May 26, 2020

HEROES ACT PASSED IN HOUSE

May 26, 2020

Round five in a sustained effort to deal with economic problems resulting from the COVID-19 pandemic was passed by the U.S. House of Representatives in a close 208-199 vote on May 15, 2020 that occurred mostly along party lines (only one Republican voted for it). Called the Health and Economic Recovery Omnibus Emergency Solutions (Heroes) Act, (H.R. 6800), this spending package would provide another $3 trillion in supplemental funds.

Among its major features, the proposed legislation would furnish an additional $100 billion for the provider relief fund initially established in the Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116-136) and also would expand the Paycheck Protection Program and Health Care Enhancement Act (P.L. 116-139). The bill also is aimed at improving the Accelerated and Advanced Payment Program by lowering the interest rate for loans to Medicare providers, reducing the per-claim recoupment percentage, and extending the period before repayment begins.

Additional measures include:

Providing $26.7 billion in emergency aid to public higher education institutions and $7 billion in emergency aid to private institutions for “education and general expenditures (including defraying expenses due to lost revenue, reimbursement for expenses already incurred, and payroll) and grants to students for expenses directly related to coronavirus.”
Extending the suspension of payments for federal student loans, interest accrual, and interest capitalization through September 30, 2021. Ten thousand dollars of loan forgiveness on all federal and privately held loans for economically distressed borrowers would be provided.
Available through September 2024, $4.7 billion would be invested for the National Institutes of Health to prevent, prepare for, and respond to the coronavirus, including $3 billion designated for offsetting the costs related to reductions in lab productivity as a result of the pandemic.
Increasing Federal Medical Assistance Percentage payments to state Medicaid programs by a total of 14%, starting July 1, 2020, through June 30, 2021.
Republican opposition indicates that the legislation already is considered dead on arrival in the Senate. A major concern is that money will go to states that have a long history of mismanaging their own respective finances. Senate Republicans have expressed interest in requiring that liability protection be included for businesses and academic institutions. Otherwise, they believe there is little guarantee that the unemployed will be able to return to their jobs and that normal functions on the nation’s campuses will be resumed any time soon. Some members of the G.O.P. also would prefer that states and local governments be given much more flexibility regarding how they can use existing relief money for operating expenses. The gradual relaxation of lockdown requirements by many jurisdictions around the U.S. will produce results about the spread of the disease and its lethality that may influence any future legislation, which possibly could be enacted into law.

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RESEARCH AND EDUCATION AFTER THE PANDEMIC

Kristen Truong

May 26, 2020

COVID-19 is having a dramatic impact on the delivery of health services as well as on the nation’s economy. A cornucopia of research topics will become available for study once the pandemic has been relegated to the past tense. As an illustration, eventual findings from retrospective reviews to create improved understandings of how to keep patients from being assigned to various settings, such as intensive care units could influence health professions education by enabling students through the use of case studies to learn about what worked effectively and what failed to do so in patient care during a pandemic.

Research wise, each year approximately 40% of the manuscripts submitted to the Association’s Journal of Allied Health are rejected, often because of serious research methodology flaws. An article that appeared in the May 2020 issue of the Journal of Clinical Epidemiology sheds light on a common obstacle encountered by many investigators, which is the ability to recognize how “confounding” threatens the process of causal inference. The authors posit that a sound understanding of confounding within the counterfactual framework of causation enables better anticipation and dealing with this source of bias in research practice.

As a remedy, they propose a simplified explanation of the counterfactual definition of confounding based on a non-technical and graphical presentation of the central role of exchangeable background risks. As a first step, the following definition from the Dictionary of Epidemiology is offered: “The distortion of a measure of the effect of an exposure on an outcome due to the association of the exposure with other factors that influence the occurrence of the outcome. Confounding occurs when all or part of the apparent association between the exposure and the outcome is in fact accounted for by other variables that affect the outcome and are themselves not affected by the exposure.”

An exposure is broadly defined as being subjected to some kind of determinant, either harmful (risk factor) or beneficial (protective factor), or to a certain intervention or treatment. Like exposures, outcomes of interest in clinical epidemiological research also are broadly defined, for example, the occurrence or cure of a certain disease or health-related condition. It is assumed for ease of explanation that exposures and outcomes are dichotomous and are related positively, e.g., exposure to a risk factor leads to more disease or exposure to treatment produces a cure. Concepts to be explained also apply, however, to exposures and outcomes that are non-dichotomous or inversely related.

Consequently, when not appropriately accounted for by design or in the analysis of an investigation, confounding may bias study findings by distorting the association measures used for quantifying the nature and magnitude of the relation between the primary exposure and outcome. A key implication regarding what may need to be emphasized from an educational perspective is that this approach could serve in a valuable way for introducing researchers and students to the underlying concepts of confounding as explained from a counterfactual viewpoint.

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ESTABLISHING HIGH PERFORMING TEAMS: HEALTH CARE LESSONS

Kristen Truong

April 27, 2020

Why is it that teams following the same best practices can achieve different results? According to a study published on February 25, 2020 in the MIT Sloan Management Review, clinics took three prototypical approaches to establishing team-based care. An aim of this research was to obtain an understanding of why some teams succeed while others struggle. Deploying effective team-based care is recognized as an essential component of three organizational priorities in health care: high-quality, patient-centered care; continuous quality improvement; and enhanced clinical work satisfaction. These objectives broadly align with the three recognized objectives of teams more generally: achieving the team’s shared goal, improving as a team, and growth of individual members. In this investigation, among clinics taking approaches to establishing team-based care, some groups pursued functional change only, with a focus on continuous improvement skills. Others pursued cultural change only, focusing on shifting team members’ roles and relationships. Another set of groups blended the two, pursuing both functional and cultural change processes simultaneously.

Functional Change Processes concerned practical, operational aspects of teaming. Clinic staff were trained on continuous improvement skills. Some clinics strategically integrated continuous improvement into everyday work, encouraging staff to identify process improvement opportunities and test new team approaches. Cultural Change Processes indicate that in order to implement new continuous improvement practices, it will require changing old ideas about personnel roles; reexamining who had authority to take initiative and lead innovation; and how “lower status” team members’ contributions were invited and valued by traditionally “higher status” colleagues. The results show that while both change processes were individually important, they were most effective when mobilized in tandem. The recursive, mutually reinforcing relationship between functional and cultural change processes was key to the effectiveness (or its lack) of team-based care.

