This weeks discussion reviews the latest in travel testing guideline, validation testing results for travelers that translates to employees and colleges and what the future o health and wellness will look like going forward
Our weekly question and answer session with Fred Goldstein, Dr. Luis Saldana, and Nick van Terheyden, MD on our COVID Insights to Action Discussion webinar that takes place live every Wednesday at 4pm ET You can register here
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Raw Transcript
Fred Goldstein
Hello, everyone, and welcome to this COVID insights to action discussion group. Thank you so much for joining us. joined again today by the our two distinguished physicians, Dr. Nick van Terheyden, and Louisa donya. Today, we’ll be discussing validation, verification and travel and what should employers consider, we’re actually going to do this backwards and start with the travel, move to verification and validation. And please, as you recognize it, you’re more than welcome to join into the conversation and ask questions either through the chat or the q&a box. Or actually, if you’d like to come on and join us with your camera, etc. Please feel free to do that. So let’s begin with our first topic, which is this travel change. And recently, the US government announced a change to the travel policy. So Louise, could you please start with that?
Yeah, and I think this kind of leads us down. Several, kind of, in the up in the front of the news topics, I think, with variants and all this. So the CDC put out guidance recently that takes place on January 26, I believe that if you’re entering the United States, from an international destination, that you have to have a negative COVID test within three days. And so that it sounds like from what they’ve said, the direction I’ve seen so far, that’s going to be enforced by the airlines when you’re boarding the plane to return to the United States. So there’s the chance that if you can’t, you don’t have that you may be staying where you are, and isolating in place or quarantining in place, or scrambling to get a test. And, and this really has a ton of applications. And we’ve certainly had some friends that have talked about it, because you also think about it. Okay, what’s coming up Spring Break presidents weekend, these are kind of typical times that Americans like to travel. And so this really kind of opens up something that we’ll see how this plays out. The idea is, they’re they’re trying to restrict kind of this wide open borders type of type of scenario, especially and I don’t know how much it factored into it with the variants that are out there. Now, we talked last week around the mutations and variants that are out there. Now, I have to think that part of this is trying to limit the entry of these new variants, though, and, you know, I think we think that they’re already here. And and probably already in, you know, passing around with community spread. But, but nonetheless, this is something that we really have to look at, we have to consider your travel plans. If you do have travel plans, where am I going to get tested? I actually have seen like places in Mexico that start offering testing. And you wonder if it’s not a business opportunity for somebody, no matter where you go, we’ll find somebody to test for you and things but but even these high end resorts, again, again, I think we’ll we’ll find a way to make that work because, heck, they may be saved for an extra week, or 10 days, possibly so so it may be it may really be a business opportunity for them. But it also goes to the questions that we’re going to talk Low blood barrier verification, the you know, the you know, validation of all this is what what do they have to present is it just going to be a piece of paper that they look at, I expect that’s what it’s going to be but, but ideally, you would like something that is you can verify this is real. Otherwise, you are going to see a bunch of American selling, selling these, these false test results with your name on them, you know, very easily that you can you can use to come back. So I think that opens to an interesting discussion, I’d love to hear you guys, kind of kind of your take on it.
Fred Goldstein
I think one of the things is to think about this, also from some of our clients perspectives, is what about your students that may have overseas travel programs or things like that, as an employer? Do you start beginning to reach out again and see more travel overseas? And I know from some of these countries perspectives, you know, we’ve talked some of the folks in the Caribbean, and they, they’re they exist on tourism, so they really trying to figure out how to solve that problem. So the tourists can come there, and then get back to the States. So it raised some interesting issues. I’m sure you’ve got some insights as well, Nick?
