees of color are posting public health message.

As vaccine rollout expands, Black Americans still left behind By HANNAH RECHT and LAUREN WEBER Kaiser Health News

The ongoing disparity in vaccinations may be a self-fulfilling prophecy: A Kaiser Family Foundation poll released in late January showed a correlation between people who know someone who has lack Americans are still receiving COVID-19 vaccinations at dra- gotten the vaccine and their willingness to get it. Thus, it is harder matically lower rates than white Americans even as the chaotic to gain ground in communities that don’t have many people getting vaccinated. rollout reaches more people, according to a Kaiser Health News One of President Joe Biden’s first executive orders prioritized analysis. COVID data collection. He also established the COVID-19 Health By late January, almost seven weeks into the vaccine rollout, states had expanded eligibility beyond front-line health care work- Equity Task Force, led by Dr. Marcella Nunez-Smith, an associate ers to more of the public — in some states to more older adults, in dean for health equity research at the Yale School of Medicine. All 23 states that were reporting vaccine data by race in late others to essential workers such as teachers. But new data showed January break out numbers for Black and white residents. But that vaccination rates for Black Americans had not caught up to beyond that, data is often limited. Eight of them do not report those of white Americans. specific numbers for Native Americans and Alaska Natives, who are Across the U.S., non-Hispanic Black Americans are 1.4 times more likely to contract COVID, and 2.8 times more likely to die of it, dying from COVID at 2.6 times the rate of white Americans, according to the CDC study. than white Americans, according to a Centers for Disease Control Vaccine providers have been required by the CDC to collect race and Prevention analysis. and Hispanic ethnicity information for each person they vaccinate. Seven more states published the demographics of residents However, race and ethnicity information in health care data is often who have been vaccinated after KHN released an analysis of 16 states in mid-January, bringing the total to 23 states with available incomplete, and COVID data is no exception. Although most states that provide the data have relatively low rates of missing informadata. tion, in a few states race or ethnicity demographics are missing for In all 23 states, data showed, white residents were being vachalf the people who have been vaccinated. cinated at higher rates than Black residents, often at double the In late January, CDC spokesperson Kristen Mordlund said offirate — or even higher. The disparities hadn’t significantly changed cials planned to add race and ethnicity data to its website by the with an additional two weeks of vaccinations. first week of February. It is not yet clear how the CDC will address In Florida, for example, 5.5% of white residents had received gaps in state data collection. at least one vaccine dose by Jan. 26, compared with 2% of Black residents. That’s about the same ratio as two weeks earlier, when Kaiser Health News is a nonprofit news service covering health the rates were 3.1% and 1.1%, respectively. issues. It is an editorially independent program of Kaiser Family The ongoing vaccination gap has prompted officials from Foundation, which is not affiliated with Kaiser Permanente. around the nation to call for action.

Laird said the community health leads in each Bon Secours Mercy Health market are helping planners understand how language barriers, mistrust of the health system and government, lack of broadband access among rural community members and similar issues may be contributing to vaccine hesitancy in these communities. They’re strategizing with the planners on ways to overcome the barriers. Bon Secours Mercy Health operates in seven states. Robinson and Capeles said an equity task force at the four-state CHRISTUS is spearheading similar intelligence gathering. Avera Health is working with individuals who hold sway in immigrant communities and representatives of organizations that are intertwined with these immigrant communities on vaccine acceptance. Such influential community members had smoothed COVID screening and testing efforts early in the pandemic, around the time that hotspots were first occurring in South Dakota. These community leaders helped Avera gain the trust of undocumented immigrants wary of health care workers. Those same people now are helping Avera understand immigrants’ concerns about vaccination.

