Health

HE A LTH • Summer 2022 9 seeing a lot of people coming into the hospital for COVID-19 who are already vaccinated, but their symptoms are much milder. Overall, we're seeing a lot less intubations and long-term hospital stays than when the virus first hit our state." Vaccine disparities Vaccines will continue to play a large role in keeping the virus at bay. However, according to Harvard's T.H. Chan School of Public Health in Boston, only 54% of Massachusetts children ages 5 to 11 have had one shot in their arm. In addi- tion, many communities have rates exceeding 90% while there remain many communities whose vaccination rates are below 50%. "We should set a goal of at least 70%, which is still well below the rates of first dose shots for children ages 12-19," said Alan Geller, senior lec- turer, Department of Social and Behavioral Sciences at Harvard Chan. "As can be seen in the vaccination rates by community, we can see huge disparities. It is for the youngest age group, chil- dren ages 5 to 11, where we have seen the starkest disparities by where one resides." As of March of this year, Worcester stands at 41% for schoolchildren ages 5 to 11 years old hav- ing received at least one dose of vaccine. In neigh- boring Shrewsbury, that number stands at 72% of schoolchildren ages 5 to 11 years old having received at least one dose of vaccine. The numbers become even more stark in the suburbs around Boston. In the city proper, the number stands at 48% while surrounding towns like Newtown stand at 95% of 5 to 11 year old's receiving at least one dose of vaccine. Social determinants of health Some of the biggest barriers impacting vaccine equity are called health determinants. These determinants can impact patient health and are stressed as important indicators of overall popula- tion health. These indicators include social norms and attitudes, exposure to crime, socioeconomic conditions including poverty and access to reli- able transportation. "Vaccination equity is huge," said Dr. David Brumley, chief medical officer of Worcester insur- er Fallon Health. "It's more important for vulner- able populations to get vaccinated because they generally have underlying health conditions which could exacerbate symptoms." One of the programs Fallon Health spearheads is the Program of All-Inclusive Care for the Elderly. Most of the participants who are in PACE are dually eligible for both Medicare and Medicaid. The program provides comprehensive medical and social services to elderly folks living in the community. "We cover transportation for our PACE mem- bers, and we do outreach as well," said Brumley. "Early on in the pandemic, we made it a point to call each and every one of our members to see how they're doing or if they needed transporta- tion to get tested. Once vaccines became eligible, we immediately reached out to all of our members to see if they needed a ride." Members that qualify for dual eligibility in the PACE program receive both a nurse and a naviga- tor. The navigators make sure members can get to appointments, get vaccinations, or coordinate ser- vices they need. "With our Medicaid population, we did a tex- ting education campaign and ended up being in the top five for vaccination rates for all 17 provider partnerships in the state," said Brumley. "We also had mobile health units where we had clinical staff to drive around to people's homes if they needed at- home services. We wanted to make sure we could come to them if they couldn't come to us." Fallon Health is piloting a pro- gram called Hospital at Home where patients who need acute treatment in a hospital but are stable enough to stay at home can do so. The program, which launched in January, sends medical equipment to patients homes where nurses conduct visits throughout the day. "It's important to sometimes help keep vulnera- ble populations at home," said Brumley. "This program allows people who may be more suscep- tible to catching COVID-19 in a hospital the option of staying in their homes where they are less likely to catch the virus." While vaccine equity will be a problem effecting overall population health, vaccines will be admin- istered for the foreseeable future. The U.S. Centers for Disease Control & Prevention announced ear- lier this year COVID-19 is here to stay and that we are beginning to transition from a pandemic to an endemic, or a virus that is constantly present but manageable. "We will continue to see ebbs and f lows in COVID-19 numbers," said Ellison. "We also can expect to see more variants down the line much like the f lu every year. It's important that people continue to get booster shots especially among the most vulnerable populations. The best hope is that severity in sickness continues to decrease as more people get their boosters and more people build immunity." H Fallon Health membership, by product in May Affordable care organizations - 123,579 Commercial - 39,208 Third-party administration (UltraBenefits) - 33,217 Medicare - 14,218 Senior care options - 9,446 Massachusetts Health Connector - 6,684 Program of All-Inclusive Care for the Elderly (PACE in Mass.) - 1,175 New York PACE and managed long-term care - 973 Source: Fallon Health The vaccination rate against COVID in Massachusetts sits above 90% although that varies widely by community and age group, with 41% of Worcester schoolchildren having been fully vaccinated. Fallon Health in Worcester is helping to lead the effort to have more medical services provided in the home. PHOTO | COURTESY OF FALLON HEALTH PHOTO | WBJ FILE

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