Gregg Masters  00:08  This episode of PopHealth Week is sponsored by Health Innovation Media. Health Innovation Media brings your brand narrative alive both on the ground in in the virtual space for major trade show conference in innovation summits via our signature pop up studio. Connect with us at www.pop.upstudio.productions. Welcome everyone. I’m Gregg Masters, the producer and co-host of the show and publisher of ACOwatch.com. And joining me in the virtual studio today are my colleagues Fred Goldstein, President of Accountable Health, LLC, a Jacksonville, Florida based consulting firm and co founder and lead host of PopHealth Week and Nick van Terheyden.MD, aka Dr. Nick, the Managing Director of Incremental Healthcare. On today’s second COVID-19 update, we get a general market overview and then look into what Fred and Dr. Nick are up to in the safe reopening space. But before I turn it over to Fred and Nick, here’s the latest data reported out from the center for System Science and Engineering at Johns Hopkins University as of August 11, 2020. The global picture presents with a total confirmed case count of 20,188,678, with deaths reported at 738,668. While in the we’re number one US the total confirm case count surpassed the 5 million mark clocking in at 5,138,850. A 25% share of the global case count, with reported deaths at 164,480, which is a 22%. Global share. Unfortunately, in the crossfire of competing narratives due to the absence of purposeful federal leadership that educates the public and thus gets us in front of and eventually stops the pandemic. Via proven public health measures, we find ourselves in a COVID-19 balancing act, often ping-ponging between the agendas of the let it rip or herd immunity crowd. In the former, what we see appears to be President Trump’s vision of letting the virus quote, wash over and eventually disappear, and quote, to achieve herd immunity, which in some studies range from a low of 15% to a high of 80%. The cost here is obviously in countless lives lost and much pain and suffering. So with that rather dark assessment, though, I would say sober assessment, Nick, why don’t you kick it off?

Nick van Terheyden  02:59  Well, there’s so much to unpack there, just in terms of where we are with the numbers, I think most folks would have probably predicted nothing of the sort, we’ve seen just an extraordinary acceleration. And, you know, I know this program. And certainly, you know, both of you, as colleagues have talked about the discriminatory nature of the virus. And I’m about to say something a little bit inflammatory and say it’s it is not indiscriminate in its attack. Now, that’s not to say that there aren’t populations affected, but it really doesn’t care who you are, where you come from, none of that, it’s actually a pretty effective tool. And some of the reasoning behind that appears to be the fact that it affects the upper respiratory tract, as well as the lower respiratory tract. And unlike SARS, which killed a fair number of people, it was stopped because its ability to shed was linked very closely with symptoms. So we could identify people, the major challenge we appear to be having is to identify people that are shedding and spreading the disease, because they have no symptoms, or they’re pre symptomatic, or in some cases, we’re not sure what that percentage is, but it’s certainly high or asymptomatic. So unfortunately, it’s spreading like wildfire. And unless you take a very rigorous approach, like some countries have done and shut things down and follow the three things that we have in our toolset, which is wear a face covering, physically distance, and wash or carry out proper hygiene, we’re not going to win, we’re just going to continue this cycle. So unfortunately, I’m not hopeful because we don’t seem to have the leadership to drive that and that’s what it requires at a federal level. The idea that this is 51 different countries that are all have different approaches to this. I’ve got to say as the immigrant here seems a little bit challenging, questionable, however you want to place it and I respect all the federal nature and you know people’s freedoms. But ultimately, we’ve seen this movie before. And those people that interact with me will know that the 1918 pandemic is essentially a, you could read everything from that and say I was reading it in 2020, because we learned, understood and demonstrated all the things that work. And that was with a different virus that had slightly different characteristics. But many of the same,

Fred Goldstein  05:24  Nick, as you pointed out, while the virus itself is indiscriminate, in terms of its ability to infect individuals, those that are most vulnerable are those in the lower socio-economic groups who have to go to work, who live in more packed in communities, or even homes or housing structures. And they’re being exposed at a much greater rate, obviously, infected at a greater rate and suffering at a greater rate. And as we focused on in the show, over the last couple of months, this whole issue of health disparities is clearly being pointed to and pointed out in this COVID epidemic, and how it’s impacting those communities. And as you said, there are simple things that we can do for this. But while the the processes in the end the three simple ideas of social distancing, wearing a mask and, and proper handwashing, and hygiene, are critical, how you implement those kinds of approaches, within an opening of your  of your businesses, or your restaurants, or your corporations is where we’ve seen it struggle, obviously, in those states that have chosen to open up more rapidly than others. And what they’ve allowed to open. I think, you know, as we’ve talked about, and worked on for a long time, that’s an area we’ve really tried to focus on is how do you help these companies make those kinds of decisions and open up in a safer manner? Obviously, it’s about risk and you can’t reduce the risk to zero.

