Nick van Terheyden 00:06
We don’t seem to learn from our past opportunities and we seem to be very short-term memory influence. So once it’s out of main view and it’s in the rearview mirror, people seem to forget all that yet what the pandemic did was essentially exposed and magnified, how much of the system is working as designed but essentially not delivering care, let alone well care or health care.
Gregg Masters 00:33
PopHealth Week is brought to you by Health Innovation Media. Health Innovation Media brings your brand narrative alive via original or value-added digitally curated content for omnichannel distribution and engagement. Connect with us at www.popupstudio.productions. Welcome, everyone I’m Gregg Masters, Managing Director of Health Innovation Media and the producer co-host ofPopHealth Week. Joining me in the virtual studio is my partner, colleague, and lead co-host Fred Goldstein, president of Accountable Health, LLC. On today’s show, we are delighted to have Nick Van Terheyden, MD, also known as Dr. Nick, who’s making an encore appearance on the show for our quarterly pandemic update. Dr. Nick is the digital health leader and a principal at ECG management consultants. He is an independent expert and leader in digital healthcare voice and sustainable innovation who brings a distinctive blend of medical practice and business strategy, both national and international to the realm of healthcare technology. So Fred, with that brief introduction over to you.
Fred Goldstein 01:47
Thanks so much, Gregg, and, Nick, welcome to PopHealth Week.
Nick van Terheyden 01:49
Thanks for having me.
Fred Goldstein 01:51
Yeah, it’s a pleasure to get you on. It’s been a while since we’ve discussed COVID. We thought we’d hit that as a sort of late almost year-end show here. So lots going on all over the place, which is not such a good deal. What do you see, Nick?
Nick van Terheyden 02:06
You know, I gotta be honest, when you say that night. It sounds like the news that I hear every night. Here we are in its name the day and they say, and it’s a really busy night. And I swear to God, not one time, have they ever said it’s really quiet night? We’ve got nothing to tell you. And it feels like that with COVID. So yes, there is a lot going on. We seem to be in the midst of an additional wave. I’m not going to number it because I think that’s foolhardy because who knows where the the truth of that is? I think everybody is COVID exhausted. I’ll I’ll count myself in. I’m exhausted with this, I’m certainly fed up with many of the things that we have to do. But the reality is that we’re seeing rising cases, we’ve seen them so dramatically in other parts of the country, that they are shutting down. In fact, Austria has shut down, I believe for the fourth time. And that shut down for them is nothing but essential. It’s kind of interesting, listening to what was essential. So going to the shops for food, bread, whatever was essential going out for sports or exercise essential, I think that’s kind of interesting. And going to work is considered essential. So it’s not quite the shutdown, that we may be associated here in the US, which was stop, that’s it. Everything’s closed except for I think hospitals and maybe a couple of other things. So they’ve done that Germany, same kind of thing. And we’re seeing reactions on the part of other communities. It’s not just the United States that seems to resist these notions of vaccine protection and vaccine distribution as well as the lockdowns. We’ve seen some pretty ugly sites in other countries. So it’s a it’s a challenging environment. And of course, I think what you’re seeing is as the temperature changes, and it shifts through to the the earth is tilting, and you get less sunlight, so we see less heating in your area. In fact, we had our first sort of freeze outside, people start to move indoors. And that means closer gatherings, more opportunity, we see, you know, essentially the progression of lots of diseases that are communicable inside because you’re now in indoor spaces. And that’s essentially driving some of this as well as the lower than anticipated or at least desired vaccination rates.
Fred Goldstein 04:38
Right. I think that temperature thing is fascinating because obviously, we saw Florida explode in July and August when it’s really hot here. People get inside to get out of that heat and the humidity. And then you know, last year if you remember it went up again in December as people went back indoors, it got a little bit colder. And so
Nick van Terheyden 04:55
Oh please come on Fred, colder in Florida just doesn’t count. I’m just saying
Fred Goldstein 05:01
It’s a great point, I’m just thinking it was 50 here today, I actually put a sweatshirt on, because I had my house in Eco mode. So it’s been it’s definitely chilling off. And but it’s interesting to think about Europe because the other interesting thing was Austria. Not only did they go ahead and say we’re gonna do a lockdown, but they’ve laid it out and said, We’re going to mandate vaccines, which is really the first country I believe to do that.
