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New COVID-19 Subvariants Emerge While Monkeypox Cases Grow, What Can You Do to Be Prepared?

With over 6,900 cases of monkeypox across 51 countries, and the emergence of new COVID-19 Omicron subvariants BA4 and BA5, we must continue to maintain heightened public health mitigation and preparedness measures through the coming summer months. 

COVID-19 cases in the United States (US) are at their highest levels since April and the increase comes as Americans have gathered for Independence Day celebrations amidst the emergence of the more transmissible, and potentially more serious, Omicron BA.4 and BA.5 subvariants. A preliminary study from the University of Tokyo shows that the new variants may have evolved to cause more serious infection of lung cells than previous Omicron variants which resulted in mostly mild cold-like symptoms. This may be the reason why countries with widespread BA4 and BA5 outbreaks, such as the United Kingdom (UK), Belgium, France, Germany, Portugal,and Israel, all with largely vaccinated populations and strong public health data tracking, are seeing sharp increases in hospitalizations. In addition to rising COVID-19 cases and hospitalizations from new emerging variants, monkeypox cases have tripled in the last two weeks.

What is Monkeypox?

Monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in monkeys being used for research. While the origin of the virus remains unknown, it was given its name due to it first appearing in monkeys. The current 2022 monkeypox outbreak is the first time in 64 years since discovery that we have seen community spread from human to human on such a large scale outside the continent of Africa. 

Monkeypox presents with normal viral symptoms such as fever, malaise, headache, and weakness. This is followed by swelling of lymph nodes, rash, and the presentation of lesions. The illness typically lasts between two and four weeks and can be potentially fatal. Thus far, community spread of the virus appears to occur when another person comes in close contact with lesions, body fluids, respiratory droplets, and/or contaminated materials, such as bedding from an infected person. There are limited quantities available of vaccines used to eradicate smallpox that appear effective against monkeypox; however, the Centers for Disease and Control and Prevention (CDC) is not yet recommending widespread vaccination but rather a more heightened focus on educating communities on how monkeypox is contracted and steps to be taken to prevent further human to human transmission if monkeypox is in your community. These steps include avoiding the following with individuals with monkeypox: 

  • Avoid close, skin to skin contact.
  • Do not kiss, hug, or have sexual contact.
  • Do not share eating utensils or cups.
  • Do not handle or touch bedding, towels, or clothing of a sick person. 

While cases of monkeypox continue to rise, most public health experts believe it will not be as widespread as the COVID-19 pandemic as it does not appear to be as transmissible at this time.

What Can Communities Do to Stay Safe?

Whether it is monkeypox, new variants of COVID-19, or any future emerging infectious disease, the mitigation and preparedness measures with widespread viruses circulating in a community remain the same. Proven measures include: 

  • Masking. Wearing a well fitted N95 or KN95 mask when in an indoor crowded setting not only will continue to protect against COVID-19 but other respiratory viruses such as cold and flu.
  • Increase ventilation indoors. While outdoors is always better than indoors, creating air exchanges indoors to move any viral particles out of the air goes a long way. Open windows or doors to allow for fresh air to circulate inside the space. In spaces without windows, consider investing in an air purification system. There are many systems available, and you should look for one that creates air movement while utilizing high level HEPA filtration to clean the air. 
  • Wash your hands often. Frequent hand washing is one of the best ways to prevent the spread of COVID-19, monkeypox, and other viruses. Throughout the day, we all touch many common surfaces and then scratch our faces, eyes, or rub our noses without realizing. Viral particles spread from common surfaces to our hands. Hand washing or use of alcohol-based hand sanitizer when you cannot wash your hands must be done for 20 seconds to kill viruses. In addition, when washing your hands, it is important to clean all surfaces including palms, under nails, between fingers, the back of your hands, and even up to your wrists. Remember to wash your hands before you prepare food and eat, after using the bathroom, and after touching any common surfaces. 
  • Get Vaccinated. Three doses of a MRNA vaccine continue to show strong results keeping people out of hospitals and with only mild disease if they contract COVID-19. We must continue to develop our vaccines to better defend against emerging COVID-19 variants.
  • Isolate. When we get sick with any illness, we should isolate ourselves from others.

Communities should have strategies in place for: 

  • Community education: Outreach and education should focus on helping people make the best-informed decisions to protect their health and the health of their loved ones. This means putting out prevention strategies for avoiding viruses and disease as well as real time data on level of risks in one’s community.
  • Efficient testing capacity with minimal turnaround time: Lessons learned from early 2020 when COVID-19 first emerged taught us the importance of testing availability, capacity, and rapid results turnaround in being able to quickly identify individuals with COVID-19 and isolate them from others. Last week, the White House announced that commercial labs in communities can begin testing for monkeypox. This significantly expands testing capacity as up until last week, clinicians performing monkeypox testing had to send samples to a CDC laboratory which slowed results processing times. Communities should continue to promote the importance of testing for COVID-19 or monkeypox if one thinks they were potentially exposed to help stop the spread of further viruses. Continued federal funding will be needed for states to maintain testing capacity. 
  • Increase vaccination capacity: Plan now for administering new vaccines that may better neutralize emerging COVID-19 strains. We may not need to fully stand-up mass vaccination sites, but we will need to expand capacity come late summer, early fall when a new vaccine is scheduled to arrive. As it relates to vaccination for monkeypox, the US continues to order hundreds of thousands of vaccines but is not yet recommending widespread administration. This could change quickly and communities should plan now if mass administration of vaccines are recommended. 
  • Increased treatment capacity: Over the last year, the US has been a few weeks behind Western European countries, like the UK, when it comes to mirroring COVID-19 trends and surges. If this continues to be the case, we must be prepared now for a rise in hospitalizations week over week and maintain healthcare capacity to care for potentially more severe disease from the BA4 and BA5 Omicron subvariants.

Emerging infectious diseases such as COVID-19 and monkeypox will continue to be with us for the foreseeable future. The faster we can adapt to basic virus mitigation measures being a part of our lives the faster we can drive down illnesses, help save lives, and keep our vulnerable populations protected. 

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Jeff Bokser is Hagerty Consulting’s Vice President of Healthcare Programs with strategic expertise in all aspects of healthcare operations, finance, crisis management, and recovery. Jeff has over 20 years of experience as a senior leader at NewYork-Presbyterian and Yale New Haven Health and served as Incident Commander guiding 40,000+ employees through numerous internal and external emergency response and recovery operations.

