Consulo Indicium - 4/11/22

Information for your Consideration…

Psst – Pass It Along – The word to pass: Be careful with iPhone 12s if you have an implantable cardioverter-defibrillator or permanent pacemaker!! Why? Because in a paper published in the March 2021 NEJM Journal Watch Cardiology, it was reported the Apple iPhone 12 magnet is strong enough to interfere or inhibit the action of these devices. Yikes!!! My cardiologist forgot to tell me after my implant last Fall. Actually, it would be wise to prevent any type of magnetic device from getting anywhere from 8 – 18 mm from the implantable according to the research. So, keep your iPhone 12 away from your breast pocket and in your holster…and, pass the word. 

The Upsides and Downsides of the Pandemic Broadside – So, the reports coming out relative to our personal performance during the pandemic is showing both upsides and downsides. On the Pandemic Upside the rate of regular exercise by the American public has increased (+4.4%), the average amount of sleep we are getting in a 24-hour period is up as well (+1.5%); and – very significantly – the rate of smoking on some of the days of the week was in decline as well (-4.0%). And, the downside? Well, the average body mass index (BMI) was moving up, up, up! Not only that but, the average number of days that included the intake of alcoholic beverages was also up (+2.7%).

Healthcare Cyberattacks Expected To Increase – In a general message to all US businesses, The White House forewarned American businesses to expect more cybersecurity attacks in the coming months and weeks from Russia – one of the major purveyors of the threats from throughout the world. The problems are expected to increase as a result of the significant economic pressure being brought to bear on the Russian economy by the Western democracies in response to the unprovoked Ukrainian war. The Biden-Harris Administration has been issuing such warnings on an almost daily basis since the start of the attack on February 24th. The major business areas facing possible attacks includes the financial, water, energy, and health care sectors – all designed to disrupt essential services and capabilities. In fact, the FBI issued a statement noting that multiple IP addresses based in Russia appear to have been engaging in “network scanning activity” as a way of identifying vulnerabilities among potential targets. The early warning is to be aware so we can be safe!

A Pandemic Update – Following the machinations of the vaccine production and boosters for effectively immunizing the populace is taking a fair amount of time. And, it seems that everything is always changing. First, we mask. Then, we don’t mask. Then, we mask with any mask. Then, we don’t mask with cloth masks. Then, we mask with surgical paper or N95 masks and then…who knows what comes next. Then, there are other questions: how long will the vaccine be effective? Which one is most effective? How long does the protection last? What happens when the protection wanes? And, about those boosters – which is most effective? Do I need to keep my booster in the same production family as my original vaccination? Can the scientists get a bit more coordinated in helping all of us to understand? But to assure you – there is a method to the seeming madness. So, in an attempt to help you, here is the guidance I’ve derived from the work of the FDA Vaccines and Related Biological Products Advisory Committee that met on April 6, 2020 to review the most current data.

First and foremost, everyone needs to keep in mind – we are still learning about this virus. It’s not just a simple flu virus. Flu viruses genetically shift in certain, predictable ways that allow the scientists to gather on an annual basis and update the vaccine so that in the fall, we all march into our primary care provider and get our flu shot. COVID is far more complex!! Its genetic changes are very unpredictable which means the pathway toward creating the right vaccine is difficult to follow from Alpha, to Beta, to Delta, to Omicron, to Whatever…

All that being said, here is my assessment of the (current) recommendations (as of April 10, 2022):

  • Pfizer-BioNTech mRNA Vaccine
    • Approved for “primary” vaccination for adults 16 and over
    • Allowed for emergency use for children 5 – 15 years
    • Add a “booster” for anyone over the age of 12
    • Add a “booster” for children 5 – 11 – ONLY if they are immunocompromised in some fashion
    • Add a “second booster” (= 4th shot) for those over the age of 50 or if immunocompromised
  • Moderna mRNA Vaccine
    • Approved for a 2 vaccination dose application separated by 30 days as the “primary” immunization
    • Add a “booster” in the same fashion as note above
    • Add a “second booster” (= 4th shot) for those over the age of 50 or if immunocompromised
  • Johnson&Johnson
    • Approved for a single vaccination dose at the “primary” immunization
    • Approved for a “booster” for anyone over the age of 18

Now, PLEASE NOTE – this could possibly change but, it will most likely be on the “booster” side of the equation and related to age since studies are still pending, especially on children. The other important point is the level of population immunity. Currently, the USA populace is vaccinated at a 70% level for their “primary” vaccination but, only at the 50% level for the “booster” vaccination. SO, GO GET YOUR BOOSTER IF YOU ARE ELIGIBLE!!!!

Finally, at the last meeting of the Advisory Committee, one area of discussion related to the role of government in guiding the production of the vaccines and boosters. At the present time, FDA has simply been waiting for the pharmaceutical industry to show up with their approach and study results. The government – in my mind – needs to take a more assertive role in guiding the production rather than simply having the companies come forward with their internally driven options. A more “coordinated” approach would clearly help expedite the production of the type of vaccines and boosters we will need for putting the COVID situation in the background. I say “background” because at this point I’m increasingly feeling it will be endemic or, something we have to deal with on a regular basis. And, that means “coordination” is even more important. End of diatribe…

The Pandemic Underbelly – In case, you missed it – J. David McSwane, a reporter with Pro-Publica – a not-for-profit investigative journalism group – recently published a book entitled: “Pandemic, Inc.” which highlights the underbelly of the freewheeling acquisition activities of the government and private health care sector as the grim reality of the pandemic finally began to set in in late 2019 and early 2020. You can also get a taste of the events occurring during this period where he was allowed (encouraged?) to be a fellow traveler with those who were cutting pandemic supply deals for the panicked buying during those early months. He briefly documents those findings in a web post for your consideration.

Telehealth Follow-Up Shown To Be Effective – A report was recently released in the Journal of the American Heart Association from a study done at Duke University Medical Center on the care of patients with heart failure (HF).  Specifically, they studied those patients who were admitted to the hospital over the one year period of March 2020 – March 2021. The researchers reported results that showed the 30-day readmission rate for hospitalized heart failure patients “on average” was 19%. But, for those patients who received an in-person visit it was 15% and for the telehealth visit patients it was 14% or, almost identical. For those patients with no follow-up care within 14 days of the hospitalization, the rate of readmission was 23.1% or, just over a 50% higher rate of readmission! The researchers concluded by stating: “Although there are concerns that some telemedicine visits such as phone calls may have not been sufficient to adequately monitor patients’ conditions, emerging evidence has suggested the feasibility and validity to perform physical assessments remotely.” So, you’ll need to be considering how to “integrate” your telehealth programs with your face-to-face programs…

AI skillsIn a separate study, the Brookings Institute conducted a study on the use of artificial intelligence as part of telehealth initiatives. The essence of the report shows that the health care community is “lagging” in the adoption which could dramatically alter the predictive capabilities of information systems to diagnose, treat, manage, and operate systems of care. If you examine the chart (SEE above), it clearly shows that the number of job postings related to artificial intelligence are among the lowest in all of the USA industrial sectors – just above construction. Even though the health care skill sets are increasingly requiring the need for understanding capabilities related to artificial intelligence, job postings for hospital-based physician, nurses, technicians, research, and managerial workers only represent about 1 in 1,250 job postings.

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