Tag: coronavirus

Colleges adapt porn industry policies for safe reopening

July 2nd, 2020 by
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Giving it the old college try

Top colleges are taking a page from the adult film industry’s playbook to ensure that they can reopen this fall and stay open, despite the COVID-19 pandemic. I applaud them for it.

As I wrote in early April (Let the porn industry reopen the economy):

Donald Trump, the CDC and much of the rest of the federal government have demonstrated sustained incompetence on getting testing going…

The obvious answer is to enlist the adult film industry in returning the economy to normalcy. The industry has operated a testing system successfully for years to stave off threats of infections from HIV and other sexually transmitted diseases.

I went on to describe the PASS system that had operated successfully for a decade, with frequent testing and follow-up. I encouraged employers to do something similar.

Employers haven’t really taken this on, but one sector of the economy is not only adopting this approach but taking it to the next level. Some high-end private colleges and universities are determined to return to campus this fall. Online classes are ok but they are a very poor substitute for the in-person experience and are frankly not worth the tuition.

Unlike some of our red state governors, certain college presidents are taking a cold, hard look at what it will take to make it happen. They aren’t relying on science and public health experts, not wishful thinking. And they have come to the same conclusions that the porn kings did.

Here’s what Colby College is doing (emphasis mine). They expect to spend $10 million this year.

Colby’s testing program… will require the participation of all members of the campus community—students, faculty, and staff. Students will be tested prior to arrival with test kits provided by Colby, and all community members will be tested three times during the opening weeks of the semester. Thereafter, everyone will be tested twice per week, a rate that scientific models have demonstrated will greatly limit the spread of the virus by detecting infections in individuals prior to them becoming contagious. To put this in perspective, we expect to administer roughly 85,000 tests in the first semester alone, a number that almost equals the total number of tests administered in the entire state of Maine since the start of the pandemic.

…Test results will be returned to the individual and the College within 24 hours, allowing for any required mitigation efforts to be instituted quickly. We have leased additional housing for quarantine and isolation of students, who will be provided with a range of support services, including facilitating their coursework, attention to medical and mental health, and food delivery.

And Brandeis?

Brandeis will provide high-frequency, mandatory COVID-19 testing to all on-campus community members…All students living in campus residence halls will be tested upon their arrival to campus, and students living off-campus will be tested at a designated time before the start of the fall term. There will also be mandatory testing multiple times per month for all students, faculty, and staff who either live on campus or who come to campus several times per week, whether or not they are symptomatic. This will enable us to quickly identify and contain any instances of infection on our campus. Those coming to campus less frequently will also be tested, though not as frequently.

Testing is part of broader plans, but it is the core and let’s us know they are dead serious. Both of these schools are working with the Broad Institute for testing.

Interestingly, some other colleges are wavering on testing or throwing in the towel with a move to online only. Good luck with that.

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By healthcare business consultant David E. Williams, president of Health Business Group.

4 predictions for the next phase of the COVID-19 pandemic

April 20th, 2020 by
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Peering into the future of COVID-19

Introduction

COVID-19’s impact on the United States and its healthcare system is unprecedented.  In this piece, I make four predictions for what the next phase will bring. Each has important strategic implications for healthcare companies and investors.

Here’s what I expect:

  1. Treatment, not testing will be key to reopening the economy
  2. Hybridization (virtual/in-person mix) will be the new reality
  3. Public health post-COVID-19 will be like security post-9/11
  4. The federal government will grow even more powerful relative to everything else

Treatment, not testing will be key to reopening the economy

It is accepted wisdom among public health experts and many others that the widespread availability of COVID-19 testing is a necessary condition to reopen the economy. It says so on the roadmaps of California, Massachusetts, the federal government, and many companies and institutions. It makes great sense: once we can see the problem clearly we can prevent infections from spreading. Other countries that are reopening –like Germany and Singapore—make extensive use of testing and contact tracing. This, we’re told, is the way things will be until a vaccine is introduced in a year or so.

Here’s the problem: progress on ramping up testing has been slow, even in Massachusetts where I assumed it would go fast. Despite lots of announcements of new capacity coming online I haven’t seen anything that makes me think there will be a breakthrough. Consider, also that effective testing for COVID-19 can’t be a one-time phenomenon. People will need to be tested over and over.

Meanwhile, with the worldwide deluge of patients, doctors are figuring out how to treat them. We might not have a vaccine in a year –or ever (unfortunately), but treatments are improving now, through experimentation, physician insight, and good luck. There is early promise from Gilead’s remdesivir; other drugs will be useful, too. But it’s not just drugs, it’s also non-drug adjustments such as how to optimize use of mechanical ventilation for these patients and even when to turn them onto their stomachs. As another example, I received firsthand reports from frontline Italian physicians who hypothesize that the coronavirus attacks the cardiovascular system first, and that is where to focus to address the root cause in a straightforward way. These are just things I’ve been privy to; certainly there are thousands of other investigations going on around the world. Some will work, and soon. These innovations can be additive or multiplicative, even if they’re not a miracle cure.