Nick van Terheyden 05:28
Yeah, I have to say, I mean, I think I, I respect the notion of freedom of choice, I think we’ve struggled in part and certainly based on a lot of the material that I’ve read, and if you you interact with some people, there are a small proportion that come at this with a different attitude. But most people don’t come at this with an entirely negative attitude. And I think the mandatory piece of this is really bothersome, especially this early on, I’m not advocating one way or the other. I think we really need people to be vaccinated. I know I’m vaccinated, my family’s vaccinated. But actually forcing people into corners, has had a deleterious effect, I think on uptake. And that’s not just here. So I wonder how that’s gonna play out. I don’t know what the results of that are going to be in a country. But once again, we’re running worldwide experiments.
Fred Goldstein 06:28
Yeah. And I think we’ve seen you know, some that already with some of the outbreaks of violence or protests in various European countries so far against some of the lockdowns or tightening up. And when you think about a vaccine, I’m with you, Nick, it’s tough to consider mandating it. I do think there are issues associated with health care workers that make it particularly more important. And you would think that given those that practice in that field would would be a broader thinking individual to say, this is impacting me, as well as those individuals who are in front of me that I’m working to help their health. And we’ve also seen some new approaches to dealing with not necessarily mandating it, but making it a little more incentivized or disincentivized. Things like, you know, we saw Delta with their $200 premium differential for those not vaccinated, you’ve now seen a couple companies come out and say, we’re going to put you into a risk pool, and you’re going to pay, for example, $60 a month to help offset the additional costs, should you get infected, because each patient’s costing our health plan about 50,000. And the other one that was interesting is people are now looking at the wellness space and saying, that’s the vehicle to do this, you put the shot into your wellness program and create a premium differential of up to 30%, which is legal, you know, per per the federal government associate with your program. So it’s interesting to see those I know that the companies that have put some of these in place have seen their rates go up and get a pretty big jump from it. And then people still have the option, obviously, to not get vaccinated. But some of that might require testing or things like that to, to and wearing masks in indoors as well.
Nick van Terheyden 08:06
Yeah, we’ve certainly seen precedents of that. I mean, the smoking differential is, I think, been in place for health insurance for certainly a few years, I’ve seen it. And you know, maybe this is part of it. I think this is slightly different. This is a actually giving of something that you know, makes it at least a little bit difficult, but I’m with you, I have to say in a really personal fashion, I really struggle with healthcare workers, so people that are practicing medicine and you know, physicians, nurses, people that actually interact with patients and deliver care. It’s a real struggle for me to understand why they don’t want to get vaccinated. And I all respect, I’d like to understand it. I just I’ve not heard a cogent argument that says this is why this doesn’t make sense for me. It’s easy to sort of point to, you know, specific medical exemptions, I should not take it or cannot take it because of that list is actually diminishingly small, relatively speaking. And then there’s religious exemptions, which, you know, we’ve seen across the board of religions, most of the leaders, certainly the religions that have leaders, not all of them do, I think some are more of a cooperative arrangement. But even in those instances, have essentially come out and said, We see no reason, in fact, completely the opposite. You know, the preservation of life, all of those things actually count up to we encourage you, this is a good thing. So I’m struggling with why that might be the case. But at the same time, forcing the issue I just think is a challenge. And we’ve just not got good history. With this. I had the pleasure of talking with Monica Ghandi, who spent her time focused on HIV and, you know, mandating no sex for people that had HIV didn’t go so well. It just it doesn’t work. And that was, you know, so mandating the use of condoms in the case of people that had HIV, again, didn’t work. It wasn’t effectively and they found other ways. And I think we can learn better techniques to actually deliver a higher rate of vaccination, and more cooperation that is positive as opposed to a negative.