COVID-19, Monkeypox, and Beyond: is Your Hospital Really Prepared?

As summer approaches, many hospitals anticipated that this could be a time to collectively catch their breath and ease the stress and anxiety put on heroic healthcare workers. They could recharge, reenergize, restore, and rebuild a more resilient pandemic-ready organization for projected fall and winter COVID-19 surges. Instead, unanticipated new Omicron variants have continued to emerge and we now find our nation’s healthcare systems handling over 100,000 new COVID-19 cases, 3,260 COVID-related hospital admissions, and 280 COVID-related deaths daily. On top of needing to respond to the latest COVID-19 case surge, there is an increasing number of Monkeypox cases globally – a disease rarely seen outside of the continent of Africa. All of this as hospitals face financial and operational challenges, including loss of patient volume, negative operating margins, and skyrocketing expenses. 

As we face the reality that COVID-19 will be with us for the foreseeable future, supply chain, inflation, and cost pressures will continue to linger and new diseases that threaten the well-being of our population will continue to emerge, hospitals must ask themselves the question, are we really prepared?

To help answer this question, hospitals should evaluate and optimize the following:

Obtain Federal Funding for COVID-19 Recovery and Future Public Health Preparedness

With the Health & Human Services (HHS) Provider Relief Fund no longer able to provide assistance, due to a lack of sufficient funds, the Federal Emergency Management Agency (FEMA)’s Public Assistance (PA) program is the best way hospitals can continue to receive reimbursement for all COVID-related expenses incurred over the last several years; however, hospitals must act quickly to potentially receive 100 percent federal reimbursement. On July 1, 2022, FEMA PA transitions to a 90 percent cost recovery for ongoing COVID-related expenses. In addition to FEMA PA, hospitals should seek out FEMA Hazard Mitigation Grant Program Funding (HMGP). The Biden Administration has made $3.46 billion available in HMGP funding to states, territories and tribes that had major disaster declarations for COVID-19. Hospitals are eligible to apply to working with their state for a portion of this funding. Finally, hospitals should optimize their funding from HHS’ Assistant Secretary of Preparedness & Response (ASPR) by working with partner facilities to optimize the dollars for regional public health preparedness initiatives such as surge capacity, community public health messaging, disease surveillance and sharing of resources and assets during emergencies.

Conduct After-Action Reviews, Hardwire Organizational Resiliency, and Preparedness Activities

Heroic efforts were undertaken over the last several years to respond to COVID-19. We must memorialize these efforts including how surge capacity was created; staff vacancies were filled; supplies procured; and lives were saved into annexes of hospital emergency operations plans.

Hospitals should conduct a comprehensive after-action report (AAR) and develop an actionable improvement plan that identifies opportunities for improvement, concrete actionable solutions and highlights strengths that can be hardwired, shared across a healthcare system or even the country with other hospitals.

In addition, we need to recognize that infection control measures such as donning and doffing Personal Protection Equipment (PPE) for routine patient contact and not just confirmed infectious cases is likely to stay for the foreseeable future. Accordingly, we must work to shift the mindsets of our caregivers so that responding to a surge of patients becomes more routine and sustainable and does not result in caregiver burnout. This means rethinking staffing, training and support considering the ongoing COVID-19 pandemic and other emerging infectious diseases.

Push the Envelope on Risk Assessments

Scenarios that once seemed unimaginable such as; a hurricane hitting New York City, a global pandemic killing over 6.2 million people, or winter storms causing regional electrical grid failures, used to be viewed as “black swan” once in a hundred year events. These events now more common occurrences. This means risk assessments should be conducted, pushing the imagination and envelope on emergency incident scenarios, and evaluating the risk on all people, processes and systems in your organization. The risk assessments should then be used to drive Emergency Operations Plan (EOP) improvements, Business Continuity Plan development, employee training and drill and exercise development. Risk should be assessed from multiple lenses but especially from the patient and employee perspective.

Serve as a Pillar and Public Health Voice of Reason for your Community

Hospitals are looked to as ‘beacons in the night’. They are expected to always be ready and have the answers when it comes to helping save lives and what people should do to take care of themselves in time of need. We are suffering from the greatest lack of trust in public health and public health messaging as result of the country’s political divide. Therefore, it is up to hospitals at the local level, who are trusted community pillars, to proactively identify emerging threats and communicate effectively with their communities. Hospitals should share public health guidance with their communities and incorporate members into after action report development, risk assessments and preparedness plan enhancement.

Hagerty Can Help

Collectively evaluating and optimizing these four critical areas will make sure your hospital is really prepared for whatever may come next. Hagerty Consulting helps healthcare organizations conduct and storyboard actionable after-action reports; risk and emergency operations plan gap assessments and public health outreach campaigns that position communities for future public health emergencies and organizations for the new Joint Commission Emergency Preparedness standards and Medicare & Medicaid Services (CMS) Emergency Preparedness Rule.

Throughout the COVID-19 pandemic, our team has been helping more than 100 hospitals, healthcare systems, and public health departments obtain the funding they are entitled to, including FEMA PA, in support of their response and recovery.

Jeff Bokser is Hagerty Consulting’s Vice President of Healthcare Programs with strategic expertise in all aspects of healthcare operations, finance, organizational resiliency, institutional preparedness, and recovery. Jeff has over 20 years of experience as a senior leader at NewYork-Presbyterian and Yale New Haven Health and served as Incident Commander guiding 40,000+ employees through numerous internal and external emergency response and recovery operations.

A January of COVID-19 Like No Other, but Hope is on the Horizon

Nearly three years ago, no one could have predicted that we would soon be in the midst of the public health crisis of our lifetime; 1.35 million daily cases, 136,640 in the hospital, and 1,700 dying from COVID-19 related illness per day. As new individuals get the Omicron variant related symptoms including: a scratchy throat, muscle aches, lower back pain, fatigue, runny nose, nausea, and a headache they find themselves unable to get a doctor’s appointment and unable to find rapid viral antigen tests or the gold standard PCR test to determine if they have the COVID-19 virus. The United States (US) Public Health System has reached a breaking point and is on the brink. Crisis of Care Standards are being implemented in several states and others have them at the ready. This means decisions are being made as to who gets certain levels of care and treatment and who does not. Emergency Departments are temporarily closing and critical services like substance abuse day treatment programs or surgeries are being canceled. Hospital beds are full in some areas and there are not enough healthcare workers to care for patients in 25% of hospitals across the country. This equates to 1 out of every 4 hospitals in the US reporting critical staffing shortages to the US Department of Health and Human Services (HHS). Another 100 US hospitals anticipate being in a staffing crisis within the week.