Nick van Terheyden
Yeah, so a couple of things. I mean, you know, this is an extension of what’s been going on certainly, in some other countries, there’s been requirements around this, I think, some important points to know, one, they don’t specify the test, they do say viral. So you know, you can’t have an antibody test and say, I’ve got antibodies, you have to show that you are negative, or it’s not detected antigen not detected, by the way, if you get one of those invalid, which does happen with some of these tests that are not acceptable. And, you know, the timeframe requires it to be, you know, within that three day period, so that sort of sets up a little bit of backtracking, to be able to make sure that you’ve got the results, and you have the test. So, you know, making sure that the countries that you’re coming from, have the capacity, and one of the things that you know, we’ve seen, certainly in other countries is that they don’t necessarily have the testing capacity. And standing that up, as you know, Luis talked about we’ve certainly talked about internally is, you know, potentially a business opportunity. But you know, one of the concerns I have is that it sort of diverts resources for these countries that they potentially need, but you know, you’re going to have to have it. So don’t go anywhere, without thinking about the fact that you can’t get back unless you get tested, you know, within the timeframe. The other thing that you know, this raises, and I think it was sort of bringing it up is okay, great. So I got the test. Let’s be frank, I’ve, you know, received a couple of tests, it is a trivial exercise, to take that document, and create the same documents for somebody for the right date, and so forth. So bypassing this process is not difficult. From a technical standpoint, it does not require a lot of expertise. And I think this is going to start to drive some requirements we just saw today or in the last couple of days, I think it was Emirates, and one other Middle Eastern airline, I’ve signed up for one of the COVID Pass technologies that tries to secure and authenticate and say this test was really delivered for this individual and it’s his test. But in the intervening time, you know, I think we have to rely on a, you know, falsifying This is probably one of the more foolish steps then we could make. So you know, first of all, don’t do it. Secondly, you know, I think the airlines and all these other places are going to have to start to account for this, make it as easy as possible. I mean, we know you can get a test and have a result within 15 minutes. Now, that creates a little bit of a problem if you’re doing that at the airport, and it comes back positive. So there are some consequences to all of this, that we have to think
Fred Goldstein
you raise a great point that I was gonna bring up is we always think, Oh, I’m gonna just clear I don’t have it. But for the person who, whether they’re an employee or a student, if they’re overseas, and suddenly they get that positive test, they coming back to the States, so they got to figure out two more weeks. And that should be planned for in advance how you might have to stay there.
Nick van Terheyden
And I would tell you, from an insurance standpoint, as best as I understand medical insurance excludes the treatment of COVID-19 when you’re overseas, so now, okay, right. If you’re one of the mild cases and you’re just isolating and you know, everything goes hunky dory. Good news. If you’re in another country, and you don’t have that experience, That creates a problem. So that needs to be some additional requirements that allows for people because you can’t transport somebody at that point, even with medical repatriation, you’re not transporting somebody, they have to be treated within country. And this is not about the quality of the medical care, this is about being able to pay for it and justify and so forth. So there is a host of logistical problems that we have to think about.
Fred Goldstein
Yeah, fascinating. So as we dive deeper into this verification topic, both of you are seasoned healthcare IT folks, are we going to solve that with some sort of technology? We obviously heard a group come out last week and say we’re putting together a passport or a vaccine passport or something. Where are we with that? Well,
Nick van Terheyden
let me kick off and say, you know, my, my big concern here is there’s going to be 16 different paths. Can you imagine the EU, actually, we could have that in the United States, we could have 51 different passports, they all came from your state? You know, it’s that kind of nightmare that really sort of concerns me and no interoperability and you show up at, you know, the airline counter, and they say, Well, no, that’s not the past we work with, what do you do. So whatever systems are put in place has to have some level of interaction, or capacity to allow you to use it, no matter where you are, you can’t have people saying work, we are only going to select or use this. Because if you can’t plug into that system, then what the people do, I think, represent same problem for clients, right? Because now you’ve got vaccination, you’ve got testing, you want something that is a little bit more universal, that allows you to track it and do so effectively. I think there are companies that are capable of doing this. The question is, has anybody really stepped up to the plate? Not to my knowledge, Louise?
Yeah, Mandy, I think Fred mentioned that collaboration. I remember my surname Microsoft was one of the was one of the players. I know, several of their say, yeah, I think you know, so I think to it’s like the beginning of starting to solve this, which is if what’s promising is, as you said, Nick, this is gonna take a while to solve this is going to be a tough nut to crack as far as that goes, but now is the time to start to work on it to try and solve the interoperability issues because they are interoperability issues, different standards, just like passports, they’re different everywhere. So this is where I think the World Health Organization is key. And I think they need to be actively involved in this. Because if I think of who can, you know, go spam those, those borders, I think you look at the World Health Organization, which maybe we’ll start getting back into possibly, if someday it can be engaged in that because obviously, as the name says, passport, it’s got to be linked to your passport, some but some form or fashion. And you have this has to be shared, shareable and verifiable. So point to point it can be shared, so it can be shared, I’m traveling with my hotel, I’m going to the airline, you know, TSA, whatever. I you know, I could share that have had, you know, whether it’s a QR code or something like that, that I could share. I think that, you know, the the standards piece is always the most difficult in the interoperability issue. But I you know, I think it’s solvable, I don’t think right now is the time that it’s useful at the point of the pandemic, where we are, I think this is going to be useful in the in the post pandemic time. That is, when we’re either at or near herd immunity. When we’re at that point, I think that’s when this is going to be most useful or helpful. Honestly, right now, I think if you’re a vaccinated person in the current world, you know, I don’t know that there’s any difference, and you shouldn’t treat it any differently. So So, but that’s why it’s important, I think, to start working on it now.