Fred Goldstein 10:32
So let’s talk about this a little bit. Holiday season’s coming up. And, you know, I believe this year, they’re talking about huge numbers of people traveling for the various holidays, the end of the year, New Year’s etcetera. How are you handling that? Or how should people be looking to handle that I’ve got my approach I’m using, what are you up to Nick?
Nick van Terheyden 10:51
Well, let’s, let’s be clear. My approach has never changed, absolutely, categorically, ever. I refuse to travel the week of Thanksgiving. And I was on the road 95% of the time, I would never travel. Now I did one year and I was very fortunate. I was just coming back from out of country I flew in I arrived on Thanksgiving, thankfully, the airport was open, I actually brought a little gift for the immigration staff and the customs staff. And I got a lot of, you know, whoa, what’s this? But it was a genuine, you know, I’m really grateful for you to be here.
Fred Goldstein 11:27
What did you have in the suitcase that they didn’t get to see?
Nick van Terheyden 11:32
But I really wasn’t I mean, it was a, it was a relatively quick trip. But, you know, I genuinely don’t. If I was traveling, I think, you know, I would take a risk assessment approach and say, where are my highest risk elements of this? One of the things I would say about plane travel is the, you know, the air system and the localization that’s been in place for a long time. We know that it’s, it’s the transition points. You know, how do I minimize that as much as possible? Trains, you know, potentially there’s more ventilation, certainly, every time I’d been on Amtrak, it feels like there’s a wind tunnel going on in my train. So probably a good thing. As for the car, well, you pick your, your folks to travel with, at least I hope, so you’re not just randomly picking up people. So you’re going to minimize that risk. So, you know, address it with an appropriate risk profile. And then when you get together, think about the people that you’re exposing to I’ve seen a number of posts from folks that are getting together with elderly folks, there are more potential risks. You don’t want to expose them. I know some people are doing testing beforehand, there’s a, you know, certain amount of feel-good that’s maybe not within the reach of every but making informed decisions based on the risk assessment of the profile of people around you.
Gregg Masters 12:50
And if you’re just tuning in the PopHealth Week, our guest is Dr. Nick Van Terheyden, the digital health leader and principal at ECG management consultants. For more information on Dr. Nick’s work, go to www.ECGmc.com. And do follow him on Twitter via at @DrNic1 number one and @E C G MC respected.
Fred Goldstein 13:14
Yeah, you know, it’s interesting, we’ve been, we’ve discussed on our little weekly Monday videos about my co2 meter. And anyone I use it on the airplane and use it in the line checking in, and there was a study that just came out, I’ll have to send that around a good talked about the risks in a plane going up during mealtime and drinking about 58%, or something like that was a fairly substantial number. And they were actually recommending that the airlines try to split the meals, so that only half or fewer of the people are without their Masks off for that extended period of time, given the aerosolization of the virus. And they did point out you know that airplanes are really relatively safe, as we’ve discussed before, but I thought that was an interesting one. And I know, you know, for my trips this year, I’ll actually be visiting some family members. They’re all vaccinated, but the youngest child has one dose. And so I’ve got a whole stack of antigen tests I’m taking with me that we’ll be using and we do have two elderly people there as well who’ve had their boosters also, just to test everybody when we get there and make sure everything’s good at that period of time.
Nick van Terheyden 14:24
You know, it’s interesting, you bring up the the plane area one of the areas that I think you’ll co2 meter informed, was sitting waiting.
