This week VeiligHealth Insights to Actions with Luis Saldana, MD, MBA, FACEP and Fred Goldstein we discuss how to get back to work and review the current Vaccine roll out and prioritization
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Raw Transcript
Fred Goldstein
Hello, everyone, and welcome to this week’s COVID insights to action discussion group. I’m Fred Goldstein. And this week we’ll be discussing getting back to work. So with that, I’ll let the two physicians introduce themselves. We’ll start with you, Nick. I,
Nick van Terheyden
my name is Nick van Terheyden, also known as Dr. Nick.
Curry saw Danny here.
Fred Goldstein
Fantastic, Well, great. This week, we’re gonna discuss getting back to work, which is obviously an interesting situation now that the vaccines coming out. Maybe we start with a little bit of where are we with the vaccine? Maybe, Nick, you can talk about that. And then we’ll get into some of the things to consider for employers, etc, as they move forward? Well, yeah,
Nick van Terheyden
where are we, where we’re not where we need to be, that’s for sure. Unfortunately, we’ve done a pretty fantastic job at getting the vaccine producing pretty substantial amounts of it in terms of pre production, getting it ready, even having distribution systems available, particularly for the cold storage or super cold storage. But unfortunately, the last mile inches, whatever into the arm is the new phrase that everybody’s thinking about and talking about, we have not done a decent job, unfortunately, we have this patchwork of implementation across different states, different counties, random, sort of some people showing up and waiting others, you know, returning doses or being asked to return doses, others getting, you know, unable to get appointments, I read some horror story of a four and a half hour jaunt for some professor at a college to get and book an appointment through multiple screens, to be able to book for the COVID. So we’re really doing a very poor job. And that is, you know, has to be our focus this is this is not a vaccine problem. This is a logistics and flow problem. And it’s something that, you know, we ought to be able to solve and should do so quickly. But I think it needs a little bit of oversight and leadership from above.
Fred Goldstein
So I guess as we think about this, and employers coming back to work, right now, there’s really not a big change. As you look at that, from what we’re doing currently, which is wear masks, you’ve got people working from home, etc, social distancing, looking at your air handling, etc. But over time, as more people get vaccinated, there may be some opportunities to shift that is that is that sort of how we should look at it,
Nick van Terheyden
I would just push back a little and say, I it’s not that it’s different, but I’ve said this a number of times now, we need to double down on all of those things, mainly because of this new variant that is emerging. That is more transmissible ultimately, we don’t think it’s more lethal, but it’s spreading faster. And that requires us to do all the things that we know work just better and more consistently and throughout the whole population without people going. I’m not going to bother doing this because I don’t need to.
Yeah, I think I was gonna say I think here we’re looking at we’re now looking at kind of two different curves. The curve for for vaccination gain gained, you know, we’re going from vaccine to vaccination, and then the race of the case, hospitalization and death numbers which which are at an all time high Continue to go higher. And so clearly we’re losing the race, if you’re looking at the immunization to get to get there on that, I think it is interesting to point out Israel on this because Israel has over 20% of their population now vaccinated. And I think the percentage of like, over 70 year olds is like, astoundingly high, it’s well above 80%. I think it’s like 80%, or something. So and, and they’re also in the midst of kind of that curve. So it’s gonna be really interesting to watch, when those curves kind of intersect and see if it actually will push that number down. A big concern of all public health experts is the fact that that is go, it’s so so much of a wildfire, that that’s why we’re seeing all these mutation and variants kind of accelerate, and such. And so I think that puts us in a really tough position. And then you just put on top of it all the challenges we’ve had with vaccination, you could say that we had a public health failure in terms of getting the these interventions maskings distance, you know, all those things, and has kind of been a bit a bit of a failure. And now we’re seeing the vaccination the same way, the promising thing is, is we’re just saying is there is going to be a new new sheriff in town, so we’ll see it, you know, it may be a reason for hope. But the biggest thing is, there’s actually will be somebody, there will actually be a quote, czar vaccines are somebody that actually is in charge right now, there’s not a accountable person. And I think we really need to have that accountable person to do that. And really pull out all the stops and look at, you know, production, distribution, storage. And then the final mile logistics, I think all of those things are, are kind of important. So hopefully, we can really accelerate those rates right now. for employees, as far as I see employers and employees, right now you’re you’re just trying to keep from getting affected, I think is probably our our single biggest task. And and then, you know, and then gain the vaccine when it when when you can,
Fred Goldstein
yeah, and I think, you know, right on target, getting back to Nick’s point, I was looking at it through my own lens, where I’m really tightly locked down. And, you know, trying to follow all the things and watching my indoor activities, etc. But you’re right, the virus is so taken off now, because we haven’t been doing that effectively. And as you pointed out, we do need to double down on that, and get everyone to recognize Now is the time to really double down on that. And it’ll be interesting to watch the Israel example, because I know they started with the elderly, and then work the ages down. And so you may begin to see early on dropping death rates, which is what they’re hoping for, as you talked about Louise. So a fascinating thing from that, it’ll also be interesting to see how they then pivot this At what point to begin to reopen and go to work, and do some of those things and see, because they’re going so rapidly ahead of the rest of us, they can provide us with some insights on what we could potentially do, or what maybe we don’t want to do, because something’s been changed and reopened that might not be as effective. But so that’ll be something interesting to watch from an employer perspective as well.
