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When it comes to public health, the outlook for the second half of 2021 looks markedly better than this time a year ago.
While the Delta variant of COVID-19 spreading in the U.S. presents a “variant of concern,” according to the U.S. Centers for Disease Control and Prevention, transmission rates locally are trending in the right direction. As of early July, COVID-19 cases in Milwaukee County were at the lowest level since the beginning of the pandemic, with the rate of positive COVID-19 cases hovering around 1% in the city of Milwaukee.
In late June, Milwaukee’s disease burden rate dropped to the “low transmission” category for the first time on record, which city health commissioner Kirsten Johnson called a “huge milestone” for the city. When the rate rose slightly to the “moderate transmission” level in early July, Johnson said the community expects those types of ebbs and flows moving forward.
“We have learned over the past 16 months to anticipate fluctuations in disease burden and we’ll continue to monitor our data and metrics closely, but unless we see a prolonged increase in cases, we will not issue health orders,” Johnson said.
However, COVID-19 vaccination distribution – for many seen as key to emerging from the pandemic – has slowed after a massive push in the first half of the year to get the vaccine to those eager to receive it. The country fell just short of president Joe Biden’s goal of getting 70% of all adults vaccinated with at least one shot by the Fourth of July, at 67%.
Wisconsin remains in the middle of the pack nationally for its vaccination rate, with 50% of the population fully vaccinated and Milwaukee County slightly lagging, at 48%.
While health officials continue to push to reach the 70-80% vaccination target, Jeff Bahr, chief medical officer of Advocate Aurora Health, said it’s likely aspirational at this point.
However, not reaching that goal doesn’t necessarily mean the region is vulnerable to the same surge in hospitalizations and serious COVID cases it saw last year.
“Are we at risk for the likes of 2020 again? No. I think if we’re diligent about protecting the most susceptible among us, we will avoid the high degree of hospitalization and death that we saw,” said Bahr.
As public health workers work to reach the vaccine hesitant with a first dose, it’s still to be determined how frequently booster doses of the vaccine will be needed moving forward.
“One theory is that COVID is endemic to us, meaning we’re going to be living with COVID, not living without it. So, will it be like the common cold or will it be more like influenza, where we’re contending with it on a fairly regular basis and we need to procure resources for those most susceptible? I suspect the truth is somewhere in that zone,” Bahr said.
For health systems that have been on the frontlines of the COVID-19 response, the drop in COVID cases has allowed for some return to normalcy in the first half of the year. At Milwaukee- and Downers Grove, Illinois-based Advocate Aurora Health, for example, its Wisconsin facilities reported 11 hospitalized COVID-19 patients as of July 2, compared to its peak in mid-November 2020 of over 500 hospitalized COVID patients.
At area health systems, patient volumes associated with routine medical visits that were put on pause in the first few months of the pandemic, along with emergency and urgent care, have largely returned to pre-COVID levels.
With current trends, that rebound is anticipated to continue for the remainder of the year, with patient volumes likely increasing with the expected rise in non-COVID-related respiratory illnesses that were kept at bay during the pandemic due to masking, said Scott Hawig, chief financial officer of Froedtert Health.
“If I use actual data to forecast ahead, versus budget, there’s really nothing we see in this volume that would suggest it would change,” he said. “Our business is always somewhat subject to seasonality, so during school seasons or end-of-year because of deductible level, we generally see changes in our volume year in and year out, based on time of year. Based on this data, there’s really nothing to suggest we shouldn’t return to pre-COVID levels and our normal seasonality.”
Hawig noted that cancer screenings, such as mammograms and colonoscopies, are the exception, with those volumes still down from normal. The question of when patients will return for those delayed services is a “wild card” that’s difficult to forecast, Hawig said.
The widespread adoption of telehealth services during the pandemic is also expected to influence the way patients seek care moving forward, health care leaders say.
While systems had little choice but to make the switch to virtual visits last year, Hawig said a Froedtert analysis indicates 20% of primary care visits could be done virtually moving forward, which opens up more flexibility for patients.
Bahr said preferences for in-person versus virtual appointments vary across segments of Advocate Aurora’s patient population, but for many it’s not a question of either/or, but of which modality makes the most sense depending on their circumstances.
“I think what we’re going to see in the future is a blended experience,” he said. “So, you as an individual will likely have both virtual services and in-person services, depending on what you have. If you are seeking advice for something rather simple or maybe a behavioral health follow-up, if virtual modalities support us conducting those services, I see us moving in that direction boldly.”