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RACIAL DISPARITIES IN AUTOMATED SPEECH RECOGNITION SYSTEMS

Kristen Truong

April 27, 2020

Automated speech recognition (ASR) systems, which use sophisticated machine-learning algorithms to convert spoken language to text, have become increasingly widespread, powering popular virtual assistants, facilitating automated closed captioning, and enabling digital dictation platforms for health care. This technology is employed in myriad applications used by millions of individuals worldwide. Some examples include virtual assistants built into mobile devices, home appliances, and in-car systems; digital dictation for completing medical records; automatic translation; automated subtitling for video content; and hands-free computing. Over the last several years, the quality of these systems has dramatically improved, due both to advances in deep learning and to the collection of large-scale datasets used to train the systems. Some concern exists, however, that these tools do not work equally well for all subgroups of the population.

As described in an article published in the April 7, 2020 issue of the journal Proceedings of the National Academy of Sciences of the United States of America, researchers examined the ability of five state-of-the-art ASR systems developed by Amazon, Apple, Google, IBM, and Microsoft to transcribe structured interviews conducted with 42 white speakers and 73 black speakers. This corpus in total spans five U.S. cities and consists of 19.8 hours of audio matched on the age and gender of the speaker. The study indicates that all five ASR systems exhibited substantial racial disparities, with an average word error rate (WER) of 0.35 for black speakers compared with 0.19 for white speakers. The investigators trace these disparities to the underlying acoustic models used by the ASR systems as the race gap was equally large on a subset of identical phrases spoken by black and white individuals in the corpus. They conclude by proposing strategies, such as using more diverse training datasets that include African American Vernacular English, to reduce these performance differences and ensure speech recognition technology is inclusive.

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Kristen Truong

April 27, 2020

Brain Health Across The Lifespan

Brain health affects Americans across all ages, genders, races, and ethnicities. Enriching the body of scientific knowledge around brain health and cognitive ability has the potential to improve quality of life and longevity for many millions of Americans and their families. To explore issues related to brain health throughout the life span, from birth through old age, a public workshop entitled Brain Health Across the Life Span was convened on September 24-25, 2019, by the Board on Population Health and Public Health Practice in the Health and Medicine Division of the National Academies. The Centers for Disease Control and Prevention estimate that as many as five million Americans were living with Alzheimer's disease in 2014. That same year, more than 800,000 children were treated for concussion or traumatic brain injuries in U.S. emergency departments. Each year, more than 795,000 individuals in the United States have a stroke. Developing more effective treatment strategies for brain injuries and illnesses is essential, but brain health is not focused exclusively on disease, disorders, and vulnerability. It is equally important to better understand the ways human brains grow, learn, adapt, and heal. Addressing all these domains to optimize brain health will require consideration about how to define brain health and resilience and about how to identify key elements to measure those concepts. A summary of the workshop can be obtained here.

Leading In A Time Of Crisis: Corporate America And COVID-19

New research from the Global Strategy Group reveals the opportunities and risks facing corporate leaders as they respond to COVID-19. While the economics of the pandemic will come into view in the months and years to come, right now, individuals in the U.S. are focused squarely on the safety, health, and well-being of their family, friends, communities, and the nation at large and they believe that corporations must do likewise. CEOs must counter the existing perception that they are focused most on the bottom line and work to support their employees and beyond by providing important benefits like paid leave; producing needed equipment and materials; and working in close cooperation with the government to respond to the pandemic. Companies are viewed as needing to tell the story of what they are doing and who they are helping with the stimulus dollars they receive to overcome negative perceptions. Eventually, they will be defined by what they do now. The reputational costs could be high. Research results can be obtained here.

Confronting Rural America’s Health Care Crisis

The rapid spread of COVID-19 has awakened the nation to the dire access problems that have long plagued rural communities and has underscored the need for immediate change. The current pandemic has highlighted the fragility of the rural health care system, in which hundreds of hospitals have already closed or are in imminent risk of folding. The Bipartisan Policy Center’s Rural Health Task Force has developed recommendations over the last year to stabilize and improve the urgent problems challenging rural communities and to do it permanently. The aim was to produce policy recommendations to stabilize and transform rural health infrastructure; promote the uptake of value-based and virtual care; and ensure access to local providers. These recommendations are contained in an April 2020 report. In addition to addressing telehealth, the task force recommendations include short-term stabilization for struggling rural hospitals and multiple pathways to transform into models that are customized to meet the needs of individual communities. The report can be obtained here.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

April 27, 2020

Lifetime Prevalence Of Self-Reported Work-Related Health Problems Among U.S. Workers

The April 3, 2020 issue of the CDC’s Morbidity and Mortality Weekly Report indicates that approximately 2.8 million nonfatal workplace illnesses and injuries were reported in the United States in 2018. Current surveillance methods might underestimate the prevalence of occupational injuries and illnesses. One way to obtain more information on occupational morbidity is to assess workers’ perceptions about whether they have ever experienced health problems related to work. Using data from the 2018 version of the SummerStyles survey, overall, 35.1% of employed respondents had ever experienced a work-related health problem. The most commonly reported work-related problem was back pain (19.4%). Among industries, construction (48.6%) had the highest prevalence of any work-related health problems. A conclusion is that workplace injury and illness prevention programs are needed to reduce the prevalence of work-related health problems, especially in higher-risk industries.

National Health Expenditure Projections, 2019-2028

According to an article in the April 2020 issue of the journal Health Affairs, national health expenditures are projected to grow at an average annual rate of 5.4% for 2019–28 and to represent 19.7% of gross domestic product by the end of the period. Meanwhile, growth in the gross domestic product during the projection period is expected to average 4.3%. Price growth for medical goods and services is projected to accelerate, averaging 2.4% per year for 2019–28, which partly reflects faster expected growth in health-sector wages. Among all major payers, Medicare is expected to experience the fastest spending growth (7.6% per year), largely as a result of having the highest projected enrollment growth, reflecting the continued shift of the baby-boom generation out of private health insurance and into Medicare. The share of health care spending financed by federal, state, and local governments is expected to increase by two percentage points during 2019–28, reaching 47% in 2028.

