This month’s episode of “News you can Use” on HealthcareNOWRadio features news from the month of September 2022
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners.
We dive into the recently published The Lancet COVID-19 Commission that reviewed the worldwide response to the Pandemic. As Craig puts it the results show we as nations countries had a very poor response to the pandemic
Click to access covid-19-commission-2022.pdf
Despite some countries having better results and responses worldwide sharing of data and international cooperation remained very poor throughout
We discuss the status of the latest boosters for COVID19 including the distribution of the bivalent COVID19 vaccine and the flu shot and I describe my experience getting both on the same day. All round a very good experience with little pain and very happy with the results
Listen in to hear our discussion now what’s old is new again with CVS’s purchase of Signify Health and their desire to bring back the physician house calls.
You can read more about the series here and the concept of keeping up with innovation in healthcare. Please send me your suggestions on topics you’d like to see covered. You can reach out direct via the contact form on my website, send me a message on LinkedIn or on my Facebook page (DrNickvT), or on Twitter by tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
And today as I am each and every month, I’m joined by Craig Joseph. He’s the chief medical officer at Nordic consulting partners. And we’re talking this month’s episode on September of news you can use, Craig, thanks for joining me.
Craig Joseph
It’s always a pleasure.
Nick van Terheyden
I don’t believe that for one second, but okay, I’ll take that compliment for for now. Thank you.
Craig Joseph
You told me I always have to say that I’m confused. You
Nick van Terheyden
mean for all the money that I pay you for doing this? Correct. So we’re, as usual, we kick off with COVID-19. We don’t seem to have emerged, although I did see something just recently that talked about the the end of the pandemic that might have come from the who, but given that we’re talking about those folks, maybe the first thing to talk about is the lancets publication. So it was a commission that always reminds me of royalty and royal commissions and stuff. So I’m not quite sure how Alliance, it comes to this commission, but their review of COVID-19 and the worldwide response, and I’m going to quote from their graphic no lettuce.
Craig Joseph
Wait, before you let me just let me guess. Before you go. We period did period. Great period.
Nick van Terheyden
On fortunately not.
Craig Joseph
Oh, all right.
Nick van Terheyden
It was I want to say, I’m not sure that it was titled this. It was just the Lancet Commission. But they actually produced an infographic and it said COVID-19 response, a massive global failure. And what did they come up with? Well, they did a comprehensive investigation analysis into the COVID responses worldwide. And, you know, looked at practical steps to control and understand the pandemic, investments in strengthening defense against these infectious agents in countries. And, you know, looking at the multiple multi-lateralism That, you know, tried to integrate the globe and get everybody to work together. Pretty much we failed across the world. No surprise there, I guess.
Craig Joseph
Sadly, sadly, no. One had hoped that maybe other countries have done better than we had, and I think they have in certain areas. But, you know, looking at some of the key findings of this Lancet Commission, a big word that I see over and over was coordination, or lack thereof, or they’re certainly here in the US, we saw a significant lack of coordination between the federal government and the states, but also a failure to coordinate among all of the the major countries of the world and couldn’t really agree on definition. The Lancet, the Lancet, thought that the World Health Organization was too cautious and too slow at the very beginning to, to say how, how serious this was, and to really try to get everyone’s attention by jumping up and down on our, on our chests, which they, which they didn’t do until, until it was a it was clear that that needed to happen.
Nick van Terheyden
Yeah, I do remember that point in time. And I guess it’s difficult to call that at the right moment. Maybe, you know, with more insight, and obviously, I certainly didn’t have the data I was being fed What was you know, delivered to my screen. But my recollection of that was, you know, a certain amount of, I don’t want to say dismissiveness, but certainly not an attention to it that said, gosh, we should, you know, this is this is a serious event. It was, well, there’s something going on over there. But you know, we’ve seen this before. Maybe not as serious. As you look around the world, I certainly have standouts in terms of response. And, you know, I’m not necessarily in favor of some of the responses and you know, somewhere impractical. Let’s pick New Zealand as an example. And Australia because they have very similar responses, but I wouldn’t put them in the same category in terms of how well they did. What were your thoughts?