Hospital expenses per patient are up over 26% from pre-pandemic levels as a result of premiums being paid to try and procure temporary agency nurses to staff positions vacated by burnout, retirement, and/or caregivers becoming sick with COVID-19 themselves. In many states, finding doctors and nurses has become so difficult that what would ordinarily be a violation of basic infection control principles are being put aside as staff who have COVID-19 themselves are being asked to come to work sick in protective gear to care for patients. The HHS, Federal Emergency Management Agency (FEMA), and National Guard are all deployed to help with the critical hospital staffing crisis. Funding is available primarily through FEMA Public Assistance (PA), HHS Provider Relief Fund and other programs. Despite all of this, the US’s healthcare system is falling behind.

UnSplash: Mufid Majnun

While the next four to six weeks will be tough, hope is on the way and there is reason to be optimistic about better times ahead in the very near future. Public health experts who have looked at data and trends from recent Omicron outbreaks in South Africa and England show that Omicron cases are likely to peak in the US starting this week in parts of the country through the end of January. By February, we should begin to return to a level of virus in our communities that we can safely live with, meaning our hospitals will not be overwhelmed and cases and deaths per day will decrease.

The tide will not turn on its own; it will take collective effort us to return to the “new normal” way of living with COVID-19 that the world began adjusting to in the fall of 2021. For us to return to this reality – one that we will be living with for many years to come – we must try to be as safe and respectful of our health and the health of others by:

  1. Being thoughtful about your daily interactions with others. The kind of activities you use to do over the summer or fall of 2021 such as gathering with vaccinated family and friends and dining indoors are now likely to expose you to the contagious strain of Omicron. According to the most recent Johns Hopkins Coronavirus Resource Data, 1 out of every 4 people tested each day have COVID-19. This means the likelihood of someone having COVID-19 in an indoor environment with greater than 4 people is high. Choose activities that you must do such as school, work, doctors’ appointments or safe gatherings to balance your mental health and well-being. This is only for a short period of time.
  2. Wearing a high-quality fitted mask. The Centers for Disease Control and Prevention (CDC) is expected to change its guidance by recommending the wearing of N-95 or KN95 masks only. This is because we now have a good supply of these masks and given the contagiousness of the new variants which require well-fitting high filtration masks versus cloth masks. If everyone wore a N95 or KN95 mask in public, it is likely we could end this pandemic and spread of virus quickly.
  3. Getting vaccinated and boosted. Vaccines are extremely protective against hospitalizations and death from COVID-19. 60-75% of all current COVID-19 Omicron variant hospitalizations are in unvaccinated individuals. The remainder are either vaccinated but immunocompromised, have underlying conditions or were admitted for another reason and then test positive for COVID-19.
  4. Testing frequently. Test at the onset of any symptom or prior to getting together with others for a family gathering or event. Testing as close to the event as possible is important as rapid antigen tests are likely to only pick up higher viral loads when you are most contagious.

Moreover, as a nation, we must start now to learn to live with COVID-19 like we do other viruses. We must start to fund programs and initiatives to mitigate the effects of future virus surges and pandemics as well as prevent our hospitals from ever being overwhelmed in the future by:

  1. Prioritizing federal funding for Public Health Preparedness. Hospitals are hemorrhaging money implementing emergency measures to take care of patients. 20 years ago, following the September 11th attacks, the federal government created the Hospital Preparedness Program (HPP). Funding must be increased and tied to specific standardized preparedness deliverables that will strengthen our public health preparedness for the future.
  2. Creating standby critical care bed and staff capacity in our hospitals. Hospital bed capacity has been shrinking across the country for decades as more and more care shifts to outpatient settings and healthcare organizations look for improved efficiency in the cost of care. We must find ways to have beds and public health doctors and nurses at the ready to scale up in times of crisis. Easier said than done, but this is a challenge that we must get creative about.
  3. Enhance standardized seasonal public health measures and messaging. The US has arguably the greatest healthcare system in the world with leading experts and scientists and doctors. We must find ways develop standardized national public health measures and messaging that are easy for all to understand and subsequently follow. This will be essential for mitigating future virus outbreaks as we balance maintaining a fully functioning society with reasonable public health measures such as hygiene, masking, ventilation, and vaccination guidelines for all.

Jeff Bokser is Hagerty Consulting’s Vice President of Healthcare Programs with strategic expertise in all aspects of healthcare operations, finance, crisis management, and recovery. Jeff has over 20 years of experience as a senior leader at NewYork-Presbyterian and Yale New Haven Health. He advanced performance and increased revenue in clinical and nonclinical settings and led innovation in daily operations and care delivery processes. Jeff is nationally recognized in the healthcare sector for his transformational leadership in the areas of emergency and crisis management; security and safety; pandemic and surge planning; and business continuity. Jeff was the system-level executive responsible for Emergency Medical Services, Emergency Management, Business Continuity, Crisis Management, Safety, Security, and Regulatory Compliance for the entire continuum of the NewYork-Presbyterian Hospital & Healthcare System enterprise. He served as Incident Commander guiding 40,000+ employees through numerous internal and external emergency response and recovery operations including Hurricane Sandy, Ebola, H1N1, and 9/11.