HEALTH TECHNOLOGY CORNER

Skin-Interfaced Biosensors For Wireless Physiological Monitoring In Neonatal And Pediatric Intensive-Care Units
Standard clinical care in neonatal and pediatric intensive-care units (NICUs and PICUs, respectively) involves continuous monitoring of vital signs with hard-wired devices that adhere to the skin and, in certain instances, can involve catheter-based pressure sensors inserted into the arteries. These systems entail risks of causing iatrogenic skin injuries, complicating clinical care and impeding skin-to-skin contact between parent and child. Described in the March 2020 issue of the journal Nature Medicine is a wireless, non-invasive technology that not only offers measurement equivalency to existing clinical standards for heart rate, respiration rate, temperature, and blood oxygenation, but also provides a range of important additional features, as supported by data from pilot clinical studies in both the NICU and PICU. These new modalities include tracking movements and body orientation, quantifying the physiological benefits of skin-to-skin care and capturing acoustic signatures of cardiac activity.

Bacterial Colonization Reprograms The Neonatal Gut Metabolome

A team of researchers at Children's Hospital of Philadelphia has characterized how the gut microbiome develops in the first hours of infancy, providing a critical baseline for how changes in this environment can have an impact on health and disease later in life. The findings were published on April 13, 2020 online by the journal Nature Microbiology. The gut in children eventually will hold hundreds of different species of bacteria, but at birth, there might only be 10 or fewer species. The investigation aimed to understand why those particular bacteria are the first to emerge and what they are doing in those first hours of life. The researchers evaluated the gut microbiome, proteome, and metabolome in 88 African-American newborns using fecal samples collected in the first few days of life. Detailed analysis of the three most common species, Escherichia coli, Enterococcus faecalis, and Bacteroides vulgatus, did not suggest a genomic signature for neonatal gut colonization. Evidence is provided that fermentation of amino acids provides a mechanism for the initial growth of E. coli, the most common early colonizer, under anaerobic conditions.

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DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

April 27, 2020

ASAHP conducted a webinar on April 17, 2020 that attracted 245 participants from 96 institutions. Discussions occurred on several topics that included the following:

How are academic programs and clinical partnerships meeting mutual needs?
What disciplines are allowed to remain on service and which are prohibited?
What criteria will determine when settings will again take students?

The Winter 2019 issue of the Journal of Allied Health featured the article entitled, “Clinical Education in Transition: Recommendations and Strategies,” which offered five recommendations that stem from a review of literature pertaining to current changes in the healthcare sector and higher education that challenge the availability of allied health clinical education. The paper can be obtained here.

Statement Of Principles On Acceptance Of Academic Credit

The American Council on Education and other major educational organizations joined together to write about one particular issue that they all will face: how to manage and evaluate academic credit and assess student transcripts that have been affected by the current crisis and, indeed, by their substantial efforts to provide flexibility to students and faculty. Institutions already are deciding how best to manage credit within their own educational contexts and that is wholly appropriate. One size does not fit all, however, and that is not and should not be an aspiration. Similarly, there is no single approach or one system that should apply to how institutions evaluate and accept credits when students seek to transfer between institutions, seek approval for nontraditional coursework, or apply to graduate and professional programs. Nevertheless, there is a set of common principles that institutions should keep in mind when developing policies regarding credit acceptance. They are:

(1) Institutional policies and the evaluation of grades and credit should recognize the extraordinary burden placed on students during this time. (2) Institutional policies and practices should recognize that traditional inequities are exacerbated in the current crisis and that “equal” treatment of students’ transcripts is unlikely to result in “equitable” outcomes. (3) Institutional policies and practices should, therefore, be as holistic as possible, taking into account the range of situational and behavioral circumstances in which students find themselves. (4) Institutional policies should, wherever practicable, provide flexibility in the timely reporting of grades and other markers of achievement, understanding that the aforementioned dislocations also are present for faculty, staff, and others. (5) Institutional policies should aim for complete transparency. (6) This transparency should extend inside as well as outside the institution. (7) Institutional decision-making regarding individual students should be swift and definitive. Finally, (8) Institutions should clarify their policies as soon as possible.

Should Regional Accreditation Go National?

The publication Inside Accreditation by the Council for Higher Education Accreditation (CHEA) features an article by Judith Eaton, that organization’s President, on the issue of whether regional accreditation should go national. During negotiated rulemaking in 2019, the U.S. Department of Education indicated that regional accrediting organizations could now be free to accredit anywhere in the United States to achieve the goal of opening up the institutional accreditation system to competition. Reasons she identified for having these organizations remain regional include: composition, culture, additional workloads, and it could lead to institutions embarking on “accreditation shopping” or a “race to the bottom.” Reasons for going national include: becoming national is acknowledgment of reality since they all operate outside their regions; increased growth opportunities; further affirming the commitment to creativity and innovation in higher education; and competition may not be negative and could emerge as valuable to strengthening accreditation.

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HEALTH REFORM DEVELOPMENTS

Kristen Truong

April 27, 2020

Ten years ago, the Affordable Care Act became law in order to reduce health care costs by encouraging doctors, hospitals, and other health care providers to form networks that coordinate patient care and become eligible for bonuses when they deliver that care more efficiently. Formation of accountable care organizations (ACOs) in the Medicare program was a centerpiece of this approach. Results of a survey conducted in April 2020 by the National Association of ACOs (NAACOS) indicate that ACOs are highly concerned about the effects of COVID-19 on their organizations. Nearly 60% of respondents in risk-based models reported they are likely to quit the ACO program to avoid financial losses stemming from the pandemic, and 77% reported they are “very concerned” about the impact of COVID-19 on their ACO’s 2020 performance.

A likely driver for ACOs to exit the program is the uncertainty about costs, quality, and utilization for 2020. COVID-19 has upended normal utilization and care patterns, disrupting ACOs’ ability to employ successful population-health strategies and causing tremendous uncertainty about costs. Notable uncertainty exists on how the pandemic will affect other aspects of the ACO program, such as changes to acuity or risk scores, diminished opportunities to meet quality requirements related to preventive care, and which patients the ACO will be accountable for this year. This uncertainty was strongly noted by survey respondents in comments, with 65% reporting that the scope of the effects of COVID-19 will make it difficult for them to predict their ACO’s 2020 performance accurately.

Loosening By CMS Of Telehealth And Scope Of Practice Regulations

April 2020 marked a temporary suspension of certain regulations by the Centers for Medicare & Medicaid Services (CMS) to make it possible for providers, such as hospitals to have more flexibility in offering clinical services in response to the current pandemic. Physicians will be able to furnish care for patients across state lines using telehealth and online communication to coordinate with nurse practitioners at rural clinics without having to be physically present. The agency also is making it possible for nurse practitioners to perform some medical exams on Medicare patients at skilled nursing facilities. Other providers, such as occupational therapists will be allowed to offer as much care as their licenses will allow. An example is that these clinicians will be able to perform initial assessments on certain homebound patients, allowing these services to begin earlier.

