COVID-19: Hydroxychloroquine and Remdesivir Updates

FDA Revokes EUA for Hydroxychloroquine and Chloroquine for COVID-19
The FDA revoked the emergency use authorization (EUA) that allowed for hydroxychloroquine sulfate and chloroquine phosphate (when donated to the Strategic National Stockpile) to be used to treat hospitalized patients with COVID-19.

Based on ongoing analysis and emerging scientific data, the FDA determined that chloroquine and hydroxychloroquine are unlikely to be effective in treating COVID-19 for the authorized uses in the EUA.

Furthermore, in light of ongoing serious cardiac adverse events and other potential serious side effects, the known and potential benefits of these drugs no longer outweigh the known and potential risks.

Because the FDA has determined that hydroxychloroquine and chloroquine are no longer suitable for the treatment of COVID-19, injured worker patients currently undergoing a regimen of hydroxychloroquine or chloroquine may need to discontinue use of these drugs.

Currently there are no proven treatments for COVID-19 and no vaccine is available.

FDA Warns of Potential Drug Interaction That May Reduce Effectiveness of Remdisivir
The FDA is warning healthcare providers that co-administration of remdesivir and chloroquine phosphate or hydroxychloroquine sulfate is not recommended as it may result in reduced antiviral activity of remdesivir.

Remdesivir is an investigational antiviral medication that has shown promise in potentially treating COVID-19, enough so that it received an emergency use authorization (EUA) from the FDA to treat COVID-19.

Hydroxychloroquine and chloroquine medications were initially given EUAs as well for the treatment of COVID-19, but those EUAs have since been revoked. Because no FDA-approved COVID-19 medications or vaccines currently exist, health providers have been using medications that have shown anecdotal promise so far.

For this reason, it is understandable, given the severity of this pandemic, why some providers may have prescribed or administered remdesivir and hydroxychloroquine or chloroquine, as all these drugs were thought to potentially help patients with COVID-19. However, it is now clear that COVID-19 patients should not mix these drugs.

Tags: FDA, COVID-19, hydroxychloroquine, chloroquine, remdesivir, antiviral, EUA, emergency use authorization

Growing Pains: The Shift from Opioids to Other Pain Therapies

For over a decade, the workers’ comp industry has battled endlessly against the inappropriate utilization of opioid pain medications. The opioid epidemic has caused 400,000 overdose deaths since 1999,1 along with untold financial ramifications.

But over the last few years, the tide has been turning. Overall opioid prescribing has been declining since 2012, with a 19% reduction in the annual prescribing rate from 2006-2017.2

This trend is so prevalent that workers’ comp professionals in managed care are now focusing more attention to other matters. According to a 2020 workers’ comp industry insights survey conducted by Healthesystems, while chronic pain remains the top most concerning health risk within claimant populations, opioids are no longer viewed by industry professionals as a top program challenge, health risk, or claim risk.3

While there’s still work to be done to end the opioid epidemic, especially in regard to synthetic opioids like fentanyl, it is clear that, within the industry, different pain therapies are being embraced. Our survey data aligns with a study by the Workers’ Compensation Research Institute (WCRI) of 27 state workers’ comp systems that found prescription opioid utilization is decreasing while the utilization of other pain management therapies are on the rise.4

As the industry embraces different pain therapies, what should workers’ comp professionals know about these therapies?

This article explores the utilization, risks and concerns, of various non-opioid therapies, including nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, gabapentinoids, muscle relaxants, physical medicine, medical marijuana, and alternative therapies.

Read the full article online at RxInformer clinical journal.

Tags: opioid, pain management, NSAID, acetaminophen, gabapentinoids, muscle relaxants, physical medicine, medical marijuana, alternative therapies

WCRI Publishes Medical Price Index

The Workers’ Compensation Research Institute (WCRI) published the 12th edition of their annual index of actual prices paid for medical professional services from 2008-2019, based on a market basket of commonly used services for treating workers with injuries. This edition covers 36 states that represent 88% of workers’ comp benefits paid in the United States.

This study focuses on professional services billed by physicians, physical and occupational therapists, and chiropractors, showing how prices paid for services compared across states, how prices changed, and whether price growth is part of a broader trend or unique to a state. WCRI also claims that this study may provide a baseline for policymakers and other stakeholders to observe any effects the COVID-19 pandemic may have on medical prices in workers’ comp across states and over time.

Overall, growth in prices paid for common professional services exhibited tremendous variation across states, ranging from a 12% decrease in growth in Illinois to a 48% increase in growth in Wisconsin. The study does make it clear that fee schedules played an instrumental role in price variation, as prices paid for a similar set of professional services for treating injured workers varied significantly across states.