Bidirectional communication Catholic health systems have been using the intelligence they are gathering on the ground and on social media to tailor their vaccine education and outreach to minority and other vulnerable communities. Medows regularly scans and posts on TikTok, Facebook, Linked In and Twitter to monitor public perception of the vaccines. She’s seen deceptive posts declaring that the vaccines contain microchips for tracking recipients. Another myth is that the vaccine will be used to sterilize women of color. Ministry systems and hospitals are hosting virtual town halls and webinars; encouraging their clinicians who are people of color to speak — in person or virtually — before churches and community groups; creating videos of people of color attesting to the efficacy of the vaccine; and rolling out social media campaigns to share information about vaccine safety, efficacy and access. Slubowski of Trinity Health noted that an ongoing challenge is balancing the great need to build confidence in the vaccines with the need to encourage patience, since most members of the public are having trouble accessing the vaccines currently, due to distribution issues. Authentic voice Laird said system and facility spokespeople are being honest about not having all the answers about the vaccines. Bon Secours Mercy Health representatives are working with community partners to understand what information would be helpful and the best ways to share this information. Bon Secours Mercy Health associates coordinating communications about vaccination are being careful to ensure that their efforts to put forward spokespeople are authentic. “We wouldn’t just want to spotlight a person of color, for example. We would want people to be able to see themselves and their values reflected in the message shared,” she said. Medows noted Providence St. Joseph Health takes pains to make sure people who are concerned about vaccines are treated with respect. “If we minimize people’s concerns, we lose the ability to communicate with them.” Robinson said CHRISTUS is ensuring that its vaccine education efforts are not perceived as pressuring people to take the vaccine. “Instead, we are empowering people with information to make decisions,” she said. Capeles added that honest, two-way communication with people of color “can build a bridge and cultivate trust.” Slubowski said of Trinity Health, “We take our role as a trusted health partner seriously. We believe the vaccine is the best path for ending this pandemic, and we are 100% confident in the vaccine. We’re using every vehicle we can to convey that to people.” jminda@chausa.org

February 15, 2021 CATHOLIC HEALTH WORLD

Long-haul COVID

long COVID appears to be a multisystem disease. Symptoms run along a focus is on neurological manifestations, the continuum from burdoctors will refer patients to other collabodensome to deadly. The rating specialists — including psychiatrists, condition can occur after neuropsychologists, pulmonologists, cardia life-threatening or relaologists, nephrologists, gastroenterologists, tively mild case of COVID. physical therapists and The researchers defined nutritionists — as needed. long COVID, or chronic Biller said that even COVID, as symptoms that though research on longlast for at least 12 weeks haul COVID is in the earlibeyond the onset of the est stages, evidence that the virus. infection can leave patients In May, Mount Sinai with lingering health probHealth System launched Biller lems is clear. what it called the “firstBiller and his colleagues at Loyola Mediof-its-kind” Center for cine — a three-hospital system that is part Post-COVID Care to offer of Trinity Health — are evaluating and man- A clinician at Loyola University Medical Center in suburban Chicago pretreatment from a multi– aging patients who are weeks past the acute pares to enter the room of a patient being treated for COVID-19. The medi- disciplinary team of stage when the virus was detectable in their cal center has treated more than 1,000 patients who have contracted the specialists. The system systems, yet still ailing. The patients’ symp- virus in the past year. did not define its tartoms may include severe fatigue; brain fog; get patient population loss of smell (anosmia); a distorted sense of “What we know already about the con- beyond those who need COVID-related taste or inability to taste (dysgeusia); head- dition, even though our knowledge is really aftercare. aches; vertigo; sleep disturbances; loss of less than one year old, based on what we muscle mass and strength (sarcopenia); and have seen at Loyola and what the literature Stricken on the job autonomic nervous system dysfunction, states, is that about two-thirds of individuals One of Biller’s patients is a woman in muscle cramps and pain (myalgia). who have had long-haul COVID may not be her 50s who was exposed to the virus on the Biller pointed to the results of a survey of able to return to full health,” Biller said. job and tested positive in August. She had 3,762 post-COVID patients from 56 counWhether those patients will eventually no underlying conditions to put her at eletries that was published in late December on regain their full health remains to be seen, vated risk and she nursed the virus at home the medical research website medRxiv. The he said. under the supervision of her primary care patients described more than 200 different Estimates of how many patients go on to doctor. (See sidebar.) Despite some lingersymptoms, the most common of which were develop long COVID syndrome vary widely. ing symptoms like headaches and fatigue, fatigue, post-exertional malaise and cogni- Even the definition of the malady is in flux. A she was well enough to return to work in tive dysfunction. paper published in The BMJ in August said October. By the end of the year her employer had notified her of three more exposures — the second and third exposures within two days of each other — and she went into quarantine each time. She had only one bout with acute illness. She hasn’t returned to work since late December when she was struck with speech problems so serious that she went to an emergency room two days in a row. A month later, her voice remained uneven. “My voice goes good for a while and then it goes bad. I get high volume, low volume. I get everything,” said the woman, who spoke on the condition that she not be identified. “The biggest rumor and myth is that people believe you have preexisting conditions” to have bad outcomes, the woman An explanatory graphic from the Centers for Disease Control and Prevention warns of long-term said. “I had nothing.” From page 1