Hagerty Health & Wellness Tips – Staying Safe this Holiday Season

The holidays are approaching, and many families will gather to celebrate together. For the past 22 months, we have hunkered down hoping COVID-19 would go away. While this holiday season there are 50 percent less daily COVID-19 cases than last year, we still must take measures to ensure holiday celebrations can be shared safely, particularly when it comes to protecting our elderly and vulnerable populations. For those who are vaccinated the thinking has changed. It is now about personal risk level and finding ways to be as safe as possible while continuing celebrations and traditions as COVID-19 will be with us for many years to come. Collectively, we can all play a role in adapting to our new normal this holiday season and stay safe and healthy this fall and winter by taking the following steps:

  • Get your COVID-19 vaccine and booster. This will be the year of Happy Vax Giving, a term coined to represent the safe gathering of vaccinated friends and family. To date, approximately 59 percent of our country is vaccinated which allows this year’s holiday season to be different from last when it comes to gatherings and celebrations. For those individuals who have received two mRNA vaccines or one does of the Johnson & Johnson vaccine, consider getting the booster shot before the holiday season especially if you are above age 65, have underlying medical conditions or work in a high risk area. If there are family members and friends expected to celebrate with you that are not yet vaccinated, consider encouraging them to do so.
  • Get your flu shot. This could be the most important flu vaccine you ever get. The US Centers for Disease Control and Prevention (CDC) suggests getting your flu shot now. Every year, flu circulates widely in communities. The symptoms are like COVID-19 and in some cases can lead to complications requiring hospitalization. The flu is circulating widely across the country and impacting those who are not vaccinated. On University of Michigan’s campus, flu is sweeping through the student population. However, of those who contracted the flu, 77 percent were not vaccinated. Public health experts worry what will happen if flu circulates widely at the same time as COVID-19. The term twindemic has already been written about by many media outlets. It refers to two pandemics happening simultaneously and could stretch our health care systems and our doctors and nurses to the breaking point.
  • Consider COVID-19 testing. While the vaccine has proven to be effective against severe illness from COVID-19, there is evidence that vaccinated individuals can still carry and spread COVID-19. Therefore, another measure that can be taken to give you and others comfort is getting tested either with a rapid antigen or PCR test prior to gatherings. Encourage all at the gathering to also get tested.
  • Continue to wear a mask. Specifically, in settings where you do not know others’ vaccination status or areas of high community spread. Evidence shows wearing a N-95 or KN95 mask saves lives. It is often said “I wear a mask to protect you, you wear a mask to protect me.” A study published in Health Affairs compared the COVID-19 growth rate before and after mask mandates in 15 states. It found that daily spread of COVID-19 dropped by 2 percent as more and more masks were worn. In reviewing COVID-19 deaths across 198 countries, another study found that those countries that societal norms favor mask wearing had lower death rates. Lives will be saved by wearing a mask when physical distancing or when knowing one’s vaccination status is not possible.
  • Increase ventilation indoors. While outdoors is always better than indoors, the colder climates particularly in the Northeast and Midwest often make this difficult. Therefore, this fall and winter as you gather indoors with vaccinated individuals think about ways to increase ventilation. Even opening a window or door allows for fresh air to circulate inside the space.  Creating air exchanges to move any viral particles out of the air goes a long way. In spaces without windows, consider investing in an air purification system. There are many systems available, and you should look for one that creates air movement while utilizing high level HEPA filtration to clean the air.
  • Wash your hands often. Frequent hand washing is one of the best ways to prevent the spread of COVID-19. Throughout the day, we all touch many common surfaces and then scratch our faces, eyes or rub our noses without even realizing it. In addition, with mask wearing we now frequently adjust and touch our masks. Viral particles spread from common surfaces to our hands or on the outside of our masks. According to the CDC hand washing or use of alcohol-based hand sanitizer when you can’t wash your hands must be done for 20 seconds to kill the COVID-19 virus. In addition, when washing your hands, it is important to clean all surfaces including palms, under nails, between fingers, back of your hands and even up to your wrists. Remember to wash your hands before you prepare food and eat, after using the bathroom, and after touching any common surfaces.
  • Find ways to maintain your physical and mental wellbeing. Staying physically fit and mentally healthy is more challenging than ever before. Social isolation, lack of physical activity and the anxiety brought on by living through a pandemic, losing loved ones and friends, economic loss, and more have taken their toll. Seek help from family, friends, professionals, or search for support online. Find activities that can bring joy. Take care of your physical health by finding ways to eat healthy, exercise,, meditate, or move around your home. This fall and winter staying physically fit and maintaining mental health is even more important than ever before as studies show a direct correlation to a stronger immune system.

Jeff Bokser is Hagerty Consulting’s Vice President of Healthcare Programs with strategic expertise in all aspects of healthcare operations, finance, crisis management, and recovery. Jeff has over 20 years of experience as a senior leader at NewYork-Presbyterian and Yale New Haven Health. He advanced performance and increased revenue in clinical and nonclinical settings and led innovation in daily operations and care delivery processes. Jeff is nationally recognized in the healthcare sector for his transformational leadership in the areas of emergency and crisis management; security and safety; pandemic and surge planning; and business continuity. Jeff was the system-level executive responsible for Emergency Medical Services, Emergency Management, Business Continuity, Crisis Management, Safety, Security, and Regulatory Compliance for the entire continuum of the NewYork-Presbyterian Hospital & Healthcare System enterprise. He served as Incident Commander guiding 40,000+ employees through numerous internal and external emergency response and recovery operations including Hurricane Sandy, Ebola, H1N1, and 9/11.

The Hagerty Advantage – Our People: Jeff Bokser

Jeff Bokser serves as the Vice President of Healthcare and University Programs at Hagerty Consulting, Inc. (Hagerty). The Disaster Discourse Team conducted an interview with Jeff to learn more about his professional background and the valuable expertise he brings to the Hagerty Team.

How does your previous experience contribute to your role as the Vice President of Healthcare and University Programs?

I have obtained a vast amount of experience throughout the past two decades of my career in all aspects of healthcare operations, finance, crisis management and recovery. I started my career in a New York City hospital in healthcare administration three months prior to September 11th, 2001. I was quickly placed in the hospital command center and helped the hospital respond to the events and the aftermath of the World Trade Center attacks.  Throughout my career, I have advanced performance in clinical and non-clinical settings and led innovation in daily operations and care delivery processes.

I have since led hospital staff in planning, executing, and responding to significant emergency events including Ebola, Hurricane Sandy, H1N1 Pandemic, (Severe Acute Respiratory Syndrome) SARS, anthrax scares, mass-casualty surge incidents, and deploying disaster response teams and telemedicine nationally. This has prepared me for public health emergencies and the response and recovery Hagerty is providing during COVID-19. It is my experience in running complex healthcare organizations, deep understanding of public health and my passion in emergency management that contributes to my role at Hagerty and ability to help advise and shape healthcare organizations, universities and public health departments across the country as they respond to the most significant multi-faceted public health disaster in recent history.