Nick van Terheyden  06:46  And, you know, it’s important to note when I say that it is indiscriminate, I am absolutely acknowledging there is no question, disproportionately affecting people, let’s be clear, but as a virus, it doesn’t sit there and say, Well, I’m going to attack it, it’s a function of what we’ve done. And in fact, all it did was expose something that existed already just in a much more severe form. So you know, that sense, it’s a good thing, because we’ve opened the kimono and people are going, Wow, really? It’s that bad.

Fred Goldstein  07:15  That’s a great Point.

Nick van Terheyden  07:16  Oh, my God. But you’re right, right. I mean, the challenge of reopening and, and here’s what really strikes me over and over again, is that the science is not clear. And, you know, we continue to chase information and make the best possible decisions. But the idea that you can do so in isolation, or by going to some site and reading a study is quite frankly, very, very challenging for me to accept. And I see an awful lot of this. In fact, I posted recently, on this very topic, there is this infodemic of snake oil that exists. And you need a good guide, somebody to take you through this whole process and tease out and help you understand the difference between good information and bad information or information that’s not fully baked yet. So that’s where we really focus on providing that and I spend, and I counted it up just recently over 60 peer-reviewed papers that I’ve consumed in the last month or so. And that’s a lot of material. And I read it hopefully with at least some level of critical eye to be able to apply some level of, you know, discernment from appropriate or inappropriate. So, you know, that’s one piece of it. But I think the strength of it is the combination. And you know, so I bring the clinical side, and everybody focuses on that. But there’s much more to it. And you have a huge contribution in all of this as well. Right?

Fred Goldstein  08:56  Well, I appreciate that, obviously, you know, we working together on this and working with some others on on on it. And whether it’s with universities or other companies or our online program, and it really is about synthesizing the data, the amazing thing to see is, we’re updating this all the time, as you said, you went through 60 peer-reviewed articles. I can’t imagine how many from the start of this thing. Because it’s changing. It was a novel virus. It was new, we learn all the time. And now, there was a big focus early on what cleaning and hand hygiene and don’t touch anything. And obviously, we’re beginning to recognize now the issues you’ve raised about droplets and aerosols. And so changing the nature of our understanding and the nature of our approach and how you then reopen in that type of an environment.

Gregg Masters  09:42  Let me ask you this, Nick. So where’s the science principally unsettled? Where do you think the tender underbelly exists here in terms of the guidance that can be responsibly provided?

Nick van Terheyden  09:53  Well, I mean, just take the aerosolization that’s really something that shifted relatively recently, I think very early on, we said droplet versus aerosols. And, you know, there’s lots of confusion, I just saw a graphic that, quite frankly didn’t help me at all. So I, I’m struggling that it’s going to help others. But it let me try and break it down it droplets larger size, and therefore gravity takes hold. And they drop to the floor quicker and therefore don’t spread in the air, aerosols, smaller size. And you can argue what that number is. Because they’re smaller, they dry out in the air very quickly. And they behave like the leaf that floats past you in a gentle breeze, when you’re outdoors. And you see it just keeps on lifting. It’s as if there’s a magical transmission of this leaf. And that’s what happens with aerosols. And that’s why that’s significant, because now suddenly, if those particles are out there, instead of falling to the ground within that sort of six feet circle around people, they’re potentially going further and hanging around for longer because they sort of float. That’s a huge change. So what do you do with that? Well, appropriately, masks remain an extraordinarily important part, but not the only part that starts to change our thinking about indoor and outdoor and ventilation Case in point. And, you know, here’s one of the things and I know, Fred was the one that sort of highlighted this. So I’m pulling from his insight. But as he rightly pointed out, the study in South Korea at the call center showed us this data some time back, because what did we see in the transmission, it was all localized based on ventilation, even on the other side of that floor where they had call center, they didn’t see the cases, and they didn’t see it in the building, with all the people going in and out of the elevators. Well, that was all aerosolization as opposed to droplet spread. As we look back at it, in hindsight, hindsight is always 2020. At least it is in my experience. So that’s one of the primary things, let me pick another that’s a hot topic for me, which is hydroxychloroquine. Oh, no, it doesn’t work. It is not treating successfully, it has side effects. I personally have experienced those side effects in my family because I lived in malarial countries. And we took that and I can point to those side effects. And I can tell you, you don’t want them, number one. Number two, we’ve done some extensive studies. And in fairness, it may still prove to have some effect, but it’s certainly not showing anything you go, Wow, I got to take this. And the piece that I keep hearing is I’ll just take it in case. So a preventative measure, I connect with Fred and I’ve got COVID-19 or I discovered it, Fred takes hydroxychloroquine because that prevents him from getting the disease. Well, the data doesn’t show it. Now, they’re still carrying out the studies. And we may show that there’s some effect, but it’s certainly not a big effect. And it’s not something that should be done in isolation, and turn it into the toilet paper of drugs. And suddenly, there’s none available for those that really need it.

