Masks Mandates and Conference Vaccine Requirements
This months episode of “News you can Use” in the traditions of “Ask Me Anything” on HealthcareNOWRadio features news from the month of June. You can read more about the series here and the concept of keeping up with innovating 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 tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners. Thanks to sponsor Atlantic.net for supporting this episode.
With the recent news from the CDC changing mask guidance which as Craig rightly points out contains some very specific details and who this applies to – in this case it is only for those that are considered fully vaccinated. We work though the details of the decision, some of the reasoning behind it and what it means to you.
We discuss the upcoming conferences including AMDIS PCC, HIMSS and HLTH which are taking place in person and come with specific guidance on requirements for attendees. HIMSS is requiring vaccination but does not have any published methodology as yet on how they will determine who has been vaccinated. HLTH is also requiring vaccination and have selected the Clear system which as yet does not exist (coming soon per their website).
We discuss the challenge of ransomware and the fact that Humans are the weakest link. This problem will continue to expand since it is big business (see Brian Krebs detailed look at the recent Ransomware gang the Darkside that attacked the Colonial pipeline) which highlights what big business this form of extortion is.
Listen in to hear our discussion on Medically Home investment from Mayo and Kaiser and the tremendous opportunity moving healthcare observations into the community but the ongoing challenges of technology setup remain as Dr Jayne (@JayneHistalkMD) detailed in her struggle with a blood pressure monitoring system for her home. If you are wondering about the continuous Blood Pressure monitoring system mentioned – that’s Aktiia approved in Europe but not yet in the US.
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
today I’m delighted to be joined by Dr. Craig Joseph. He is the chief medical officer at Nordic consulting partners for our episode on news you can use Craig, thanks for joining me. Well, thank
Craig Joseph
you again for having me.
Nick van Terheyden
Today’s episode is sponsored by lantic dotnet, the award winning cloud hosting company trusted with securing data critical data for over 25 years, their industry leading HIPAA compliant cloud hosting solutions are backed by a fully audited 100% service level agreement, and a customer satisfaction guaranteed. Get started today with your free trial at Atlantic dotnet. So, Craig, for the purposes of this month’s news, you can use I guess, the most pressing couple of items that I think are worth talking about the CDC mass guidance, and vaccines and conferences. Let’s start with vaccines and conferences. It’s coming up to a season where we might actually have some in person conferences. In fact, I’ve got one in my future for next month. And this is potentially in person and I’m looking forward to that. But hymns, which is the biggie coming up in Las Vegas, one of your hot property towns that you like, are you going to the conference? Did you see the vaccine news? And what’s the story? Well, I
Craig Joseph
am going in and I also am going to the conference. So potentially, I will see you in a couple of weeks. And I’m not really sure you’re a real person. Because I haven’t seen you in a long time besides through a video screen. So this this might be very exciting. As you mentioned, several of the very big now this ambitious conferences a very small conference, relatively speaking with a bunch of geeky doctor type people, which I enjoy
Nick van Terheyden
being resemble that remark. Yeah, I
Craig Joseph
know you do. But you’re talking about some very big with 10s of 1000s of people attending and hims and the health conference, H LTH Health conference, both denounced that to attend in person, you must prove that you have been vaccinated fully vaccinated against COVID-19. The you know, looking at social media, I think the preponderance of the of the audience of the folks that are going to be going to that applauded it, and and I certainly applaud it. There are going to be it’s going to be great to know that everyone that’s in the exhibit hall, everyone that’s in the in the seminars, is fully vaccinated, does it mean that I’m 100%? safe? Absolutely not. We know that that’s not the case. But we do know that it’s highly unlikely that if you’re fully vaccinated, you’re going to have severe disease or end up in the hospital or die. And so I do think it’s great. And I personally am willing to give up the the privacy concerns that some have with respect to proving to a group that I’m fully vaccinated. And I think that’s appropriate, I understand because you can tell some I already know some folks are going to be upset. I understand there are folks who think that that’s a an invasion of their privacy, and that they can’t be required to give that information up. And they’re right, it is an invasion of their privacy. And they can’t be required to give that information up. But it also means that the the private conference that’s being held on a private property doesn’t need to admit you. And so those are decisions that they’re making. And it’s it’s I think, well within the right to make and given the way we understand, you know, how the pandemic has gone and how we anticipated it moving forward. So long, long, a lot of talk a lot of words for me basically to say like, I think it’s great. I’m glad they made the decisions, and I’m happy to share with them via whatever technology they want my status with respect to the COVID vaccine.