Craig Joseph
Well, I think it’s, you know, the more we learn the seemingly the less we know some Sometimes, I think it’s confusing. It’s confusing to look across the country and you see certain see, again, I think it’s played out. Now, you don’t really have to look outside the US you have certain states that were very aggressive and shutting down and, and doing other kinds of public health interventions, just like you do certain countries that were very aggressive. Some of the countries are islands, and they’re able to really control who comes in and who weeks. And some of the data seem to indicate that that one group did better than the other. But there are always other ways of looking at some of those data points or different points altogether. So I think this is going to be we’re continuing to learn and we’ve talked about this on this show before where, where initial if people are accused of making up things, when in fact, it’s just confusing, and you’re reacting to the data that you have in front of you. And I still think we’re in it, right? We’re not? I haven’t really heard very many people say that this pandemic is behind us. We hope it is. Certainly we’re much better prepared now than we were two years ago for for anything. But
Nick van Terheyden
actually, do you actually think that’s true? Because I’m not sure I believe that?
Craig Joseph
Well, we are we have medications, we have vaccines. From that standpoint, we’re better prepared. We’re
Nick van Terheyden
basically prepared for COVID, but not for the next thing.
Craig Joseph
100% agree with you. Sadly, yeah, we’re not prepared for the next thing. And we’re also potentially not that prepared for the next COVID thing, whatever that is, you know, what can imagine some sort of strange mutation that, that we’re not really ready for that instead of the the minor movements where it doesn’t the vaccine doesn’t work as well, but it still functions at a more basic level? Yeah, we’re not. And I think monkey pox showed us how how poorly prepared, we were for the next for the next virus that comes over and looks different and acts different and to which most of us have never been exposed? So we were humans don’t seem to learn lessons very quickly. And sometimes not not at all. And certainly we’re, we don’t seem to want to put the money or the time or the investment into public health. And so when will the next pandemic come? And will it be, you know, 10 years from now or a century from now? Or or next week? We don’t know. But I don’t think we’ve written the final word on on COVID. And we’ll certainly be learning lessons, especially from long COVID, I think, in the decades to come.
Nick van Terheyden
Yeah, so one of the things you brought out, and I think, you know, it’s tied to me in public health, so that the foundation of this if we were to really learn from the experience, and try and turn this into a positive experience for the future and say, This is how we might respond in the future. It was coordination. And the coordination in my mind would be founded on data and open data sharing, which we I think, did not see. Certainly, across states even I’m not sure not internationally, I think we saw that sort of wide variation. There was a flip, I don’t know if you recall this, it was brought home to me because I had a friend who drove from New York, down to Florida, in the very early days. And this was the time when New York had very bad outbreaks and Florida and instituted border entry requirements and giving all people that crossed into Florida, a requirement to go into quarantine to sign off that they would go into court. As I think about how things developed into the future, it was kind of ironic that that was the case. And maybe that would have happened the other way around. But it certainly didn’t we we sort of struggle with that. But I would say that let’s focus on the data. And actually the sharing of that open sharing for the benefit of everybody. Do you think that’s possible? Or are we just too politicized to international challenge to be able to achieve that?
Craig Joseph
Well, I suspect it’s it’s never. Let’s see, you asked a very nuanced question. So let me give you a nuanced answer. No, no, I don’t think it’s possible. I don’t think it’s possible because the, because of the way we react, right, so how do we react when we find out that there’s a virus, a novel virus in China, right? We shut down our borders with China, as does everyone else and I And that that first instinct, which I, I fully understand and probably will support the next time it happens. That is that that incentivizes countries via China or the US or any other country to minimize, right? Why would we want to tell you exactly what’s going on, if it’s not good, when the reward for being transparent is a punishment, the reward is, is a lack of trade and lots of other problems that happen. And so, so there are disincentives to sharing data, especially at the beginning. And we really have to overcome those, either by making sure that we we go out of our way not to, not to punish people for doing our countries for doing what we want them to do, or making it so it’s very difficult to do. So if you had if you had monitors or if you had other sorts of international equipment that that couldn’t be, couldn’t be suppressed or mess with perhaps something like that would also help but boy, boy, when when the incentives are to do not share, it’s not shocking that we don’t share.
Nick van Terheyden
Yeah, I think, important points. And, you know, it reminds me of our conversation about the nurse that was prosecuted, you know, for the error that was made in the drug that was given to the patient and, you know, specifically around errors when you go after people, you lose the trust element and people stopped reporting, which, you know, was the reason that the airline industry really tried to focus on root cause analysis without apportioning blame. I albeit imperfectly. For those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Dr. Craig Joseph, the Chief Medical Officer at Nordic consulting partners, we’re covering September’s News You Can Use we were just talking about the Lancet Commission, it’s damning report, unfortunately, and thankfully, Craig gave us a nuanced response to that particular question. As we think about, you know, moving forward, we’re still in an era of dealing with COVID. Or at least that virus. Have you had your booster yet? Or? Well, let’s booster booster I’m not even sure how to describe this, but I think there is a new round of vaccination that’s available. People are talking about it the by Vaillant. Have you heard yours?