Fred Goldstein 14:35
Exactly. And they talked about Nick the, the in this article about the fact that the risk is up during that time when you’re getting on the plane and everybody standing together and moving into the plane as well as when you’re loading your stuff up because you’re breathing down on the people
Nick van Terheyden 14:52
but all of that is obvious the piece that was a surprise to me from your data, which I thought was interesting was everybody’s on they close the door, and then you had to sit at the gate waiting for pushback authorization from ATC. And you know, it’s only the APU that’s on in the back, there’s not a lot of air flow you don’t have you can hear it, that everything shuts down, they spin up the engines and then suddenly get shhh. And you know, it’s all fine. And that’s why you saw the increase in co2. And that was, I mean, in hindsight, it’s not a surprise, but it is, as you think about it. And I think that’s one of the great things about data. That’s what we need more informed, informative pieces of data that says this is a high-risk process. This is where we need to focus on here are the times when you you spend a little bit more energy and try and be more protective. And other times you go, Hmm, not so much, we can be a little bit more lax and give people more freedom,
Fred Goldstein 15:44
right? I think it really is about that ability to be flexible. This virus, you know, it goes up, we see a spike, and then we see it come down. And we’ve seen that a number of times, and in the future, we’ll wait and see I know the US now has reached the point where it’s beginning to go back up, whether that’s slow or fast. We don’t know yet. But clearly the the northern parts of this country now, I know in Minnesota, I think are one of those states up there, they’ve called in the National Guard now, because their hospitals are full
Nick van Terheyden 16:10
right
Fred Goldstein 16:11
there, I see your full. They’re one of the hospitals that I guess the number one facility in the state said that they’re refusing 50 patients a day, because they’re full.
Nick van Terheyden 16:20
Yep.
Fred Goldstein 16:20
And that’s a scary situation because studies have now come out that show two weeks post your ICU being full, you’re seeing an increase in death rates, that normally you would not see occur for individuals with those types of conditions.
Nick van Terheyden 16:32
And that’s not just COVID. That’s, you know, the people don’t get treatment its diversion of patients, all those things. So, I let’s talk a little bit about what the future holds. Because I think for me, that’s certainly one of the things I think about a lot, you know, what’s next, we’re now approaching year three, dear, Lord, who would have ever thought that I guess, you know, inevitably, some, you know, positive signs within all this, we’ve got vaccines, albeit not the uptake. And hopefully, we’re going to see more of that we know more about it, we’ve learned, I think we’re getting better most of the time, although I think some of the communication is a little bit spotty. But the thing that really, I’m I’m excited about or improves the potential outlook that we’ll see some improvement is treatments, we’ve seen an expansion of treatments that essentially, you know, from Merck, molnupavir, I think is the way it’s pronounced in Paxlovid, which is from Pfizer, both effective. And, you know, surprisingly effective. And even there was a study just recently on a readily available medication, that potentially might have some positive effects. So add that in, and now you’ve got some scope to say you’ve got COVID, we can give you something we’re not, you’re never going to feel the symptoms, you’re actually going to get treated, vaccinated or not vaccinated, we’re able to do that. So we can start to reduce or decrease the incidence of that. So for the most part, I’m, I’m a little bit more hopeful about year three. My glass has always been full, as you folks know, it’s half full of whiskey and half full of air. And I’m like to find the positive in all this.
Fred Goldstein 18:18
Yeah, no, I think there’s been an incredible progress. You know, since it started, obviously, in the last year, we’ve seen that go really fast with these newer approaches, newer treatments, better understanding of the virus. And so yeah, I think year three potentially could be better. Once again, I tend to be a little bit more of a skeptic than you are, Nick. And I look at it and say, but and it’s always sort of from the perception that, well, we can always do better. So how do we get there? What do we need to do? And we need, like you said, as we discussed early on, we need to be able to better understand behavior, change how we can help people. But whether it’s protection, wearing a mask, or a vaccine, or understanding how best to to mitigate some of the risk in your situations and help people better understand that. So they can make decisions that keep them healthier, all the way up to the newer technologies that are being applied and the newer drugs that are coming out. It’s been fantastic to watch that. It’ll be interesting to see. Because you definitely like we talked about early, we’re all tired. It’s really tough on people. It’s amazingly tough.
