Rethinking the value of COVID case counts

Transcript

NIALA: Good morning! Welcome to Axios Today!

It’s Tuesday, January 11th.

I’m Niala Boodhoo.

Here’s what you need to know today: the healthcare worker shortage, by the numbers. Plus, why the James Webb Space telescope is such a huge deal.

But first, understanding the value of COVID case counts….is today’s One Big Thing.

NIALA: COVID case numbers have been breaking records in the last few weeks here in the US, but deaths and hospitalizations are still largely down. That got us thinking, how useful are case counts actually in understanding where we are right now in this wave of the pandemic.That's the question that I wanted to pose to Dr. Jennifer Nuzzo, an epidemiologist at Johns Hopkins University's COVID-19 Testing Insights Initiative and she's with us now. Hi, Dr. Nuzzo.

JENNIFER NUZZO: Hi there.

NIALA: Thank you for joining us. Are case counts useful at this point? I actually had a listener ask me this last week, why we were referencing case counts in Florida without talking about hospitalizations or death rates. What do you think?

JENNIFER: Case counts are still useful. But in epidemiology it's rare that any one measure tells you everything you need to know and how we use cases has changed throughout the course of this pandemic.

NIALA: So what's different now?

JENNIFER: We are in some places, particularly the high vaccination coverage areas, seeing hospitalizations and deaths not rising as steeply, with the case numbers that are rising quite steeply. But in other places, the hospitalizations and deaths are a bit too linked to cases that I would like to see at this stage of the pandemic. So, we look at it particularly because it's one of the first measures that we get hospitalizations and deaths tend to lag. And just seeing that we're on the upswing tells us what to potentially expect in hospitalizations and deaths, even if the increase isn't as steep as it would have been earlier in the pandemic.

NIALA: And at this point in the pandemic, people also have a lot more access to home testing, but those numbers may not be actually reported to the state or the federal government. So do we know how accurate our case numbers are even at this point?

JENNIFER: We have never thought that the reported case numbers capture all the infections that are occurring in part, because some people get the virus and never even know, never even think to get tests. So it's always been true that our reported case numbers were likely a subset of the infections that were occurring. But now it's likely much more the case because people are increasingly using home tests to figure out whether or not they have the virus. But also people may have milder symptoms than they did earlier in the pandemic, which could either lead to, you know, not getting tested because people waive it off. Or, maybe they want to get tested, but they just haven't been able to so we're likely missing those infections as well.

NIALA: As an epidemiologist. How do you think those of us who are not public health experts should be looking at all of these different data points?

JENNIFER: In my view the most important thing is to look at the directionality of the numbers and to look at it across multiple metrics. If you see all arrows pointing up, then that's probably the time to take more precautions, then when you start to see a number of the arrows turning downward.

NIALA: Dr. Jennifer Nuzzo teaches at Johns Hopkins university, where she's also an epidemiologist at the COVID-19 Testing Insights Initiative. Thanks for taking the time to speak with us, Dr. Nuzzo.

JENNIFER: Thanks for having me.

NIALA: In 15 seconds: why we’re short on American healthcare workers.

NIALA: Welcome back to Axios today. I'm Niala Boodhoo. Even before the pandemic, the Association of American Medical Colleges predicted there could be a shortage of up to 124,000 doctors by 2034. And just in the past few weeks, more than half the hospitals in states like Vermont and New Mexico have reported critical level staff shortages. This is the first of several conversations over the next few weeks we're going to have on the podcast about the healthcare worker shortage. But to start, we invited Axios’s healthcare editor Tina Reed to take us first behind the numbers. Hi, Tina.

TINA REED: Hi, Niala.

NIALA: Tina, we've heard a lot about this since we first began hearing about COVID-19, but can you put this in context? How significant a shortage are we talking about?