Bottom line, I think it’s likely that COVID-19 will become a manageable disease within a few months or even a few weeks, and that’s what will enable us to start to go back to work and school and to start flying again with an acceptable level of risk. For better or worse, it’s also more consistent with how the American healthcare system works: treat the sick.

It would be so much better to have ample testing in place before trying to reopen. Until we get there the US will suffer from higher disease burden, greater cost, higher inequities, and more skittishness about public gatherings compared to other countries. Yet as a whole we will figure out how to make do without the testing capacity that everyone wants.

 Hybridization (virtual/in-person mix) will be the new reality

 When COVID-19 hit, telemedicine made more progress in one week than it had in the past 10 years. Suddenly patients were scared to come to the office or hospital (and doctors/nurses/staff were afraid of the patients), reimbursement with in-person visits was equalized, and cross-state licensing restrictions were eased. People are getting accustomed to online meetings, online socializing, online schooling, and online shopping. Some of it –like convenience, immediacy—they like. Other parts –such as the difficulty building new, trusting relationships and absence of physical contact, and difficulty interacting with groups or teams—they don’t.

The pandemic will be with us for a while, which means people will have plenty of time to get used to being remote, understand better how to make it work, and won’t always default to the old ways. This is true even for some older Americans who thought they’d be able to ride out their careers or lives without jumping into the digital waters.

There has been a gradual shift to online over the past couple of decades, but the pandemic changes things. Now, we realize that we may have to suddenly revert to a remote world at any time, so we had better be ready for it. Social distancing is likely to be required to some degree over the next couple years, which means offices, factories, schools and entertainment venues won’t be able to return to their previous density. We can expect to see a rotation of remote and in-person staff and students –instead of total shutdowns. And kids may not like it, but there will be no excuse for another snow day!

Health status and age will play important roles in how hybridization is realized. Older people and those with conditions making them vulnerable may find that they have to spend more time in the digital world than their younger and healthier peers, because it’s not safe for them to show up in person. Ageism and discrimination against people with disabilities is already a major problem. It will become much more so in a COVID-19 influenced economy, especially during a recession where the job market favors employers.

For healthcare delivery and clinical trials, it is likely that more routine interactions will be conducted online rather than the office, and that the home will become even more attractive for recovery, aging and research. Providers will make greater use of nurse practitioners and physician assistants as front-line representatives, for triage, follow up and care coordination. It’s more straightforward to standardize protocols and supervise staff in the digital realm, plus it’s cheaper. We will also see a rise in asynchronous interactions, which are often more effective and efficient than as live video call. With the right leadership, these changes can also facilitate an increase in value based and evidence based cared.

The current situation has very negative consequences for the health of people with chronic and even acute conditions, who are avoiding the doctor and hospital at all costs. Meanwhile, providers face financial ruin as patients stay away. It has to be addressed, and hybridization is the way to do it. 

Public health post-COVID-19 will be like security post-9/11

After 9/11, security came to the fore. Suddenly there was visible security at airports, in office buildings, and throughout public spaces. New physical and digital surveillance technologies and practices were introduced and there was massive hiring of security guards, analysts, etc.

Now that COVID-19 has struck, we can expect public health to be similarly elevated. It will become a pervasive part of our economy and society. Expect temperature –and maybe face mask and hand washing– checks at the office, school, and any public venue.  Contact tracers may call or visit our homes or scrutinize our cellphone records. Event managers and employers will need to hire a health team and devise a health/safety plan to prevent outbreaks and provide confidence.

New products and tools will be needed to sanitize surfaces, detect pathogens in the environment, and monitor outbreaks. Sick leave policies will need to be revised and enforced. New cultural norms will be established –for example on the wearing of masks, shaking hands, what personal space means. Mental health needs must also be recognized and addressed in the adult and pediatric populations.

It won’t be enough to pursue these approaches privately. Local, state, and federal agencies will have to invest in order to deploy a comprehensive strategy to protect and reassure the public.

The new public health approach will dovetail with existing post 9/11 security measures and infrastructure. For example, the Red/Orange/Yellow/Blue/Green threat level developed for terrorism is actually more suitable to viral dangers. There will also be opportunities to redefine and expand the corporate wellness industry, which at last will be able to demonstrate a robust return on investment.

Federal government will grow even more powerful relative to everything else

The federal response to the pandemic has been problematic. The US had time to prepare after observing China and Europe, but largely failed to do so. States complain that there’s been little federal response or coordination and that they have been left to fend for themselves. The underlying reasons and political elements can be debated elsewhere.