States with no fee schedules for professional services paid 42-174% more for services when compared to the median of states with fee schedules; the median for overall prices in non-fee schedule states was 64% higher than the median for fee schedule states. Overall prices paid ranged from 28% below the 36-state median in Florida – a state with fee schedules – to 165% above the 36-state median in Wisconsin – a state without fee schedules.

Most states without fee schedules experienced faster growth in prices compared to states with fee schedules; three states without fee schedules – Indiana, Missouri, and Wisconsin – saw price increases range form 34-48%, while price changes in states with fee schedules ranged from a 2% decrease in South Carolina to a 25% increase in Maryland.

Seven states made significant fee schedule changes over the last several years, which have resulted in major changes to prices paid. This includes the following results:

  • Virginia fee schedule changes in 2018 resulted in a 13% decrease in overall prices paid from 2017-2018
  • North Carolina fee schedule changes in 2015 resulted in a 17% increase in overall prices from 2014-2016
  • Kentucky discontinued relative values from Medicare’s RBRVs in 2014, transitioning to state-specific relative values based on FAIR Health data; this resulted in a 19% increase in overall prices paid from 2013-2015
  • Arizona fee schedule changes in 2013 resulted in a 10% increase in overall prices paid from 2013-2014
  • Illinois fee schedule changes in 2011 resulted in a 27% decrease in overall prices paid from 2010-2012
  • Texas fee schedule changes in 2011 resulted in a 16% increase in overall prices paid from 2010-2011
  • Massachusetts fee schedule changes in 2009 resulted in a 15% increase in overall prices paid from 2008-2010

At 182 pages, this report contains a significant amount of data and insights for all states. For more information, visit WCRI online.

Tags: WCRI, price, medical price, fee schedule

Washington Issues Guidelines on COVID-19 Masks for Workers

The Washington Department of Labor & Industries published new guidance on which types of face coverings are necessary for certain occupations to prevent COVID-19 infection at work.

The guidance stresses that while face coverings and masks can help prevent the spread of COVID-19, that they do not eliminate the need for physical distancing, frequent handwashing, cleaning and disinfecting, and other safety measures.

Occupations are broken into the following risk categories:

  • Negligible risk
  • Low risk
  • Medium risk
  • High risk
  • Extremely high risk

Negligible-risk jobs can involve working outdoors or in a building while around, but separate, from several other people where workers may only pass within six feet of others once or twice a day. These workers may require a cloth face covering. Cloth face coverings help particles that the wearer exhales from escaping in the air, but they do not effectively filter out particles already in the air from others.

Negligible-risk jobs can include telecommuters who are the sole occupant of an office with a door, small landscaping crews of three or four who work outside and apart from each other, and delivery drivers who have no face-to-face interactions with others.

Low-risk jobs are required to use cloth face coverings. Low risk jobs involve working around or traveling with others but staying at least six feet apart, except for briefly passing others up to several times a day. This can also include when one or two workers provide personal services to healthy clients who also wear a cloth face covering.

Examples of low-risk jobs include light manufacturing facilities, custodial staff who work after hours and do not clean known COVID-19 impacted areas, restaurant workers at curbside pick-up services, and mechanics.

Medium-risk jobs require disposable masks, which are usually more protective than face coverings, such as dust masks and surgical-style masks. Medium-risk jobs involve staying six feet away from others except for several times throughout the day when the distance barrier is broken for several minutes and physical barriers aren’t feasible

This can also include when three-to-six people provide personal services to healthy clients wearing a cloth face covering. Examples of medium risk jobs include commercial fishing crews, field workers transported to nearby planting sites, grocery store workers who work around customers, kitchen workers in restaurants, ride-service drivers who pick up masked passengers, and transit operators.

High-risk jobs require respirators approved by the National Institute for Occupational Safety and Health (NIOSH), which offer a higher level of protection than face coverings and masks because they prevent wearers from inhaling particles already in the air.

High-risk jobs involve working or traveling within three feet of others for more than 10 minutes an hour, many times a day, or when cleaning or sanitizing COVID-19 impacted areas or providing services to clients with known COVID-19 infection.

Extremely-high-risk jobs require NIOSH-approved N95 respirators with cartridges or powered air-purifying respirators (PAPRs) with cartridges, or other FDA-approved equivalents. High-risk jobs must also use personal protective equipment (PPE) including goggles or face shields to protect the eyes and face, and surgical masks for clients to wear when feasible.