Nick van Terheyden
And I would say, I’d do one other thing and just go and say, What the hell are you doing? And just copy that.
Fred Goldstein
So you know, it’s fascinating, I’ve looked into it a little bit they have for national health plans, you choose one of the four, and they told the health plans, it’s your job to distribute these to your members, you have electronic health records on all of them with both of you are experts in you know, and they’re effectively and efficiently identifying those people. And through that plan, getting them the shots. So really an interesting use of technology and approach.
Nick van Terheyden
I you know, and Luis brought this up earlier when we were talking separately. And I think this is a really interesting point. You know, we’ve got all these electronic health Black Girls, but people are talking about sequencing of who gets their vaccination and there is no use of the electronic health record is filling a form. I’m I am waiting for the fax, you know, I’m gonna walk into a vaccine place and I’m gonna get the five page form. How preposterous is that? When did we introduce electronic medical records? We still can’t use it.
Fred Goldstein
And how many times have you seen the pictures of the piece of paper that says you’ve got the first one you know that you’re gonna carry around
with you still I still have mine I gotta store that that baby for now. But until you know, I have a way to digitize it. I have to hold on to my until I get my, my second my second second vaccine. So So yeah, I definitely and again, another failure that probably doesn’t get pointed out was the failure of technology to really enable Or execute on on this on both? Like we said, prioritization, then also, you know, the things that will be important to employers and things is how will we prove that we’ve been vaccinated with it? This kind of, I guess, what do they call it the, you know, backfeed pass or health pass of some sort, that is going to basically be your passport in to kind of say, I’ve had this so, so I’m okay to do for these activities.
Fred Goldstein
Right. And just like we’ve seen with the rest of health care, we have completely created multiple versions of it. So how many different vaccine passports will there be to show? Well, I’m using the one from Google, I got the one from Apple, I got the one from my local health plan. I’ve got the paper one. You know, I’m wondering, Louise, I don’t know when can you take your form and run it through a fax machine to send it in? For your vaccine?
That’s that’s still the rely? Yeah, there’s a lot of reliance still on on fax machine. So definitely, you see that there’s not there isn’t currently a standard for getting it into Apple Health people are taking pictures of theirs. And having some record, I guess you can find a way to have it stored in Apple Health or, or something like that. But there needs to be a standard. You know, we need to have standards for for that, as we said that are that are transferable. How do we know it’s verified? valid?
Fred Goldstein
Right. And if you think about that, from an employer perspective, I know I’ve seen some things about people already faking those. Yep. And so, you know, you’re an employer, they walk up with this, how do you know that one’s real? It’s just an interesting question that people have to deal with. So one of the other issues, I think it’s, it’s fascinating is, it’s clear that work at home is going to continue for a lot of folks, you know, companies are deciding not to have people come back to the offices. Some I know, Rei actually built this beautiful big headquarters out in Seattle, it was just brand new and sold it. And so you then get these issues around employee health? And how do you help those employees with their health when they’re at home? And what are the issues that are raised, we’re seeing a lot of issues around mental health, anxiety, stress, depression, because of some of this and lack of interactions. So that’s clearly something that employers are gonna have to think about employers, you have to think about going forward through this even with or without a vaccine. Yeah, I
Nick van Terheyden
think it’s just accelerated the need for better monitoring at home. And the capacity to push out clinical capabilities into the home setting so that we can monitor I mean, we’ve seen a number of companies emerge that sort of talk about COVID monitoring. In fact, one of my compatriots from the NHS, developed a sort of home health home hospital monitoring system for COVID-19 patients tied around temperature, pulse ox, you know, some devices that essentially allow them to safely monitor individuals, but I wouldn’t, I would imagine, we’ll see more of that, in terms of the monitoring and capabilities, so that we can provide more of that oversight, and then deal with the exceptions, as opposed to having to sort of check in with everybody, you know, manually.
