This month’s episode of “News you can Use” on HealthcareNOWRadio features news from the month of July 2022
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners. We discuss my joining the growing number of people who have succumbed to COVID and the challenge of enduring the symptoms that were significant and lasted well over a week for me personally.
I describe my personal experience and the crushing level of fatigue and inability to do much of anything, which included going out to obtain Plaxovid to reduce the severity and extent of the disease in my case spending a number of days exhausted and in bed. I detail the diagnostic process and the continued challenge we have in this country of providing any realistic tracking data of the incidence of the disease given the lack of public health capabilities despite all of our experience we should have learned from the pandemic over the last 2 or more years. Long COVID continues to trouble many and remains a concern while we try to understand why this occurs in some and not others and what can be done to help mitigate the symptoms
We discuss the growing concern and incidence of Money Pox and while clinically we have some established pathways to treating and controlling this disease thanks to the failure of our public health institutions this disease continue to cause concern
Listen in to hear us discuss the recently published study Assessing the Clinical Robustness of Digital Health Startups: Cross-sectional Observational Analysis reviewing digital health companies and how they perform as measured with a single clinical robustness score
You can read more about the series here and the concept of keeping up with innovation in healthcare. Please send me your suggestions on topics you’d like to see covered. You can reach out direct via the contact form on my website, send me a message on LinkedIn or on my Facebook page (DrNickvT), or on Twitter by tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
And today as I am each and every month, I’m delighted to be joined by Dr. Craig Joseph. He’s the chief medical officer at Nordic consulting partners. And we are as we do each month, looking at news you can use and various insights into what’s gone on in the previous month. Craig, thanks for joining me today.
Craig Joseph
Excited to be here, as always.
Nick van Terheyden
So let’s kick off as we should I think we’ve continued to do so we haven’t really avoided it for the last. I don’t know how many months, we’ve still got COVID. It seems like COVID is exploding. I think the numbers are actually higher than they’ve been. In many of the points during the pandemic in, you know, some of the major times, we’ve got better treatments. We’ve got people that are vaccinated. And at this point, there is a view if you haven’t had it, just wait. I can certainly attest to that since I’d been unfortunate. It hit our family. I contact traced it, it was the result of a visit to a restaurant. My wife and I both caught it, we got varying degrees, but I felt like Terminator the T two in T two when Arnie smashed in with the big truck, and he exploded into lots of little pieces. That’s how hard it hit me.
Craig Joseph
That sounds that sounds pleasant. So it sounds like you you had a pretty good case. You weren’t questioning whether or not you were sick?
Nick van Terheyden
No, there was no question. I could see it very clearly in my test I home tested. Unfortunately, it all sort of unfolded at the weekend, which made for a slightly more challenging approach to getting treatment and made me respect what I’ve seen in New York, in the last several weeks, they’ve created some mobile clinics that drive around and are equipped to both test. And importantly, from a diagnostic standpoint, I think antigen tests aren’t considered at least not ones that are self administered at home to be diagnostic. So you have to have a PCR test, and then actually having packs delivered, and treatment available for patients that are diagnosed, that you can go to these mobile clinics be seen tested and depart with treatment, which I have to say was not something I was able to navigate in my local area. And I didn’t get packs of it. And I can tell you the eight or nine days of misery that I endured, I’m sure would have been slightly shorter as a result of this but wasn’t so I wish I had.
Craig Joseph
Can you explain to me how exactly you reported your positive test to the Public Health Department so that they were aware that you had this disease and could properly account for how many people are sick? Just go into very gory detail back and neck about how how are people supposed to report this information? Well, so I guess it’d be a sarcastic question.