Nick van Terheyden 19:22
Hey one thing if you were to pick out of the set of NPI’s or whatever, you know, I think it’d be an interest. I’d actually like to know the results of this survey. What is the one thing that people would love to see disappear and, you know, return or disappear out of the sort of control mechanisms that we have? Do you have an answer to that? I know what mine is.
Fred Goldstein 19:43
My guess is probably masks.
Nick van Terheyden 19:46
Right.
Fred Goldstein 19:47
But yeah
Nick van Terheyden 19:48
and if that’s the case, what do we have to do? Because for me, that’s the most imposing element of this pandemic that inhibits all sorts of things were so
Fred Goldstein 20:03
yeah. So think about that, what could we do? And there is something we could do, Nick. But do you want to use a $1 mask, or a $50,000 air handling system in a room to just clean the heck out of it, exchange that air like crazy through HEPA filters, etc, maybe UV, to make those indoor spaces safer, it becomes a really difficult problem, where we’re at now, because masks are really a very inexpensive way that show they’re very effective.
Nick van Terheyden 20:33
No dispute there’s an economic elements of this. But if you were to sort of focus on the one thing in my mind, it’s its removal of those that really sort of inhibits, and it’s not just, you know, the physical, it’s the the mental effect. It’s this, you know, barrier that we placed between we’re social human beings. And, you know, what did you associate masks with before who was allowed to walk? I wasn’t even allowed to walk into a bank with my motorcycle helmet on in the past. Now, if I’m not walking in with that people are going to put your mask on? Oh, yes. Okay.
Fred Goldstein 21:11
Well, what could we create? That’s cool. You know, we like space Kennedy Space Center, do we want to walk around as an astronaut.
Nick van Terheyden 21:18
I’ve seen some interesting versions of this where they’re physically, you know, it’s a sealed unit. And I’m trying to think of the Sci-Fi episodes where you have that. And it sucks on your face, but actually does that, but you’ve got a full visual, I’ve got to say, if I could see somebody’s face, and I can see their lips moving, and you get all of those that input and hear them. That’s the other thing that master doing, I think is causing big challenges. That will be an improvement. Maybe that wouldn’t be accept? I don’t know. And I know that sounds more expensive. I’m just, I like to think of other things potentially, because we are COVID tired. And you know, the more tired we get, the less likely we are to conform at least.
Fred Goldstein 22:01
Yeah, no, it would be interesting. Is there something you know, think about that? Is there a technology that you could essentially just place over your mouth and your nose, maybe two pieces, that flex that you could talk through that would make the same effect and keep that air filtered the same way while keeping the rest of the face? Open?
Nick van Terheyden 22:22
Oh, I think if you’ve seen Dune, if you’re a fan of that particular genre, didn’t they have little nasal things that stick underneath that give them you know, constant feed of whatever? And I don’t know, I’m, I’m thinking outside the box. I’m driven by science fiction, because I think science fiction is eventually become science facts, at least Isaac Asimov proved that a number of times. So you know, what, what can we learn that could do better? For the new age that we live in?
Fred Goldstein 22:51
Yeah, it’s it’s a fascinating question. I know, early on, there was one company I was looking at him that had this helmet. That was all glass on the front, they were selling it on, somewhere up there. And it’s still exist. I looked at them a couple weeks ago, I don’t think they’ve sold many I’ve never seen one in the in the in the wild, I guess. But it was an interesting approach. But it was a couple $100 for that thing. But there have got to be other ways we can use to find something that maybe is as efficient as an N95. But much smaller might be helpful.