Fred Goldstein
Yeah. And that’s it, to throw a bunch of cold water on this thing. But I happen to read an article I think it was yesterday or this morning in which one of the pharmacies I believe it was in your state of Texas, Louise, vaccinated 500 people and went and looked into the state system and showed that they still had 500 vaccines to give. And they were extremely concerned about how the technology was being set up to try to do this. And we know in healthcare, we’ve struggled with this for a long time. So I’m sorry, Nick, I stepped in front of you there.
Nick van Terheyden
Yeah. No, no, not at all. I think that the whole standardization is critical. It’s interesting. You bring up that point about, you know, passports are non standard, but they have standardized and I know it’s not completely universal, but it’s actually it’s pretty basic technology is OCR technology with a font that is on the bottom edge of your passport, that slidable that allows, you know, and maybe it’s as basic as that the one thing that you said Luis that really just made me think I don’t know I never was. You said, well, it’s interoperability and you know, health care. And I’m thinking, interoperability and healthcare hasn’t been solved in 20 years. Man is
my boy,
Fred Goldstein
I guess we’ll just have to wait and see what comes out. But ultimately, it’s got to be some form of something on your phone. You know, this paper sheet that you’re getting now, as you talked about, Nick, can be replicated. I believe that probably people out there doing it now.
Yeah, well, Apple Health, I think is a they’re doing in California, I think Apple help. So that’s, that’s who’s also involved.
Nick van Terheyden
But I wouldn’t discount the paper at this point, just because it’s a simple solution. And, you know, some level of validation. I mean, I lived with a vaccine passport for much of my early life, I had a yellow fever vaccination, because I lived in the yellow fever endemic areas, it was a moment, and you showed up, and I wish I could find the dogeared tag, you know, whatever. And I’m talking as a baby, I have multiples of these shots. But you know, we kept it, it was a requirement. And we took it pretty seriously. And that was a standard for certain countries that this is not unique or new. And whilst we’re sort of sorting out the technology, that doesn’t seem a terrible solution, and quite frankly, chasing down the people that are doing things and having some pretty severe consequences for anybody with falsifies that information, would be a big sort of deterrent, that, you know, I think would help just in the early state. I mean, I’m not advocating paper to be clear, but I think, you know, we could do something in the intervening period of
Fred Goldstein
time. So as an employer today, as you begin, as you said, Louise, it’s really not that important you believe at this point. But going down, as we get closer to herd immunity, it becomes important, and employers are going to want to know, have you been vaccinated, to come back into the office? So they’ve got to keep up with some of these things and understand where it’s going to go? And how they might be able to do that, as they begin to open further and operate their companies?
Yeah, absolutely. Absolutely. I think they work for companies. You know, I think companies were thinking ahead to return to work the same way. In that post pandemic phase, they just start thinking through these things. I think now’s the time to be making your plans, and really look at the risk in your workplaces and your workforce. I think you have to look at both of those things, and assess the risk of that. How much do you need to have people in offices? or How much do you have to have people traveling booked already talked about travel? How much do you have to have people traveling, you’re going to have to have processes for exceptions. And people that can’t come to work you they’re immunocompromised, they’re undergoing chemo for cancer, and the there always has to be those processes. But I think right now is the time to really think through those processes. Think ahead to that post early post pandemic phase, okay to getting back safely. I think the companies that will do that, if they you know, there’s a they really think there’s value in having people in those workplaces are it’s necessary for them. They’re going to figure some of this out, because you got to think through, you know, the ventilation, what does the office look like how you know, you got to have your peepee ready, you got to have masks for folks, for visitors, you got to have hand in hand sanitizers. Be sure that folks can can distance that the capacity issues. And again, the ventilation assessment, those are all things that you can be doing as well as testing, having access to convenient testing, as well for your employees and then thinking through what’s our policy, if somebody has to has to be out to isolate or quarantine, it’s now’s the time really to be thinking through those things.