effects from COVID-19.

Infection strikes patient in peak health, leaves lingering challenges S

he wowed her colleagues in July when she did a handstand on the armrests of a seat. It was a demonstration of strength and agility the 56-year-old had honed over years as a gymnast and later as a coach. She regularly swam 40 laps and bicycled for 10-15 miles. These days, just getting dressed can leave her winded. The woman, who spoke on the condition that her name and line of work not be revealed, said her athletic prowess drained away after she came down with COVID-19 in August. She joined a growing group of patients who endure lingering symptoms. Hers are uncontrollable fluctuations in the volume and timbre of her voice, severe headaches, shortness of breath and memory loss. She weathered the acute stage of COVID alone at her suburban Chicago home. She felt miserable, but her six siblings took turns checking on her and dropping off medicine and groceries. She had virtual visits with her physician and used a pulse oximeter to monitor her blood oxygen level. After her recovery she was cleared to return to work in October. On her first day back, she was exposed to the virus again. While quarantining, she studied for an annual exam required to keep her job. Severe headaches and a general brain fog made her feel almost as if she had suf-

fered a concussion. “I was so nervous and had to study so much extra on subjects that should be easy for me from years of training,” she recalled. She did pass the exam. While back on the job in December, she was exposed to COVID twice more. She has since been recuperating at home while she deals with her lingering symptoms and the new one that arose at the end of December: the inability to modulate her voice. Tests confirmed that she hadn’t had a stroke and she was negative for COVID. Since then, she has been under the care of Dr. José Biller, chair of the department of neurology at Loyola University Medical Center. By mid-January, he had ruled out aphasia, a loss of ability to understand or express speech caused by brain damage. More evaluations are under way. Meanwhile, she is working to overcome exhaustion and rebuild her endurance. Tests show that her heart and lungs are healthy. “I get tired every day of everyone asking me how I am,” she said. “I know they mean well but I get tired of thinking about it because I want to stay positive and focused.” — LISA EISENHAUER

Heart afflictions Dr. Lowell Steen is an interventional cardiologist, chief of cardiology for Loyola Medicine and a professor of medicine at Loyola University. He said his care of COVID patients and review of research confirms that those with long-term Steen symptoms are not necessarily those who had health issues beforehand or those who suffer the severest cases of the infection. He pointed to research published in July by JAMA Network. Doctors in Germany studied 100 recently recovered COVID patients who all underwent cardiovascular magnetic resonance imaging. “A total of 78 patients who recovered from COVID-19 infection had cardiovascular involvement as detected by standardized CMR, irrespective of preexisting conditions, the severity and overall course of the COVID-19 presentation, the time from the original diagnosis, or the presence of cardiac symptoms,” the study found. Two-thirds of the patients in the study had not been hospitalized for COVID. “I think the messaging about COVID early was not everyone’s going to die from it, it’s only 1%,” Steen said. “But my message to people is you don’t want to get COVID because we just don’t know the long term on it. And this is a perfect example of what I’m talking about, which is that even though you may tolerate the infection fine and think you’re fine, there are some longterm effects that you may not be aware of.”