U.S. Constitution’s Fourth Amendment And COVID-19 Digital Surveillance And Privacy

South Korea and Israel are examples of nations that have employed digital surveillance measures using cell phone location data, among other means, in an effort to track and limit the transmission of COVID-19. In the U.S., the federal government and some state and local governments reportedly have begun to gather geolocation data voluntarily provided by the mobile advertising industry to assess how individuals are continuing to move and congregate during the pandemic. This development has led to speculation about the potential in this country for more invasive, obligatory data collection and tracking practices emulating the measures taken in some other parts of the world. A legal sidebar issued by the Congressional Research Service (CRS) on April 16, 2020 provides an overview of the Constitution’s Fourth Amendment, along with certain relevant doctrines and exceptions before discussing how the relevant legal frameworks could apply to coronavirus-related government surveillance.

The Fourth Amendment protects against “unreasonable searches and seizures” and provides that “no Warrants shall issue, but upon probable cause,” among other things. The Supreme Court has recognized that the fundamental purpose of the Amendment “is to safeguard the privacy and security of individuals against arbitrary invasions by governmental officials.” The question of whether official action has run afoul of the Amendment’s dictates entails consideration of at least two distinct analytical components: (1) the existence of a search or seizure, and (2) the reasonableness of that search or seizure. Not only does the federal government play a central role in the provision and payment of health services, it has a duty to protect the inhabitants of the U.S. when their lives are threatened. What may need to be resolved at some future juncture is how extensive such protective efforts can be while continuing to adhere to provisions of the U.S Constitution.

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FAST CHANGING LEGISLATIVE ENVIRONMENT

Kristen Truong

April 27, 2020

Similar to other initiatives expressed in major battle-like terminology, governmental responses to the coronavirus pandemic have been stated as declaration of a war on COVID-19. Legislators and government administrators throughout the U.S. have been working assiduously to mount an effective series of initiatives to combat and repel this deadly disease.

Although not having a particulary strong record for crafting legislation when control of the two congressional chambers is divided between the political parties, especially during an election year, the year 2020 is monumental in significant ways. Many pieces of legislation can languish for months and even years prior to being passed. The existence of a pandemic can change the timetable quite dramatically.

As of late April, the Trump Administration and Congress were busy negotiating the next stage of economic recovery legislation. The purpose of the bill is to provide additional funds for the Paycheck Protection Program for small businesses and nonprofits since the money supply was exhausted on April 16. Once enacted, companies that continue paying their employees will be eligible to receive forgivable loans underwritten by the federal government. House and Senate Democrats are in favor of directing some funding to minority-owned and rural businesses, and to add more for hospitals and enhanced COVID-19 testing capacity. Not as large as the $2 trillion CARES Act that became law in late March, the new infusion of funding would represent a sorely needed stimulus to an economy that is sagging from this disease.

This legislation proceeded at a rapid pace albeit being accompanied by serious disagreements regarding its contents. One controversial provision revolved around the issue of diagnostic testing. Democrats favor establishment of a national strategy for testing while Republicans are more inclined to place authority for making decisions at the state level.

The Senate on April 21 unanimously passed a $484 billion package that renews funding for a small- business loan program, boosts aid for hospitals, and expands testing for COVID-19. The bill then went to the House for approval. The aid deal includes more than $320 billion for the Paycheck Protection Program for small businesses, $60 billion for the small-business disaster fund, $75 billion for hospitals and $25 billion to increase COVID-19 testing. President Donald Trump then signed the legislation (H.R. 266) into law (P.L. 116-139) on April 24, 2020. As pandemic events continue to unfold. It remains possible that efforts will be made on Capitol Hill to add more money to deal with the effects of this disease.

Until recently, an increased pace of globalization has characterized economies around the world. A pandemic helps to change the focus by making it necessary for nations to ensure that individuals are protected within their respective borders. Immigration and travel policies become more restrictive. Manufacturing of essential medicines for domestic use no longer can be viewed as a luxury that is left to other nations to provide. COVID-19 has heightened a perceived threat that the U.S. has become too dependent on letting other countries be the main suppliers of health products needed here. Bipartisan interest is being renewed in S. 1317, the American Mineral Securities Act, as a way of enhancing production of dozens of minerals, including rare earth elements used in pharmaceuticals and medical devices. The bill would require nationwide assessments of more than 50 minerals and boost the U.S. workforce needed to produce the substances.

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STUDENT UNCERTAINTY ABOUT RE-ENROLLING IN FALL 2020

Kristen Truong

April 27, 2020

Now that colleges and universities across the nation have closed their doors for the current semester, a question worth pondering is what can be expected to happen in the Fall and will all students return to campus if able to do so? A national survey commissioned by the American Council on Education (ACE) and the American Association of Collegiate Registrars and Admissions Officers (AACRAO) administered to more than 2,000 currently enrolled U.S. college students finds that nearly one in five are uncertain about their plans for re-enrolling in the fall, or definitely are not going at all. Eighty-two percent of students say, however, that they will be able to complete all or most of their spring coursework as planned, while just 5% indicated they will not be able to complete any courses as planned.

Some 12% are uncertain or no longer plan to enroll at all. An additional 3% say they are planning to enroll in the fall to make up classes not completed in the spring due to COVID-19, meaning it is not clear they are planning to re-enroll fully. Finally, 3% say they were not planning to enroll previously and that has not changed. Hence, students who are uncertain or definitely not returning present a mixed picture for institutions already suffering significant financial losses due to the pan- demic and adding to an uncertain portrait of what fall enrollment might look like. An Infographic containing more information can be obtained here.

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PRESIDENT’S CORNER

Kristen Truong

April 27, 2020

BY ASAHP PRESIDENT PHYLLIS KING

CONTINUITY, CONNECTIVITY, AND CONVERGENCE

We have been thrust into the digitization of healthcare. The pandemic has fast-forwarded our adoption of technologies to serve the healthcare industry in almost every way. The convergence of technology, digitalization, additive manufacturing, machine learning and 3D modeling is here. Innovations as a result of these changes will significantly impact the patient experience, businesses, and the

modeling of education to prepare the next generation healthcare workforce.

The question for higher education is how fast can we understand, adapt, anticipate and project patient care needs and healthcare innovations to prepare our students and meet the needs of this new world? Digital literacy has become a necessity. Data-informed decision-making offers us a superior advantage. Collaborations and partnerships are critical.

