by Jeff Tieman

VAHHS President and CEO

As you know, VAHHS has long been a champion of mask-wearing. There's another way we want Vermonters to get covered—by health insurance.

America is in the middle of the worst health crisis in modern history. It has caused an economic crisis as well. Millions of people have lost their jobs and precious health insurance benefits.

While Vermont continues to have one of the lowest uninsured rates in the country, many people still lack complete or affordable coverage. Sometimes those who need coverage are eligible for assistance.

Vermont, along with the American Hospital Association, has signed onto Get Covered 2021, a broad coalition of states, consumer groups and health care providers promoting coverage ahead of the 2021 open enrollment period. We want to broadcast both COVID-19 safe practices, like mask wearing, and the importance of accessing insurance coverage.

Acting together, let’s connect uninsured people with the resources and financial help they need to obtain coverage through state marketplaces or Medicaid. If you know someone who needs health coverage, please urge them to visit getcovered2021.org. There they will find tips for choosing the right plan and information on enrollment and subsidies in their state. If the person you know is a Vermonter, you can also point them to Vermont Health Connect.

Thank you for helping to keep Vermonters and all Americans safe during the pandemic and prepared for their health needs.

Vermont has reinstated stringent hospital visitation protocols and will make testing more available to the general population this week amid a record number of new coronavirus cases.

Gov. Phil Scott's administration outlined the developments during a press conference Tuesday, projecting a bleak outlook for the coming weeks as the virus continues to creep through the state.

"We're seeing rapid growth, and this growth is not because of tourists," Scott said. "Not because of restaurants. Not because of gyms. Not because of schools. It's because adults continue to get together with other adults — multiple households, inside and outside — in situations usually involving alcohol where they stop taking precautions."

The state reported 95 new cases Tuesday, a day after setting a single-day record of 122. The seven-day average has now surpassed 90, and officials forecast a 50 percent case growth over the next six weeks.

In response to the surge, Human Services Secretary Mike Smith said he has ordered hospitals to suspend volunteer programs and reimpose strict visitor policies from the spring to cut down on the possibility of transmissions. "No visitors are permitted at this time, until further notice, with some limited exceptions," he said, such as for child patients and end-of-life care.

Last month, it was announced that the University of Vermont Medical Center and Vaccine Testing Center at the University of Vermont's Larner College of Medicine had been selected to participate in a Phase 3 trial for an Oxford University-AstraZeneca COVID-19 vaccine.

Phase three is the final phase in the vaccine testing process, the trial launched last Nov. 10. Vermont Edition spoke with one of the researchers involved about where this local trial fits in the global search for a coronavirus vaccine.

VPR’s Jane Lindholm spoke with Dr. Kristen Pierce, a clinical infectious disease specialist at the University of Vermont and a sub-investigator for the trial.

Jane Lindholm: Let’s first talk about what the trial that University of Vermont Medical Center and Larner College of Medicine are participating in actually is. What is this trial?

Dr. Kristen Pierce: Yes. So this is as you said, this is AstraZeneca’s vaccine, also known as the Oxford vaccine, because it was developed by researchers at Oxford University in England. And this is, as you said, a Phase 3 study. This is a national and international study, so it's conducted in the U.S. and also in sites in India, Brazil, South Africa and it is ongoing in England as well.

The hope is to enroll 30,000 volunteers in the U.S. alone. In this Phase 3 study here in Vermont, we are hoping to enroll about 250 people – that's what we've been asked to enroll by the study's authors.

Vermont reported a record 148 cases Thursday, and state officials predict there will be a 50% increase in cases over the next six weeks.

The current wave is worse than when the pandemic first hit Vermont this spring. Back then, state officials frantically set up emergency hospitals and stocked up on gear to prepare for a surge in cases that never materialized. Now they are repeating some of those same precautions, and warn that unless people follow public health guidelines, they may well have to start using them.

On Thursday morning, the sound of drills and hammers echoed through the expo hall at the Essex Junction fairgrounds. The room was a maze of walls made of plywood and two-by-fours. A group of four or five guys from the Vermont National Guard held one wall while their colleague anchored it in place.

The Guard is re-assembling a 200-bed field hospital that will be used to care for non-COVID patients if hospitals run out of space due to an influx of coronavirus cases. There’s also a separate 50-bed pod for people with COVID-19.