Somewhat paradoxically, the pandemic has strengthened the federal hand relative to others. Consider:

  • With interest rates near zero, the federal government is easily able to borrow $2+ Trillion for the CARES Act
  • The Federal Reserve has propped up the stock and bond market with its promise to buy essentially anything, including non-investment grade securities
  • States are facing huge drops in revenues thanks to the shutdown of the economy. They need to balance their budgets and don’t have the borrowing powers of the feds. They also have to beg the federal government for assistance with the current crisis
  • The completely unprecedented surge in unemployment is leading to dependency on programs such as SNAP and Medicaid that are primarily funded at the federal level
  • Many industries –think travel, tourism, restaurants—are essentially shut down and need a bailout to restart
  • Colleges and universities, are hamstrung by having to close their campuses -possibly through the fall semester as well—and the question of whether domestic and especially international students will return
  • The healthcare delivery system is suffering from a huge disruption as essentially all resources are diverted to COVID-19 or idled

The broad implications of this sudden swing will play out over time and will be affected by the November elections (assuming they occur on schedule). The pandemic really does place the country at a crossroads. The conditions are ripe for further dividing the nation along various fault lines (rural/urban, nationalist/globalist, etc.) or for bringing us together. We may also see blocs of states ally more formally to coordinate with one another and attempt to shift the balance of power. Meanwhile, it is notable that this federal power expansion, involvement in the economy and massive increase of borrowing are occurring under ostensibly conservative leadership.

One near-term result is that the country has jumped much closer to the left-wing policies of Bernie Sanders and Andrew Yang than would have seemed imaginable in February. Everyone will be covered for COVID-19, whether directly through their insurance plans or through federal subsidies to providers, and the $1200 stimulus checks with the president’s signature are like Yang’s Universal Basic Income.

Massive unemployment will shift millions of people to Medicaid, so we may have Medicaid for All rather than Medicare for All. (This is actually a better idea, in my view.) I think we’ll see the holdout states finally accept the Affordable Care Act’s Medicaid expansion now that their backs are to the wall. And I also expect the COVID-19 experience means the Supreme Court will decline to strike down the Affordable Care Act, even though that won’t be the explicit rationale.

Conclusion

The situation is fluid and each of these predictions is subject to change. But I wanted to get some thoughts down while they were fresh, with the goal of spurring conversation and debate. In addition, I hope that clients will find this thinking useful as they determine what to do next and make longer term strategic and investment plans.

By healthcare business consultant David E. Williams, president of Health Business Group.

Let the porn industry reopen the economy

April 16th, 2020 by
Anthony S. Fauci M.D. NIAID Director 26759498706
Give the people what they want!

We’ve heard it over and over again. We can’t reopen the economy until we have a robust testing process in place for #coronavirus. Employees need to be tested frequently so they can return to work and stay on the job without infecting others and causing the whole worksite to have to close down and stay shut.

Meanwhile, Donald Trump, the CDC and much of the rest of the federal government have demonstrated sustained incompetence on getting testing going. Countries like Germany and China are organizing testing programs and restarting their economies.

Obviously we aren’t Asia or Europe. We need an American solution! And we need an adult in the room.

The obvious answer is to enlist the adult film industry in returning the economy to normalcy. The industry has operated a testing system successfully for years to stave off threats of infections from HIV and other sexually transmitted diseases.

From Rewire.News

The [Free Speech Coalition] took over managing sexual health protocols for the mainstream, straight porn world in 2011. It has since developed a set of testing guidelines known as the Performer Availability Screening Services (PASS) system. The guidelines have shifted over the years, but as of today, performers in the system test every two weeks for HIV, chlamydia, gonorrhea, syphilis, Hepatitis B and C, and trichomoniasis at a handful of clinics that partner with the FSC. If performers test positive for any non-HIV infection, a central database visible to agents, studios, and other performers automatically flags them as unavailable for work until they test negative. It also flags them if they have gone more than two weeks without being tested…

Unlike old systems of bringing copies of a recent test to a set, this database system protects performers’ real identities and medical information—and prevents test doctoring to hide results, an issue that has led to outbreaks of STIs like syphilis in the past.

Here is some background from the PASS website. Forgot about the titillating nature of the work for a moment. Replace “performer” with employee and there you have it. Why wouldn’t we want the same thing for other workplaces?

Performer Availability Scheduling Services provides guidelines and services for the adult production industry designed to ensure a safe and healthy work environment of performers and adult film professionals. The program includes:

  1. A series of nationwide testing sites providing low cost, high-quality testing in a timely manner

2. Performers have electronic access to testing results directly from labs

3. Variety of medical providers for treatment of performers in need of medical follow-up

4. Consistent standards and guidelines for testing and treatment of adult performers

5. A secure database that ensures performer privacy and protects producer liability

6. Protocol for performer support in the event of a positive HIV test result, including funding for testing of 1st and 2nd generation partners

It’s time for Dr. Fauci to team up with stars of the adult film industry to replace the President’s daily briefing with a more informative, entertaining and productive replacement.

Strange times make for strange bedfellows. So be it!

Coronavirus: We are all in this together

March 20th, 2020 by

In this edition of #CareTalk, Carecentrix CEO John Driscoll and I discuss the impact of COVID-19 in the US and around the world.  John retracts his earlier claim that the feds are doing a good job, and we go on to discuss the fact that we’re all in this together, universal coverage is a sensible policy, science matters, and government can help.

We agree with Tony Fauci, who said, “If it looks like you’re overreacting, you’re probably doing the right thing,” and we also look for signs of hope on the horizon (or just over it).


By healthcare business consultant David E. Williams, president of Health Business Group.

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