ASAHP supports, informs, guides, leads, and works with you to advance education, practice, and research, and influence policies through partnerships. Let’s work together to shape our future. ASAHP is adapting to a more virtual reality and virtual forms of engagement with members to be more responsive to members. Join a community of learning and conversations on our website (click here to join).

More frequent webinar offerings on important topics to the health professions are being developed. The first webinar on “Clinical Education in the Time of COVID-19” received an overwhelmingly positive response with 245 participants from 96 institutions. The webinar is posted on the ASAHP website in case you were not able to attend. We will continue to bring you the latest news and information via multiple communication channels. Join us when you can.

STUDENT UNCERTAINTY ABOUT RE-ENROLLING IN FALL 2020

Now that colleges and universities across the nation have closed their doors for the current semester, a question worth pondering is what can be expected to happen in the Fall and will all students return to campus if able to do so? A national survey commissioned by the American Council on Education (ACE) and the American Association of Collegiate Registrars and Admissions Officers (AACRAO) administered to more than 2,000 currently enrolled U.S. college students finds that nearly one in five are uncertain about their plans for re-enrolling in the fall, or definitely are not going at all. Eighty-two percent of students say, however, that they will be able to complete all or most of their spring coursework as planned, while just 5% indicated they will not be able to complete any courses as planned.

Some 12% are uncertain or no longer plan to enroll at all. An additional 3% say they are planning to enroll in the fall to make up classes not completed in the spring due to COVID-19, meaning it is not clear they are planning to re-enroll fully. Finally, 3% say they were not planning to enroll previously and that has not changed. Hence, students who are uncertain or definitely not returning present a mixed picture for institutions already suffering significant financial losses due to the pandemic and adding to an uncertain portrait of what fall enrollment might look like. An Infographic containing more information can be obtained here.

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CALLING ALL CARS AND HEALTH DETECTIVES

Kristen Truong

April 27, 2020

If the novel COVID-19 pandemic happened to be considered a crime scene, then at some point health detectives, also known as epidemiologists, would be called to investigate. Apart from the heroic efforts of respiratory therapists, dietitians, physical therapists, and other health professionals, such as physicians and nurses who are on the front lines administering care to patients, the efforts of epidemiologists will be necessary to explain what happened at key stages of this disease and the subsequent havoc that it wreaked.

It is worth noting that the eminent biologist J.B.S. Haldane in 1963 (Journal of Genetics) described important stages of acceptance in the advancement of science:

Stage 1: This is worthless nonsense.
Stage 2: This is an interesting, but perverse point of view.
Stage 3: This is true, but quite unimportant.
Stage 4: I always said so.

Since the dawn of recorded history, humans have been confronted with infectious disease outbreaks that have ravaged the population. Throughout the millennia, it has been common for mistakes to be made in understanding the true nature of invading agents and how best to treat their dire effects. The situation this time is quite similar. Errors have been made in several nations regarding whether COVID-19 was deemed to be a problem of deadly significance and whether constructive responses were and are being made in a timely manner.

Some epidemiology models are developed on the basis of collecting data involving four key building blocks: Susceptibility, Exposure, Infection, and Recovery (SEIR). Data in each category can undergo changes on a daily basis. A report from the CDC on April 8, 2020 sheds light on the susceptibility aspect of COVID-19 by providing age-stratified, disease–associated hospitalization rates for patients in March 2020. Among patients hospitalized: 74.5% are aged ≥50 years; 54.4% are male, and among adult patients with data on underlying conditions, 89.3% have one or more of them with the most common being hypertension (49.7%), obesity (48.3%), chronic lung disease (34.6%), diabetes mellitus (28.3%), and cardiovascular disease (27.8%). Moreover, among patients where race/ethnicity data were available, 33.1% are non-Hispanic black.

Linking data from the S component of an epidemiology model to both the E and the I portions creates an opportunity to employ some prevention measures to reduce exposure and the likelihood of infection (e.g., social distancing). For the R part of the SEIR model, a serological test may prove that an antibody response occurred after infection of a patient. Still unknown is whether individuals who test positive will remain immune either to infection or reinfection. Also, if the virus mutates, will those antibodies produce a comparable level of protection? Someday, epidemiologists will have answers for all these questions. It also will be interesting to see if any pundits eventually migrated from Haldane’s Stage 1 to Stage 4.

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QUICK STAT (SHORT, TIMELY, AND TOPICAL)

Kristen Truong

March 25, 2020

Trends In Alcohol-Induced Deaths In The United States, 2000-2016

According to a paper appearing on February 21, 2020 in JAMA Network Open, a total of 425,045 alcohol-induced deaths were identified from 2000 to 2016. The rate of such deaths increased substantially among men and women and accelerated recently. The largest increases by race/ethnicity were observed among American Indian and Alaska Native men, American Indian and Alaska Native women, and white women. Despite initial declines among black women, black men, and Latino men, increases occurred later in the study period. Among American Indian and Alaska Native individuals, increases throughout the age range were observed, with the largest absolute increase occurring for ages 45 to 49 years among men and for ages 50 to 54 among women. This study found large increases in alcohol-induced death rates across age and racial/ethnic subgroups of the US population, which have accelerated over recent years. Large increases in these deaths among younger age groups may be associated with future increases in alcohol-related disease.

Attention-Deficit/Hyperactivity Disorder And Learning Disabilities Among U.S. Children Aged 3–17 Years

According to data released in March 2020 from the National Health Interview Survey, in 2016–2018, nearly 14% of children aged 3–17 years were reported as ever having been diagnosed with either attention-deficit/hyperactivity disorder (ADHD) or a learning disability. Non-Hispanic black children were the most likely to be diagnosed (16.9%). Among children aged 3–10 years, non-Hispanic black children were more likely to have ever been diagnosed with ADHD or a learning disability compared with non-Hispanic white or Hispanic children. Diagnosis of ADHD or a learning disability differed by federal poverty level for children in all racial and ethnic groups. Diagnosis of ADHD or a learning disability differed by parental education among non-Hispanic white children only. Attention-deficit/hyperactivity disorder (ADHD) and learning disabilities are the most commonly diagnosed neurodevelopmental disorders in children and often coexist.