Fred Goldstein
And we’re also seeing this rapid uptake of telehealth, you know, of visits, you know, doctor visits, etc, done via technology, like zoom or these others. And, and I would assume that’s going to continue, as we move forward, which may create, you know, employers need to be sure that as they look at their plans, they have these kinds of options available for their employees to be able to access care through their, their whoever they’re, whether they’re self insured, or going through a payer, that they’ve set those things up and, and I would guess, use them as broadly as clinically feasible, without going too far, and trying to tell a health visit certain things that obviously it wouldn’t work for,
Nick van Terheyden
right eye and, you know, back to the original point of electronic medical records, making sure that that information is tied back into a repository that, you know, the prevailing physician of record can actually see, as opposed to some random individual that they happen to consult that was in Alaska, and was awake at the time that they had a question. You know, I I’m a little bit concerned about the coordination of all of that and the sharing of information. Now I’m, I don’t know what they have set up. But certainly my personal experience has been, it sits out on its own it’s another island of information.
Yeah, I’m going to point out something out kind of another piece of this and that goes to the work at home or, you know, work from home or remote work. And then telehealth, and all that thing is that I always point this out, I think we’re in a critical time for mental health as well. Is it? You know, is it different when you see somebody around the water cooler, or somebody in the office versus somebody on a zoom call, and you don’t know how they’re doing at home? And, you know, you don’t know what their support system is, like? So so I think that, that that’s an area that is going to need even more attention and almost be looked at proactively, how do we evaluate and assess the social situations, identify folks that are at risk at home, maybe maybe it is productivity, maybe it’s they’re not showing up, or whatever it is, I think that’s going to be kind of an important part of this, and I think probably gets, you know, short shift on on a lot of the efforts for, you know, kind of moving towards, towards telehealth and, and work from home and things like that. It saves employers money for people to be work from home, I mean, obviously not right now they’re paying for rent for a big building an office building that’s empty, nobody wants to have that. But if you eliminate that part of it, it’s a it’s a cost savings for for employers. So it would be excellent if some of that could be applied back to employees, and their overall maintain their overall health, looking at their work set up, you know, some evaluation assessment of their work setup revolve, how they’re doing on a day to day basis and check some kind of a check in have some maybe there’s a regular person they check in with, you know, for mental health, you know, that type of thing. So, so I just want to raise that, because I think it’s an important point that often gets gets gets orange easy to overlook,
Nick van Terheyden
it’s, I think it’s a great idea. It reminds me of some of the companies that tried to sort of handle the whole supplies, issues, staples, posters, all of those things that, you know, they had centralized stores, and some brave companies said, we’re gonna stop providing this for our employees in the office setting, we’re going to give you a $50 allowance for your supplies. And they saved gargantuan amounts of money, because now suddenly, there was some personal responsibility and shared whatever. And I think, you know, same principle applies here, if you get, get some savings, apply them back to give people some, you know, positive reinforcement.
Fred Goldstein
It also raises a really another interesting issue. Luis, I’m glad you brought this up. If you think about it, a typical employee health improvement program does an HRA at the beginning of the year, and sub lab and biometrics. And they use that to identify the risks and their population and say, Well, these people are struggling with this. And you may do a pH q nine, which is, you know, a depression screening or something like that. But given all of the stress of working at home, we probably need to adjust our assessment tools and frequency and say to ourselves, you know, we should be asking, Is there a child at home, who’s being homeschooled, you know, is your other is your significant other or spouse or partner, also working from home? And those kinds of things that may impact it, and then do a more frequent assessment, like you said, maybe it’s a daily little check in off an app, as you mentioned, Luis or something like that, to begin to identify those people. And then the question becomes, okay, now that we’ve identified and assessed this population, how do we go ahead and apply resources to them, you’ve got EAP services, you have mental health, you have telehealth, but they all need to be amped up, it’s that whole double down thing you talked about, from a perspective of keeping us healthy, it now becomes double down on identifying and engaging and intervening to help these individuals maintain their health in a completely new environment. From a work perspective.
Nick van Terheyden
I would even go a bit further than that, and say that I want to be big brother here. But I’ve talked about for a number of years, the capacity to use camera tracking of individuals, you can incorporate that into zoom. And you can get a really good sense of somebody’s mood, basically, based on their visual expressions, engagement, you know, all of those things that you could almost sort of do as a passive. Now, I wouldn’t want to see that use pejoratively. But why wouldn’t it be great to actually do some surveillance and start to understand, you know, play some intervention on some of that?