Nick van Terheyden
No, I think that’s a good question. In fact, it depends very much on the state. My particular state has a whole text messaging system that is designed to allow you to communicate your status. In fact, I had this when I was returning from overseas when we had to test and that was tracked, and I would get messages from the system to say, are you okay? Unfortunately, what they seem to fail to understand was at some point they needed to switch them off. So I personally had to switch them off and mute them. In my particular instance, I did I did perform my civil duty and that I did get tested at one of the departmental sites with a PCR test as a confirmation, in part because I felt like I needed that from a clinical standpoint, because my antigen tests and a picture of it wouldn’t suffice for me to satisfy a requirement at some point in the future to say, Have you or have you not so I did. Interestingly, subsequent to that I didn’t receive any text messages follow up. That could have been me because I suppress them so they may be disappearing into the spam folder. I’m just not sure. Well, I
Craig Joseph
you know, I am glad to hear you did that. I would I would argue that most of us do not do that. On, most of us would probably just take the rapid strep rapid strep, there’s my pediatric background, the rapid test and whether or not it’s when it’s positive, just deal with that and hopefully isolate. But that’s part of the problem is that we don’t really know how many people actually have COVID, right, where we’re guessing we used to know, with some certainty, because the only way to find out was to go to the drugstore, or go to a lab. And all of those were uniformly reported to the Public Health Department, and then hopefully sent off to the CDC so that we had numbers that we compare and contrast, right now really, our best bet is, is unfortunately, looking in the sewers, or I don’t know if it’s unfortunately or fortunately, but, you know, looking at wastewater and, and assessing how much virus is in there tends to be actually predictive of outbreaks. And so that is one way of kind of gauging where we are. But I think one of the benefits, it’s a double edged sword, right? Now you can test them, you don’t need to stand in line or wait for an appointment. So you know, very quickly with some certainty, but the downside is, once you find out that you’re positive, you just deal with it. And you and so we don’t really know how many people aren’t getting sick.
Nick van Terheyden
You know, it’s interesting, you bring up wastewater, because I think it’s, it’s unfortunately, we didn’t capitalize enough on that I saw some great value propositions, we’ve seen it for other instances, for the cases of tracking opioid abuse, you can actually look at wastewater and look for those metabolites in cities and areas. And you know, the more granular you get, the better you could get it terms of predicting, but one of the things that really strikes me, and you know, it’s an n of two in our family, but it was clear from the antigen test, I could see that I had a very big dose of this virus, at least my body had it inside, because I was showing a very positive reaction on the antigen test, it appeared very quickly. And it was a real solid line, it was Hello, I’m here. Whereas in the case of my wife, actually, in the first test that we did when she definitely was symptomatic, it was really vague, you know, not even sure it was there, and it took a day. And when she did it every time, it would take eight 910 11 minutes before the line would really, you know, you go Yeah, I do think it’s there. And that is an indication of the viral load. And I had far worse symptoms. So what we get from that wastewater is people that are excreting more of the virus, we know we’re going to have more symptomology and more people with the disease. So it’s very clear that there are some opportunities to benefit from all of this science. But as you rightly point out, we haven’t learned I learned a lot of things. Which brings me to monkey pox, the latest in our series of diseases. Are you worried Craig?
Craig Joseph
And I think I’m worried less about the specifics of monkey pox. I am worried about the evidence that we have learned nothing from the last two years and that question, few people are getting monkey pox right now. And the vast majority of people that get it, do not die from it, and don’t require hospitalization. And so it’s in the big scheme of things, it’s much smaller, but what concerns me is, yeah, what have we learned? What What lessons have we learned from this global pandemic, which is still going on clearly, but really, is affected the entire world and affected everyone? And now we’ve got another another virus that shouldn’t be here that is here. And we seem to be unable to respond quickly from a government standpoint, to get the right information out to people to and of course, you know, science develops and we learn things but monkey pox is something we’ve known about it is not a novel virus like the Coronavirus was number that we didn’t have a name for it. We just called it the new the new Coronavirus. Yeah, we know about monkey pox. We actually have a vaccine for it. It’s a combination monkey pox, smallpox vaccine. And yet, despite all of that, We seem to be repeating the same thing, same problem. And so what, what I’m very concerned about is, well, what happens with the next with the next virus that we’ve never seen before? Will we just repeat this over and over the cycle of let’s pretend it’s not there? Let’s, let’s not give out information that that as soon as we get it, because it might be confusing. Let’s not if we know we have ways of from a public health standpoint of decreasing the transmission, let’s not take those because some people might not want to wear a mask. It just it Yeah. So. So yeah, here we go again. monkeypox, hopefully, given the fact that we have vaccines or some treatment. There’s some research going on, although generally, it’s there’s no definitive treatment, you just kind of go through it. And, and it’s, it’s more difficult to transmit clearly than your traditional respiratory virus. So this is more typically very close contact. So you know, walking next to someone unlikely to get monkeypox, quite likely to get specifically to you know, to get COVID. Much more likely to do that. So that’s the good news about monkey pox. But the bad news is boy does learn like, seem like we have learned too many lessons.