HEALTH TECHNOLOGY CORNER

Lab-On-Chip Ultrasonic Platform For Real-Time And Nondestructive Assessment Of Extracellular Matrix Stiffness

According to an article published in Issue 4, 2020 of the journal Lab on a Chip, similarly to how a picked lock gives away that someone has broken into a building, the stiffening of a structure surrounding cells in the human body can indicate that cancer is invading other tissue. Monitoring changes to this structure, called the extracellular matrix, would give researchers another way to study the progression of disease. Detecting changes to the extracellular matrix is hard to do, however, without damaging it. Purdue University engineers have built a device that would allow disease specialists to load an extracellular matrix sample onto a platform and detect its stiffness through sound waves. Researchers first demonstrated the device as a proof-of-concept with cancer cells contained in hydrogel, which is a material with a consistency similar to an extracellular matrix. The team now is studying the device's effectiveness on collagen extracellular matrices.

Brain Reading Technology And Development Of Brainwave-Controlled Devices

Researchers at the Francis Crick Institute, Stanford University, and University College London have developed a new method to record brain activity at scale accurately. A manuscript appearing on March 20, 2020 in the journal Science Advances indicates that the technique could lead to new medical devices to help amputees, patients with paralysis, or individuals with neurological conditions, such as motor neurone disease. The system consists of a bundle of microwires mated to large-scale microelectrode arrays, such as camera chips. This system has excellent recording performance, demonstrated via single unit and local-field potential recordings in isolated retina and in the motor cortex or striatum of awake moving mice. The modular design enables a variety of microwire types and sizes to be integrated with different types of pixel arrays, connecting the rapid progress of commercial multiplexing, digitization, and data acquisition hardware together with a three-dimensional neural interface.

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REPORTING OF RACE AND ETHNICITY IN THE MEDICAL LITERATURE

Kristen Truong

March 25, 2020

Far beyond mere academic interest, the collection of race and ethnicity data is an important way to identify and ultimately address disparities in access to treatment and inequalities in health care provision. The extent to which race and ethnicity, a multifaceted concept, is reported in the medical literature is extremely variable, according to an article published in the March 2020 issue of the Journal of Clinical Epidemiology. Investigators sought to determine objectively the quality of reporting of race and ethnicity in original medical research papers. A retrospective bibliometric analysis was used. Two independent investigators analyzed original articles investigating race and ethnicity, published between 2007 and 2018, in the 10 top-ranking academic journals in each of the following categories: general medicine, surgery, and oncology.

Among 995 original articles reporting race and ethnicity in the top 10 ranking medical academic journals, only 4.52% provided a formal definition of race and ethnicity and only 10.25% described the method used to classify individuals as to race and ethnicity. Eighty-one different race and ethnicity classifications were identified, but they often were imprecise and open to interpretation. A reasonable question is what, if anything, does this information add to what already is known? The adherence of leading medical academic journals to International Committee of Medical Journal Editors (ICMJE) and also the American Medical Association (AMA) Manual of Style guidelines was poor (still poor when considering previous studies). Pertinent questions are what is the implication and what should change now? The investigators conclude that there is significant room for improvement in the collection, reporting, and publishing of data describing ethnicity and race. Given that many national and international agencies, including the National Institutes of Health, require extensive data sets to identify and ultimately prevent health disparities, the lack of adequate reporting of race and ethnicity in the medical literature presents a significant and clinically relevant problem.

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TEETH, EARLY-LIFE ADVERSITY, AND MENTAL HEALTH RISK

Kristen Truong

March 25, 2020

Exposure to early-life adversity is one of the biggest risk factors for both mental and physical health problems across the lifespan. A need for objective measures that are noninvasive, inexpensive, and able to provide more accurate information about the presence and timing of childhood adversity has been recognized. If such a measure existed, its public health implications would be profound. For the first time, clinicians would be able with confidence to identify children on a population-wide scale who experienced childhood adversity during sensitive periods in development and therefore are at future risk for developing a psychiatric or other disorder. A manuscript appearing in the March 2020 issue of the journal Biological Psychiatry advances the proposition that teeth potentially could serve as a promising and actionable new tool capable of achieving key primary prevention goals. To support this claim, researchers first summarized empirical work from dentistry, anthropology, and archaeology on human tooth development and show how these fields collectively have studied human and animal teeth for decades, using teeth as time capsules that preserve a permanent, time-resolved record of life experiences in the physical environment.

Specifically, the investigators articulate how teeth have been examined in these fields as biological fossils in which the history of an individual’s early-life experiences is permanently imprinted, acknowledging that this line of research is related to, but distinct from, studies of oral health. They then integrate these insights with knowledge about the role of psychosocial adversity in shaping psychopathology risk to present a working conceptual model, which proposes that teeth may be an understudied yet suggestive new tool to identify individuals at risk for mental health problems following early-life psychosocial stress exposure. They end by presenting a research agenda and discussion of future directions for rigorously testing this possibility and with a call to action for interdisciplinary research to meet the urgent need for new biomarkers of adversity and psychiatric outcomes.

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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY

Kristen Truong

March 25, 2020

Characteristics And Health Status Of Informal Unpaid Caregivers: 2015-2017

The Centers for Disease Control and Prevention (CDC) has released a report, Characteristics and Health Status of Informal Unpaid Caregivers. In 2015, an estimated 17.7 million U.S. persons were informal caregivers who provided substantial services through in-home, unpaid assistance to their family members and friends. Caregiving can have many benefits, such as enhancing the bond between caregiver and recipient, but it also can place an emotional and physical strain on caregivers, leading to higher rates of depression, lower quality of life, and poorer overall health. Based on three years of Behavioral Risk Factors Surveillance System (BRFSS) data across 44 states, the findings indicate that approximately 20% of respondents were caregivers, and nearly 20% of these caregivers reported fair or poor health. Demographic characteristics and health status of unpaid caregivers, along with implications of the findings are discussed. Unpaid family and friend caregivers are paramount to the care of older adults, as well as the health system more generally. Unfortunately, caregivers are often under-supported and consequently may suffer adverse health effects. The report can be obtained here.

2020 Alzheimer’s Disease Facts And Figures

2020 Alzheimer’s Disease Facts and Figures is a statistical resource for U.S. data related to Alzheimer’s disease, the most common cause of dementia. This disease is the most common cause of dementia, accounting for an estimated 60% to 80% of cases. Recent large autopsy studies show that more than half of individuals with Alzheimer's dementia have Alzheimer's disease brain changes (pathology) as well as the brain changes of one or more other causes of dementia, such as cerebrovascular disease or Lewy body disease. This condition is called mixed pathologies, and if recognized during life is called mixed dementia. Difficulty remembering recent conversations, names or events is often an early clinical symptom. Apathy and depression also often are early symptoms. Later symptoms include impaired communication, disorientation, confusion, poor judgment, behavioral changes and, ultimately, difficulty speaking, swallowing, and walking. Background and context for interpretation of the data are contained in the Overview. Additional sections address prevalence; mortality and morbidity; caregiving; and use and costs of health care and services. A Special Report examines primary care physicians’ experiences, exposure, training, and attitudes in providing dementia care and steps that can be taken to ensure their future readiness for a growing number of Americans living with Alzheimer’s and other dementias. The report can be obtained here.