Nick van Terheyden
And the other thing I would say around this, you know, it’s important to note and I think you said it, Luis but I’m just going to re emphasize it is okay, so you’re going to have a community that is mixed in terms of vaccination status. To be clear, that doesn’t stop any of this. And we continue to test even those people that have been vaccinated. And I’ll give you one simple example that I keep using, even in that group of vaccinated madana vaccine, assuming the data shows and proves through, you’re still going to have 5% of that population that can get COVID-19 and we don’t know whether they can transmit it. So they need to be treated until such time as the general population changes. And we changed from being in a pandemic to hopefully no damage, but you know, maybe it’s end
Fred Goldstein
Yeah, and that raises some interesting thoughts as I was thinking about companies that operate and stuff is you suddenly say to yourself, okay, I have 100 employees, 50 of them have gotten vaccinated. So I bring those 50 back. But as you point out, you really can’t just bring them back without having the safety measures in place, because some of them might get infected. So it’s probably best from an overall strategy to look at the overall group. And then to say, we’re going to continue on with our safety measures, we’re going to continue on with our mask wearing and social distancing until sometime, as you point out in the future, maybe we’ll get to the point where we can scientifically show that that’s not necessary.
Yeah, yeah. And when things I mean, maybe I think the time dimension is when things Biden that because expected to sign is a mask, quote, mandate, because it’s only applies to federal kind of related things, that it’s federal employees, afterward, on federal property, you have to wear a mask. Man, I’ve kind of mentioned that, but because that is related to federal workers, and those types of things, and also something for us to consider. If we go to federal, federal or federal building, you better have your that, you know, there, and that’s going to be part of it, as well. And as we’re seeing the current, you know, high numbers, sky high numbers, the and I saw some this morning, only watching the inauguration, double math, that, you know, thinking about if you’re going to be in the office, that you should consider wearing two masks, you know, to good Master, consider the re the quality and fit of your masks. But you know, there’s there’s a lot of recent things that either double mask is very protective and things like that. So. So I think it’s a good time just because of this, this changeover in the administration that I think we’ll be we’ll be seeing that, that it’s time to think about that as well.
Yeah. Today,
Nick van Terheyden
I’m just gonna say, I’m gonna stick my neck out and say, I think that might have been actually signed by this point. You’ve never done it. Yeah. 17 executive orders. So if he hasn’t gotten off the stage yet and sign them he’s damn close to doing this.
Yeah, yeah, exactly.
Fred Goldstein
Yeah. So another interesting point, obviously, is we’ve seen these double mask ideas. I think it’s a great one to bring up Louise. And the last topic we wanted to get on. And please, if you have any questions is pointed out in the chat box, feel free to to ask some of us. And I know, we’ve got one question that came in prior that we’ll get to as well. The the issue of on a broader perspective for employers is they look to bring in and they’ve had health improvement programs. And obviously now there’s this programs around COVID and creating a safer environment, this idea of how do you validate those? How do you confirm that those programs are actually working? And what do you need to do to measure that? So who would like to kick off with that, and happy to get involved as well?
I’ll just kick off. I mean, you know, obviously, it’s always about some, some data and analytics, you know, and having and capturing data to kind of verify that difference. I think, you know, one interesting thing that we’re seeing right now is, wow, no, no flu, no flu season, hey, this may be a record, look at jigsaw, knock on our glass, I don’t have one here. But but but a record low flu season. So it shows that Sunday things work. And then there’s privacy, there’s privacy issues to think through. And in looking at this, the data has to be kind of population level data, I think we’d be very careful to respect people’s privacy on that, what they have at home. So, you know, how do you weave together all these things, these are all things you have to do very thoughtfully, you know, what kind of data and analytics to any set up, who has access to what a public facing versus an internal private facing data and analytics, a dashboard, I think it’s a good idea for large companies to have these kind of dashboards for health tracking, quarantine tracking, isolation, you know, sick sick time away those type of things. Also good time to think through, rethink those those, those sick time policies is well, so so i think that you know, that those are just my Top of Mind box.