Gregg Masters  13:07  Let me ask you another question. So what’s emerging now data printed in academic journals is that there’s a for instance, Australia, they were very aggressive in a containment campaign, they had parabolic rise, and they had systemic reductions down to the pre-infection baseline. And now they’re going back into a parabolic second wave that exceeds the first wave. So there’s some saying that, if herd immunity is as low as 15%, there’s some evidence for that, where that may be happening based on serum prevalence surveys, some are saying, you know, the cost of this thing is to let it rip. And yes, they’re going to be vulnerable at-risk populations. But by and large, the traditional and I’m a public health guy. All right. So the traditional blocking and tackling of public health mitigation and containment strategies is not advisable that this virus is going to have its way the cost is in lives for which there’s just incredibly high statistical calculations. But it’s the only way that we’re going to reach her immunity for disease that seems to have its way.

Nick van Terheyden  14:19  First of all, is it really a second wave? And you know, what is the second wave mean? That’s typically in a different season? Is it a different season for Australia? I don’t know. You know, there’s some information floating around regards to the genetic drift and whether you can have a vaccine and again, all unsettled science. So it’s very hard to sort of focus in an answer that very specifically, but what do we know about this? Well, we know that if you have an exposure of any virus, based on the spread ability, we can calculate what that required herd immunity percentages. I don’t think I’ve seen a single virus ever that has herd immunity is at 15%. It’s just not the case. And this is behaving more like, I hesitate to say measles, because we all know that it’s highly infectious. And it’s not at that end of  R18, or whatever it is for, for the spreadability, but it certainly it spreads pretty easily when we’ve not managed to control it. And the the herd immunity requirement for measles is really high. For all the reasons that are obvious. If you don’t have enough people that have immunity, then it just gets distributed. So unless it has a very low R naught, which I don’t think I’ve seen, and certainly, I want to say between two and three, maybe it’s one and three, I’m, and, you know, I’m not the expert to define that I try and tease that out. That requires a herd immunity far above 15%. So that just seems wrong. But to your other point, here’s what I would say. And, you know, will I be proud of what I did in relation to this, because my children and their children are going to be talking about this event for years to come in the same way that we did about the pandemic and the, you know, the influenza pandemic of the 1918. And, you know, I’m gonna channel my inner Britishness and quote, Queen Elizabeth, who got on public radio and said, You know, I hope in years to come, everyone will be able to take pride in how they responded to this challenge, and saying, I don’t care, let’s just let a bunch of people die. Oh, by the way, it’s all the people that are less fortunate. All the things that you’ve described, doesn’t seem like a really good strategy. And I recognize there is lots of people that are hurting really badly, with economic challenges. And, you know, shutting things down, we have to take care of that. And it’s possible to do so there are methods to do this. But it doesn’t require having, you know, essentially sacrificial lambs. Is that what we’re saying? I mean, that’s what it sounds like to me.

Gregg Masters  17:04  And if you’re just tuning in, you’re listening to PopHealth Week. My guests are Fred Goldstein, President of Accountable Health, LLC, a Jacksonville, Florida based consulting firm, and co-founder and lead co-host at PopHealth Week. And Nick van Terheyden, aka Dr. Nick, Managing Director of Incremental Health Care.

Fred Goldstein  17:24  And I’m going to flip that on its head a little bit, and I think you’re right on target. So we look at Florida now, we had this reopening, and it exploded, pretty much you know, so you will watch that curve go up like a rocket, I think we hit a high of 15,000 1 day, we’re down 10, we’re down to 10,000, 9000, places are still open. But what did we do? We we closed the places that were high risk, we closed the bars, we closed those kinds of events, we said distance yourself a little bit more, by the way, wear a mask. And so the good news is, you can actually see the impact of that even here in Florida, the numbers are down because we changed some things. Can we reopen the bars again? I don’t know yet?