Nick van Terheyden 23:20
One of the other things worth talking about is the differences that we’ve seen in countries. Right. You and I have talked about this a lot. You know, we’ve focused on Bangladesh, where you just saw a much lower rate of mortality, did they do something different that we could have learned from. Paper just released in JAMA that essentially reported that not only was COVID mortality rates lower for the year, but all cause mortality rates, which I thought was actually intriguing, because that means that everything that they did not only improved or in a managed to mitigate COVID, but it actually decreased all-cause mortality, which suggests that there’s something else going on there. It doesn’t answer the question. But, you know, again, what can we learn from other countries that, you know, potentially didn’t have as much of an impact? Did they have a better public health system? We certainly talked about that. And you know, the supporting infrastructure. And you know, if we can answer that question, was it underreported? I know, you and I have talked about that. I don’t know if that’s the case. But
Fred Goldstein 24:22
I think it’s also early on, I saw something coming out of Africa, because that’s certainly been another area that’s been questioned seriously as to why the majority of Africa now understand South Africa is struggling a bit, but much lower. And they’ve got say a 5%. You know, vaccination rate. I saw one recent study that pointed to the the possibility that prior exposure to malaria is one of the things that looks like it may have an impact on how badly or whether you get infected with COVID. And so I think we’re gonna find things like that, or maybe people were exposed to unique Coronaviruses or something else that created some level have immunity in those populations? You know, we tend not to dig around the dirt as much as kids as we used to do. And that’s certainly something they talk about. So yeah, it’d be fascinating to research some of these areas and find out what’s going on.
Gregg Masters 25:12
Yeah, guys, let me step in because I want to follow up on the future vision. Okay, so poised for a fourth surge. What have we learned from this, particularly at the level of health system financing and delivery? I mean, are there going to be any durable lessons learned here? It did, we just put our toe in the water with telehealth and, and now. And they’ll see oh,
Nick van Terheyden 25:37
wait, we put our toe in? No, actually, we jumped in, we washed around in telehealth and said, Wow, this is fantastic. And then we drained the bath and said, nope, nope. Enough, because they’ve already started pulling them back. Right
Gregg Masters 25:48
Right. So I’m just curious, are we going to line up the acute care system with the public health infrastructure? Or is this a one-time blip on the radar screen?
Nick van Terheyden 25:59
I, I’m, I’m gonna pull a thread here and say, I’m not as optimistic about that, just because we don’t seem to learn from our past opportunities. And we seem to be very short-term memory influence. So once it’s out of main view, and it’s in the rearview mirror, people seem to forget all that yet, what the pandemic did was essentially exposed and magnified, how much of the system is working as designed, but essentially not delivering care, let alone well care or health care?
Fred Goldstein 26:34
So So Gregg, in response to your great question, you have a huge heart. You’ve been trying to fix health care for 30 plus years, and banging your head against the concrete wall? Do you really think you wouldn’t be banging your head against the concrete wall for another 30 years,
Gregg Masters 26:50
I’m going to leave that to the next generation. I have battled fatigue as we’ve often spoken.
Nick van Terheyden 27:01
I think we all do. And, you know, that’s the subject of my new podcast healthcare upside down, which is essentially focused on, you know, where are the elements and, you know, I close that every time with, you know, meanwhile, take care of your health and, you know, focus on it. Because one day soon, you may need it. And I think that’s the problem with healthcare is all the people that we need to focus on this. I don’t need. It’s all okay, I’m not touching it. As soon as you touch it. And let’s be clear, I’ve been touching it. Anybody that tracks or follows me knows that I’ve had my run-ins with insurance, physicians, you name it, and the system does not serve my needs. I know exactly what I need. I’m three months into being essentially incapacitated. And I am I’ve just been unable to get a basic investigation to determine it’s it’s awful, Gregg. And I have to say it drains my Ted Lasso batteries every single time.
Fred Goldstein 28:07
With that wonderful ending Nick will have to close out this episode. And it’s going ack to you, Gregg.
Gregg Masters 28:14
And thank you, Fred. That is the last word for today’s broadcast. I want to thank Dr. Nick Van Terheyden for his time, insights and levity today for more information on Dr. Nick do follow him on Twitter via @ DrNic the number one that’s @DrNic1 or his work at ECG via www.ECGmc.com. And finally, if you’re enjoying our labor of love here at PopHealth Week, please do subscribe to our channel on the podcast platform of your choice and follow us on Twitter by @ PopHealthWeek. bye now.