The most prevalent problem the German study discovered was inflammation, which Steen said parallels what he and his colleagues have seen at Loyola. They even have had acute COVID patients present with symptoms that would indicate a major heart attack only to have testing reveal no blockage, pointing to inflammation as the culprit. While the link between COVID and heart complications is in the early phases of study, Steen said it’s another reason the virus should not be taken lightly even by people who are in top condition. He said he worries about professional athletes who resume playing just days after their COVID recovery. He recommends that his patients wait six weeks after they are cleared of the virus before they return to intense exercise. “We think COVID’s primarily an illness of the lungs because that’s where all the ACE2 receptors (that the virus binds to) are, but we now have scientific evidence that that’s not (exclusively) true,” Steen said. “It’s not just the lungs, it affects the heart as well, so we have to be mindful of that.”

Many unknowns Dr. Joshua Larned is a cardiologist and medical director for congestive heart failure services at Holy Cross Health, a teaching hospital in Fort Lauderdale, Florida, that is also part of Trinity Health. He and colleagues there are conceptualizing Larned a cross-disciplinary care program for post-COVID patients who have long-term symptoms. “We’re starting to see patients who are recovered from COVID, a large amount of them, who have some form of ongoing medical issue that they didn’t have before their COVID illness,” Larned said. How long the patients’ symptoms will last and whether those symptoms will affect their life spans are questions “we simply don’t have an answer to yet,” he said. Another unknown that concerns Larned is how prevalent the conditions are because many post-COVID patients and primary care doctors might not have made the connection between lingering symptoms and the infection. Until that is determined, he said the medical system won’t know how taxing caring for these patients is going to be. “This is a very, very important topic,” Larned said. “The story needs to be told now because we’re focusing so much of our effort appropriately on prevention and vaccination and managing COVID illness in its acute phase, but we haven’t really wrapped our clinical expertise around some of these symptoms that are present in the recovery phase.” Another reason for vigilance Dr. Ethan W. Carlson is a family practitioner in Baraboo, Wisconsin, and medical informatics director for SSM Health in Wisconsin. He said he and his colleagues are seeing many patients with what could be long COVID. They have sympCarlson toms like fatigue, loss of taste or smell, coughs and gastrointestinal issues that won’t go away. As to whether their ailments are definitely connected to COVID, Carlson said: “Of course we do not know that, and we cannot say that.” While doctors and patients wait for researchers to confirm the link and devise the best treatment protocols, Carlson is doubling down on his efforts to get his patients to take all precautions to avoid contracting COVID. “I think for quite some time we’re going to have to reinforce the importance of masking and social distancing and all the behaviors that have been important at the beginning and middle of the pandemic,” he said.

CATHOLIC HEALTH WORLD February 15, 2021

Dr. Diaz From page 1

vast expansion of telehealth that’s allowed many more patients to get medical care without leaving their homes. “I think that, at least within our health system, we’re proud of the way that we’ve dealt with this pandemic,” he said.

