Health systems in Hawaii and Maine fared best during the COVID-19 pandemic, according to new rankings that take into account factors such as vaccination rates, hospital and intensive care unit capacity, and death rates.

Alabama came last in the rankings, followed by Oklahoma, Kentucky, Mississippi and Georgia.

rankings released on Thursday, were compiled by the Commonwealth Foundation, a private foundation that promotes health equity and improves the quality, efficiency and accessibility of health care. Each year, the Commonwealth uses dozens of indicators to rank public health systems. This year it added categories relating to how public health systems performed during COVID-19 from February 2020 to the end of March 2022. Vermont, Washington and Oregon round out the top five.

Generally, states that have health systems rated stronger also scored high on COVID-19 performance. The reverse is true for those who scored low in the overall health rankings.

How quickly states got vaccinated after vaccines first became available in late 2020 was one of the metrics the Commonwealth used to gauge a state’s response to COVID-19.

Vermont moved the fastest, followed by Massachusetts, Connecticut, and Maine. They were able to fully vaccinate (which usually means two doses) 70% of the population aged 12 years and over within 200 days of vaccines being available.

In contrast, by the end of March 2022, 21 states were still under 70%. Alabama, Mississippi and Wyoming failed to reach even 60%.

State history

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Although the US Centers for Disease Control and Prevention recommended boosters, less than 40% of adults in the United States received them by the end of March, with rates varying significantly by state.

More than half of adults have received booster shots in Maine, Rhode Island and Vermont. In contrast, even a quarter of adults in Alabama, Mississippi, and North Carolina did not receive a booster shot.

Another metric that Commonwealth analysts looked at was the strain on hospital systems during the pandemic. The report notes that from August 2020 to March 2022, there were 4.6 million COVID-19-related hospitalizations in the country. To determine how overwhelmed healthcare systems are, analysts measured the number of days during that time when at least 80% of ICU beds in each state were occupied.

They found that in 16 states and the District of Columbia, intensive care units were running at 80% capacity or higher for at least 150 days. Texas and Alabama were at or above this percentage for 566 and 517 days, respectively. Georgia, Mississippi, New Mexico, Oklahoma, and Rhode Island all exceeded 300 days at 80% or higher.

Another metric the Commonwealth used in its ranking was the number of “extra” deaths in each state during the pandemic. The analysis clarifies that excess mortality means deaths above the norm, some of them as a result of COVID-19, and others as a result of interruptions in access to medical care caused by the pandemic.

Generally, states with stronger health care systems had fewer excess deaths than states with weaker systems.

The number of excess deaths ranged from 110 per 100,000 people in Hawaii to 596 per 100,000 people in Mississippi.

The analysis showed that nationwide, premature deaths from treatable conditions such as heart disease and diabetes rose from 83.8 to 89.8 deaths per 100,000 inhabitants between 2019 and 2020. The most notable growth was in the Midwest and South.

The good news in the report was that the number of people with health insurance has remained fairly stable in the states during the pandemic, although it has dropped slightly in 2021.

Reasons: Fewer people lost their employer-sponsored health insurance than expected, social protection provisions in the Affordable Care Act helped those who lost their insurance, Congressional action early in the pandemic kept people enrolled in Medicaid, and during the pandemic became increased subsidies available. to help people pay for private health insurance plans.

Some of these provisions will expire when the national public health emergency is eventually lifted, which could lead to a sharp decline in the number of people with health insurance.

Effectiveness of the public health system in relation to COVID-19

1. Hawaii 26. Ohio
2. Maine 27. Kansas
3. Vermont 28. Michigan
4. Washington 29. Rhode Island
5. Oregon 30. South Dakota
6 Maryland 31. Tennessee
7. Utah 32. North Carolina
8. Massachusetts 33. Indiana
9. Minnesota 34. Montana
10 Connecticut 35. Nevada
11. Virginia 36. Wyoming
12. Illinois 37. New Mexico
13. New Hampshire 38. Arizona
14. Alaska 39. Missouri
15. Nebraska 40. Louisiana
16. New York 41. North Dakota
17. Colorado 42. Arkansas
18. New Jersey 43. Texas
19 California 44. West Virginia
20. Wisconsin 45. South Carolina
21. Iowa 46. ​​Georgia
22. Idaho 47. Mississippi
23. Delaware 48. Kentucky
24. Florida 49. Oklahoma
25. Pennsylvania 50. Alabama

Source: Commonwealth Fund.

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