Extremely-high-risk jobs involving settings within six feet of people with COVID-19, or coming into close contact with exhaled saliva, mucous, or tears that may contain the virus. Transmission risk is also extremely high when coming into direct contact with peoples’ eyes, nose, or mouth. Examples of extremely high-risk jobs include EMTs, long-term care facility workers who care for clients ill with COVID-19, occupational or physical therapists providing therapy to quarantined clients, and more.

When respirators are required, employers must provide NIOSH-approved respirators and ensure requirements around medical evaluation, fit tests, training, maintenance, storage, and other provisions are fulfilled. N95 masks and other respirators require a clean-shaven face to form a protective seal.

This guidance does not apply to workers treating active COVID-19 patients in hospitals and clinics; those workers must follow CDC guidelines for selecting respirators and other PPE equipment.

Tags: Washington, COVID-19, mask, face, face mask, covering, face covering, respirator, risk

Employee Stress and Mental Health When Returning to Work

The National Safety Council recently published two resources regarding employee stress and mental health surrounding the return to work following COVID-19. The reports are Stress, Emotional & Mental Health Considerations: Providing Employees the Support Needed to Return to Work and Managing Employee Stress and Anxiety: Returning to the Workplace.

These reports note that the COVID-19 pandemic has increased the risk of mental distress among employees, both from directly worrying about exposure to the virus, but also from downstream impacts of the virus, including worries surrounding finances, employment, food, housing, child and family care. Furthermore, extended social distancing can exacerbate pre-existing medical conditions and increase the risk of depression, poor sleep quality, impaired cognitive function, and suicidal thoughts.

When concerns such as these are met with the stress of returning to work, this can lead to serious concerns, as poor mental health and stressors in the workplace can contribute to hypertension, diabetes, cardiovascular conditions, burnout, absenteeism, negative impact on productivity, and an increase in healthcare costs.

These reports encourage employers to allay concerns, anxieties, and uncertainty from workers returning to work, providing tips and resources on how to do so.

First and foremost, employers are encouraged to approach employees’ return to work with respect and understand the difficulty of the situation. This includes reducing workplace expectations to avoid overloading employees readjusting to the workplace, which involves decreasing non-essential demands, spacing out deadlines, recognizing the difference between urgent and important tasks, and demonstrating, encouraging, and supporting a work/home life balance when working remotely.

Additionally, leaders are encouraged to adopt flexible policies for paid time off (PTO) in order to address routine medical care that may have been delayed, or to allow employees to spend time with family and loved ones who they may have been isolated from.

Furthermore, leaders are advised to practice transparency with business decisions and to communicate major changes openly to alleviate uncertainty. This involves regular communication between leadership and employees, which can include virtual townhalls, as well as different confidential feedback avenues to bridge gaps with employees, including anonymous surveys and internet channels.

In particular, the reports recommend explicitly communicating what workplace protections will be in place, such as social distancing guidelines, diagnostic testing, and personal protective equipment (PPE) available.

Employers are also encouraged to build short- and long-term responses to mental health considerations and ensure mental health considerations be prioritized after immediate return. This includes providing support and information for employees anxious about leaving the safety of quarantine and about reducing social isolation for remote workers.

These reports encourage the creation of mental health taskforces with management representation from all functional areas. A goal of this taskforce should be to provide training that helps spot signs of mental health issues, including:

  • Feeling physically and mentally drained
  • Difficulty making decisions or staying focused on topics
  • Easily frustrated on a more frequent basis
  • Arguing more with family/friends
  • Feeling tired, sad, numb, lonely or worried
  • Experiencing changes in appetite or sleep patterns
  • Overacting to normal stimuli like noises and lighting

Furthermore, these taskforces should adopt strategies for approaching individuals who may be experiencing mental distress. This can include:

  • Providing workers with education and opportunities to practice practical ways of reducing stress, such as mindfulness training, deep breathing exercises, and yoga
  • Providing easy links to national support and resource hotlines such as the Suicide Prevention Hotline, the Domestic Violence Hotline, Eldercare Locator, the Sexual Assault Hotline, and more
  • Providing a hub on company intranet and frequent communications with best practices from the CDC, FEMA, OSHA, and more
  • Provide training on stress and resilience, and reminding employees stress symptoms may show up anytime
  • If there’s interest, consider creating peer-led initiatives, such as Slack or Teams channels or support groups, while also providing training for peer leaders on moderator skills, handling sensitive topics, and more
  • Utilizing employee assistance programs (EAPs) and health insurance programs to assist employees with mental distress

For more information, read Stress, Emotional & Mental Health Considerations: Providing Employees the Support Needed to Return to Work and Managing Employee Stress and Anxiety: Returning to the Workplace.

Tags: COVID-19, National Safety Council, mental health, stress, anxiety, emotion