Ready early on As of Feb. 2, the United States had surpassed 26 million cases of COVID Diaz and more than 440,000 Americans had died from the virus, according to the Centers for Disease Control and Prevention. A year earlier, the nation had no idea what was to come. Diaz said Providence St. Joseph Health jumped into action early on. The system started prep work for caring for COVID patients as the novel coronavirus that causes the illness was spreading elsewhere in the world. His hospital stocked up on personal protective equipment, made plans to activate a special isolation unit and ran simulations so everyone would know their roles and proper practices. On Jan. 19, when a man who had recently returned from the virus’ epicenter in Wuhan, China, turned up at a Providence clinic in Everett with a potential COVID infection, clinicians were ready. “He was very upfront about his symptoms and his travel, and so at the clinic, they were able to get him appropriately isolated,” Diaz recalled. The clinic’s staff alerted the Snohomish County health department, which in turn contacted the CDC. Officials there told the clinical workers what samples to collect. The patient went home for the night and the samples were flown to Atlanta for testing. The next day the CDC confirmed that the test was positive and asked Providence to admit the patient for observation. “At that point, we activated our special pathogens unit to be able to house a patient with a highly communicable, infectious disease, which is essentially a unit that we created for patients with Ebola,” Diaz said. “There’s a lot of operational pieces to stand up a unit like this. It requires having enough facilities ready, the staff ready, all the equipment and other supplies, to get it all in place.” Experimental treatment The patient at first had a mild case of the illness. Over the next four days, however, his condition escalated to pneumonia and he needed oxygen. Diaz and his colleagues saw that the trajectory of the man’s illness paralleled reports coming out of Wuhan of COVID patients who developed pneumonia and then suffered severe lung damage. They conferred with the CDC about experimental therapies and doctors there pointed to remdesivir. The antiviral had proven to be safe for use but ineffective against Ebola. In later animal tests, it had shown promise against other types of coronavirus, including MERS. While the patient was hospitalized, a protocol for remdesivir’s use to treat the new virus was approved by the Food and Drug Administration. Providence Regional Medical Center Everett became the first hospital in the world to use the treatment for COVID when Diaz and his team administered it to their patient. “The protocol was actually designed for a 10-day course of therapy,” Diaz recalled. “Our patient had a fairly prompt response to treatment and he got better over the course of five days.” Providence St. Joseph Health has since taken part in two later studies of remdesivir — one to confirm that the drug itself worked against COVID and another on whether the five-day protocol was equally effective. The results in both cases were positive, Diaz said, and the studies were published in The New England Journal of Medicine. The

revised protocol has become a standard of care for COVID pneumonia in the U.S. and became the first FDA-approved treatment for COVID pneumonia.

Better medicine, practices After that first patient recovered and went home, the isolation ward was briefly empty. But in the months since Diaz and his colleagues have treated hundreds of COVID patients and taken part in several more clinical studies. One is of an immune modulator called tocilizumab that is made by Roche and already in use in England. Early findings show that the drug blocks hormones that cause inflammation and can help keep COVID patients’ illness from progressing to the point where they need ventilators. “We’re hopeful that our results will match what’s been seen in England, that tocilizumab is going to be effective in reducing mortality in critically ill patients with COVID pneumonia, and hopefully that it will also become standard of care over the next few weeks to months,” Diaz said. In addition to advances in medications, Diaz has seen the standard of care for COVID improved through new practices. He pointed to the use of proning, turning patients onto their stomachs, to improve breathing and to better techniques to man-

age the flow of oxygen and keep patients off of ventilators. The biggest improvement in practices in Diaz’s view has been the expansion of telehealth. Through the use of virtual visits and devices such as oximeters, care providers have found that patients’ conditions can be monitored while they stay at home. “That program has also allowed us to avoid being overrun with patients in the hospital, because we can safely manage very large numbers of patients at home through telehealth who would otherwise potentially need to be admitted, and then consume resources like PPE and nursing staff and hospital beds,” Diaz said.

Imperfect response While he’s proud of how Providence St. Joseph Health and other systems have responded to COVID, Diaz said that the early federal response to the crisis had clear shortcomings. One is what he called the “misalignment with messaging” between officials in the Trump administration and public health experts. He pointed to masking as an example. Even though the use of face coverings was shown to reduce the spread of COVID, the practice was scoffed at by some and led to wider spread of the virus. “Because of this mixed messaging that

was coming from the prior administration, I think that has allowed certain states to avoid the measures that are really needed to prevent deaths in their state,” Diaz said. He also thinks there is room for improvement of the COVID vaccine rollout and for countering disinformation about the vaccines’ safety and effectiveness. “That’s been a big problem with people not even wanting to get the vaccine, even if they really qualify for it,” Diaz said. He has done his best to dispel the vaccine falsehoods, giving interviews to the media in hopes of assuring the public that the shots are safe. He does some of those interviews in Spanish to reach an even wider audience. He makes those appearances at the request of Providence St. Joseph Health, a system he, as a Roman Catholic, is especially proud to work for because of its mission to serve the poor and vulnerable. If he could give a nationwide public service announcement right now, Diaz said it would be to urge everyone to get a vaccine. “I would really strongly suggest that people use trusted sources of information to get information about the vaccine, and if possible, receive it, so that all of us can be safe, and move past the pandemic.” leisenhauer@chausa.org