With COVID cases and hospitalizations rising again, the Vermont National Guard Thursday began rebuilding a surge hospital at the fairgrounds in Essex Junction. Statewide, around two-thirds of all in-patient beds and all intensive care beds are now full, but officials want to be ready in case those numbers increase.

The Champlain Valley Expo is again turning into an overflow hospital. “In March, we did basically the very same construction that you see behind me,” said Vermont National Guard Maj. Matthew Lehman. He says when the surge site was taken down this summer due to a decline in coronavirus cases, they packed it up so it could easily be put back together. “We are using the same material as last time. There is some plumbing stuff, a little bit of electric stuff you can’t reuse, but other than that, everything is the same material that was all purchased by the state of Vermont in March, now we are just reusing it.”

The design will fit 200 beds total for non-COVID patients. Down the hall, in a separate part of the Expo, Lehman says they never took down the 50 beds they set up for patients with COVID. “That stayed up and they left that in place and ready to turn back on at a moment’s notice,” he said.

Spartan Arena in Rutland is also on call to be set up again as a surge site. State officials say this is all precautionary and there is not a need for the overflow hospitals for now.

COVID-19 case numbers continue to surge to record levels in Vermont, and the spread is particularly high in Washington County, where 265 cases have been reported in the last two weeks.

The case count in the central Vermont county is far higher than what it experienced in the spring, when the highest case numbers were reported in Chittenden County. So is the health care system in Washington County prepared to handle this uptick in coronavirus cases?

To explore this question, VPR’s Henry Epp spoke with Anna Noonan, president and chief operating officer of Central Vermont Medical Center in Berlin. Their conversation has been edited and condensed for clarity.

Henry Epp: Hospitalizations often lag behind new cases of COVID-19. So are you seeing an increase in COVID-19 patients at CVMC yet?

Anna Noonan: Yes, we are. We've seen an uptick that started in the last few weeks with increased admissions and increased prevalence even of individuals coming in through our emergency department.

The state announced Thursday it will embark on an extensive overhaul to Vermont’s all-payer health care system.

Ena Backus, director of health care reform, proposed changes to the state's all-payer model that will create more transparency, change funding structures and increase the participation of doctors and hospitals.

The 23-page report offered a “blunt outlook of the faults and the issues that we need to address and what we need to change for the model to be successful in the future,” said Mike Smith, secretary of the Agency of Human Services, in a press briefing on Thursday.

Smith commissioned the report after the Centers for Medicare and Medicaid Services rebuked the state for falling short of targets for patient participation two years in a row. The system, run by the for-profit company OneCare Vermont, creates a structure to pay hospitals in monthly fixed payments, rather than for each patient procedure. The state Medicaid program is participating in OneCare, and state regulators signed off on the all-payer system in 2016.

So far, about 223,000 people are enrolled in the model, about 42% of the eligible population. The state was supposed to reach 58%, or about 322,000, by the end of this year. In 2021, about 238,000 people will participate.

Vermont could see a vaccine “on its doorsteps” by Dec. 10, the state’s health commissioner, Dr. Mark Levine, said Friday at the governor’s Covid-19 press briefing.

Levine noted that the pharmaceutical company Pfizer is expected to file for emergency authorization with the U.S. Food and Drug Administration for their vaccine candidates by the end of the day Friday. Pfizer and its partner, BioNTech SE, have said their vaccine candidate could be available to high-risk populations in the U.S. by the middle of December.

Levine said the Advisory Council on Immunization Practices, which advises the Centers for Disease Control, will meet Monday to discuss the vaccine candidate.

“Perhaps the earliest Vermont could see a vaccine on its doorsteps for a limited number of doses would be in the range of Dec. 10,” Levine said.

Gov. Phil Scott said Friday that four Vermonters have died of Covid-19 in the past 2 weeks, bringing the total number since the pandemic began to 62. The state reported more than 140 new infections Thursday and again Friday, an infection rate the governor called “very concerning.”

Chris Finley, the immunization program director at the Vermont Department of Health, on Wednesday said she doesn’t have any safety concerns with the Pfizer vaccine or another being developed by the pharmaceutical company Moderna.