Nick van Terheyden
I agree with you. I mean, I think it’s it’s a reasonable ask. I know there are folks that I certainly can think of folks that believe that that’s overstepping the boundaries. But you and I have talked about this before. And, you know, this is not not a new circumstance. The yellow fever vaccine is a requirement, you have to prove that yellow fever vaccine. And it’s done with a paper based solution that is written in and says you’ve had the yellow fever vaccine, albeit that’s a an approved vaccine, although interestingly, there was a requirement in my household for having that vaccine and The approved FDA approved vaccine is not available, it’s in short supply. And the family member had to have one that was not FDA approved. Because they required it for that particular job. So, but I think my question or challenge and you know, it’s it’s as evidence with health, and hence, health, I think has come out and said, we’re going to use clear, clear, clear system, which is clear as in the airport system. By the way, that doesn’t exist. They I think they acknowledge that or, at least, that’s what I’m aware of. So
Craig Joseph
absolutely does not exist. As of now.
Nick van Terheyden
It doesn’t mean he does not, which makes me supremely nervous. Given that we’ve had these vaccine booking systems, we’ve got millions, and then didn’t do a particularly good job,
Craig Joseph
can I just say, Can I just as an aside, I actually traveled on an airplane over the weekend, and which was very, very exciting for me. And the clear, I hadn’t been at a clear sight, obviously, since March, in the pre pandemic time. You just walk up to this machine at the airport, and it has a retina scan that you’ve given it. And I just looked at the machine for about a second and a half. And it it found me like I didn’t, it didn’t know who I was, and then compare the records. Just by looking at my eyes. It found me. So my point is, I think clear, seems from a company standpoint, very able to get their technology in order. But your points well taken. Health has announced that it’s going to be the clear app, and the clear app doesn’t really exist with respect to this. And I’m I’m very curious, how are they going to do this? So many people got vaccine from so many different sources. And and you know, every state has a state immunization registry or multiple state immunization registries. And it just it’s going to be difficult. It’s a difficult technological question. Because one would assume, again, that your piece of paper is not what they want for proof. They’re going to want digital proof.
Nick van Terheyden
It reminds me of a problem that I don’t know, I’m scratching my head, I think it was it was a big problem in one industry somewhere, interoperability or something I seem to have this challenge that just, you know, data was not shared. There was no standards. No, if you’re if you’re an ATM, it works great. But it doesn’t work. banking. No, no, I
Craig Joseph
think you might be referring to health care, you might be referring to health care. Yeah. Yeah. So we do have a problem. And and, you know, how are these apps going to figure out? Again, assuming that the piece of paper that we all have, and we treasure, and I know I’ve scanned it, and taken three pictures of it to make sure I always have it. That’s useless. If I’m assuming that that’s not going to be good enough proof, because so it’s so clearly and easily faked. So, you know, going to the source, either from the electronic health record of the health system that that administered it, or, you know, if you went through CVS, or Walgreens or one of the big systems that that way, you know, it’s digitally there, how do we get that information out and into an app? that’s complicated, hard stuff, interoperability is very difficult. So yeah, I think it’ll be fun. My main point I want to emphasize is I’m glad I don’t have to do that job.