Fred Goldstein
Yeah. Obviously, there are some issues around the privacy and stuff like that, that come up from an employer perspective. But you’re seeing some of that newer technology also, as you look at in the elderly, with some of these in home systems that are looking at how often they’re walking through a space, are they getting out of bed at the same time? I mean, you can really get some detailed information around individual needs and the issues they’re dealing with or potentially dealing with, by by tracking some of that, but I think an early step would be really taking a strong look at your company’s benefits package around mental health, service delivery around mental health, and also how you’re determining who may be struggling. And and those types of assessment tools will be really useful going forward to ensure that your employees are as healthy as they can be and functioning at the highest level they can.
I think that’s exactly right. I think the support systems for this needs to be for working work from home world needs to be rethought out I mean, what worked for in person, they may not be that what works now and for going forward. Certainly, people played sometimes they paid for gym memberships, maybe now you pay for a peloton, or Yeah, or whatever. Yeah, so there’s a lot of aspects to to look at as far as as far as that goes. So. So it’s an area that I don’t think has really gotten gotten enough, enough attention, I think this is going to be a good time for us to reevaluate all the things around work. And that’s coming back to the office, whether it’s, you come back one or two days a week, or you work totally remotely those type of decisions that are all gonna be
Fred Goldstein
big. Right? I’m thinking of this also from the perspective of, well, when we used to go into the office, and we would do a lunchtime walk, or we would have you know, the healthy lunch room, and you now don’t have that opportunity. And so the question becomes, can you like you said, go in with it with peloton or something like that create that environment? But also, we know it’s safer outdoors than indoors? So are there ways to create some of your work activities and use that space like that in a safe distance, masked social manner, to at least have more interaction than we tend to have over this type of technology?
Right? Yeah. And I’ll say one thing, I think we all have been kind of victims of the mean, death by meeting, you know, but and I think a part of it is the way they’ve been structured. So maybe now they need to change the structure maybe to have, okay, what kind of mean is this is a zoom, or this is a walking meeting, I’m I’m walking, you’re walking, you have a one on one, you’re both walking or something like that out doors, if that’s possible. And also, you know, does that mean has to be an hour is 30 minutes adequate? You know, I think all those things need to really be rethought for, for kind of this new this new working world, you know, as we get into it.
Fred Goldstein
Yeah. And the mental health aspect. And then you have the other issue that’s going on is, you know, we’ve typically, as an employer work, Health Improvement Organization tried to ensure that individuals get appropriate screenings as per PTSD, you know, the USPTO, SF guidelines and things like that. And so now you have a lot of people who are either afraid to go to their physician’s offices, or missing that thing, etc. And so how do you then create that kind of environment to help your employees get those things that they should be getting tested and looked at, etc? Maybe there’s some ways to incent that or provide those services in a different manner.
Yeah, the long COVID and a talk about the people that are gonna have long COVID you know, the ongoing symptoms that for that, and also PS PTSD, for whatever reason, you’re hospitalized, or even just had prolonged symptoms, all those things can cause you know, PTSD symptoms and things, those those are, are going to be important considerations, you know, as well.
Fred Goldstein
So, are there any other areas you think of that employees should be thinking employers should be thinking about in terms of monitoring or looking at how they can get access to vaccines, how they can help individuals potentially with that, is that something they should be looking into for their employees?
Nick van Terheyden
Well, I think they’re inevitably going to be getting questions. I mean, that’s, you know, part of the sort of employee employer relationship, is that going to be a requirement to come back to work? Those are, you know, legal questions that, you know, I don’t feel qualified to answer but I think businesses are going to have to start thinking about is that, you know, no, you can’t enter the shop without a T shirt and shoes. So does that now include vaccination? I mean, I’m, you know, I don’t use that entirely flippantly. And then, you know, how do you validate that somebody has, what vaccines are available when you know, and how do you sort of, if you’re low down on the priority list, which is outside of your control, that’s, you know, essentially coming down from the at least the federal or the state authorities? What happens to people that can’t have access? Are they specifically excluded? Is there some alternative, you know, this is all sort of a pretty complex area. Health and Health Management that’s going to require significant help. And, you know, that’s areas of specialism that I know you’ve focused on. And you know, one of the things that we certainly think about offering from our services.