Nick van Terheyden  18:11  Not yet.

Fred Goldstein  18:12  But right? Clearly not now. And so then you begin to say, okay, so if this is the way that this is gonna work, how do we how do we create a maximum economic capability within this framework?

Nick van Terheyden  18:26  Right?

Fred Goldstein  18:27  How do we how do we do that? How do we get people to reopen appropriately? Are there ways that we can safely open a school maybe in some communities there aren’t because the infection rate is too high, or something like that. But in other communities, maybe there are ways with spacing and different schedules and other things that we can actually do that. And that’s what we need to figure out, we’re getting better answers around that. And that’s where we need to go with it.

Nick van Terheyden  18:50  And that’s part of what we’re trying to do with many of the folks that we’re working with is to essentially come up with those methods, concepts that guide you through this process to say, No, this is the way that you can do it. Here are the risks there is, you know, this is another thing that drives me nuts, it is impossible to drive out all risk. It’s just not possible. So how do you minimize it? And you know, I’ll quote one of our colleagues who talks about the funnel, reduce the number of people in the funnel so that you reduce the risk of exposure. That’s the smart thing to do. But it’s not easy to do. And it’s so dependent on your local circumstance. And by the way, this is not forever. Will this virus go away? Absolutely not, in my view, I could be wrong, but I just don’t think so. But will it be the significant thing forever? Absolutely not. We have over 150 things going on, targeted at treating this disease. That’s more than anything on any other disease at any other point, more than 70 vaccine trials and I saw three or four this week that are publishing really positive results. So I think we’re seeing that plus treatments Plus, you know, all these other things. There’s real hope here, but apply it and apply science and thinking, but do so thoughtfully based on a balance of the risks and the information and the local status of things that are going on in your community.

Gregg Masters  20:15  Let me ask you this. And I want to clarify one thing. I’m not an advocate of the let it rip crowd. Okay,

Fred Goldstein  20:21  we knew that.

Nick van Terheyden  20:24  I didn’t think that one second. going on. I was just saying, Yeah,

Gregg Masters  20:30  there is a cost to the lives. And it’s not just financial. But let’s talk about what you’re doing. Since the two of you enterprising souls have launched a service now, I think it’s in the safe reopening genre. Talk about that, what are you doing?

Nick van Terheyden  20:46  Well, so I, you know, I guess almost a natural pivot to, you know, a requirement that I certainly saw, in part because as I watched this unfold, in the very early days, I was just buried under an avalanche of questions, people look to me, because I have an MD after my name. So there’s some level of expectation of intelligence. But just to be clear, having an MD doesn’t necessarily equate to having intelligent opinions, as is demonstrated by some folks online are truly astounding. But what was clear to me was, there was a desperate need for guidance and counsel based on the latest information, and you can go to the CDC, WHO they’re really the baseline, if that, and they’re not always up to speed, they take a little bit of time. And what we’ve put together is both a subscription level type service, a training course, that allows you to bring people up to speed, it’s been updated, I mean, the the number of updates to this really demonstrate the fast-moving nature of this, I can’t believe how many versions that we’ve got so constantly updated with latest information, keeping your employees up to date, because there’s nothing worse than just being given a list and said, do this, if you don’t understand the reason. So explaining all that, and then putting it in the context of the individual business or organization so that you can apply the best possible understanding at the time. And we’ve got a number of clients, a lot of it’s focused on education at the moment, because we’re in that sort of cycle of, we’re trying to open or bring kids back to school colleges and so forth. And people want to do it as safely as possible. And certainly I as a parent want my my children to be going back to a safe environment.

Gregg Masters  22:41  Are you dealing with the schools? Or is this general business?

Nick van Terheyden  22:44  No it’s the schools and colleges, in fact, as well, and, you know, some of the it’s interesting, you know, wide range of experiences, everything from some months ago, that folks were really planning that I think, you know, just really grabbed this particular issue and said, we’re going to deal with it. And, you know, face it head on to some folks who come to the party a little bit later in the process, and are thinking, wow, this is, we better get on and, you know, that creates a little bit of pressure.