Nick van Terheyden
Well, and I think you raise an interesting point with clear, let’s be frank, I mean, they’re doing that from a airline security security standpoint. And I have to believe that they’re validating against a central registry of recorded individuals to be able to validate and securing that information because we’re talking about biometrics. So I think they have a good chance. But then I’ve heard of other large companies that you know, do stuff really well, who tried to step into a healthcare arena, and let’s be clear, vaccination feels very health carry ish, and struggled. So yeah, jury’s out, we’ll watch but I, you know, reasonable behavior. If you’re not vaccinated, you’re not coming to hims. And I think that’s also or not being allowed into the various things. So maybe there’s going to be an outer conference in non vaccinated individuals. I don’t know. But I’m looking forward to going I’m looking forward to seeing people. I have the privilege of having been vaccinated and excited to explore that. So moving on, let’s talk about the CDC because they obviously went to the school of brief change management and said, Okay, we’re just going to swing this way and say no more masking required. Thought.
Craig Joseph
Yeah, well, again, I I emphasize I’m glad I’m not having to do that job. They were in a bad position where they wanted to get information out very quickly. And they wanted to make it science based and, you know, buried in lots of evidence so that if folks had questions, they could they could look at the the source information. And so they got that information out very quickly. To your point from a change management standpoint. It was it was horrible. And, and you would have wanted to prepare a lot more plan a lot more about how you’re going to get this information out. What specific recommendations, various interest groups, you can give to them, for instance, employers, hey, you know, you’ve got a 10 or 10,000 or a million employees, what what does this mean to you? And so, and and, you know, you just said master no longer required? Well, that’s not what they said, actually. Right. what they said was, if you’re fully vaccinated, unless you’re under these certain certain circumstances, meaning planes, trains, buses, those kinds of things. Masks are not required for you. But that doesn’t change anything for for folks that are not fully vaccinated. And by fully vaccinated, we mean two weeks after your final dose, or two weeks after your first dose, you’re only dose if you were getting back the vaccine that only requires one of the j&j. So yeah, it was, I was glad to see it, I thought that they were overly conservative. People who are much smarter than me from a public health perspective had been pushing for weeks for the CDC to say, Hey, you know, the risks are so low that you’re being overly cautious. And so you know, we all deal with risk in our life every day. And we make certain allowances, I’ve given clear the company, I’ve given them my fingerprints, right, I’ve given them other biometric information on them on me that that’s something that’s a risk I’m willing to take in order to get the convenience and the benefits from it. So, so long story short, I think it was great. I think that they I’m glad they did it, I understand the problem that they had and trying to get it out quickly. But it did cause a lot of confusion. It’s still confusing. And ultimately, every organization, whether it be a county health department or a small employer, they have to figure out what they’re going to do.
Nick van Terheyden
Right. And all of this is going to break down in some complex ways. For those of you just joining, I’m Dr. Nick the incrementalist today I’m joined by Dr. Craig Joseph, he is the chief medical officer at Nordic consulting, he joins me each month on news you can use. Just a reminder on today’s sponsor, get started with your free chart trial at Atlantic dotnet. The simple solution for your HIPAA compliance and cloud hosting needs. We were just talking about the CDC mass compliance or mask, unmasking compliance that basically came out. And Craig, you rightly pointed out, it’s not No, you don’t have to wear a Masters series of conditions. But certainly the interpretation has been challenging. The change management, if I was to sort of be charitable about this as I was trying to be, I think, you know, the question always remains, at what point would it have been okay? To say, right, we can say masks off, I think the CDC has run this balancing act. They’ve had this pendulum, and you highlighted it, one of my guests is coming up. Marty mcherry will be talking about this and the challenge with the over conservative nature of CDC. And it feels like somebody goes by we’ve really got to show these people we’re not conservative. But equally, I would say, you know, we reached some level. And I know, I can’t say what it is today. But I know certainly it’s over 50% of the population in the US has had at least one dose is my understanding. And some smaller proportion of that have had two doses or considered fully. So we’re not at any level where numbers have been cited for, you know, this all invasive herd immunity, which is only truly understood in hindsight. So we can never say with certainty, yes, we reached herd immunity. But we are seeing huge declines in cases in intensive care, use bad usage, ventilator usage, all these places where they’ve actually tracked all this information. And if it was good enough, or you know, appears it’s heading in the right direction, what is then the line and I think in some respects, it’s a reward, right? where everybody’s