In our country’s current COVID-19 environment, what do you believe are the most important steps to help clients in the healthcare industry?

Right now, hospitals and healthcare systems are facing significant financial challenges from the effects of COVID-19 testing, treatment, and care.  In addition, to the cost incurred for caring for COVID-19 patients, hospitals face a loss in revenue from a drop in non-COVID-19 patient visits. They are dealing with recovery in the midst of what is going to be a prolonged response. Normally there is a time when an emergency ends and recovery begins; right now, they seem to be blending. Hagerty is unique – we have vast experience in disaster response and recovery, and we are bringing them both to the table for our clients during COVID-19. Currently, the most important role we are helping with in financial recovery is identifying ways to work with federal and state funding streams to help with short-term cash liquidity and positioning for long-term financial recovery. We are also starting to see a shift to work in preparedness including After-Action Reports (AARs) for hospitals and healthcare associations, emergency operation plan enhancements and response work for planning of field hospitals, testing sites and vaccination planning.

Most of our hospital clients are still in the heat of battle with COVID-19, but we need to have a paradigm shift for the future. This Public Health Emergency (PHE) comes down to the recognition that we all have to adapt to this new normal, while recognizing that even if it doesn’t affect you as an organization now, at some point it will. We all have to work together to make a strategic change and build a stronger public health infrastructure. Historically hospitals have operated independently; we need to have a collective goal to take care of people across the country.

We also need to understand that this PHE is not just about the immediate aspects of caring for COVID-19 patients or caring for COVID-19-related job loss. We are seeing the economic impact and social isolation results that will play out for years. We are going to see individuals during this time who are putting off their health needs. It is far greater than just the immediate threat of COVID-19. This PHE has societal impacts; the faster and better we can help all those components, the better off we will be.

What led you to emergency management and your public service mindset?

 I have always felt that helping others is a huge part of who I am and is embedded in my DNA. My appreciation for emergency management was born out of tragedy. As a teenager, I was involved as a passenger in a serious car accident and lost a friend. The accident set in motion my desire to make a difference in others’ lives.

In times of crisis, I have always been someone who has remained calm, which is key when stress steps in during an emergency. I always try to be prepared for whatever might come next and what needs to be addressed in advance to be threat ready. There is no such thing as complete preparedness, yet each day we need to be thinking through plans and requirements for whatever emergency we may face next. As emergency managers, we can never fall into the mindset of “we just responded to the biggest emergency,” there is always something new on the horizon. In this job, you can never become complacent.

What do you find most rewarding about working in the field of emergency management?

You have to enjoy what you do. Because of my passion and connection, I have always gravitated towards community management. I’ve always felt that when you work in our field, the work you do contributes to the fulfillment of a larger and more meaningful purpose. Our work at Hagerty – with our healthcare partners and universities across the county – is contributing to helping society and is enhancing individuals lives during what will likely prove to be one of the most trying times in our nation’s history.

What do you like to do in your spare time?

I love to spend time with my daughters and wife, travel, golf, and work on projects around the house. Last summer I built a deck on my yard. It has come in handy with all the time we have been spending at home.

 

JEFF BOKSER is Hagerty Consulting’s Vice President of Healthcare and University Programs and has strategic expertise in all aspects of healthcare operations, finance, crisis management, and recovery. Jeff currently leads Hagerty Consulting’s Healthcare and University practice focused on COVID-19 response and financial recovery and is working with public health departments, hospitals, healthcare systems, and universities across the country. 

FEMA’s BRIC Program: A Timely Lifeline

Yesterday, as the East Coast was pummeled by strong winds and numerous tornadoes from Tropical Storm Isaias, the Federal Emergency Management Agency (FEMA) unveiled the Notice of Funding Opportunity (NOFO) for its new mitigation program, Building Resilient Infrastructure and Communities (BRIC). Amidst the ongoing COVID-19 pandemic, Tropical Storm Isaias caused millions to lose power – there were nearly 1.4 million power outages in New Jersey alone – and power restoration is anticipated to take several days. The current outages are about half of the more than 2.7 million customers who lost power at the height of Hurricane Sandy in 2012 – the largest outage in the state’s history. Events like this often cause communities nationwide to contemplate the increasing frequency and severity of natural disasters and what solutions are available to help us become a more resilient nation; BRIC is one of them.

BRIC’s New Focus

Disasters cause substantial damage and disrupt socioeconomic activities in ways that we cannot fully measure. Additionally, climate variability is causing more frequent and powerful storms that are responsible for unprecedented devastation and costly disaster recovery operations. BRIC aims to categorically shift the current federal focus away from reactive disaster spending towards research-supported, proactive investment in community resilience. BRIC, which replaces FEMA’s legacy Pre-Disaster Mitigation (PDM) program, supports states, local communities, tribes, and territories to become more resilient through capability and capacity building and development of large-scale hazard mitigation projects designed to break the repetitive cycle of damage and loss.

The BRIC program will support community resilience in four tangible ways:

  1. Provide larger monetary investment in pre-disaster mitigation to reduce future disaster risk. Last year, FEMA’s PDM program allocated $250 million for mitigation and resiliency activities. That level of investment was historic in its own right, as it was the highest level of funding awarded in the history of the legacy PDM program; however, BRIC’s first-year funding doubled that investment, making $500 million available to eligible state, tribal, and territorial applicants.
  2. Place a greater emphasis on capability and capacity building to promote a culture of preparedness. BRIC sets $600,000 in funding aside – per eligible applicant – to enhance mitigation expertise, knowledge, and practice at the state and local level. Eligible expenditures can include building code activities, partnerships, project scoping, mitigation planning, and planning-related activities. This funding is designed to result in a resource, strategy, or mitigation product that will ultimately reduce or eliminate risk and damage from natural hazards.
  3. Increase project caps to allow for larger-scale infrastructure projects. BRIC changes the national competition cap for mitigation projects, which increased from $10 million to $50 million per project. This increased project cap allows for larger-scale projects that invest in public infrastructure and harden community lifelines. These projects will undergo additional programmatic review, which will evaluate not only technical merit but qualitative criteria such as the population impacted, outreach activities, future conditions, and resiliency effectiveness.
  4. Expressed commitment to nature-based solutions that promote sustainability. BRIC encourages communities to explore nature-based solutions that can serve as eligible project types and mitigate hazards such as riverine flooding, urban drainage flooding, coastal flooding and storm surge, landslides, and drought. Unique, nature-based solutions can provide short- and long-term environmental, economic, and social advantages that improve a community’s quality of life and make it more attractive to new residents and businesses. Potential project types include land conservation, greenways, wetland restoration, stormwater parks, floodplain restoration, rain gardens, and more.