Craig Joseph
I have not had my payment yet. I’ve had I’ve had for you know, it is very confusing talking about these two. So I’ve, I’ve decided I just want to tell you how many I’ve had. So I’ve had four, but I have not had the buy Vaillant one just yet. I’m well on my way. I just haven’t gotten around to it. Of course, there’s controversy about the flu vaccine as well. Not sure it’s a controversy whether you should get it at the same time. Where do you where do you stand? Have you have you had the vaccines yet? Yeah. So
Nick van Terheyden
I, as I think I shared I endured a bout of this, and I’m pretty hard on this in terms of getting covered. I do recognize that there is some timing because there is some drop off in terms of the immunity. So you know whether you get it too early. This has also been true of the flu vaccine, but there’s also just a pure function and I happen to be scheduled for my booster booster. I think that would have been number four for me. Literally, I got COVID, three days before I was scheduled for it. So I guess I’m a little bit ahead of the curve. And I did have it this week. And since I have two arms, I had both I had my flu vaccine and my COVID COVID-19 by Vaillant jab and, you know, one on each side. And for me, it was entirely unproblematic. I had a little bit of a sore arm, nothing else to speak of.
Craig Joseph
And did you get did you have two people give you shots at the exact same time? I’ve seen pictures of those. That’s what I would have wanted. But I suspect you didn’t you didn’t get that?
Nick van Terheyden
No. And you know, so here’s the interesting thing about vaccination and I typically we go as a family you know, it’s a, you know, a family that vaccinates together stays together. I don’t know if that’s true. But I, for me, it’s a little bit of pulling. Not that there’s a lack of willingness to get vaccinated. It’s just it’s a very unpleasant experience, I think especially for women who have less flesh and musculature so getting a vaccine can be a little bit harder. And in fact, my wife has had some pretty miserable experiences. I know some of these folks have hit bone, which is entirely inappropriate, I just have to tell you. But we actually had a very good, very adept individual. And he, I have to say, I’ve had lots of these I probably have, I counted it up, somebody challenged me and said, you know, that’s just not possible. But I, I’d had many, many vaccinations. By the time I’d hit, you know, six or seven, because I lived overseas, I had to have yellow fever all the time, because we lived in yellow fever endemic areas. And this particular individual was outstanding. He, I didn’t even feel the need or go in. And I didn’t feel the distribution. Sometimes you get a stinging, it was a out of out what hands down one of the best experiences. And that’s a function of the operator. I know, I’ve seen a few robots doing this, I’m not sure I’d be too excited about an Arnie Schwarzenegger look at like, coming at me with a needle quite yet. But I have seen where they pin you down, because they don’t want you to move when this thing sweeps into action.
Craig Joseph
Now you now I’m picturing our old coming out of me with a syringe and a needle. And you said you didn’t want an Arnold Schwarzenegger look like but I don’t think I want Arnold Schwarzenegger himself either coming out with a needle uncertain. So which one was more painful the next day,
Nick van Terheyden
so only one I had pain in. And that was the by valence. And it was very hard for me. The flu was I didn’t even feel any pain. And had almost I would say, I had no symptoms. My wife had a little bit she had, you know, some clearly her immune system reacting. And as I said to her, I felt like I got COVID Worse than she did. So I think my immune system said, seen this before, no problem.
Craig Joseph
Fair enough. Fair enough? Well, I think that’s, you know, I think it’s good advice. It will be interesting to see who are how the pickup is in the United States for both booster and, and for the flu shot. There have been some predictions that this is going to be a pretty severe flu season, based on how it happened in the southern hemisphere. And they, they, they go before us, and and so if we if, if we can take what happened in the southern hemisphere, to be predictive of what’s going to happen in the northern hemisphere, there gonna be a lot of sick people. And from the flu, forget about COVID just strictly from the flu. So I certainly
Nick van Terheyden
I’m going to counter that and say, please know that we go before them.