done the right things, you know, and also potentially some cajoling, influencing type activity to say, Hey, if you’re not vaccinated, you really have to still follow these procedures. But if you aren’t, are vaccinated, now you’ve got some additional freedoms That’s a little bit of the carrot in my mind. So I, I’m, I’m in favor of it, I’ve spent a lot of time explaining this. And, you know, dealing with the challenges. I think the principle underneath underneath this, as you highlighted is, to me very clear, if you’ve been vaccinated, you are both protected. If you’re, you know, from exposure, and if you do get exposed, you don’t get severe diseases we’ve seen in a couple of studies out of Israel, and importantly, you don’t spread it. So the virus doesn’t show up in the nasal pharynx and pharynx. And you’re not shedding high quantities of the virus load, which is, you know, we talked about IDD infected dose deposited or infected deposited dose, which is a measure of the amount of Vax of virus that gets shared. And you’re exposed to. So all of that, to me adds up to, oh, this is reasonable. And at some point, we have to return to some level of normality. So I’m, I’m good with that. I think it’s, you know, it’s good news, albeit it’s going to create some confusion. So moving on, scripts ransomware. They’re apparently still down two weeks later, have you had experience in all your it dealings with challenges of ransomware? Is this a problem that we’re going to see more and more of, do you think?
Craig Joseph
Well, I have not personally dealt with ransomware. But you know, it’s a it’s a huge problem. And it’s highly profitable, and relatively easy to do. You don’t have to be a computer science guru. To do this, you certainly have to know a lot about computers. But the my understanding is, you can, evil actors can easily get access to some of the technology that’s required. And it all it takes is one person at your organization to do the wrong thing. And usually, it’s almost always, I shouldn’t say almost, it’s always accidental, someone clicks on something that they probably shouldn’t have. And maybe it was obvious, maybe it wasn’t obvious. But that combined with combined with software that is either not updated typically or not configured, the way optimally should allows, allows the bad Dewar in. And typically what they do is scramble all of your data with a code, and then tell you, if you want to get the code to get all your data back is going to cost you a lot of money. And so with the with the ability of getting that money via Bitcoin, which can’t be traced, or certainly can’t be easily traced, oh,
Nick van Terheyden
I’m gonna stop there and say, actually, you know, I think that’s a little bit of a misnomer. And, you know, one of the the services actually happened in the last week or so one of the services in the Bitcoin world was a laundering, money laundering. So, Bitcoin, you know, it’s an irrefutable record that ultimately should be able to tie back to individuals now you can conceal and it’s not tied to a banking system. So there is some ability, but it’s not quite the anonymous system that everybody believes it to be. And certainly people have been caught by their associations with bitcoins, and an individual that set up a whole business that was essentially throw all your money into this big tumbler, and I’ll mix it all up and then redistribute it. And that’s one of the techniques of shielding. So yes, that’s true, but I think it’s more of a convenience. It’s a bit like paintball. It’s just, hey, this is an easy way to pay me $3 million. Just send me the Bitcoin.
Craig Joseph
I wish you would have told me about this before. Now, I feel like no. All right, well, be that as it man, you certainly know more about about this than I do. ransomware is easy to do, and it’s easy to get the money back and you just have to be persistent, it seems. And so we think crime is not supposed to pay when crime does pay, you’re gonna see more crime. And
Nick van Terheyden
it’s and you’re right. It’s big business, if you looked at the piece on that, that sort of bid the expos a on. It’s a huge business. I mean, they have massive teams of people that are focused on there. So, you know, having a single security officer is oftentimes insufficient to sort of cope and deal with this and you know, the weakest You are the weakest link. I mean, that’s one of my blog posts that I posted a long time back. You know, unfortunately, it boils down to the individuals You know, I just got a phishing exercise in one of my emails that was designed to test me out. Now, I’m super suspicious, but not everybody is. And, you know, even when you’re super suspicious, you can still get caught out because they do what’s termed spear phishing. So they pick things that they know, your look at, Oh, that makes sense. I, you know, I should be receiving this and click on it. And, you know, so huge challenge. But you know, here’s a, an institution that is essentially down. And, you know, I know they’re struggling, although there’s very little information coming out. We’ve got a few minutes left, I wanted to just briefly talk about them medically home, that big investment on the part of mayo and Kaiser, we don’t know how much but the certainly substantial amounts of money that essentially is in this investment vehicle that is trying to put healthcare into the home. So putting resources and having you at home versus coming into the hospital, all sorts of economic implications, because we set up hospitals and the payment screens to work that way. But from a clinical standpoint, have you had any experiences though?