FEMA BRIC and Nature-Based Solutions Presentation: Source

Next Steps

In preparation for the application period opening, FEMA will host a series of webinars to further discuss the grant program details, the agency’s funding priorities, common application pitfalls, and the new system for grant submission (FEMA GO). More information on the upcoming webinar dates and times can be found here. Registration information will be available soon.

The BRIC application period opens on September 30, 2020 and closes on January 29, 2021; however, BRIC project applications will take a significant amount of time and resources to complete. We encourage potential applicants and sub-applicants to begin their planning efforts as soon as possible.

Hagerty is here to help. While the cost share for this program is 75 percent federal and 25 percent non-federal, FEMA will provide 100 percent federal funding for management costs associated with the administration of a BRIC-awarded mitigation measure or project. Therefore, our professionals can help at little-to-no additional cost.

Hagerty’s Mitigation Team are experts in navigating the pre- and post-disaster funding world. We are available to talk about your recovery needs, including how to access all funding available through federal grant programs. To learn more, contact us.

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Amelia Muccio is the Director of Mitigation at Hagerty Consulting and a subject matter expert in disaster recovery. With over 15 years of experience in public health, disaster preparedness, mitigation, and financial recovery, Amelia has helped clients obtain $5 billion in federal funds after major disasters, including Hurricane Sandy, the California Wildfires, and Hurricane Harvey.

Katie Grasty is the Deputy Director of Mitigation for Hagerty Consulting. Katie has over 10 years of experience with federal grant management with FEMA and the United States Department of Transportation (USDOT). Prior to Hagerty, Katie was the senior program lead for Hazard Mitigation with FEMA Region 9, where she managed over $2 billion in federal funds for flood, fire, and earthquake risk reduction projects.

How to Jumpstart Your Recovery from COVID-19

The COVID-19 pandemic has turned the nation upside down, and American lives are changing in new ways daily. Today, we are seeing positive cases surge across the country while many communities brace for the impacts of a devastating second wave. Consequently, business, community, and government leaders are continuing to face significant budget shortfalls while continuing to encumber unforeseen expenses. While federal aid to assist them with cost-recovery is available, it has been dispersed across numerous federal departments and agencies posing considerable bureaucratic challenges. Therefore, expeditious financial assistance is difficult to obtain, often resulting in consequential delays for those in immediate need.

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Hagerty can help. In this unique environment, Hagerty professionals are prepared to support a wide range of recovery needs. Our firm has extensive experience helping clients learn how to: manage funds in a results-driven way to account for future impacts; understand what federal funding they are entitled to; and establish a sound readiness posture as they adjust to a “new normal.”

While the road to recovery from COVID-19 will be long, here are some important tips to jumpstart the process.

Take inventory and track incurred costs. It is critically important to assess the financial impact the crisis is causing, and likely to cause, a business or community. To do this effectively, first take inventory of available resources. This helps better understand where gaps are, and what is needed to fill them to ensure successful short-term response and long-term financial recovery.

While federal funding programs provide the opportunity to better prepare for, respond to, and recover from the ongoing COVID-19 crisis, many of these programs are reimbursement mechanisms that require proof of expenditure and loss. Therefore, proactive management and tracking of response activities and associated costs will be the key to success when applying for federal grants.

To begin the tracking process, here are some best practices to follow:

  • Establish clear roles, responsibilities, and procedures for document collection, organization, and review.
  • Create activity logs that can be used to track qualitative information needed to support costs infcurred.
  • Generate unique project numbers, activity codes, and descriptions for tracking costs. It is also vitally important to save all documentation associated with these costs.
  • Establish reporting dashboards and summaries to understand the financial impact and costs, as well as support future financial decision-making.
  • Communicate and train employees on the documentation and tracking process. An informed workforce is critical to future success.

Understand cost-recovery opportunities. Given the significant, unforeseen costs associated with the pandemic, Congress appropriated nearly $3 trillion, and is considering more, to assist state, local, tribal, and territorial governments; healthcare systems and hospitals; as well as some private businesses with cost-recovery. While federal financial support is greatly needed, the increasingly complex eligibility requirements associated with it unintentionally causes many to leave eligible federal funding on the table, thereby slowing the overall pace of recovery.

To tackle this challenge, it is important to create a recovery roadmap. Once again, cost-tracking is important as expenses incurred and revenue lost must be cataloged and justified. Then it is time to strategically sequence and apply for available funding opportunities. This is best done using a single program that can actively seek reimbursement and manage any potential duplication of benefits, which could lead to grant denial. This is not a one-size fits all approach as each recovery is different and varying funding sources are available across the federal government and the private sector – each with their own grant and regulatory compliance requirements. Moreover, it is important to establish an understanding of existing funding overlaps as duplicative benefits could lead to grant denial.

Prepare for future needs. As the COVID-19 response continues to evolve and the potential for a second wave looms, it is important to take the time now to reflect upon prior response efforts to understand what worked well and what did not. After-action reporting is designed to do just that – analyze the management of and response to an incident by identifying strengths to be maintained and built upon, as well as identifying potential areas for improvement. Relevant to the pandemic, it is important to focus on critical functions that can save lives such as logistics management, supply burn rates and tracking, situation assessment and reporting, and crisis communications.

Additionally, as the response and recovery to COVID-19 continues, it is important to be prepared to simultaneously respond to other hazards. Soon, the nation will enter the historical height of hurricane season in the east and the peak time for wildland fires in the west. The pandemic has prompted new challenges and often unpredictable needs for resources, policies, and personnel – now is the time to consider these needs. In this rapidly changing environment, exercises, workshops, and other facilitated discussions should be used to test adaptations that may be necessary during a COVID-19 co-response.

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Let Hagerty be a part of your solution. Community recovery from COVID-19 will be a marathon, not a sprint. As the nation seeks to establish a “new normal,” Hagerty understands our clients’ needs are and will continue to be dynamic, and we stand ready to address emerging priorities. We can help navigate this complicated landscape by tailoring a wide range of services to meet your needs.