TINA: So according to the latest Bureau of Labor statistic numbers, uh, the hospital sub sector workforce dipped nearly 90,000 people since March of 2020. Among nurses, The American Nurses Association expects there'll be more than a hundred thousand RN jobs available annually by next year. And then when we look at federal data, it shows that more than a quarter of hospitals in at least 13 states are struggling with these critical shortages of nurses, doctors, and other medical staff. And when we hear that hospitals are saying that they're-they're being overwhelmed, what they're often meaning is that they're running out of people to help take care of people in-in beds. It's not so much that they're running out of the beds themselves.

NIALA: Tina, we know that some hundreds or thousands of workers might call out sick on any given day lately because of COVID...but how much of the shortage is the result of working through the pandemic?

TINA: We're seeing a lot of shortages because…it's wearing on people. It's the really long hours, the stress of working with COVID-19 patients. We are seeing some people who are moving to other jobs within the sector, or who may even be leaving the sector altogether because they've got other options outside of healthcare.

NIALA: How have we seen that change when we think about the idea of burnout compared to the beginning of the pandemic and now?

TINA: When I spoke to healthcare workers, early on in the pandemic, we actually saw anecdotally, at least, that burnout seemed to drop. And that was largely because healthcare workers were feeling like they were all in this together. In a lot of places, they went to emergency protocols, so some of the things that were contributing to burnout such as being inundated with paperwork were pushed aside so they could really prioritize what was important. But we've quickly seen that return, and get much, much worse as the pandemic has drawn on. We've been going through this for more than two years now, and people are really getting tired.

NIALA: So what are hospitals doing to try to keep their staffing numbers up in the short term?

TINA: Hospitals have been adding signing bonuses. They've been taking a look at whether or not they should be increasing their compensation. And they've been looking a lot at their benefits packages, trying to provide benefits that could help people with their mental health. But in some cases, we've actually seen some of the solutions become part of the problem. They're actually bringing on a lot of travel nurses to try and fill the gaps. And in a lot of cases, those travel nurses are getting paid two to three times what the local staff nurses are making. And so that in itself is adding to some hard feelings.

NIALA: As I said, we're going to be following this issue on the podcast over the next couple of weeks. Tina Reed is Axios’ healthcare editor and author of Axios’ Vitals newsletter. Thanks, Tina.

TINA: Thank you, Niala.

NIALA: The highly anticipated James Webb Space Telescope fully deployed over the weekend. Axios space reporter Miriam Kramer has been watching this and is here to tell us what this telescope is going to actually do. Hi, Miriam.

MIRIAM KRAMER: Hi, thanks for having me.

NIALA: Miriam, what do we need to know about the JWST?

MIRIAM: Yeah, so one of the main things about this telescope is that it's able to see in infrared light. So that means you can see stars forming in clouds of dust. You can see the first galaxies to form. You can see things like, the atmospheres of alien planets and what they look like and if maybe they're habitable, like that's one of the big things that this telescope is supposed to do. So it could really transform our understanding of the universe.

NIALA: Miriam, in your world there has been so much excitement over this. Can you put in context how important this telescope will be for scientific discovery of space?

MIRIAM: So I have been covering the JWST in some form or fashion for my entire career. So that's about 10 years of news coverage. A lot of people didn't think it would work. It's still kind of difficult for me to believe that it has launched and that it deployed perfectly. I mean, it had over 300 single points of failure that could have just completely stymied any of the science that the JWST was set up to do. So the fact that it launched successfully, deployed without a hitch and now could function for over 20 years in space, having this long and incredibly, hopefully, successful scientific career is truly amazing.

NIALA: And how long will it take for us to get these images back and see them?

MIRIAM: It's going to take a while to get out to its position, sort of a million miles from earth. We should expect the first sort of big science moments to come kind of mid-year.

NIALA: Miriam Kramer covers space for Axios. Thanks Miriam.

MIRIAM: Thanks for having me.

NIALA: Before we go today: keep an eye out next time you get a quarter with your change! The US Mint announced yesterday it has started circulating coins honoring the late writer and activist Maya Angelou, the first in a series recognizing notable women in American history.

That’s all we’ve got for you today! I’m Niala Boodhoo - thanks for listening - stay safe and we’ll see you back here tomorrow morning.