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Catholic Health Care’s Commitment to Community Health: A Resource for Boards

Addressing the root causes of health issues is part of the tradition of Catholic health care. Our faith compels us to give special attention to our neighbors who are economically poor and vulnerable and to work for the common good. CHA has developed a set of resources that explains why Catholic health care is

called to take a leadership role in addressing the social determinants of health. This work is not new to the Catholic health ministry, it is part of our heritage, started by our founding congregations who often addressed the social needs of those in their care alongside the medical needs. It is also part of our future, as our knowledge of health and well-being evolves, so must our approach to carrying on the healing ministry of Jesus.

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February 15, 2021 CATHOLIC HEALTH WORLD

KEEPING UP PRESIDENT/CEO Kathleen Healy-Collier to market president for the Acadiana Region of Franciscan Missionaries of Our Lady Health System of Baton Rouge, Louisiana. Facilities within that region are Lafayette, Louisiana-based Our Lady of Lourdes Regional Medical Center; Our Lady of Lourdes Women’s & Children’s; Our Lady of Lourdes Heart Hospital and Lourdes Physician Group. Healy-Collier most recently was chief operating officer of HSHS St. John’s Hospital and St. John’s Children’s Hospital in Springfield, Illinois.

ADMINISTRATIVE CHANGES Dr. John Mohart to senior vice president of clinical services and chief clinical officer of Mercy of Chesterfield, Missouri. Organizations within Trinity Health

Mercy Health – Cincinnati and Dr. Farzan Irani to vice president of medical affairs for Fairfield Hospital, part of Mercy Health – Cincinnati. Margaret Brodie to vice president of mission integration for St. Mary’s Healthcare of Amsterdam, New York, part of Ascension. Feagins

Irani

of Livonia, Michigan, have made these changes: Mary T. McFadden to chief nursing officer of Saint Alphonsus Regional Medical Center in Boise, Idaho. Marisol Wandiga Valentin to executive director of McAuley Ministries, Pittsburgh Mercy’s grant-making foundation. A region within Bon Secours Mercy Health has made these changes: Dr. Stephen Feagins to chief clinical officer of

ANNIVERSARY St. Joseph Mercy Chelsea, Chelsea, Michigan, 50 years.

GRANT AND GIFT An $8 million donation from the Rosalee and Harold Rae Brown Charitable Foundation will support immunotherapy and genomic research at the John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, California. The gift will help

the cancer institute to expand treatment options. The donation will be counted as part of the Power of Partnership Campaign to raise $200 million for Providence Saint John’s and its affiliate institutes, including the cancer institute and the Pacific Neuroscience Institute. St. Joseph Health, Queen of the Valley of Napa, California, has received a grant from the Napa Valley Vintners for an emergency department modernization and expansion project. Half of the Vintners’ $500,000 grant was offered as a matching gift challenge. The emergency department project will include construction of a seven-bed fast track unit where clinicians will treat patients with less critical needs, reducing wait times for them, while opening private emergency bays for patients requiring a higher level of care.

CommonSpirit Health hospitals to join Essentia Health CommonSpirit Health and Essentia Health have signed a letter of intent to have 14 CommonSpirit Health hospitals and a network of other facilities join Essentia Health, potentially by summer. The CommonSpirit facilities operate

under the CHI “brand” and they include the 237-bed CHI St. Alexius Medical Center in Bismarck, North Dakota, as well as 13 critical access hospitals and affiliated clinics and eldercare facilities in North Dakota and Minnesota.