With the assistance of our digital grants management tools, Hagerty’s diverse team of policy, healthcare, and financial management experts work the overall cost-recovery and reimbursement application process from start to finish, offering real-time guidance and navigation of the often complex and fluid funding streams available across all levels of government as well as the private sector. Furthermore, this process establishes automated reporting which many federal agencies require for the purpose of detailed record-keeping purposes, particularly in the event of a future audit. Moreover, because Hagerty places a premium on quality work, an investment in our services today, could save you significant time and money in the future. Throughout the long-term recovery process, our professionals emphasize the importance of timeliness and efficiency balanced with regulatory compliance. This ensures you are positioned to capture all eligible costs for reimbursement while minimizing the risk of negative audit findings and grant clawback in the future.

Additionally, even in times of significant fiscal instability and uncertainty, our experts can help at little-to-no additional cost to many of our clients. The Federal Emergency Management Agency (FEMA) provides funding for administrative costs related to managing Public Assistance (PA) grants and the application process. This funding is available for PA-eligible applicants – state, local, tribal, territorial governments, and certain non-profit organizations – and their respective sub-applicants. This funding may be used to hire disaster recovery consultant experts, like ours, to strategically augment staffing capabilities and expedite results when they are needed the most.

To learn more about our firm and our work during COVID-19, please visit Hagerty’s ‘Disaster Discourse’ Blog.

Kyle McPhee, currently Director of Preparedness Programs for Hagerty, is an experienced management professional who has worked with international, national, regional, state, local and private-sector organizations in the areas of emergency management, homeland security, business continuity, and public health preparedness.  His expertise includes project management, planning, facilitation and evaluation related to various topics including catastrophic incidents, mission ready packages, mass care, and evacuation

Hospital Financial Recovery in the Midst of a Prolonged Response

As outbreaks of COVID-19 occur across the country, hospitals and healthcare systems continue to respond with live-saving resources and heroic measures to treat and care for patients. The response to the pandemic has created significant financial challenges for hospitals and healthcare systems from the effects of COVID-19 testing, treatment, and care. In addition to the cost incurred for caring for COVID-19 patients, hospitals face a 54% drop in patient visits originally from the cancelation of non-emergency and elective procedures. Deferral of procedures is continuing with the fear that one will get infected with the highly transmissible virus simply by going to a hospital for care.  As a result, hospitals’ staggering losses in revenue are mounting. According to a new study by Strata Decision Technology, United States (U.S.) hospitals are losing an estimated $60.1 billion a month and facing a 114% increase in uninsured patients from individuals losing employer sponsored insurance.

Our team at Hagerty Consulting is working with hospitals, healthcare systems, and universities across the country to maximize federal and state short-term liquidity funding opportunities and long-term cost recovery. We craft custom cost recovery roadmaps by understanding the unique expenses incurred along with revenue lost to strategically apply the various state and federal programs available to meet the needs of each institution.

Available Federal Funding Opportunities

To help offset lost revenue and costs incurred for testing, treating, and caring for COVID-19 patients, the federal government allocated $175 billion in relief to hospitals. This funding has been allocated through the Health & Human Services (HHS) Provider Relief Fund (PRF) as follows:

 

In addition to the $175 billion in relief through the HHS PRF, hospitals are eligible to apply for funding through various other programs, with up to $616 billion in available funding through known allocations and funding streams.

Prospective Federal Funding Opportunities

The U.S. House of Representatives passed the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act. The HEROES Act would provide an additional $100 billion appropriation for the PRF along with new provisions for unobligated PRF funding– originally allocated from the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Healthcare Enhancement (PPPHCE) Act — can be distributed and utilized. Currently, the HEROES Act is being considered by the U.S. Senate. If enacted, the law will likely have much needed application-based distributions that will help healthcare providers not only with incurred eligible expenses from caring for COVID-19 patients, but also lost revenue.

On June 12, 2020, the U.S. House of Representatives also introduced the COVID-19 Hospital Forgiveness Act. This Act would facilitate loan forgiveness for hospitals and healthcare providers who applied for and received Medicare accelerated and advanced payments. Without the COVID-19 Hospital Forgiveness Act, the $40.4 billion total loan amount will begin to be repaid by providers who received loans. These payments would begin in August of 2020 through the offset of additional Medicare payments.

Hospitals are facing a severe economic crisis. Our team at Hagerty Consulting offers real-time guidance to navigate the complex and dynamic disaster recovery funding available,  including programs through the CARES Act, the Federal Emergency Management Agency (FEMA) Public Assistance (PA) Program, the Coronavirus Relief Fund (CRF), and other federal and state grants available to support recovery. Our diverse team of policy, healthcare, and financial management experts work with our hospital and healthcare system clients from start to finish in the complex application process to seek and maximize federal and state reimbursement for COVID-19 incurred costs and revenue loss. We emphasize timeliness and efficiency balanced with regulatory compliance to position organizations to capture eligible costs for reimbursement without experiencing de-obligation in the future.

The COVID-19 emergency is an unprecedented public health and economic challenge. The robust federal funding provided so far has been essential for hospitals to be able to continue to deliver much needed medical care. Going forward, additional federal funding will be necessary to properly outfit our public health infrastructure and prepare hospitals that are caring for the sickest of COVID-19 patients while advancing financial recovery in the midst of a prolonged emergency response.

 

Jeff Bokser is Hagerty Consulting’s Vice President of Healthcare Programs with strategic expertise in all aspects of healthcare operations, finance, crisis management, and recovery. Jeff has over 20 years of experience as a senior leader at NewYork-Presbyterian and Yale New Haven Health. He advanced performance and increased revenue in clinical and nonclinical settings and led innovation in daily operations and care delivery processes. Jeff is nationally recognized in the healthcare sector for his transformational leadership in the areas of emergency and crisis management; security and safety; pandemic and surge planning; and business continuity. Jeff was the system-level executive responsible for Emergency Medical Services, Emergency Management, Business Continuity, Crisis Management, Safety, Security, and Regulatory Compliance for the entire continuum of the NewYork-Presbyterian Hospital & Healthcare System enterprise. He served as Incident Commander guiding 40,000+ employees through numerous internal and external emergency response and recovery operations including Hurricane Sandy, Ebola, H1N1, and 9/11.