Craig Joseph
A bit, you know, this this concept of hospital at home, which is what we’re talking about, it’s a little different than what most of us have experienced in telehealth, you know, talking to a doctor over the over the computer. This is these are sick people who typically would be in a big building, with with doctors and nurses and respiratory therapists and dietitians, and all those folks. And the you know, the idea is, of course, can some of those less sick, still very sick, but less sick patients be managed in their own house? And can you do that safely? How do you give them IV antibiotics? How do you how do you do monitoring, and that, you know, that sort of thing. And, you know, some expect to some extent, it’s clearly technology related, you know, I need to be able to monitor them and watch them and see their vital signs, I need them to be able to get on scales. So we can, you know, check weights and those. But there’s, there’s also a big organizational perspective, right, you still are going to need folks to go out to their homes fairly frequently, most likely daily, to check on everything and make sure everything’s going well. But the benefits are huge. And if you can do it safely, and some have shown that they can, and a lot of that’s picking the right patients, right, who are the patients that are likely to thrive at home, and then making sure you have the right safety measures in place and quality measures. So you can ensure that they’re getting the same outcomes that they would have gotten in the hospital, it’s so much better as a patient to be in your own home, and not be woken up by noises from other folks or machines. And it’s cheaper, so much cheaper, in the long run. So lots of benefits to all involved parties, if they can make it work.
Nick van Terheyden
And you know, it’s interesting, you bring up, it’s better in the home, our cat recently had to go and see the bet it was necessary. And like a human. What happened, she ended up getting a cold when she came back. And I can only believe because she hasn’t had one in years that she goes out in the veterinary practice. And I think that’s the same problem. So another good reason for this telehealth is to, you know, prevent that. from a technology standpoint, I agree with all the supporting services. But here’s a call out on technology. And Dr. Jain featured this in her blog. And I thought it was kind of interesting, she was having to measure her blood pressure, something I do at home with a manual blood pressure machine. And I entered in and track it far better in terms of resources. But she spent a considerable amount of time just connecting this device because it was supposed to be quick and easy. And I think that’s one of the critical elements of this sort of digital health promotion that we have to make things as easy as the iPhone. So I would always cite my mother when she was still alive if she could use it that it was, you know, valid. Ultimately, she did get it working. But by the time she got it working, she had a headache. So I’m not sure that that technology worked. And if I had a recommendation for I’d say pick the most simple version of this, which act tilia has come out with a blood pressure monitor that looks like a Fitbit watch uses the same principles of plethysmography. And as a continuous monitor that you can just essentially when very exciting, very simple, put it on connected to your device and you’re up and ready and going. Unfortunately, she’s going to have to get some friend who lives in another country. Europe because it’s authorized the you can’t buy it in the US because the FDA hasn’t approved it. But hopefully they will. There you go. For me, exciting scope and the fact that the mayo and Kaiser is investing in that makes a tremendous amount of sense. I think we’re going to see more of this. Unfortunately, we’ve run out of time. I just like to thank our episode sponsor today, Atlantic dotnet. Keeping your focus on the patient is essential. And having the wrong cloud service plan can be costly. start your free trial of HIPAA compliance cloud hosting today at Atlantic dotnet. Just remains for me to thank you as usual, Craig, always a pleasure. I look forward to seeing you IRL, as they say, in a few weeks time.
Craig Joseph
Excellent. I’ll try and remember what you look like based on the video.