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The facilities had been part of Catholic Health Initiatives, which merged with Dignity Health in 2019, to form CommonSpirit. CommonSpirit is a nonprofit, Catholic health system based in Chicago. The system has 139 hospitals and more than 1,000 additional health care sites in 21 states. Dr. Cliff Robertson, senior vice president for CommonSpirit’s Midwest division, said in a press release that the proposed deal between CommonSpirit and Essentia is intended to give patients access to a strong network of rural and tertiary hospitals, primary and specialty care and telehealth services. He said Essentia is well-positioned to integrate the facilities into a continuum of care. Based in Duluth, Minnesota, Essentia

has 14 hospitals and a network of other care sites in Minnesota, Wisconsin and North Dakota. Some of Essentia’s facilities are Catholic, including Essentia St. Joseph’s Medical Center in Brainerd, Minnesota; Essentia Health St. Mary’s Medical Center in Duluth; St. Mary’s Hospital of Superior in Superior, Wisconsin; Essentia Health Holy Trinity Hospital of Graceville, Minnesota; and Essentia Health St. Mary’s of Detroit Lakes, Minnesota. Robertson said Essentia will carry on the Catholic heritage and mission of the facilities it is acquiring from CommonSpirit. Visit chausa.org/chworld to see a list of hospitals that would join Essentia Health under the deal.

PAU S E . B R E AT H E . H E A L .

Both Day and Night For just this moment, bring your attention to your breath. INHALE deeply and settle yourself into

your body. EXHALE the stress and tension you feel.

On your next inhale, pray, Both Day And Night And as you exhale, Belong To You Both Day And Night Belong To You KEEP BREATHING this prayer for a few

moments. (Repeat the prayer several times) CONCLUDE, REMEMBERING:

Even now, God is with you, as near to you as your breath. Continue giving yourself the gift to pause, breathe, and heal knowing you are not alone.

established the sun and moon. PSALM 74:16 Go to chausa.org/prayers/cha-prayer-library for more prayer resources. © Catholic Health Association of the United States

CATHOLIC HEALTH WORLD February 15, 2021

Pandemic takes harsh toll on people isolated by dementia The social isolation and disruption of everyday routines caused by the coronavirus pandemic have been especially devastating for older Americans with dementia — a reality that has received little attention, said Jan Dougherty, a nationally recognized dementia care consultant. “The negative outcomes are alarming, Dougherty which is why I’m concerned that there has been so little focus on people living with this chronic serious illness and to their caregivers,’’ said Dougherty. “We know everybody’s struggling. But now we have people with memory problems who rely on a family member or care partner who are also very challenged and isolated” because of the pandemic, she said. “We are seeing a greater decline in thinking skills and a change in (patients’) overall ability to function as independently as they did prior to the pandemic.’’ Dementia is an isolating disease even for people still able to live at home and participate in the community. It is also progressive, and people with later stage dementia are generally cared for in a longterm care setting, Dougherty said. The isolation is magnified for those patients when infection protocols put extreme limits or bans on visits from family and friends. While visitor restrictions may save

Photo courtesy of Dementia Friendly Tempe

By MARY DELACH LEONARD

Before the pandemic forced programming to move online, people living with dementia and their care partners socialized at weekly sessions of Dementia Friendly Tempe's memory cafe.

lives, separation from loved ones has contributed to cognitive decline among people with dementia because people do better when they see their loved ones, she said. Patients with dementia may not even recognize staff members who are wearing masks and personal protection equipment. This could add to their confusion and suffering. Dougherty, a registered nurse and dementia expert, previously led family and community-based efforts for the Banner Alzheimer’s Institute in Phoenix.