COVID-19 Cases Experience an Uptick in the United States While Europe Considers Reopening Measures

June 26, 2020 AT 6:00 PM  EDT

On June 25, the United States (US) recorded 40,401 new COVID-19 cases; the highest recorded number of confirmed cases in a single day since the previous record of 36,291 on April 24, according to data from the Johns Hopkins University & Medicine Coronavirus Resource Center. The US is currently leading the rest of the world, both in the current official count of COVID-19 cases and reported COVID-19-related deaths; the country reported 2,422,310 cases and 124,416 deaths. 

The US experienced a 25 percent increase in new COVID-19 cases for the week ended June 21, compared with the prior week. According to a  Reuters analysis Arizona, Florida, and Texas faced  record increases in new cases last week. Of the different states experiencing an increase in infections, Texas faced one of the greatest surges, with 24,000 new COVID-19 cases for the week that ended June 21; increasing 84 percent since the previous week. Florida also experienced a swell of new cases, increasing 87 percent in the prior week to almost 22,000 COVID-19 cases, while Florida’s positive test rate for COVID-19 patients almost doubled to 11 percent. Arizona additionally has experienced an influx of new COVID-19 cases with 17,000 new cases, a 90 percent increase, compared with the previous seven days.

In response to the increase of confirmed cases, Texas Governor Greg Abbott declared the state would “pause” reopening the economy, while Arizona Governor Doug Ducey cautioned Arizona residents to stay at home, without invoking any additional measures. 

Centers for Disease Control and Prevention Director Robert Redfield stressed that the case numbers within the US were likely to be understated, and the final tally might be far greater than what is currently being reported. The new estimates are based on results from antibody testing that identifies immune cells that react to SARS-CoV-2. Redfield said the new serology tests have shown “about 10 times more people have antibodies in the jurisdictions tested than had documented infections.”

The European Union (EU) aims to lift travel restrictions at its borders starting on July 1, and EU ambassadors met to discuss the criteria necessary to allow travel to Europe, including having an infection rate lower than  the EU. At present, EU diplomats are considering allowing approximately 50 countries to restart flights within the EU, based on the established requirements. This initial list excludes the US, Brazil, and North Macedonia. Travel to and from China would be allowed. 

Victor He: Unsplash

Despite talk of resuming travel, the World Health Organization Regional Director for Europe Hans Kluge cautioned that Europe has experienced an increase in weekly COVID-19 cases “for the first time in months” on June 25. Kluge listed 30 countries that have seen an increase in new cases, while an additional  11countries faced a “significant resurgence” in cases that might  “push health systems to the brink once again in Europe” if kept unchecked.

The Hagerty Team encourages our readers to heed advice of international health organizations, government agencies, and local officials when responding to and protecting against COVID-19. The Hagerty Team will continue to provide information and updates on current events and disasters impacting the nation.

STAY UPDATED AND LEARN MORE HERE:

 Keep track of Hagerty’s Incident coverage here:

DISASTER DISCOURSE CORONAVIRUS UPDATES

COVID-19: US Considers A Reopening Strategy To Support The Declining Economy

FRIDAY, MAY 29, 2020 AS OF 5:00 PM EST

Worldwide, there are approximately 5,831,000 confirmed cases of COVID-19, with roughly 1,722,000 of those cases presenting in the United States (US). While the US is experiencing a downward trend in new cases overall, the number of cases and deaths is rising in more than a dozen states. To date, the number of deaths in the US has exceeded 100,000, which is the highest in the world and surpassed the initial estimate of 50,000 – 60,000 deaths.

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Unemployment continues to rise throughout the US, despite the gradual reopening of business across the country. Currently, it is now estimated that 1 in 4 Americans are unemployed. This is the highest number of unemployed Americans since the Great Depression, with the current unemployment rate reported at 14.7 percent. This level of damage to the US economy and hardship cannot be quickly fixed; Americans can expect economic revitalization to take many years. The Coronavirus Aid, Relief, and Economic Security Act or CARES Act, passed under the Trump Administration in March, provides a short-term solution to a long-term economic problem. Millions of Americans are relying on government assistance to abate poverty, hunger, and financial hardship. On Thursday, New York City Mayor, Bill de Blasio, shared his plan for  400,000 people to return to work, taking the first steps to reopen the City since its quarantine began.

Pharmaceutical companies and leaders have reported progress is being made in vaccine development. At the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) event, speakers such as AstraZeneca CEO Pascal Soriot and  GlaxoSmithKline chief Emma Walmsley addressed how each company was working individually and collaborating with others to develop a new COVID-19 inoculation. There are currently over 100 vaccines in the pipeline to treat the virus and Jin-Bo Gou of CanSino Biologics and colleagues reported in The Lancet that the first COVID-19 vaccine in a Phase I clinical trial was found to be safe and generated an immune response against SARS-CoV-2 in humans.

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Global incidence continues to climb while the world continues to respond to and recover from the impacts of COVID-19. The World Health Organization (WHO) established a foundation that will focus on addressing global health needs worldwide. This independent grant-making foundation will focus on protection from health emergencies, universal healthcare coverage, and holistic health and wellbeing for individuals.

The WHO and the Smithsonian launched a COVID-19 guide for youth, which provides information about how youth can protect themselves and their community from COVID-19. The United Nations Children’s Fund (UNICEF) noted that roughly 80 million children are at risk of contracting a disease across 68 countries due to disruptions in routine immunization programs as a result of COVID-19. The United Nations has decided to delay the 2020 Climate Summit until 2021. Despite being rescheduled, nations are still expected to deliver on pledges made during the 2015 Paris Agreement.

Additionally, research is currently underway to quantify the number of people who have been infected and have immunity, to assess whether herd immunity is established across cities, towns, and communities. While the virus has infected many individuals across the world, the majority of people (even in the hardest-hit cities) remain vulnerable to contracting the virus. In fact, contact tracing efforts have begun in England and Scotland, with 25,000 contact tracers working to identify people at risk of infection.

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The Hagerty Team encourages our readers to heed advice of international health organizations, government agencies, and local officials when responding to and protecting against COVID-19. The Hagerty Team will continue to provide information and updates on current events and disasters impacting the nation.

STAY UPDATED AND LEARN MORE HERE:

 Keep track of Hagerty’s Incident coverage here:

DISASTER DISCOURSE CORONAVIRUS UPDATES