Critical Analysis Of Existing And Emerging Patient Safety Practices

Despite sustained national attention and notable successful interventions in recent years, patient safety remains a significant problem in the United States. Harms such as adverse drug events, healthcare-associated infections (HAIs), falls, and obstetric adverse events are responsible for thousands of deaths and hundreds of thousands of injuries each year. An estimate is that in 2017, there were 86 hospital-acquired conditions per 1,000 hospital discharges, a figure that has fallen steadily in recent years, but remains alarmingly high. The Making Healthcare Safer III report by the Agency for Healthcare Research and Quality (AHRQ) addresses this continuing problem by supporting the implementation of patient safety practices where appropriate, advancing a framework for patient safety transformation, and considering the contextual factors that can lead to successful use of patient safety interventions. Forty-seven practices are reviewed that target patient safety improvement in hospitals, primary care practices, long-term care facilities, and other healthcare settings. The practices are categorized among 17 chapters that represent harm areas including medication management and diagnostic errors. The practices include clinical decision support and those designed to prevent medication errors and reduce opioid misuse and overdose. The report can be obtained here.

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DEVELOPMENTS IN HIGHER EDUCATION

Kristen Truong

March 25, 2020

As the month of March 2020 draws to a close, the nation is experiencing an unprecedented array of governmental and non-governmental proactive and reactive initiatives to mitigate the impact of COVID-19. Closing K-12 to postgraduate education activities will exert a wide variety of strains on students and their families. For example, a health professional who also happens to be a single parent with children is placed in the unenviable position of trying to juggle the responsibility of going to work every day to provide care for patients while also contending with the challenge of assuming family life duties for offspring who are at home because of school closings.

Portions of the education sector are being affected in different ways. Classroom teachers throughout the nation have to figure out how best to furnish a comparable level of education for their students who now are at home rather than on school grounds. Children who depend on school nutrition programs for food need to have effective alternative ways of being fed satisfactorily. Colleges and universities fortunate enough to possess hefty endowments may not have any immediate concerns of having to make refund payments to students for dormitories that have been closed and classes that have been suspended indefinitely. The same is not true, however, for institutions with little in the way of financial reserves and that rely heavily on tuition income. A related concern is that the high cost of operating intercollegiate athletic programs for students cannot be offset by post-season tournament revenues derived from television and ticket sales.

Governmental Assistance For Education In Response To The Spread Of The Coronavirus

Phase 2 of a federal stimulus package in the form of the Families First Coronavirus Response Act (P.L. 116-127) expands paid family and medical leave for child care due to school and day care closings for both private and public employers with less than 500 employees. Recognizing that more assistance is needed, legislators continue to seek agreement on how to address related situations that include: (1) Continuation of school lunch programming; (2) Allow the secretary of education to defer student loan payments, principal, and interest for three months without penalty to the student, with an additional three months’ deferment available if necessary; (3) Ensure that students at eligible institutions whose semesters were ended due to the emergency do not have to return their Title IV aid or have the distributed aid count towards their loan limits; and (4) Allow institutions to issue work-study payments to a student who is unable to work due to work-place closures and grant institutions the ability to transfer unused work-study funds for supplemental grants.

Under a change announced on March 20, borrowers can suspend payments for two months by contacting their servicers and enrolling in “forbearance.” No interest would accrue during that time. The plan would apply to all loans made directly by the federal government and to a portion of those made by private lenders and guaranteed by the government under a program that ended in 2010. However, loans made under the federal guarantee program that are held by commercial institutions won’t qualify. Approximately 43 million Americans owe roughly $1.5 trillion in federal student loans. The typical family spends $179 a month on payments, according to a July 2019 report by the JPMorgan Chase Institute.

Accreditation In The Context of Disease Transmission Increases

The congressional legislative hopper contains bills aimed at improving accreditation. The necessity of focusing on initiatives that bear directly on controlling the spread of disease means that for the immediate future such legislation will not move forward. Examples are: H.R. 5768, the Accreditation Reform Act to amend the Higher Education Act of 1965 to protect students and taxpayers by modernizing evaluation and increasing transparency in the accreditation system, and for other purposes; and H.R. 5171 to authorize the National Advisory Committee on Institutional Quality and Integrity permanently. Currently, it must be reauthorized each time the Higher Education Act is extended or reauthorized. Meanwhile, Education Secretary Betsy DeVos announced finalization of a package of regulations on college accreditation that are designed to erase any distinction between regional and national accrediting agencies. If the original schedule is adhered to, they will be effective this coming July 1. Aimed at promoting innovation in higher education, consumer advocates have expressed concerns that new regulations will enable low-quality institutions to shop for friendly accreditors more easily, thereby allowing them to access federal funding.

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HEALTH REFORM DEVELOPMENTS

Kristen Truong

March 25, 2020

Across the decades, policymakers have strived assiduously to produce improvements pertaining to the metaphorical three-legged stool of health care quality, access, and cost. The Patient Protection and Affordable Care Act of 2010 came into effect in March of that year. It represented a highly comprehensive approach of dealing with a wide range of defects and deficiencies in health care that continued to persist in the first decade of the 21st century.

Until several weeks ago, efforts to reform health care have proceeded in incremental and uncoordinated ways. The sudden appearance of a new communicable disease in the form of a pandemic has resulted in an explosion of new initiatives launched through a combination of coordinated federal and state interventions. Such new efforts continue at a rapid pace, but they do so in a time of considerable uncertainty. Some essential issues that continue to call for a clear resolution involve the following considerations: the best way of slowing the spread of infection, accurately determining how many individuals continue to circulate freely as their infection goes undetected, understanding how long the current appearance of the disease will last, and even if it apparently disappears, what the likelihood is that it could resurface later in the year. Also, if an appropriate vaccine becomes available, it remains to be seen whether it will result in any untoward hazardous side effects.