Nick van Terheyden
Yeah, I think the shame of this is that we have so many outstanding individuals with tremendous insights, I certainly track and follow a number of these people who’ve, you know, continued to educate, follow the science. And despite that we seem to struggle at a national level that, you know, has troubled you and I both and I think many of our colleagues in the healthcare profession who feel like, you know, as you said, here we go again. But instead of being really prepared and ready, and feeling like we had a good playbook. It’s, it’s back to square one almost, which is just a tragedy, that shouldn’t be the case. For those of you just joining, I’m Dr. Nick the incrementalist today, I’m talking to Craig Joseph, he is the Chief Medical Officer at Nordic consulting partners were focusing on news from the past month, and just talking about monkey pox. And the fact that, you know, our struggle is more about the response than actually the concern of the disease, given that we have some reasonable vaccines and also, you know, potentially understand it well, to be able to prevent it. Before we sort of move off the COVID. Discussion, I think it’s worth just bringing up long COVID, I’ve continued to see, I think, you know, increasing numbers of reports, of sort of relatively widespread, I’d say, of the order of between five to 20% of people suffering from long COVID in a variety of extents. And I’ve seen it very severe, particularly around cardiac symptoms, but it’s a wide range across the board. What are you seeing?
Craig Joseph
I think it’s the same, you know, I don’t think there’s any question now, there’s lots of questions. What percentage of people who get COVID are going to have long? COVID? What exactly do we mean, when we say long? COVID? How long will it last? How can we get lots of those are all great questions, the question that’s no longer there, is there such a thing, as long COVID, we, we now know that some significant portion of people who get COVID are going to have symptoms for a long time. And that means months to years at this point, and we don’t really know what to do about that. So I think some of the research has shown that the more severe your symptoms were, the more likely you are to have symptoms for a longer time. Right? So if you were hospitalized, then you’re at higher risk than if you were not hospitalized. And so we there are some patterns that are there but fully what what is this and why do people get it and some of them seemingly get better and some of them seemingly don’t get better? And it’s, it’s, it’s kind of horrible to to have that out there and to know so little, but to see people who who were previously running races and now we’re having trouble walking across the street. And all they said was, well, I got cold. That’s the only thing that made any sense. And so certainly lots of research going on into it. And, and and I think the good thing is that people are taking it seriously and have for a while this is not some, you know, fringe group of people who were who were complaining and and we can’t validate their their signs and symptoms, we certainly can. We know it’s there. But we don’t know, why have lots of theories, and we don’t know what to do to make it better at this point.
Nick van Terheyden
Yeah, I think that’s exactly right. And, you know, genuine, serious concern, it’s going to add to the already stressed out system with additional symptomology. wide spectrum. I think, interestingly, you’re right about the severity. But I’ve also seen people with mild to almost no symptoms of the actual disease still end up. So, you know, our understanding is very limited. At this point, I’ve seen a number of studies that are trying to look at predictive factors, even trying to use some of the machine learning capabilities that we have to apply it to this data set that we don’t see patterns in, but maybe there are patterns that we’re not able to pull out. So obviously a potential to maybe identify some of the reasons, which elegantly I think I’m just going to say, brings us to the study that was published that I thought was just quite brilliant in its approach, assessing the clinical robustness of digital health startups. And it was a cross sectional observational analysis, it was published just recently, they looked at digital health companies that have been around for on average 7.7 years. And they developed a score, it was a bit like red light, green light kind of approach, to see how clinically robust these companies were, and what their value proposition was, based on some, I think, really interesting metrics, I think, relevant, in my view, measured by the number of regulatory filings. So how much have they done in those spaces, because if you’re really a digital health company, I think you have to file to gain approval, otherwise, you’re a consumer product. And, you know, in some cases, is just sort of kicking the can down the trail, a little clinical trials and indeed public key data. But from from a result standpoint, what really stood out to me was the average number of public claims was about 1.3. The medium was one, and there was no correlation whatsoever observed between the robustness and the number of claims. And the upshot of this was for all of the money that we’ve invested in digital health, I don’t think we’re seeing the value. But maybe you have a different view.