Fred Goldstein  23:17  Absolutely. And so yeah, we have a deeper consulting role that we can provide to companies and, and businesses. And then as we said, we have this online platform, really, we built that for smaller companies that we felt would not have the access to resources. And this is a way for them to inexpensively, both use the online program as well as get some hours from us if they’d like. And we can assist them talking through their specific issues, all the way to really deep integrations with companies over a number of months, as they think through the broad spectrum of issues that they face and trying to reopen in a safer way.

Gregg Masters  23:51  So these are learning modules and available online.

Fred Goldstein  23:54  The online ones are Yes. And and and as he said, we’re updating those all the time I update, put an update up this morning, and and reloaded the site and, you know, it goes through the key areas we think that people need to understand. So they can go beyond just the basics of I need to wear a mask, the CDC says I need to distance to really think through their unique situation, whether they’re a call center or a restaurant, or even somebody’s going into somebody’s home. And how do you do that?

Nick van Terheyden  24:21  There’s so many variations on a theme. And I think one of the things that certainly the clients we’ve had really value is the opportunity to ask a question of a group of individuals that come with a variety of insights and experiences that has tremendous depth, thanks to the broad nature of the background of the individuals that have a different lens. You know, I have my own lens, and I always put the sort of clinical hat on but I also pull on a technology hat because we’ve looked at apps and you know, should you trace people and what about geolocation and gosh, you know, I could track you with cameras and then we know and we’ll do and you know, so there’s the validity in a lot of the experiences that I think we can bring to this plus, I think, an enormous appetite for the absorption of information, and teasing out fact from fiction, and also, you know, settled science versus uncertain science and explaining that because a lot of the decisions are not ours. They’re ours to help guide people and say you need to make it but here are the pros and cons.

Gregg Masters  25:26  For those who may have an interest, how do they get in touch with you,

Fred Goldstein  25:29

You can go to safehealthywork.com as one website, and the other one is safehealthywork.Thinkific.com. And that’s where the course is. But the first site will lead you to the website that explains our services and goes through that.

Gregg Masters  25:45  So any concluding thoughts?

Nick van Terheyden  25:47  Let me conclude by saying that I see this as an opportunity, first of all, to create a better world that we all inhabit. And everybody gets a fair sort of crack of opportunity and experience in a world that has been very unjust to many groups in population. So it’s exposed a lot of things that I think we have the opportunity to fix, I forget who said originally that, you know, don’t let a crisis go to waste, it doesn’t matter. But I think you know, the principle is correct. The other thing that I always like to finish with is, I’m extraordinarily hopeful about this, as I said, during the conversation, the extent of the science and focus in the coming together, excluding some of the bad actors and folks that you know, are using this for political purposes as an example. So follow the science, not the politics is just fantastic. And the idea that this is going to just continue on in the same way that the 1918 pandemic did, just doesn’t fit with where we are in terms of the application, as I said, over 150 different approaches. And if I could give you a visual, imagine, the plumber that comes in with one Spanner will actually have three spanner he had a spanner, a screwdriver, and a something and that was physical distancing, face coverings, and good hygiene, and we’re going to pour in another 150, or let’s take 50% of them, 75 new tools into his toolbox, he’s going to get a lot better at fixing and treating those things. And that’s exactly what’s going to happen. And it’s happening relatively quickly. Just in terms of testing, I think we’ll see at point of care testing, fast, rapid testing, the pregnancy kit, testing of COVID-19, which is essential, albeit imperfect, because we don’t all present with virus when we’re already infected. But you know, it’s part of a portfolio of things that we’ll approach and it will give us a reasonable crack at getting over this.

Gregg Masters  27:53  Well, thanks, guys. So that is the last word on today’s broadcast. I want to thank Fred Goldstein, President of Accountable Health, LLC, a Jacksonville, Florida based consulting firm, and co-founder and lead co-host at PopHealth Week. And Nick van Terheyden, MD aka Dr. Nick, the Managing Director of Incremental Health Care for their time and collective wisdom shared today. For more information on Fred and Dr. Nick’s work in this space do follow them on Twitter by  @fsgoldstein @DrNick the number one respectively (DrNick1). And for more information on their work in the safe reopening space, go to www.safehealthywork.com and do follow me on Twitter as well by @2healthgurufor PopHealth Week my colleagues Fred Goldstein and Dr. Nick and Health Innovation Media. This is Gregg Masters saying please stay safe everyone we are in this together and we will get through this only. If we toe the line on social distancing. proper hygiene and by all means do wear those masks when in public bye now.