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She helped Tempe, Arizona, become one of the first dementia-friendly cities in the United States when Banner partnered with city officials, health care providers and nonprofits to create Dementia Friendly Tempe in 2016. The initiative helps residents living with dementia remain active and engaged in the community. It provides resources for residents and their caregivers, plus educational programs for the first responders, business owners and religious leaders who interact with them. In an interview with Catholic Health World, Dougherty discussed ways socialization programs for patients with Alzheimer’s are being modified during the pandemic as well as the need for communities to start planning now to accommodate an increasing number of residents who will be coping with dementia in the future. Like many communities, Tempe has a “memory cafe” where residents with dementia and their caregivers can socialize with people in like circumstances. How has the pandemic impacted that? The Tempe memory cafe shut down in March due to the pandemic, but every Monday the folks who lead the efforts send an email with words of encouragement to participants. It includes a column I write about events and resources available to caregivers, as well as virtual engagement opportunities for the person with dementia. I think it’s been useful in keeping our constituents engaged. The memory cafe programs are designed to offer programs that engage people with dementia, with separate sessions for caregivers that are very strategy-driven. As people develop early symptoms of dementia — short-term memory loss and language difficulties — they become embarrassed about going out in public. Many begin to self-isolate. People can develop inertia. It’s difficult to get up and go or to initiate activity, although once they’re out and about, they usually do well. Many are able to cooperate with the safety protocols of COVID-19, including wearing masks and social distancing. If they’re married, their spouse might isolate with them, so now there are two people isolated from family and friends. During this pandemic, caregivers are really struggling with depression and declines in their own health because they are often not keeping medical appointments for themselves. This is where the dementia-friendly work comes into play. Those who can reach out virtually are probably getting better support than most. Are community organizations that provide day care programs for residents with dementia still able to serve their clients during the shutdowns?

Nonprofits serving older adults, and particularly people with dementia, have tried to innovate and bring online opportunities. But it relies on the family or the caregiver in the home to set up the connection and facilitate the actual engagement opportunity. So, that can be hit or miss. Some day care programs are reopening but with limited capacity. Many of the participants who previously attended daily are now attending only a few days a week. However, family caregivers and participants are happy even for that opportunity. We’re also seeing organizations finding innovative ways to teach coping strategies for caregivers. For example, a colleague of mine just ran a virtual program on self-compassion. Dementia Friendly Tempe focuses on educating first responders and business owners about dementia. Why is this so vital? People tend to think that persons living with dementia are in care homes and assisted living settings — that they have no interaction with the world around them. But people with dementia often live at home for years. They’re going to the grocery store. They’re going to gas stations. They’re going to banks. They’re going to call 911. We need these places and employees to better accommodate them. We also started a program called Dementia Friends based on a program that began in the United Kingdom. It’s a grassroots awareness program that explains the signs and symptoms of dementia and how to help someone you suspect might be confused. We ask volunteers to go to their neighborhood, their Bible study, book club, scouting group — their circle of influence — and hold a onehour informational session about what dementia looks like. The sessions are now all virtual. What should people who are not medical professionals know about dementia? We’ve got to remove the stigma from dementia. There are many lingering falsehoods. For example, people will come to lectures and ask, “When can I expect that my loved one will get aggressive?” Less than 10 percent of people with dementia will ever get aggressive. Most of the time, aggression is provoked by someone or by an environment that is overwhelming. But because of false information, friends become afraid. They feel like they don’t know how to communicate. People talk about the “friendship divorce” — friends who go away after they learn that someone is living with dementia. We see that with children who think, “Well, this is not my mother anymore.’’ We help friends and family members understand what’s changing, but also what’s not changing, so they can continue to communicate. A beautiful and important outcome of the memory cafe are the friendships that form. Before the shutdowns, couples would go to lunch together afterward or gather for a barbecue at somebody’s house. And that’s important because so many people lose their friends very early. The aging of baby boomers will swell significantly the number of people with dementia. How will that increased demand for dementia care be met? It is a new era, and we’ve got to get it together in the next 10 years. I think we’re going to see a lot more community-based programs and strategies because of the cost of care. And I have concerns about our shrinking workforce. The expense to our kids is going to be immense, and we need to figure that out now.