In our 99th episode on COVID19 we look at the latest news and updates on the Pandemic, asking the question what it means going forward. COVID19 remains a pandemic based on the classification of outbreaks that continue to occur worldwide, but countries are pulling back on mitigation measures and differing views on what we should be monitoring going forward. We are still seeing a substantial number of deaths per day attributed to COVID in the US and around the world but in many places the level of risk of exposure and significant negative clinical consequences is decreasing leading to a reduction in masks requirements and changes to immigration or border control requirements
Next week we will wrap our series with the 100th episode and look back and ask what we have learnt and what we failed to learn from this pandemic and look into the future with some key points for business and individuals going forward
https://youtu.be/bwIeDOI2o2s
Raw Transcript
Nick van Terheyden
Hi, this is Dr. Nick on the incrementalist here with incremental insights for better business better health.
Fred Goldstein
And I’m Fred Goldstein with Accountable Health here helping employers payers and health care systems with their population health improvement programs. So Nick, we’ve been riffing on this issue. It’s now number 99, Episode 99, we’re approaching the triple digits, Mark. And we’re sort of in an unusual place right now. Not a lot of interesting news coming out. So what do we think’s going on? And where do we think it’s gonna go from here?
Nick van Terheyden
Well, I’m just gonna say 99, red balloons. And the whole story behind that, and how that I think, set off a war. And it was originally in Germany, if I recall, but Eurovision Song Contest for those of you that don’t know, but yeah, you’re right, there’s not not a lot. I mean, I’m seeing a fair amount of traffic content that’s saying withdrawing, reducing, essentially, if I go two miles one way, where I live, all the restrictions are off mask requirements are gone. They’re still in place, but not for much longer. In my particular county, there’s, you know, wide variations. CDC is talking about changing the requirements. You know, at this point, it’s business as usual, with the inverted commas, I think, whatever usual, is in your particular instance. And that probably varies by country as well.
Fred Goldstein
Absolutely. And I think I saw an article in which the Maderna CEO said, it looks like we may be approaching the end of the pandemic, with Corona, possibly, maybe, whatnot. And it is
Nick van Terheyden
purely a classification, right? I mean, pandemic is a status, and it lends specific oversight regulations, and importantly, reporting regulations for health authorities, both domestically and internationally to say, if you identify that disease, then you must report it. So that comes with a bunch of requirements. But, you know, beyond that, we move to endemicity. And then Miss assisity. I’m not sure how to say that. But, yeah,
Fred Goldstein
yeah. And the other thing that was interesting is at the same time, I think it was Dr. Topol or somebody put up there on Twitter, we’re still seeing 3000 deaths a day COVID, which is not an insignificant number. But as a community, as people, we’ve sort of reached that point, I guess that limit where we’re gonna try to move on a bit, which maybe as the numbers keep dropping, will be appropriate. And we can get back to some level and then see how this thing rises or doesn’t in the future.
Nick van Terheyden
Yeah. And I think the the metrics that people are following or be focusing on even the CDC has shifted, and certainly in one of the interviews that I did, earlier on in the pandemic, is moving away from reporting the number of tests to the number of hospital cases and the number of severe and, you know, consequential hospitalized based impact of the disease, then becomes the monitor point for saying problem or not a problem versus we’ve identified it. I think, at this point, we’re seeing it much more frequently, but not necessarily with clinical symptoms.
Fred Goldstein
And that brings up a really interesting point that’s raised its head over the last couple of weeks, which is admitted from COVID, or admitted with COVID. And I look at that, as a former hospital administrator, and having looked at coding and all this stuff, and population health programs and say, yes, there are differences. But sometimes, the width COVID, the diabetes flared up or the heart condition flared up because of the underlying COVID infection. So that should have been the cause of admission. Correct?
Nick van Terheyden
Yeah, I think it’s very hard to tease that out and say, Oh, well, you came in for diabetes, but you happen to have COVID. And depending on which side of the fence and I don’t want to call it offense, because I don’t see it as a conflict of, you know, opinions. I think we have differing opinions and it depends, you know, I used I remember learning when I did statistics, you know, there are lies, damned lies, and then statistics, you can make the statistics sort of show, whatever you want them to show and that’s also subject to the source data and how you interpreted and that’s part of what you’re referring to, and, you know, you’re entirely right. Sometimes somebody may come in for another condition, but it was contributory because they had COVID That it worsened? And then the question is what do you code for? And that’s one of the challenges with coding, you assign a code. We’re not codes, we’re complex human beings that come with many different contributory factors. And, you know, that’s going to make life much harder moving forward from an assessment standpoint, and, you know, be lots of opportunity for arguments about I imagine. Yeah,
Fred Goldstein
and it certainly, you know, as we look at the situation, now, the infection rates are coming down, which means as you just walk around, there’s less risk associated with bumping into potentially bumping into somebody who’s infected. So that makes everything a little bit easier, and does allow, obviously, to begin to open up and do other things, I think we still need to look at some of the lessons learned are things like air handling systems, you know, we’ve locked buildings down tight, you’ve talked about that before, and things like that. And as we go forward, I know, I’ll change some of my behaviors going forward. You know, we’ll see wear masks, I think are appropriate or not, but certainly things around indoor ventilation stuff have raised their level in my mind, and things I’ll probably follow through with going forward.
Nick van Terheyden
Yeah. And, gosh, I remember the time when buildings became hermetically sealed, and you walked in, you got trash, if you opened a door into an office, and you go, Whoa, you know, and you couldn’t open any of the windows. I think, hopefully, we’ve learned a little bit from that. I think the one area that remains challenging, because it’s such it’s, you know, potentially even worse than the United States is all of the international aspects and travel because prior to that, there were some limitations. So I certainly existed. In a world that had yellow fever vaccine, I had the yellow fever vaccine multiple times as a child because of where we lived, it was a requirement. Question is now are you going to need it. And it is a smorgasbord of regulations. So good luck trying to work out, I think you still need a test to get back into the US at this point that may disappear.
Fred Goldstein
Right? There’ll be nursing, watching how each of these countries handles it. And then where we go in the future with new other pandemics that will come at some point, we’ll have different things come out, and how we choose to handle those and the methods we use and some of the things hopefully, we’ve learned from this one, both from our successes and our mistakes that we made.
Nick van Terheyden
And from our 99 episodes, absolute right, Fred, hopefully we’ve contributed to the the growing knowledge of all of this.
Fred Goldstein
So at the next one for 100. We’ll have to see maybe there’s something unique we have to do. Is there any of those helmets left you used to wear with the aluminum foil on your head?
Nick van Terheyden
I hadn’t moved house, I’d be able to find it. Actually, I might try and find it and make a new one.
Fred Goldstein
That sounds great. Well, once again, another fantastic week, Nick, congrats on achieving 99 Red Bull. This is Fred Goldstein with Accountable Health. If you’d like more information, please reach out to Accountable Health. llc.com
Nick van Terheyden
and this is Dr. Nick, I’m the incrementalist here with incremental insights for better business, better health.