Craig Joseph
You’re right, you’re right. Since we are since in the north, north america is as we all know, on top of the world, what is the center of the US? When you look at the Globe? Certainly North America is on top and, and South America is below. So you’re right. We do go first. And I clearly misspoke and apologize for that. No,
Nick van Terheyden
no, no, I’m teasing. One year I was down down in Australia, and I decided to get my flu vaccination whilst I was there, because they were at the tail end. And I got whatever it was that they were offering I, some of my colleagues from medical school actually live and work there. And I got one of them to, you know, sign off and get me vaccinated. I don’t remember how it worked out. I mean, for the most part, I’ve I didn’t when I was in my sort of, you know, relative youth, but I’ve been pretty consistent. I think it’s just smart. I’d rather not get the sickness, quite honestly. So I hope people do. But I’m not encouraged with the way that things are. But I certainly did. And I know, you obviously will. So
Craig Joseph
I will and we should remount we should remind everyone that just like the COVID shot just with the flu shot, the goal is not to prevent illness. With that would be nice. And that sometimes happens the goal is to prevent serious repercussions from the illness. So the goal is that not necessarily that you won’t get the flu, but if you do get the flu, your chances of ending up in the emergency department or at the hospital ICU are much less and much like it’s the same with COVID. So again, people should go in with the understanding that and then the expectations are our programming. So
Nick van Terheyden
yeah, we were a little bit spoiled with the COVID vaccines. I think we saw some incredible rates and I’ve seen a lot of interest in some The output of possible vaccines using that particular platform that I think will be much improved, including I think, some early work on the malaria vaccine, which, you know, that would be astounding, because that still kills about 4 million people a year, worldwide. So. So, in the news, I think CVS brought bought, signify, I think, signify health, which is, you know, clinicians that provide in person evaluations. The article I read said, CVS is bringing back physician housecalls, which, you know, what’s old is new, I’ve long been a believer that, you know, there’s tremendous value in that. You think that’s a realistic economic potential opportunity?
Craig Joseph
I think it’s, um, first of all, I would agree with you and what you just said, in terms of the benefits, and I think we’ve seen some of those benefits even virtually right. So the the opportunity for physicians to see in your house, see what’s behind you see how you’re interacting with the people that are around you, outside of their office, is is exceedingly helpful. So, so house calls would benefit, you get a be able to see their house and some of the some on gain some understanding as to how they live, but you will also be able to physically examine it, but you, you can’t do virtual visits. So, so huge benefits, is it going to be something that we see commonly, I still suspect not? Because it’s going to be very expensive to send physicians, physicians up to the house now to send physician extenders to send nurses and, and others who are specially trained to kind of do most of that reconnaissance work, and then potentially bring in some physicians or more likely refer you to where the positions are often in the hospital or clinic. That seems to be a big lots of potential there. And I I don’t think this is anything that has never been tried before. I think it’s, it’s much more common in Europe. I’ve seen, I’ve seen videos of of, of nurses going out in England, you know, routinely kind of doing assessments that in the US will make people come in for so. So certainly we’re not breaking any new ground here. But I I do think it’s exciting. And again, as things change, the more they change, the more they stay the same. Who would have thought that a drugstore chain would be interested in coming to your house with a doctor or nurse like that? That is pretty. I think 10 years ago, that would have been fairly shocking.
Nick van Terheyden
Yeah, I, I’ve always been a big fan of the home home visit. You know, I grew up in a country that had it. My brother was a GP, he was doing home visits right up until the point that he retired, maybe not as many, but it was a fundamental part of his daily practice, he would get a list at the end of running surgery, as they called it, it wasn’t surgery, but that’s how they referred to, you know, the appointments. And then he would go out on his rounds visiting. And indeed, there were probably regulars. And in fact, my wife was a nurse midwife health visitor and she was part of the community system at one point. For for every mother that has a baby had a baby, I don’t know that this is still true. I think we’ve lost a lot of this. They would receive a community midwife visit daily for the first 14 days. And you know, that might sound excessive. But you know what, that is such a stressful time. Even a husband and wife like us, physician, nurse, midwife health visitor, we felt incredibly a net when that first baby arrived, despite knowing all the things that we did scientifically seem to have no contribution. It was a huge positive and, and I think your point is exactly right, seeing that setting, even virtualized, I think has tremendous value. And I hope we see a big return of that. I really do. But the economics of it have to be worked out. So maybe it’s that physician extenders, but Hooray for that. Unfortunately, as we do each week, we’ve run out of time, so just remains for me to thank you for joining me on the show. As usual, Craig, thanks for joining me It’s been fun can’t
Craig Joseph
wait till next month