Craig Joseph
I Unlike you, I believe everything that I read, and so I don’t understand the question. No, I, you know, I, we’re in the infancy of, of, of digital health. And it’s hard to, I guess what I’m looking at, from if I’m looking at it from the company’s standpoint, right. They, they, they have some runway, they have some money that they’ve got from from high risk investors. And they certainly want to show that they’re that this, the tools that they’re creating are helpful, but science moves quite slowly. And that we’ve learned that right. I think that most scientists, and hopefully, many clinical folks realize how slowly, slowly science figures out what’s going on. The rest of the population hadn’t until the last two years. And that’s when they figured that I think there was a lot of eye opening. And so this is the this is the this is the same i It’s certainly not good to say that your your software tool solves a problem that you can’t prove that it does. And so I think we have to take out all of their all of the many claims pretty much for everything that’s not done in an independent peer review fashion with a grain of salt and so sure, does your does your app actually predict people were going to have these symptoms it doesn’t actually improve depression or or, you know, improve whatever it is that it’s trying to help resolve and that you know, I think it, what this study was doing was looking at more standard ways of proof, as opposed to, well, I’ve worked with a company, and we’ve surveyed 1000 people, and 800 of them, like the product that they paid for. And 200 100 of them didn’t write. And so scientists might have some problems with that study in terms of how it was sourced and how it was reviewed, and how it was organized. And so that would never make a put an independently proved that that work. So long and short. I think we just have to, you know, apply the rules of caveat emptor, and buyer beware, and so know that what you’re getting, when you get some of these tools and software, or hardware, or whatever it is, then the science probably isn’t clear. And this thing might help you, and it might not. And, and we have to move forward, because a lot of these things are going to ultimately help in some way. And I think we know that. So it’s not like they’re, it’s a it’s a these are charlatans who are who were trying to take our money, although I suspect, some of them are, but most of them are not. And it’s an interesting study, you know, looking at it, again, to take all of the work that a company does, and to boil it down to one number between one and 10. That’s hard. And, and but the distribution was not good. Looking at the numbers were much the frequency was much, much higher on the on the low ends of the scores. Yeah. And
Nick van Terheyden
it raises an issue that, you know, it’s quite contextual, in part because I happen to catch the dropout, which was John Kerry’s book on thoroughness, dramatized I forget which particular group put this out, I think it was six or seven episodes, it was very compelling. And, you know, obviously, as you rightly say, Caveat emptor, or you have to take it with a grain of salt given that, you know, there’s certainly some poetic license with some of it. But what I found really interesting about and I think it’s relevant here, you know, there’s, there’s this real sort of fake it till you make it, you need to sort of show progress to get the funding. And, you know, there was a little bit of that. And what I noticed, in this, and I read the book, which I thought was excellent, you know, the Expos A, that John Kerry, you, you know, worked very thoughtfully on to sort of drive this all to a conclusion was the point at which they broke bad. And for me, in the the evidence that was presented, it was the point where they were going to present, they had actually successfully run the test with their device, and they flew to Switzerland, and in the flight over and in the hotel room, prepping for the meeting the following day, they could not get it to work again, despite being on the line all night long, you know, trying to work through all those errors. And they had this critical meeting with a drug company that was, you know, going to be essential for forward progress. And that was, you know, a small, fake it, we have done it, We’re faking it, this instance, it was a little bit concealed. And, you know, what I’ve seen with a number of these things is that, you know, the intention at the origin was not where, you know, we’re going to conceal whatever, they broke bad because they needed that success or felt like they did, and if they hadn’t had it, maybe would have imploded, who knows. And, you know, I think my sympathy a little bit with these companies, because I think there’s a lot of that that goes on, there’s, you know, genuine, certainly the folks that I have the fortune of interviewing that talk about some of these things, some never make it out of the sort of laboratory, but you know, this is, this is progress. And, you know, as you rightly point out, we’ve got, we’re going to see it, I mean, we’ve we’ve seen it with some of these things. So, for me, I thought it was interesting, I think it’s helpful, but you know, what needs to happen is people have to have a really critical eye and look for that. Unfortunately, we’re not all well, well enough trained with the statistical analysis, the ability to look at, you know, causation, correlation, you know, and overcome our own personal biases. I’ve got my own I mean, I’m a I’m a geek, I want all of this stuff to work. Oh, yes. That’s fantastic. I’m, I’m into the future and loving it, but I try and temper myself. But I think fascinating study, I think, at least, you know, shines a light on something that you’ve got be at least a little bit concerned about unfortunately as usual we’ve run out of time so just remains for me to thank you as I do each and every month for joining me on the show Craig thanks for joining me for our next one