Role Of The Health Workforce And Challenges It Faces

A steady accumulation of new cases of COVID-19 in both the U.S. and in other countries that occurs as diagnostic testing for the presence of this disease increases, means that much greater stress is being placed on the capacity of the network of health care services to deal with this situation. Apart from the basic question of whether there are sufficient numbers of many kinds of health professionals in appropriate venues, such as hospitals to meet patient demands for care, there is the matter of the increased risk of disease exposure these personnel must confront when providing treatment. Not all of these individuals have the protective equipment needed to prevent infection. Logistically, more effort is needed to increase the supply chain and ensure that effective masks and hazard protection clothing are distributed rapidly. Otherwise, a serious problem becomes even more threatening if front line health care practitioners are sidelined because they also become seriously ill.

The Left Hand Giveth While The Right Hand Taketh Away

Many actions taken with the best of intentions, unfortunately often are accompanied by unintended negative consequences. For example, according to the Congressional Research Service, the current COVID-19 outbreak may pose significant challenges for the United States’ blood supply. Mitigation strategies to prevent the spread of this disease, such as closures of schools and workplaces, have led to blood drive cancellations, resulting in a critical blood supply shortage in the Pacific Northwest (specifically, western Washington and Oregon). School closures, event cancellations, and other mitigation strategies in other areas of the country may provide challenges for maintaining a sufficient blood supply. The management and distribution of the supply in this nation is coordinated largely by private organizations (e.g., Red Cross), with some oversight by the Department of Health and Human Services (HHS). Congress may need to consider how best to address critical shortages, such as through HHS or the U.S. Food and Drug Administration’s (FDA) authority over blood safety and donation guidance.

The VA Health System Within A Nonexistent System

Calling U.S. health care a system is a misnomer. Rather than a single unified entity, it is a collection of various systems that include government providers (e.g., Veterans Health Administration and Medicare) and non-governmental providers (e.g., private sector employers and private insurance). At a time of COVID-19 crisis, the Veterans Administration is of special interest. Because of their age, patients who served in Vietnam, Korea, and World War II are an important part of a demographic group designated as being at high risk for this disease. The VA currently administers the provision of health care services for more than nine million beneficiaries. Having served their nation in time of need, every effort should be made to ensure that these individuals receive the kind of care they need in this period of crisis.

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RISING TO THE OCCASION

Kristen Truong

March 25, 2020

Ordinarily during a presidential election year, significant legislative proposals grind to a halt. The party controlling the White House would like to be able to enact laws that bolster its reputation in ways that strengthen the rationale for voters to retain it in office. Opponents in the other party are less inclined to aid in achievement of that goal. Instead, it is much more to their advantage to portray the incumbents as being ineffective and give the electorate good reasons for removing current officials from office.

A good crisis can act as a circuitbreaker that disrupts this pattern of doing business and it arrived in the form of a declaration by the World Health Organization that a pandemic is underway accompanied by the establishment of a national emergency by the Trump Admiistration regarding the outbreak of COVID-19. These developments have set in motion some extraordinary responses in the form of legislation aimed at providing nostrums for the perceived health and economic threats posed by this disease. The following description of the steps being taken may be considered partial as of the date this section of the newsletter is being written because each passing day stimulates the arrival of new responses to the challenges arising from the spread of communicable disease.

In phase one of providing financial assistance, the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (P.L. 116-123), which passed with near unanimous support in both the House and Senate, was signed into law by the President on March 6, 2020. The bill provides $8.3 billion in emergency funding for federal agencies to respond to the coronavirus outbreak. Of that amount, $6.7 billion is designated for the domestic response and $1.6 billion for the international response. The next major step taken was completion of the second supplemental legislative package aimed at seeking to contain and combat the COVID-19 pandemic. The president signed the Families First Coronavirus Response Act H.R. 6201 (P.L. 116-127) on March 18. The House had passed the bill on both a 363-40 vote on March 14 and a subsequent March 16 unanimous vote to add technical corrections. The Senate then passed the measure on a vote of 90-8 on March 18.

The scope of these initiatives is vast insofar as recognition is being accorded to major disruptions caused by health care facilities in the U.S. possibly being overwhelmed by the demand for services and economic dislocations that result from workers becoming unemployed, along with the production of essential goods and services being curtailed. The kinds of situations either addressed by existing initiatives or being contemplated for future action include: unemployment insurance; enhanced paid leave and sick leave; direct financial payments to individuals; federally guaranteed loans to employers; loans to distressed industries, such as airlines; and increased funding for medical supplies and equipment.

P.L. 116-127 makes it possible for group and individual health insurance plans to cover approved diagnostic tests as well as office visits, treatment at urgent care clinics, telehealth, and emergency room visits that result in orders for coronavirus diagnostic testing, insofar as the services received during the visit relate to testing or determining the need for testing. Plans will not be able to impose cost-sharing or subject enrollees to prior authorization or other medical management requirements.

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PRESIDENT’S CORNER

Kristen Truong

March 25, 2020

BY ASAHP PRESIDENT PHYLLIS KING

We are living in an unprecedented reality that is likely to have a transformational effect on aspects of our lives, especially higher education. No doubt everyone has had to demonstrate adaptability and creativity to address changes under challenging conditions. The pandemic has altered our routine lifestyles to one of disruption, social distancing and isolation. Use of technology has provided us with a means of continuity in operations and communications. This is a time to model resilience, persistence, strategic thinking, leadership and teamwork, as we all work together to recover.

The Higher Logic platform is a member benefit of ASAHP where you can share online your questions, concerns, announcements, best practices, and many other items (click here for the ASAHP Community). I encourage you to join this community and reach out to others sharing similar experiences. Show your support and learn from one another collectively how to handle challenging times and build a road to recovery. ASAHP is here for you.

The Association has been instrumental in providing resources for institutions of higher education. The following examples indicate efforts aimed at continuing to monitor COVID-19:

Interim Guidance for Administrators of US Institutions of Higher Education (IHE) to Plan, Prepare, and Respond to Coronavirus Disease 2019 (COVID-19)

Interim Guidance: Get Your Mass Gatherings or Large Community Events Ready for Coro- navirus Disease 2019 (COVID-19)

CDC Coronavirus Information

Harvard Medical School Coronavirus Resource Center

Department of Education Coronavirus Information and Resources for Schools and School Personnel

Federal Student Aid Guidance

Federal Student Aid FAQ

Inside Higher Ed Article - March 6, 2020

Inside Higher Ed Coronavirus Coverage

World Health Organization Coronavirus Information

White House Coronavirus Guidelines for America

Kaiser Family Foundation Tracking

HRSA Coronavirus Resources

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More May 2020 TRENDS Articles

RESEARCH AND EDUCATION AFTER THE PANDEMIC

PRESIDENT’S CORNER