Nick van Terheyden
But it’s another silver lining of this pandemic is the refocus on employee health, personal health. And, you know, addressing something that, you know, years ago in the transition from, you know, manual labor into factory work we have OSHA emerged as an organization that focus of, you know, the white or blue collar workers. Now, we’re predominantly white collar workers. We don’t have as much of that, but we’ve got the same health issues. Not just COVID. But I think this is a broader perspective. And this is an opportunity to really focus on that and start to deliver insights into those groups to change the trajectory that has been, quite frankly, awful. We’ve seen it across the population. And this is our moment, I think, at least I hope it is.
Fred Goldstein
Yeah, I think you raised both really interesting points, good ones about getting the data put together. And you can think of a classic example of how to take this and then say to yourself, how do I apply this to a broader population? When you think about the Meatpacking plants, I just read a recent article on one of them that had an outbreak, and then did some things, but then had another. And so that points to the fact that probably their interventions within that facility, were not of a high enough standard to create a safer place, in essence for those folks or to improve the health of that population. And so you can take those kinds of things, these dashboards, we’ve talked about grabbing various points of data, and apply that to your broader employees around their other health issues. In as you point out Louie’s a HIPAA compliant manner. Obviously, you can’t be seeing this at a individual level. And there are certain group sizes that once a company gets too small, you just can’t look at anyhow, because you can figure out who it is. But in these larger populations, to be able to take those same things we’ve looked at to measure our programs, keeping people from becoming infected with COVID, etc, or identifying those at higher risk, and providing a safe environment for them and use those same tools and techniques around diabetes management, or asthma, or heart failure, or just wait it things like that and
Nick van Terheyden
apply them that way. Or imagine if you had been doing this for flu seasons every year. Look at what we did, right? I made? Sure.
Fred Goldstein
Yeah, think about the impact of flu on employers, when you have all big flu season go through and suddenly a group of your employees are at home. And look what’s happening this year, knock on wood again, Luis, obviously. But yeah,
and you touched on on like having that. So you have these other dashboards for your population, looking at these other conditions. COVID is just gonna be kind of one of those. But you’re right, you have to tie it to interventions and be able to connect Okay, on this at this date and time we did this intervention. And then and then, you know, kind of go back and look at that at time. But the thing that’s really important to think through is our is your current employee health plan, supporting this? How does that support and line up with this? And what about what your employee health strategy? Who’s going to be doing all this? Yeah, I’m saying I think companies in the past, maybe have been able to get by without, you know, some employee health type of things. But I think now you’re rethinking What’s our angle for employee health, which needs to probably be different than your personal health plan and those types of things. So, so I think there’s a lot of considerations here. When will we start talking about the workplace workspace. And that’s kind of why we started, you know, started looking at this, we said, there’s a lot of things in between, in between these different spaces that people probably aren’t even thinking through. They’re just trying to survive.
Nick van Terheyden
And shout out at this point on sick, sick policy, which, you know, historically, certainly in this country is very different to the one that I came from, that does not do a good job of allowing people to say, I’m going to take this day off, when I’m not feeling well, and not come in and spread germs to everybody because of the way that the policy is written. So providing for that, I think is going to be an essential part of this.
Fred Goldstein
And I just want to quickly touch on the question we had gotten, which was how do we create a consistent policy in a multinational company? And obviously, there are legal issues, countries have different laws, rules and regs and you have to follow those there are different medical approaches. But it’s really about your internal culture. And then looking at COVID from Well, this country’s getting vaccines now this country may be getting them later. But things as you’ve talked about, Luis these safer measures that we know are globally exempted, need to be continued on and pushed out through the organization, correct?
Yeah, exactly. I think he when you look at a kind of a big project like that, you break it down to what are the common threads, you know, we see that healthcare, cross state lines, you deal with different regulatory type things. You don’t standardize around those things where there’s exceptions. You standardize around the things that are common common agreement that everybody agrees there’s consensus. This is something we can agree on. That’s where you start I think in that then you start getting your attorneys and other folks involved that you know, how to deal with you know, the different different legal aspects or, or different regulatory issues when you go across borders.
Fred Goldstein
Fantastic. So we’re coming up on the end, I’d like to thank you again, both and those who have joined us this week. We’ll have another one next week on Wednesday again at 4pm. If you’d like more information or if you want to reach out to us go to veilig health.com. You can find us there. And we’d be happy to talk to you about any specific situations you have more questions you have regarding COVID or your broader employee health improvement programs. So thanks again so much for joining us. We look forward to seeing you next week.