Yeah, well, I’ll say I think it’s, it’s kind of sad to see that right now. We’re in this point of vaccination, where it’s, it’s a it’s a really deeply constrained resource. So that’s driving this prioritization, this kind of elbowing out who gets it who doesn’t get it, this type of thing? That’s a failure, because what we should have is there’s enough out there for everybody we have these things solved. It’s how do we get it out fast enough for everybody? I think that making that transition where it’s it’s not, we’re not constrained by that resource, the resource constraints should be me. You know, we worry about vaccine hesitancy. Well, we’re not even at that point, right now. There’s people that want it and can’t get it, we want to be at the point that I can get anytime I go online, and I sign up, I don’t care what priority you’re in, we need to get it in, in all these arms. I mean, that’s, that’s the key. And I’ve seen that starting to get messaged from that, because I think there’s been a lot of elbowing out for, because it has been so short, that we’ve wasted time, doses get wasted, because they’re scared, if I don’t give, if I don’t get exhausted, they’ll get in trouble with with giving it to somebody that doesn’t deserve it, what have these doses left, just just give them to mem say, I will, I will praise the day that we see that that point that we don’t have to be worried about that that will be that will be a real landmark day for the United States to me.
Fred Goldstein
Yeah, and I think, you know, as you mentioned earlier, we may see in the cup with the coming administration, a little more of a focus on how we logistically get this thing done, and and standardize a little bit, like we were talking about earlier, you know, we’ve got five counties around me, six of them, and every one of them is doing it differently. And that’s so confusing for the individuals who are trying to get vaccinated to try and figure out what they just want to have to call that one, I have to, you know, go online, this one is doing people in Florida and outside of Florida, this one is not. So hopefully, we can standardize some of that. And then, you know, as rapidly as we can get this into individuals, so we can then begin to look at how do we reopen it for various things in the future?
Nick van Terheyden
And I think the thing that, you know, I wonder, I don’t know what the answer is in Israel, because you talked about that up front, in terms of their rollout, did they also cover the funding, as part of that, you know, attribution to the for health insurers or whatever, right? Because you can’t do this with fresh air. And it’s difficult. And if you’re not sort of taking account of that, then you know, you’ve just run into problems. We, we know how to do this, we just have to follow through and make this happen.
Fred Goldstein
So I guess if we think about this, from an employer perspective, they need to really take a look at what their benefits systems are, what kind of package they have, what they plan to do in the future, from an operational perspective, and then what sort of things they need to put in place to assess their employees from the various issues that they’ll face working at home or coming to an officer or combination, and then put in additional programs, whether it’s around mental health, or some of these other areas to meet those needs. Right?
Yeah, great. Yeah, great. Well, it
Fred Goldstein
really makes it you know, it makes a lot of sense. I think, you know, as employers consider this, you know, we’re obviously here to help think this through from a medical operational employee health improvement perspective. And I think, you know, please feel free to reach out to us, we’d be happy to talk to anybody about this. And obviously, there are things we can do better and help. We’ve been helping some companies so far work through this and get themselves going. And, and now I think the vaccines great news is a you’ve all talked about, it’s amazing that has come out this quickly. Right now it’s a matter of, it’s sort of what you would think was the easy stuff, which is getting in into somebody’s arm versus the science it takes to them to develop that thing and test it and run those phase three trials to get it out. So we’re in an interesting transition point. And hopefully we can, as you said, Louise, get the vaccine out ahead of the of the spike to see this baby go the other way. Right. Yeah. Any other comments you want to make before we finish up here?
Nick van Terheyden
No. critical time and we need to focus on getting vaccines in arms to Louise’s point, there should not be a single drop of that stuff wasted. At any point in time. If it’s available, put it in.
I know I’ll still say, you know with where the numbers are now, we really need to really be much more thoughtful about these nonpharmaceutical interventions and masks distancing reduce you for God’s sakes we’d reach reduce our total contacts per day to the to the bare minimum we should need to think through. How do I plan my day? How many people are going to come in contact with? Is there some that I don’t need? Absolutely don’t need to. To do that he may come in contact with I think we wanted we started the holidays is these things that could have probably been put off. We all want to be with family, you know, and it ended up cost having a big cost to it. things as well. So, so please, you know, wear masks, they are effective. We’ve seen more, we said we were talking about study on double masks and things and some situations that might be a good idea. So So anyway, that’s all I want to say.
Fred Goldstein
Yeah, I think a fantastic end today. And thanks so much for joining us, everyone. If you’d like more information, you can find it veilig health.com. And we’re happy to talk to you and look forward to next week. We’ll get that topic out coming up soon. Thank you
